RESUMEN
Immunophenotyping of inflammatory dermal infiltrates in Malassezia folliculitis (MF) and pityriasis versicolor (PV) lesions is less reported. Immunohistochemistry was performed on 21 MF lesions, 10 PV lesions, and 10 control skin. CD3+, CD4+, CD8+, CD20+, CD68+, and CD117+ cells were increased in MF compared with PV and normal skin (P < 0.01-0.05), while CD3+, CD4+, and CD20+ cells were higher in PV than in normal skin (P < 0.05). Dermal CD1a+ cells were higher only in PV (P < 0.05). Although both cellular and humoral immune responses are involved in pathogenesis of MF and PV, their difference may contribute to clinicopathological discrepancy between two disorders. LAY SUMMARY: Malassezia folliculitis and pityriasis versicolor are common Malassezia-induced superficial mycoses. Their clinicopathological discrepancy may be due to the difference of cellular and humoral immune responses.
Asunto(s)
Dermatomicosis , Foliculitis , Malassezia , Tiña Versicolor , Dermatomicosis/inmunología , Foliculitis/inmunología , Humanos , Inmunofenotipificación , Tiña Versicolor/inmunologíaRESUMEN
BACKGROUND: Neutrophilic folliculitis is an inflammatory condition of hair follicles. In some neutrophilic folliculitis, such as in patients with acne and hidradenitis suppurativa, follicular hyperkeratosis is also observed. Neutrophilic folliculitis is often induced and/or exacerbated by a high-fat diet (HFD). However, the molecular mechanisms by which an HFD affects neutrophilic folliculitis are not fully understood. OBJECTIVE: Our aim was to elucidate how an HFD promotes the development of neutrophilic folliculitis. METHODS: Mice were fed an HFD, and their skin was subjected to histologic, RNA sequencing, and imaging mass spectrometry analyses. To examine the effect of an HFD on neutrophil accumulation around the hair follicles, phorbol 12-myristate 13-acetate (PMA) was used as an irritant to the skin. RESULTS: Histologic analysis revealed follicular hyperkeratosis in the skin of HFD-fed mice. RNA sequencing analysis showed that genes related to keratinization, especially in upper hair follicular keratinocytes, were significantly upregulated in HFD-fed mice. Application of PMA to the skin induced neutrophilic folliculitis in HFD-fed mice but not in mice fed a normal diet. Accumulation of neutrophils in the skin and around hair follicles was dependent on CXCR2 signaling, and CXCL1 (a CXCR2 ligand) was produced mainly by hair follicular keratinocytes. Imaging mass spectrometry analysis revealed an increase in fatty acids in the skin of HFD-fed mice. Application of these fatty acids to the skin induced follicular hyperkeratosis and caused PMA-induced neutrophilic folliculitis even in mice fed a normal diet. CONCLUSION: An HFD can facilitate the development of neutrophilic folliculitis with the induction of hyperkeratosis of hair follicles and increased neutrophil infiltration around the hair follicles via CXCR2 signaling.
Asunto(s)
Dieta Alta en Grasa/efectos adversos , Foliculitis/inmunología , Folículo Piloso/inmunología , Hiperqueratosis Epidermolítica/inmunología , Infiltración Neutrófila/efectos de los fármacos , Animales , Susceptibilidad a Enfermedades/inducido químicamente , Susceptibilidad a Enfermedades/inmunología , Susceptibilidad a Enfermedades/patología , Foliculitis/inducido químicamente , Foliculitis/patología , Folículo Piloso/patología , Hiperqueratosis Epidermolítica/inducido químicamente , Hiperqueratosis Epidermolítica/patología , Inflamación/inducido químicamente , Inflamación/inmunología , Inflamación/patología , Masculino , RatonesRESUMEN
ABSTRACT: Patients with eosinophilic pustular folliculitis (EPF), a sterile eosinophilic infiltration of hair follicles, often present with papulopustules that tend to form annular plaques. Histopathologic examination revealed eosinophilic infiltration around the pilosebaceous units and eosinophilic microabscess formation. Although the pathogenesis of EPF is unknown, T-helper type 2 immune responses were suggested to be important based on their stimulating effect on the sebaceous glands. Here, we report the first case of EPF associated with herpes zoster, indicating that herpes zoster and EPF are correlated with T-helper type 2 immune responses.
