This review discusses the biology and behavior of Propionibacterium acnes (P. acnes), a dominant bacterium species of the skin biogeography thought to be associated with transmission, recurrence and severity of disease. More specifically, we discuss the ability of P. acnes to invade and persist in epithelial cells and circulating macrophages to subsequently induce bouts of sarcoidosis, low-grade inflammation and metastatic cell growth in the prostate gland. Finally, we discuss the possibility of P. acnes infiltrating the brain parenchyma to indirectly contribute to pathogenic processes in neurodegenerative disorders such as those observed in Parkinson's disease (PD).
Palmoplantar psoriasis is a variant form of psoriasis that characteristically affects the skin of the palms and soles. It is chronic and inflammatory in nature and presents with hyperkeratotic, pustular, or mixed morphologies. Painful fissuring and bleeding may occur, which produces significant physical, functional, and social disability. Palmoplantar psoriasis is a therapeutically challenging condition and notoriously difficult to treat with topical therapy alone. Furthermore, limited data exist on treatment given that patients are typically excluded from clinical trials, which often require at least 10% body surface area (BSA) involved as an inclusion criterion. This article reviews the topical and systemic agents including biologics that have been investigated in the treatment of palmoplantar psoriasis. Combination therapy, comprising topical, systemic, and/or light treatments, with a particular focus on improvement in function and pain reduction, appears to be the most effective approach in treating these patients.
Ledderhose disease, or plantar fibromatosis, is a benign hyperproliferative disorder of the plantar aponeurosis. It presents as one or more round, firm slow-growing plaques or nodules on the plantar surface of the foot, typically on the medial side. The etiology is unknown, though it has been associated with trauma, liver disease, diabetes mellitus, epilepsy and alcoholism. Histopathological examination of plantar fibromatosis reveals dense fibrocellular tissue with parallel and nodular arrays of fibrocytes and fibrillar collagen with a distinctive cork-screw morphology. The differential diagnosis includes various fibroblastic and myofibroblastic proliferations.
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