Ingenol mebutate (IM) is highly effective in the treatment of human papillomavirus (HPV)-induced anogenital warts (AGW) leading to fast ablation within hours. However, the exact mode of action is still largely unknown. We performed dermoscopy, in vivo confocal microscopy (CLM), histology, immunohistochemistry, and immunofluorescence to gain insights in mechanisms of IM treatment in AGW. In addition, we used in vitro assays (ELISA, HPV-transfection models) to further investigate in vivo findings. IM treatment leads to a strong recruitment of neutrophils with thrombosis of small skin vessels within 8 h, in a sense of immunothrombosis. In vivo and in vitro analyses showed that IM supports a prothrombotic environment by endothelial cell activation and von Willebrand factor (VWF) secretion, in addition to induction of neutrophil extracellular traps (NETosis). IM superinduces CXCL8/IL-8 expression in HPV-E6/E7 transfected HaCaT cells when compared to non-infected keratinocytes. Rapid ablation of warts after IM treatment can be well explained by the observed immunothrombosis. This new mechanism has so far only been observed in HPV-induced lesions and is completely different from the mechanisms we see in the treatment of transformed keratinocytes in actinic keratosis. