Features of seborrheic keratoses in patients with carbohydrate metabolism disorders

Multiple seborrheic keratosis (SK), especially when there is overexpression of the epidermal growth factor receptor (EGFR), is considered paraneoplastic dermatosis, but it is almost always associated with multiple fibroepithelial polyps (PF) and pseudoacanthosis, skin diseases in which the leading role is played by insulin resistance and type 2 diabetes mellitus. The study examines the possibility of the effect of disorders of carbohydrate metabolism on the clinical picture of multiple SK and the expression of EGFR.Aims. To study the clinical features of multiple SC and the expression of EGFR in patients, depending on the presence of concomitant type 2 diabetes mellitus.Materials and methods. There were 65 patients with multiple SK at the age from 55 to 77 years, including women (44) and men (21). All the patients were examined skin, consultation of the endocrinologist. For a histological and immunohis-tochemical study (IHC), a single SK was surgically excised in each patient. IHC-reactions were carried out with monoclonal antibodies to EGFR. The result was assessed by the number of stained cytoplasmic membranes of tumor cells.Results. In 81.5 % of cases, multiple SK was associated in patients with type 2 diabetes mellitus. The location of the SK was also characteristic mainly in large folds of the skin, in contrast to patients without disorders of carbohydrate metabolism, in which the SK were located mainly on the lateral surfaces of the trunk and abdomen, without affecting the large folds of the skin. Multiple PF were also characteristic of individuals with type 2 diabetes mellitus. In IHC studies EGFR expression was detected in 100 % of cases in individuals with multiple SC and type 2 diabetes mellitus in over 30 % of tumor cells, and only in 16.7 % of cases in individuals with multiple SK without violations of carbohydrate metabolism.Conclusions. The presence of multiple SK in patients, in combination with multiple PFs with characteristic tumor localization in large folds of the skin, serves as a diagnostic marker of carbohydrate metabolism disorders or predispositions to the development of type 2 diabetes. Increased expression of EGFR plays a leading role in the pathogenesis of multiple SK, stimulating the proliferation and growth of SK, in turn, as a consequence of impairment of insulin signaling pathways and insulin resistance

Case report of leprosy in the Russian Federation

A clinical case of leprosy diagnosis in a citizen of the Republic of Chad (lepra-endemic region), а 24 year old male, student is presented. In 2019 the patient received permission to stay in the Russian Federation for educational purposes, entered one of the federal universities, and studied in Moscow, living in a hostel. During these years, he applied to various clinics, complaining of skin rashes and other symptoms characteristic of leprosy, without the effect of the prescribed treatment. In 2023, after contacting the clinic of skin diseases of the I.M. Sechenov First Moscow State Medical University (Sechenov University), was first sent to the The Federal State Research Center of Dermatovenereology and Cosmetology of the Ministry of Health of Russia with suspicion of leprosy. The results of clinical and laboratory studies including bacterioscopic examination of skin scarifications and pathohistological study of the skin confirmed the diagnosis: A30.5 Leprosy, multibacterial form, lepromatous type, active stage. This case presentation testifies to the lack of alertness regarding leprosy, especially among doctors conducting medical examinations of foreign citizens in order to obtain permission to stay in the Russian Federation, which may cause the spread of dangerous infectious diseases on the territory of the Russian Federation

Seborrheic keratosis: current concepts of pathogenesis

The article covers problems of seborrheic keratosis. The authors discuss current concepts of the etiology and pathogenesis of the disease paying special attention to the histology and immunohistochemistry of different forms and diverse clinical presentations. They describe Leser - Trelat syndrome as well as potential neoplastic transformation of seborrheic keratomas and their association with malignant skin neoplasms

Kindler syndrome - a rare type of hereditary epidermolysis bullosa

The Kindler syndrome is one of the types of hereditary epidermolysis bullosa with its onset related to mutations of the KIND1 gene. The authors describe a case of a family with three members suffering from this rare disease. All of these patients have typical clinical manifestations of the Kindler syndrome such as the formation of blisters on the skin and mucous membranes right after the birth, scarring with the formation of contractures, pseudosyndactyly, microstomia and ankyloglossia, progressive poikiloderma, photosensibility, affections of the gastrointestinal tract - dysphagia, esophagostenosis, stool disorders, dental pathology, phimosis vaginalis in women