Asunto(s)
Eosinofilia/patología , Foliculitis/patología , Herpes Zóster/patología , Herpesvirus Humano 3/patogenicidad , Enfermedades Cutáneas Vesiculoampollosas/patología , Piel/patología , Eosinofilia/tratamiento farmacológico , Eosinofilia/inmunología , Eosinofilia/virología , Femenino , Foliculitis/tratamiento farmacológico , Foliculitis/inmunología , Foliculitis/virología , Herpes Zóster/inmunología , Herpes Zóster/virología , Herpesvirus Humano 3/inmunología , Antagonistas de los Receptores Histamínicos/uso terapéutico , Interacciones Huésped-Patógeno , Humanos , Piel/efectos de los fármacos , Piel/inmunología , Piel/virología , Enfermedades Cutáneas Vesiculoampollosas/tratamiento farmacológico , Enfermedades Cutáneas Vesiculoampollosas/inmunología , Enfermedades Cutáneas Vesiculoampollosas/virología , Esteroides/uso terapéutico , Células Th2/inmunología , Resultado del Tratamiento , Adulto JovenRESUMEN
Importance: Baricitinib, an oral selective Janus kinase 1 and 2 inhibitor, effectively reduced disease severity in moderate to severe atopic dermatitis (AD) in 2 phase 3 monotherapy studies. Objective: To assess the efficacy and safety of 4 mg and 2 mg of baricitinib in combination with background topical corticosteroid (TCS) therapy in adults with moderate to severe AD who previously had an inadequate response to TCS therapy. Design, Setting, and Participants: This double-blind, placebo-controlled, phase 3 randomized clinical trial, BREEZE-AD7 (Study of Baricitinib [LY3009104] in Combination With Topical Corticosteroids in Adults With Moderate to Severe Atopic Dermatitis) was conducted from November 16, 2018, to August 22, 2019, at 68 centers across 10 countries in Asia, Australia, Europe, and South America. Patients 18 years or older with moderate to severe AD and an inadequate response to TCSs were included. After completing the study, patients were followed up for up to 4 weeks or enrolled in a long-term extension study. Interventions: Patients were randomly assigned (1:1:1) to receive 2 mg of baricitinib once daily (n = 109), 4 mg of baricitinib once daily (n = 111), or placebo (n = 109) for 16 weeks. The use of low-to-moderate potency TCSs was allowed. Main Outcomes and Measures: The primary end point was the proportion of patients achieving a validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD) score of 0 (clear) or 1 (almost clear), with a 2-point or greater improvement from baseline at week 16. Results: Among 329 patients (mean [SD] age, 33.8 [12.4] years; 216 [66%] male), at week 16, a vIGA-AD score of 0 (clear) or 1 (almost clear) was achieved by 34 patients (31%) receiving 4 mg of baricitinib and 26 (24%) receiving 2 mg of baricitinib compared with 16 (15%) receiving placebo (odds ratio vs placebo, 2.8 [95% CI, 1.4-5.6]; P = .004 for the 4-mg group; 1.9 [95% CI, 0.9-3.9]; P = .08 for the 2-mg group). Treatment-emergent adverse events were reported in 64 of 111 patients (58%) in the 4-mg group, 61 of 109 patients (56%) in the 2-mg group, and 41 of 108 patients (38%) in the placebo group. Serious adverse events were reported in 4 patients (4%) in the 4-mg group, 2 (2%) in the 2-mg group, and 4 (4%) in the placebo group. The most common adverse events were nasopharyngitis, upper respiratory tract infections, and folliculitis. Conclusions and Relevance: A dose of 4 mg of baricitinib in combination with background TCS therapy significantly improved the signs and symptoms of moderate to severe AD, with a safety profile consistent with previous studies of baricitinib in AD. Trial Registration: ClinicalTrials.gov Identifier: NCT03733301.
Asunto(s)
Azetidinas/administración & dosificación , Dermatitis Atópica/tratamiento farmacológico , Glucocorticoides/administración & dosificación , Purinas/administración & dosificación , Pirazoles/administración & dosificación , Sulfonamidas/administración & dosificación , Administración Cutánea , Administración Oral , Adulto , Azetidinas/efectos adversos , Dermatitis Atópica/diagnóstico , Dermatitis Atópica/inmunología , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Esquema de Medicación , Quimioterapia Combinada/efectos adversos , Quimioterapia Combinada/métodos , Femenino , Foliculitis/inducido químicamente , Foliculitis/epidemiología , Foliculitis/inmunología , Glucocorticoides/efectos adversos , Humanos , Janus Quinasa 1/antagonistas & inhibidores , Janus Quinasa 1/metabolismo , Janus Quinasa 2/antagonistas & inhibidores , Janus Quinasa 2/metabolismo , Masculino , Persona de Mediana Edad , Nasofaringitis/inducido químicamente , Nasofaringitis/epidemiología , Nasofaringitis/inmunología , Purinas/efectos adversos , Pirazoles/efectos adversos , Infecciones del Sistema Respiratorio/inducido químicamente , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/inmunología , Índice de Severidad de la Enfermedad , Transducción de Señal/efectos de los fármacos , Transducción de Señal/inmunología , Sulfonamidas/efectos adversos , Adulto JovenAsunto(s)
Eosinofilia/diagnóstico , Foliculitis/diagnóstico , Prurito Vulvar/diagnóstico , Enfermedades Cutáneas Vesiculoampollosas/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Cuello del Útero/diagnóstico por imagen , Cuello del Útero/patología , Cuello del Útero/cirugía , Eosinofilia/complicaciones , Eosinofilia/inmunología , Eosinofilia/terapia , Femenino , Foliculitis/complicaciones , Foliculitis/inmunología , Foliculitis/terapia , Humanos , Indometacina/uso terapéutico , Prurito Vulvar/inmunología , Prurito Vulvar/terapia , Enfermedades Cutáneas Vesiculoampollosas/complicaciones , Enfermedades Cutáneas Vesiculoampollosas/inmunología , Enfermedades Cutáneas Vesiculoampollosas/terapia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Neoplasias del Cuello Uterino/complicaciones , Neoplasias del Cuello Uterino/inmunología , Neoplasias del Cuello Uterino/cirugía , Vulva/inmunología , Vulva/patologíaRESUMEN
Papulopustular rash, an acneiform rash, appears on the seborrheic region during the first to second week of treatment with an epidermal growth factor receptor inhibitor (EGFRi). The rash gradually disappears after the fourth week; however, it persists or newly develops in other regions during EGFRi treatment. Because Staphylococcus aureus is frequently isolated from late-phase papulopustular rash, we assessed the incidence of bacterial infection and treatment outcomes of patients with late-phase papulopustular rash. Sixty-four cases treated with an EGFRi over 4 weeks who presented with papulopustular rash were assessed retrospectively. The median duration of EGFR inhibitor treatment was 5 months. Grade 2 and 3 papulopustular rash was observed in 47 and eight cases, respectively. Bacterial culture was performed in 51 cases, 50 of which yielded positive results: methicillin-sensitive S. aureus in 29, methicillin-resistant S. aureus in 14, Staphylococcus species in five, Pseudomonas aeruginosa in three, and other in four cases. Of the S. aureus isolates, 42% were resistant to minocycline and 40% to levofloxacin. After treatment with topical and/or oral antibiotics without topical corticosteroids, the papulopustular rash rapidly improved by an average of 2.9 ± 3.4 weeks. However, use of a combination of antibiotics and a topical corticosteroid prolonged the recovery period to an average of 18.9 ± 11.4 weeks. In conclusion, folliculitis that develops over 4 weeks after the initiation of EGFRi treatment is typically caused by staphylococcal infection. Bacterial culture is necessary due to the high rate of antibiotic resistance. It is important to distinguish late- from early-phase papulopustular rash and to treat using different approaches.
