RESUMEN
Prurigo nodularis and herpes zoster frequently lead to the diagnosis of HIV in tropical areas. The WHO has established a clinical definition of AIDS for undeveloped countries. Prurigo and herpes zoster are both classified as stage 2. The main objective of this study was to compare the level of immunosuppression of patients diagnosed as HIV-positive after consulting for prurigo nodularis or herpes zoster in French Guiana. A retrospective study was conducted including patients consulting at the Department of Dermatology, Cayenne Hospital (French Guiana) for prurigo nodularis or herpes zoster between 1989 and 2007 for which the systematic HIV test was positive. Demographic data and CD4 counts of both groups were compared. Analysis of 346 patients consulting for herpes zoster (n=192) or prurigo nodularis (n=154) led to the discovery of 129 HIV infections. The positive predictive value (PPV) for HIV positivity was 38.5% for herpes zoster and 36% for prurigo nodularis. The median lymphocyte count was 302/mm(3) in herpes zoster and 87/mm(3) in prurigo nodularis (P<0.001). The PPV for having a CD4 lymphocyte count<200/mm(3) was 26.5% for herpes zoster and 72% for prurigo nodularis. Prurigo nodularis was predictive of advanced immunosuppression. This questions the pertinence of the WHO clinical classification of AIDS. In the absence of CD4 count, the present results suggest that for patients with prurigo nodularis, antiretrovirals should be initiated without delay.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Seropositividad para VIH/inmunología , Herpes Zóster/inmunología , Prurigo/inmunología , Infecciones Oportunistas Relacionadas con el SIDA/patología , Adulto , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , Femenino , Guyana Francesa , Seropositividad para VIH/diagnóstico , Seropositividad para VIH/tratamiento farmacológico , Herpes Zóster/patología , Humanos , Tolerancia Inmunológica/inmunología , Masculino , Valor Predictivo de las Pruebas , Prurigo/patología , Estudios RetrospectivosAsunto(s)
Humanos , Prurigo/etiología , Prurigo/genética , Prurigo/inmunología , Prurigo/terapia , Diagnóstico Diferencial , Glucocorticoides/administración & dosificación , Inmunosupresores/administración & dosificación , Rayos Ultravioleta/efectos adversos , Talidomida/administración & dosificación , Talidomida/efectos adversos , Talidomida/uso terapéutico , Trastornos por Fotosensibilidad/diagnóstico , Trastornos por Fotosensibilidad/inmunología , Trastornos por Fotosensibilidad/terapiaRESUMEN
BACKGROUND: Human leukocyte antigen (HLA) DRB1*0407 had been associated with actinic prurigo in different populations. This class II HLA-DR subtype had not been studied in Colombia. OBJECTIVE: The objective of this study was to establish whether there was an association of actinic prurigo with HLA DR in a Colombian population. MATERIALS AND METHODS: Forty patients with a clinical diagnosis of actinic prurigo and 40 healthy subjects, paired by age, sex and birthplace, were studied. HLA typing for HLA DRB1 and DRB1*04, if necessary, was performed by the PCR-SSP method using blood samples. RESULTS: A high frequency of HLA DRB1*0407 was found in the patients (97.5% vs. 30%; P<0.00001). The allelic frequency of HLA DRB1*0407 was 63.8% in the case group, and 14.5% in the controls (P<0.00001). In the control group, there was a higher frequency of the alleles DRB1*01 (14.5% vs. 1.25%; P=0.0027) and DRB1*13 (23.7% vs. 2.5%; P=0.00013). LIMITATIONS: The small number of controls does not allow us to drive conclusions about other HLA alleles. CONCLUSIONS: HLA subtype DRB1*0407, found in actinic prurigo patients in studies conducted in England, Scotland, Ireland and Mexico, was also associated in Colombian patients. This finding, concordant in patients from different ethnic groups, could be helpful in the diagnosis of this disease and probably important in its pathogenesis. DRB1*01 and DRB1*13 alleles were more frequent in controls than in patients; we do not know whether they play any role in the resistance to the disease.