Squamous cell carcinoma in a psoriasis patient after multiple courses of phototherapy

The authors present a clinical case study of squamous cell carcinoma in a psoriasis patient after 24 courses of phototherapy (22 courses of PUVA therapy and two courses of mid-wavelength ultraviolet therapy (311 nm)). The malignant neoplasm developed against the background of signs of a chronic photodamage of the skin: lentigo, actinic elastosis, diffuse hyperpigmentation, spotty skin pigmentation

Overexpression of p63 Protein in Patients with Seborrheic Keratosis in the Setting of Carbohydrate Metabolism Disorders

Aim. The paper studies p63 expression in patients with seborrheic keratosis in the presence or absence of carbohydrate metabolism disorders.Materials and methods. The study involved 130 patients with seborrheic keratosis. Following the endocrinologist’s consultation, the patients were divided into two groups. The fi rst group comprised 68 people: 44 patients with type 2 diabetes and 24 patients with impaired glucose tolerance. The second group was composed of patients without carbohydrate metabolism disorders (62 people). The authors performed a histological study and an immunohistochemical (IHC) test using monoclonal antibodies to р63. The results of the IHC test were analysed according to the number of stained tumour cells: 0 — no response or weak staining of less than 10% of the cells, 1 — from 10% to 30% of tumour cells are stained, 2 — staining of more than 30% of tumor cells; as well as according to the colour intensity: weak (+) and marked (++).Results. The IHC test using monoclonal antibodies to р63 produced a positive reaction in 82.3% of cases. Sixty-fi ve seborrheic keratomas (SK) (50%) exhibited a diffuse pronounced expression of p63. Weak nuclear staining (10%–30% of cells) was recorded in 42 SKs (32.3%). The study revealed a high correlation dependence of p63 expression in SK on the presence of carbohydrate metabolism disorders in patients (R = 0.82, p = 0.0000001). Thus, in patients with carbohydrate metabolism disorders, overexpression of p63 in SKs was found to be signifi cantly higher — 89.7%, as compared to 6.4% in patients without impaired carbohydrate metabolism (p = 0.00001).Conclusion. P63 overexpression in seborrheic keratosis correlates with the presence of chronic hyperglycemia in patients. Disruption of cellular metabolism leads to changes in the balance between p63 isoforms and plays an important role in the pathogenesis of seborrheic keratosis

Neurotrophins and neuropeptides as inflammatory mediators in case of chronic dermatosis

This literature review examines the role of neurotrophins and neuropeptides for the development of skin inflammatory reactions in case of chronic inflammatory dermatoses. The article describes inflammatory effects of neurotrophin, a nerve growth factor, neuropeptide substance P and calcitonin gene-related peptide. Factors affecting the condition of skin innervation and development of inflammation - neurotrophin, a nerve growth factor, amphiregulin, an epidermal growth factor, and semaphorin 3A, a nerve repulsion factor - were examined. Searching for and administering antagonists of proinflammatory effects of neuropeptides, neurotrophins and epidermal growth factor can become new approaches to the treatment of chronic inflammatory dermatoses

Assessing the itching intensity using visual analogue scales in atopic dermatitis patients against the background of a therapy with calcineurin inhibitors