Asunto(s)
Antibacterianos/uso terapéutico , Antineoplásicos Inmunológicos/efectos adversos , Exantema/diagnóstico , Foliculitis/diagnóstico , Infecciones por Pseudomonas/diagnóstico , Infecciones Estafilocócicas/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/farmacología , Cetuximab/efectos adversos , Farmacorresistencia Bacteriana , Receptores ErbB/antagonistas & inhibidores , Exantema/tratamiento farmacológico , Exantema/inmunología , Exantema/microbiología , Femenino , Foliculitis/tratamiento farmacológico , Foliculitis/inmunología , Foliculitis/microbiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neoplasias/tratamiento farmacológico , Neoplasias/inmunología , Panitumumab/efectos adversos , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/inmunología , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa/efectos de los fármacos , Pseudomonas aeruginosa/inmunología , Pseudomonas aeruginosa/aislamiento & purificación , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/inmunología , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/inmunología , Staphylococcus aureus/aislamiento & purificación , Factores de TiempoRESUMEN
Eosinophilic dermatoses are a heterogeneous group of diseases, characterized by an eosinophil-rich infiltrate and/or degranulation of eosinophils. Blood eosinophilia may be an associated feature. Typical, albeit not specific histological findings include 'flame figures', which are caused by the accumulation of cationic proteins released by eosinophils and subsequent collagen denaturation. "Classic" eosinophilic dermatoses include eosinophilic cellulitis (Wells syndrome), granuloma faciale, eosinophilic fasciitis (Shulman syndrome) and eosinophilic folliculitis (Ofuji disease). In addition, there is a multitude of skin diseases that present with varying degrees of eosinophilic infiltration. These include atopic dermatitis, bullous pemphigoid, urticaria, allergic contact dermatitis, prurigo nodularis, arthropod bite reaction, parasitic infections, and drug hypersensitivity. Even though these disorders share a common characteristic (tissue eosinophilia), they differ greatly in their clinical presentation.
Asunto(s)
Colágeno/metabolismo , Proteína Catiónica del Eosinófilo/metabolismo , Eosinófilos/inmunología , Enfermedades de la Piel/inmunología , Celulitis (Flemón)/tratamiento farmacológico , Celulitis (Flemón)/inmunología , Celulitis (Flemón)/patología , Dermatitis Alérgica por Contacto/tratamiento farmacológico , Dermatitis Alérgica por Contacto/inmunología , Dermatitis Alérgica por Contacto/patología , Dermatitis Atópica/tratamiento farmacológico , Dermatitis Atópica/inmunología , Dermatitis Atópica/patología , Hipersensibilidad a las Drogas/tratamiento farmacológico , Hipersensibilidad a las Drogas/inmunología , Hipersensibilidad a las Drogas/patología , Eosinofilia/tratamiento farmacológico , Eosinofilia/inmunología , Eosinofilia/patología , Eosinófilos/patología , Eosinófilos/ultraestructura , Fascitis/tratamiento farmacológico , Fascitis/inmunología , Fascitis/patología , Foliculitis/tratamiento farmacológico , Foliculitis/inmunología , Foliculitis/patología , Granuloma/tratamiento farmacológico , Granuloma/inmunología , Granuloma/patología , Humanos , Mordeduras y Picaduras de Insectos/tratamiento farmacológico , Mordeduras y Picaduras de Insectos/inmunología , Mordeduras y Picaduras de Insectos/patología , Enfermedades Parasitarias/tratamiento farmacológico , Enfermedades Parasitarias/inmunología , Enfermedades Parasitarias/patología , Penfigoide Ampolloso/tratamiento farmacológico , Penfigoide Ampolloso/inmunología , Penfigoide Ampolloso/patología , Prurigo/tratamiento farmacológico , Prurigo/inmunología , Prurigo/patología , Enfermedades de la Piel/clasificación , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/patología , Enfermedades Cutáneas Vesiculoampollosas/tratamiento farmacológico , Enfermedades Cutáneas Vesiculoampollosas/inmunología , Enfermedades Cutáneas Vesiculoampollosas/patología , Urticaria/tratamiento farmacológico , Urticaria/inmunología , Urticaria/patologíaRESUMEN