Asunto(s)
Antígenos HLA-DR/inmunología , Trastornos por Fotosensibilidad/inmunología , Prurigo/inmunología , Adolescente , Adulto , Niño , Colombia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Polimorfismo Conformacional Retorcido-SimpleRESUMEN
BACKGROUND: Actinic prurigo (AP) is a frequent photodermatosis among Amerindians, with a high incidence among women and children below ten years of age. Neither the cause of actinic prurigo nor its etiological agent have been described. Not much is known about the pathogenic mechanisms of the disease, although associations with the human leucocitary antigens (HLA) and local immune responses seem to play an important role in its expression, as is the case in other skin autoimmune disorders, such as pemphigus and psoriasis. MATERIAL/METHODS: In this paper we compare cellular and humoral immunity through in vitro proliferation studies, ELISA and immunofluorescence tests in actinic prurigo patients and healthy controls. RESULTS: Autoantibody reactivities on the skin and also proliferative responses to isolated autologous skin antigens were higher in patients than in controls. The polyclonal cellular immune response against T cell mitogens and against allogeneic stimuli was found to be diminished in patients. CONCLUSIONS: We found autoimmune reactivity in patients suffering from actinic prurigo. We postulate that AP patients may have one or more skin antigens that stimulate an autoimmune response, which causes the observed skin lesions. As AP is a pathology that affects mainly the skin, any immune response should be localized and the observed infiltrating lymphocytes in skin biopsies should be activated by these hypothetical antigens.
Asunto(s)
Antígenos/inmunología , Autoinmunidad , Trastornos por Fotosensibilidad/inmunología , Prurigo/inmunología , Piel/inmunología , Adolescente , Adulto , Biopsia , Estudios de Casos y Controles , Niño , Ensayo de Inmunoadsorción Enzimática , Femenino , Técnica del Anticuerpo Fluorescente Directa , Técnica del Anticuerpo Fluorescente Indirecta , Humanos , Inmunidad Celular , Inmunidad Innata , Masculino , Persona de Mediana Edad , Linfocitos T/efectos de los fármacos , Linfocitos T/inmunologíaRESUMEN
BACKGROUND: Actinic prurigo (AP) is a photodermatosis with a restricted ethnic distribution, mainly affecting Mestizo women (mixed Indian and European). The lesions are polymorphic and include macules, papules, crusts, hyperpigmentation and lichenification. Thalidomide, an effective immunomodulatory drug, was first used successfully to treat AP in 1973. In this work we describe the effect that thalidomide had on TNF-alpha sera levels and on IL-4- and IFN gamma (IFNgamma)-producing lymphocytes of actinic prurigo (AP) patients. METHODS: Actinic prurigo patients were analyzed before and after thalidomide treatment. The percentage of IL-4+ or IFNgamma+ CD3+ lymphocytes was analyzed in eight of them by flow cytometry. TNFalpha in sera was measured by ELISA in 11 patients. RESULTS: A direct correlation was observed between resolution of AP lesions and an increase in IFNgamma+ CD3+ peripheral blood mononuclear cells (P < or = 0.001) and a decrease in TNFalpha serum levels (no statistical difference). No IL-4+ CD3+ cells were detected. CONCLUSIONS: Our findings confirm that AP is a disease that has an immunological component and that thalidomide clinical efficacy is exerted not only through inhibition of TNFalpha synthesis, but also through modulation of INFgamma-producing CD3+ cells. These cells could be used as clinical markers for recovery.
Asunto(s)
Inmunosupresores/uso terapéutico , Prurigo/inmunología , Talidomida/uso terapéutico , Adolescente , Adulto , Complejo CD3/inmunología , Femenino , Estudios de Seguimiento , Humanos , Interferón gamma/sangre , Interleucina-4/sangre , México , Persona de Mediana Edad , Trastornos por Fotosensibilidad/tratamiento farmacológico , Trastornos por Fotosensibilidad/etnología , Trastornos por Fotosensibilidad/inmunología , Estudios Prospectivos , Prurigo/tratamiento farmacológico , Prurigo/etnología , Inducción de Remisión , Linfocitos T/efectos de los fármacos , Linfocitos T/inmunología , Factor de Necrosis Tumoral alfa/análisis , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresRESUMEN
Actinic prurigo (AP) is an idiopathic photodermatosis that affects mainly the mestizo population in Latin America. It has an early onset, a slight predominance in women, and affects the sun-exposed areas of the skin, causing erythematous papules and lichenified plaques secondary to intense and chronic pruritus. Lesions can be induced by both ultraviolet A (UVA) and ultraviolet B (UVB). An association with several human leukocyte antigen (HLA) alleles has been reported. AP is unique among all photodermatoses in its remarkable response to thalidomide. In the past the microscopic features of AP have been considered as nonspecific; however, the constant finding of dense lymphocytic inflammatory infiltrates and the immunogenetic features of AP support the existence of an immunologic mechanism in its pathogenesis.
Asunto(s)
Trastornos por Fotosensibilidad/diagnóstico , Prurigo/diagnóstico , Fármacos Dermatológicos/uso terapéutico , Diagnóstico Diferencial , Humanos , Trastornos por Fotosensibilidad/tratamiento farmacológico , Trastornos por Fotosensibilidad/inmunología , Prurigo/tratamiento farmacológico , Prurigo/inmunología , Talidomida/uso terapéuticoRESUMEN
BACKGROUND: Actinic prurigo is a photodermatitis in which UV light is implicated by an unknown mechanism. METHODS: Skin biopsies of 19 patients with actinic prurigo and 11 controls were analyzed by immunohistochemistry. RESULTS: In actinic prurigo patients, there was a significant increase in the number of CD3, CD4, CD8, CD45RA, CD45RO, and CD45RB lymphocytes and Langerhans cells, as well as in the level of human leukocyte antigen-DR (HLA-DR) expression and cell adhesion molecules lymphocyte functional antigen-1 (LFA-1), intercellular adhesion molecule-1 (ICAM-1), and endothelial leukocyte adhesion molecule-1 (ELAM-1). Actinic prurigo patients were treated with cyclosporin A (CsA), and a final skin biopsy was taken after 6 months of treatment. All the cell populations and markers studied, except for the CD4 lymphocytes, Langerhans cells, and HLA-DR expression, returned to normal levels. CONCLUSIONS: CsA was found to be effective in relieving the clinical symptoms of actinic prurigo.
Asunto(s)
Moléculas de Adhesión Celular/inmunología , Ciclosporina/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Células de Langerhans/inmunología , Prurigo/tratamiento farmacológico , Prurigo/inmunología , Subgrupos de Linfocitos T/inmunología , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Selectina E/efectos de los fármacos , Selectina E/inmunología , Femenino , Antígenos HLA-DR/efectos de los fármacos , Antígenos HLA-DR/inmunología , Humanos , Inmunohistoquímica , Molécula 1 de Adhesión Intercelular/efectos de los fármacos , Molécula 1 de Adhesión Intercelular/inmunología , Antígeno-1 Asociado a Función de Linfocito/efectos de los fármacos , Antígeno-1 Asociado a Función de Linfocito/inmunología , Masculino , Prurigo/patología , Piel/inmunologíaRESUMEN
Actinic prurigo (AP) is a chronic photodermatosis in which genetic and immunological factors has been implicated in the pathogenesis of the disease. This work was designed to investigate the existence of clonal populations of T and B lymphocytes in lesions of the labial mucosa and conjunctiva of patients with actinic prurigo. Genomic DNA of three patients with actinic prurigo and controls were analyzed in Southern blots using DNA molecular probes for the b subunit of the T-cell receptor for antigen (TCR beta) and for the heavy chain of immunoglobulin genes (lg-JH). Clonal rearrangements of T-cell receptor genes were detected in biopsy samples taken from the labial mucosa of two patients and of immunoglobulin genes in DNA extracted from the conjunctiva of a different patient. The presence of distinct clonal T or B lymphocyte populations in patients with actinic prurigo indicates that the immune system may play a relevant role in the pathogenesis of the disease.
Asunto(s)
Subgrupos de Linfocitos B/inmunología , Enfermedades de los Labios/inmunología , Prurigo/inmunología , Subgrupos de Linfocitos T/inmunología , Adolescente , Niño , Preescolar , Femenino , Reordenamiento Génico de Cadena Pesada de Linfocito B/genética , Reordenamiento Génico de Linfocito T/genética , Humanos , Inmunidad Celular , Enfermedades de los Labios/genética , Prurigo/genéticaRESUMEN
Se reportan los resultados de un estudio inmunohistoquímico del infiltrado inflamatorio de biopsias de la piel, el labio y la conjuntiva de pacientes con prurigo actínico (PA), donde se aplicaron anticuerpos monoclonales contra vimentina (para saber si el tejido necesitaba recuperación antigénica), contra antígeno común leucocitario (CD45), UCHL-1 (anti-CD45RO) marcador de linfocitos T, L-26 (anti-CD20) marcador de linfocitos B. Se demostró la presencia de linfocitos B y T en los infiltrados inflamatorios; cuando éstos se disponen en folículos linfoides los linfocitos B se encuentran al centro y los T en la periferia
Asunto(s)
Anticuerpos Monoclonales , Linfocitos B/citología , Biopsia , Inmunohistoquímica , Inflamación/inmunología , Prurigo/inmunología , Linfocitos T/citologíaAsunto(s)
Indígenas Norteamericanos , Indígenas Sudamericanos , Trastornos por Fotosensibilidad , Prurigo , Adulto , Factores de Edad , Canadá , Colombia , Femenino , Antígenos HLA/análisis , Humanos , Masculino , Trastornos por Fotosensibilidad/diagnóstico , Trastornos por Fotosensibilidad/inmunología , Trastornos por Fotosensibilidad/fisiopatología , Trastornos por Fotosensibilidad/prevención & control , Prurigo/diagnóstico , Prurigo/inmunología , Prurigo/fisiopatología , Prurigo/prevención & controlRESUMEN
BACKGROUND: Actinic prurigo (AP) is triggered by sun exposure. Its prevalence in Mexicans seems to be particularly high, which suggests a genetic susceptibility. OBJECTIVE: Our purpose was to determine the role of major histocompatibility complex (MHC) genes in the genetic susceptibility to AP. METHODS: Fifty-six Mexican Mestizo patients with AP underwent serologic typing for HLA class I and class II antigens. Class II MHC genes were also studied by DNA analysis. Findings in patients were compared with 100 ethnically matched healthy controls. RESULTS: We found that 92.8% of patients with AP were HLA-DR4 positive (corrected p = 0.002; odds ratio [OR] = 10.1). The class I antigens HLA-A28 and HLA-B39 (B16) were also significantly increased (p < or = 0.000001, OR = 20.9 and p = 0.0001, OR = 6.7, respectively) compared with normal controls. Allele-specific oligonucleotide DR4 subtyping showed that 80.7% of HLA-DR4+ patients with AP were also positive for the DRB1*0407 allele. CONCLUSION: These results confirm the role of HLA-DR4 (DRB1*0407) in the genetic susceptibility to AP and raise the possibility of a role for class I MHC antigens HLA-A28 and B16 in Mexican patients.