Goal. To assess the effect of topical treatment of atopic dermatitis patients with the 0.1% tacrolimus ointment on the itching intensity and skin expression level of growth factor proteins affecting the intensity of cutaneous innervation. Materials and methods. Fifteen patients suffering from atopic dermatitis underwent treatment with the 0.1% tacrolimus ointment. The SCORAD index was calculated to assess the severity of clinical manifestations. The itching intensity was assessed using a visual analogue scale. The skin expression of nerve growth factors, amphiregulin, semaphorin 3A and PGP9.5 protein (a nerve fiber marker) was assessed by the indirect immunofluorescence method. Results. An increased expression of the nerve growth factor and reduced semaphorin 3A expression levels were noted in the patients’ epidermis; there was an increase in the quantity, mean length and fluorescence intensity of PGP9.5+ nerve fibers. As a result of the treatment, the disease severity and itching intensity were reduced, the nerve growth factor expression level was reduced while semaphorin 3A expression level increased in the epidermis, and the mean length and fluorescence intensity of PGP9.5+ nerve fibers was also reduced. A positive correlation among the itching intensity and nerve growth factor expression level, quantity and mean length of PGP9.5+ nerve fibers in the epidermis was revealed, and negative correlation between the itching intensity and semaphorin 3A expression level in the epidermis was established. Conclusion. Topical treatment with the 0.1% Tacrolimus ointment reduces the itching intensity in atopic dermatitis patients, which is related to the therapy-mediated reduction in the epidermis innervation level, decreased expression of epidermal nerve growth factor and increased semaphorin 3A expression level

Inflammation and itching in patients suffering from atopic dermatitis and psoriasis. Assessment of the expression of neurotrophins аnd neuropeptides

Goal. To assess the expression of neurotrophin, a nerve growth factor, amphiregulin, an epidermal growth factor, semaphorin 3A, a nerve repulsion factor, and PGP9.5 protein, a nerve fiber marker, in the skin of patients suffering from atopic dermatitis and psoriasis. Materials and methods. The study involved 30 patients suffering from atopic dermatitis and 30 patients suffering from psoriasis vulgaris. The disease severity was assessed by SCORAD and PASI. The extent of itching was assessed by the visual analogue scale. The expression of amphiregulin, semaphorin 3A (a nerve growth factor) and PGP9.5 protein (a nerve fiber marker) in the skin of patients was assessed by the indirect immunofluorescence method. Quantitative parameters of their expression were assessed by using the basic pack of the Olympus Fluoview software, Ver. 1.7b. Results. Increased epidermal innervation was revealed in the patients suffering from atopic dermatitis and psoriasis, which demonstrates an increased skin production of anti-inflammatory neuropeptides and reduced itching sensitivity threshold. A positive correlation between the itching extent and skin expression of neurotrophin (a nerve growth factor) was revealed in the patients with atopic dermatitis. In patients with severe psoriasis, an increased skin expression of amphiregulin, an epidermal growth factor, was discovered. Conclusion. These data demonstrate a pathogenic value of neurotrophin, a nerve growth factor, for the development of itching in patients with atopic dermatitis and amphiregulin in case of psoriasis vulgaris

Dynamics of expression rates of growth factor proteins in psoriatic patients receiving a phototherapy

Goal. To study the dynamics of expression rates of growth factor proteins in psoriatic patients receiving the PUVA therapy. Materials and methods. The authors conducted a study of 30 patients with psoriasis vulgaris treated with the PUVA therapy. The psoriasis severity and extent of itching were assessed prior to and after the treatment by the PASI index and visual analogue scale, respectively. The expression of semaphorin 3A, amphiregulin, nerve growth factor and PGP 9.5 protein (a nerve fiber marker) in the skin was assessed by the indirect immunofluorescence method. The expression of PGP 9.5 protein was used to assess the quantity and mean length as well as average and total fluorescence intensity of nerve fibers. Results. An increased expression of amphiregulin and nerve growth factor as well as increase in the quantity, mean length and average and total fluorescence intensity of nerve fibers were revealed in the epidermis of psoriatic patients. Following a course of the PUVA therapy, a decrease in the PASI index and extent of itching, reduced expression of amphiregulin and nerve growth factor as well as reduced quantity, mean length and average and total fluorescence intensity of nerve fibers in the epidermis were observed. Direct correlation dependence between the extent of itching, amphiregulin and nerve growth factor expression level and quantity and length of nerve fibers in the epidermis was discovered. Direct correlation dependence between the amphiregulin and nerve growth factor expression level, and average length of nerve fibers in the epidermis was discovered. Conclusion. The itching intensity in psoriatic patients receiving the PUVA therapy is reduced due to the decreased skin expression of the nerve growth factor and amphiregulin