Primary cicatricial alopecia (PCA) is a group of poorly understood mechanisms in which the destruction of hair follicles leads to permanent hair loss. Lichen planopilaris (LPP) is a type of lymphocytic PCA and it has been known for epidermal Langerhans cells (LC) to disappear in the scar of LPP. We also found that epidermal LC also disappeared in the scar of folliculitis decalvans (FD), a type of neutrophilic PCA. Of note was that epidermal LC did not disappear in the scar of discoid lupus erythematosus, another type of lymphocytic PCA, suggesting that LC disappearance in the scar was not always a common feature of PCA. We found that the expression of integrin (ITG)-αvß6 in scar epidermis was significantly diminished in LPP and FD, but not in other PCA and disorders accompanied with scar formation. We also found that exogenous interleukin-1ß and α-interferon downregulated ITG-αvß6 expression in normal human epidermal keratinocytes. These data suggest that downregulation of ITG-αvß6 may be one of the causes of LC disappearance in the scar of LPP and FD.
Asunto(s)
Alopecia/patología , Antígenos de Neoplasias/metabolismo , Cicatriz/patología , Foliculitis/patología , Integrinas/metabolismo , Células de Langerhans/inmunología , Liquen Plano/patología , Adulto , Anciano , Anciano de 80 o más Años , Alopecia/inmunología , Antígenos de Neoplasias/inmunología , Cicatriz/inmunología , Regulación hacia Abajo , Células Epidérmicas/inmunología , Epidermis/inmunología , Epidermis/patología , Femenino , Foliculitis/inmunología , Folículo Piloso/inmunología , Folículo Piloso/patología , Humanos , Integrinas/inmunología , Queratinocitos , Liquen Plano/inmunología , Masculino , Persona de Mediana EdadAsunto(s)
Eosinofilia/patología , Foliculitis/patología , Cuero Cabelludo/patología , Enfermedades Cutáneas Vesiculoampollosas/patología , Enfermedades de la Piel/patología , Antiinfecciosos/administración & dosificación , Antiinfecciosos/uso terapéutico , Dapsona/administración & dosificación , Dapsona/uso terapéutico , Diagnóstico Diferencial , Eosinofilia/inmunología , Foliculitis/inmunología , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Humanos , Lactante , Masculino , Prednisolona/administración & dosificación , Prednisolona/uso terapéutico , Cuero Cabelludo/inmunología , Enfermedades de la Piel/inmunología , Enfermedades Cutáneas Vesiculoampollosas/inmunología , Resultado del TratamientoAsunto(s)
Eosinofilia/tratamiento farmacológico , Foliculitis/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Metotrexato/uso terapéutico , Enfermedades Cutáneas Vesiculoampollosas/tratamiento farmacológico , Piel/efectos de los fármacos , Anciano , Biopsia , Eosinofilia/diagnóstico , Eosinofilia/inmunología , Foliculitis/diagnóstico , Foliculitis/inmunología , Humanos , Masculino , Inducción de Remisión , Piel/inmunología , Piel/patología , Enfermedades Cutáneas Vesiculoampollosas/diagnóstico , Enfermedades Cutáneas Vesiculoampollosas/inmunología , Resultado del TratamientoRESUMEN
Folliculitis decalvans (FD) is a chronic inflammatory disease leading to scarring alopecia with poorly defined pathogenesis. The aim of this study was to investigate the expression of markers associated with the activation of innate immune signals, such as inflammasome (NALP1 and NALP3), interleukin (IL)-1ß and IL-8 and type I interferon (MxA). A retrospective monocentric study was conducted and included 17 patients with FD with available biopsies. Disease activity (stable vs. active) was defined clinically and histologically. Immunostaining was performed using antibodies directed against NALP1, NALP3, IL-1ß, IL-8, and MxA on FD skin biopsies. Results were compared with normal controls and lichen planopilaris. Eleven patients had active disease and 6 had stable disease. NALP1, NALP3, and IL-1ß expression were significantly increased in hair follicles in FD compared with controls and lichen planopilaris. This study highlights the predominant immune signal associated with inflammasome activation in FD, suggesting the use of IL-1ß blockade in FD.