Asunto(s)
Antígenos HLA-DR/análisis , Prurigo/etiología , Prurigo/genética , Luz Solar/efectos adversos , Adolescente , Adulto , Niño , Susceptibilidad a Enfermedades , Etnicidad , Femenino , Antígenos HLA-B/análisis , Antígenos de Histocompatibilidad Clase I/análisis , Antígenos de Histocompatibilidad Clase II/análisis , Humanos , Indígenas Norteamericanos/genética , Masculino , México , Persona de Mediana Edad , Fenotipo , Prurigo/etnología , Prurigo/inmunología , Población Blanca/genéticaRESUMEN
The Chimila, a Colombian Amerindian group that lives at a low altitude, have a high incidence of actinic prurigo. We present the human lymphocyte antigen (HLA) findings of 43 Chimilas with the disease and of 62 control subjects and show an association of actinic prurigo with the Cw4 antigen.
Asunto(s)
Antígenos HLA/análisis , Indígenas Sudamericanos , Prurigo/inmunología , Adulto , Colombia , Femenino , Humanos , Masculino , Linaje , Prurigo/genética , Rayos Ultravioleta/efectos adversosRESUMEN
Os autores apresentam o estudo das imunoglobulinas e fraçöes protéicas eletroforéticas nos soros de doentes com prurigo de Hebra. Foram estudados os soros de 36 doentes. Com os dados obtidos chegam às seguintes clonclusöes: 1) Existe aumento da gamaglobulina em 77% dos doentes com prurigo de Hebra. 2) A IgG encontra-se aumentada na maioria dos doentes (70%). 3) A IgE encontra-se aumentada em 81% dos doentes. 4) Os resultados encontrados sugerem a possibilidade de neste grupo de doentes, o prurigo de Hebra ser manifestaçäo atópica
Asunto(s)
Preescolar , Niño , Adolescente , Adulto , Humanos , Masculino , Femenino , Inmunoglobulina E/análisis , Inmunoglobulina G/análisis , Prurigo/inmunología , BrasilRESUMEN
Thirty-one patients with actinic prurigo were human lymphocyte antigen (HLA)-typed. The results showed an association of this disease with the alleles B40 and Cw3, both usually found in linkage disequilibrium in most populations. Because these two antigens are more frequent in Amerindians than in whites, it is suggested that they may partly account for the restricted ethnic distribution of this disease.
Asunto(s)
Antígenos HLA/análisis , Antígenos HLA-B , Antígenos HLA-C , Prurigo/inmunología , Adulto , Femenino , Antígeno HLA-B40 , Prueba de Histocompatibilidad , Humanos , Masculino , Luz SolarRESUMEN
Four patients with classic recalcitrant prurigo nodularis had symptomatic and physical responses to thalidomide with remissions. Three of the four patients had increased IgE levels that decreased during therapy. In two patients, short-term treatment (2 to 3 months) was not sufficient to produce remission, but retreatment was effective. Two patients had long-term remission with more than 6 months of treatment. No significant side effects occurred.
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Inmunoglobulina E/inmunología , Linfocitos B/inmunología , Linfocitos T/inmunología , Prurigo/inmunología , Prurigo/tratamiento farmacológico , Talidomida/uso terapéuticoAsunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Pruebas Cutáneas , Alérgenos , Venenos de Artrópodos/inmunología , Culicidae/inmunología , Hipersensibilidad/diagnóstico , Mordeduras y Picaduras de Insectos/diagnóstico , Mordeduras y Picaduras de Insectos/inmunología , Prurigo/etiología , Prurigo/inmunologíaRESUMEN
The clinical dermal manifestations induced by hypersensitivity toward mosquito bites were studied in 50 patients of both sexes whose ages ranged between 0 and 15 years. Among 13 forms of lesions found papules and vesicles were the most frequent. A predominance of females when compared to other statistical data was evidenced. The correlation of these lesions with atopy is assessed, and pruritus, scratching and secondary infection are pointed out as factors worsening this state. Among sensitive subjects, skin tests using a 100 UNP concentration of the whole mosquito body extract were the most reliable.