Asunto(s)
Proteínas Adaptadoras Transductoras de Señales/análisis , Proteínas Reguladoras de la Apoptosis/análisis , Foliculitis/metabolismo , Folículo Piloso/química , Inflamasomas/química , Interleucina-1beta/análisis , Proteína con Dominio Pirina 3 de la Familia NLR/análisis , Dermatosis del Cuero Cabelludo/metabolismo , Cuero Cabelludo/química , Adulto , Anciano , Biomarcadores/análisis , Biopsia , Femenino , Foliculitis/inmunología , Foliculitis/patología , Folículo Piloso/inmunología , Folículo Piloso/patología , Humanos , Inmunohistoquímica , Inflamasomas/inmunología , Interleucina-8/análisis , Masculino , Persona de Mediana Edad , Proteínas de Resistencia a Mixovirus/análisis , Proteínas NLR , Estudios Retrospectivos , Cuero Cabelludo/inmunología , Cuero Cabelludo/patología , Dermatosis del Cuero Cabelludo/inmunología , Dermatosis del Cuero Cabelludo/patología , Adulto JovenAsunto(s)
Quimiocina CCL17/sangre , Eosinofilia/sangre , Foliculitis/sangre , Enfermedades Cutáneas Vesiculoampollosas/sangre , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Quimiocina CCL17/inmunología , Eosinofilia/diagnóstico , Eosinofilia/inmunología , Eosinófilos/inmunología , Femenino , Foliculitis/diagnóstico , Foliculitis/inmunología , Humanos , Inmunoglobulina E/sangre , Masculino , Enfermedades Cutáneas Vesiculoampollosas/diagnóstico , Enfermedades Cutáneas Vesiculoampollosas/inmunologíaAsunto(s)
Eosinofilia/complicaciones , Eosinofilia/patología , Foliculitis/complicaciones , Foliculitis/patología , Complicaciones del Embarazo/patología , Enfermedades Cutáneas Vesiculoampollosas/complicaciones , Enfermedades Cutáneas Vesiculoampollosas/patología , Adulto , Eosinofilia/inmunología , Femenino , Foliculitis/inmunología , Humanos , Recién Nacido , Masculino , Embarazo , Complicaciones del Embarazo/inmunología , Enfermedades Cutáneas Vesiculoampollosas/inmunología , Células Th2/inmunologíaRESUMEN
We report a case of folliculitis decalvans (FD) successfully treated with intravenous human immunoglobulin (HIG). Many conventional treatments with topical agents and oral antibiotics had failed to achieve disease remission, treatment with HIG at a dose of 2 g/kg for the first month, reduced to 1 g/kg for second to fourth months was therefore started, which resulted in rapid improvement and ultimately complete resolution of FD. Clinical improvement was noted after the first infusion of HIG and remission of inflammation was achieved after the fourth infusion. Disease remission was sustained for six months following the last HIG infusion. The exact mechanism of action of HIG is poorly understood. However, it is thought to act as an immunomodulatory agent by altering different components of immune functions. To our knowledge, this is the first case reported in the literature of FD successfully treated with intravenous HIG.
Asunto(s)
Alopecia/terapia , Foliculitis/terapia , Inmunoglobulinas Intravenosas/uso terapéutico , Administración Intravenosa , Adulto , Alopecia/tratamiento farmacológico , Alopecia/inmunología , Antibacterianos/uso terapéutico , Biopsia , Cicatriz/terapia , Foliculitis/tratamiento farmacológico , Foliculitis/inmunología , Humanos , Factores Inmunológicos/uso terapéutico , Inflamación/tratamiento farmacológico , Masculino , Inducción de Remisión , Resultado del TratamientoRESUMEN
Neutrophilic folliculitis is an often overlooked chronic condition characterized by a monomorphic eruption of "sterile" papulopustules. Neutrophilic folliculitis is often refractory to conventional treatment with topical and systemic antibiotics or isotretinoin. We report a case of severe pustular neutrophilic folliculitis successfully treated with the tumor necrosis factor-alpha inhibitor adalimumab.
Asunto(s)
Adalimumab/uso terapéutico , Antiinflamatorios/uso terapéutico , Foliculitis/tratamiento farmacológico , Trastornos Leucocíticos/tratamiento farmacológico , Neutrófilos/efectos de los fármacos , Enfermedades Cutáneas Vesiculoampollosas/tratamiento farmacológico , Piel/efectos de los fármacos , Anciano , Enfermedad Crónica , Foliculitis/diagnóstico , Foliculitis/inmunología , Humanos , Trastornos Leucocíticos/diagnóstico , Trastornos Leucocíticos/inmunología , Masculino , Neutrófilos/inmunología , Neutrófilos/patología , Inducción de Remisión , Piel/inmunología , Piel/patología , Enfermedades Cutáneas Vesiculoampollosas/diagnóstico , Enfermedades Cutáneas Vesiculoampollosas/inmunología , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Factor de Necrosis Tumoral alfa/inmunologíaRESUMEN
Malassezia yeasts have long been considered commensal fungi, unable to elicit significant damage. However, they have been associated with a diversity of cutaneous diseases, namely pityriasis versicolor, Malassezia folliculitis, seborrheic dermatitis, atopic dermatitis, psoriasis, and confluent and reticulate papillomatosis. Several hypotheses have been proposed to explain the pathogenic mechanisms of these fungi, but none have been confirmed. More recently, such organisms have been increasingly isolated from bloodstream infections raising serious concern about these fungi. Given the difficulty to culture these yeasts to proceed with speciation and antimicrobial susceptibility tests, such procedures are most often not performed and the cutaneous infections are treated empirically. The recurring nature of superficial skin infections and the potential threat of systemic infections raise the need of faster and more sensitive techniques to achieve isolation, identification, and antimicrobial susceptibility profile. This article reviews and discusses the latest available data concerning Malassezia infections and recent developments about diagnostic methods, virulence mechanisms, and susceptibility testing.
Asunto(s)
Dermatomicosis , Malassezia , Antifúngicos/uso terapéutico , Dermatitis Seborreica/inmunología , Dermatitis Seborreica/microbiología , Dermatomicosis/diagnóstico , Dermatomicosis/epidemiología , Dermatomicosis/inmunología , Dermatomicosis/terapia , Foliculitis/inmunología , Foliculitis/microbiología , Humanos , Malassezia/aislamiento & purificación , Malassezia/patogenicidad , Pruebas de Sensibilidad Microbiana , Piel/inmunología , Tiña Versicolor/diagnóstico , Tiña Versicolor/microbiología , VirulenciaAsunto(s)
Eosinofilia/inmunología , Eosinofilia/patología , Foliculitis/inmunología , Foliculitis/patología , Macrófagos/patología , Enfermedades Cutáneas Vesiculoampollosas/inmunología , Enfermedades Cutáneas Vesiculoampollosas/patología , Antígenos CD/análisis , Antígenos de Diferenciación Mielomonocítica/análisis , Eosinofilia/terapia , Foliculitis/terapia , Humanos , Macrófagos/química , Masculino , Persona de Mediana Edad , Prurito/etiología , Receptores de Superficie Celular/análisis , Enfermedades Cutáneas Vesiculoampollosas/terapiaRESUMEN
OBJECTIVES: Most human immunodeficiency virus (HIV)-infected patients develop various skin diseases. These skin manifestations not only act as markers but also reflect the patient's underlying immune status. Investigating CD4 counts is costly and not always possible. Thus, the potential value to be gained by using skin manifestations as predictors of low CD4 counts and disease progression should be explored. The present study attempted to correlate the association of various cutaneous disorders found in HIV patients with CD4 and CD8 counts, the CD4 : CD8 ratio and stage of HIV infection. METHODS: This was a prospective study involving 61 patients who were HIV-positive and demonstrated skin lesions. Punch biopsies of skin were taken for histopathological diagnosis. CD4 and CD8 T cell counts were performed. RESULTS: The study sample included a majority of male patients, most of whom were aged 21-40 years. Pruritic papular dermatitis was the most common skin manifestation, followed by molluscum contagiosum, eosinophilic folliculitis, and Hansen's disease. Most of the lesions were associated with CD4 counts of <220/µl (n = 38). All skin lesions associated with HIV or acquired immune deficiency syndrome (AIDS) showed a CD4 : CD8 ratio of <0.50. CONCLUSIONS: The study findings demonstrate an inverse relationship between CD4 counts and the occurrence of skin lesions. The majority of lesions were associated with stage 3 or stage 4 infection. Thus, specific cutaneous manifestations can be considered as good clinical indicators for predicting underlying immune status in resource-poor countries.
Asunto(s)
Eosinofilia/patología , Foliculitis/patología , Infecciones por VIH/complicaciones , Molusco Contagioso/patología , Infecciones Oportunistas/patología , Enfermedades Cutáneas Vesiculoampollosas/patología , Enfermedades de la Piel/patología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/inmunología , Adulto , Biopsia con Aguja , Recuento de Linfocito CD4 , Estudios de Cohortes , Países en Desarrollo , Eosinofilia/complicaciones , Eosinofilia/inmunología , Femenino , Foliculitis/complicaciones , Foliculitis/inmunología , Infecciones por VIH/diagnóstico , Infecciones por VIH/inmunología , Humanos , Huésped Inmunocomprometido , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Molusco Contagioso/complicaciones , Molusco Contagioso/inmunología , Infecciones Oportunistas/complicaciones , Infecciones Oportunistas/inmunología , Estudios Prospectivos , Prurito/complicaciones , Prurito/inmunología , Prurito/patología , Índice de Severidad de la Enfermedad , Enfermedades de la Piel/complicaciones , Enfermedades de la Piel/inmunología , Enfermedades Cutáneas Vesiculoampollosas/complicaciones , Enfermedades Cutáneas Vesiculoampollosas/inmunología , Adulto JovenAsunto(s)
Terapia Antirretroviral Altamente Activa/efectos adversos , Eosinofilia/inducido químicamente , Dermatosis Facial/inducido químicamente , Foliculitis/inducido químicamente , Terapia de Inmunosupresión/efectos adversos , Macrófagos/inmunología , Enfermedades Cutáneas Vesiculoampollosas/inducido químicamente , Adulto , Antígenos CD/análisis , Antígenos de Diferenciación Mielomonocítica/análisis , Eosinofilia/inmunología , Eosinofilia/patología , Dermatosis Facial/inmunología , Dermatosis Facial/patología , Foliculitis/inmunología , Foliculitis/patología , Infecciones por VIH/tratamiento farmacológico , Humanos , Macrófagos/química , Masculino , Receptores de Superficie Celular/análisis , Enfermedades Cutáneas Vesiculoampollosas/inmunología , Enfermedades Cutáneas Vesiculoampollosas/patologíaRESUMEN
Eosinophilic pustular folliculitis (EPF) is a disorder associated with a high expression of interleukin-5 by T helper 2 cells. Treatment involving T helper 1 (Th1) modulation has been shown to be effective. We report that the occurrence of Bowen's disease in the medical care zone of the University of Occupational and Environmental Health in the Kitakyushu industrial area is more frequent in Yahatahigashi-ku, Yahatanishi-ku, and Wakamatsu-ku than in Tobata-ku, Kokurakita-ku, and Kokuraminamiku. We also show that these cases are more common in the regions with steel- and coal-related industries, which is suggestive of a higher rate of Th1 modulation associated with these occupations. Similarly, the incidence of EPF per unit population was found to be high in Tobata-ku and low in Yahatahigashi-ku, which indicates that EPF is a typical disease of hygiene hypothesis.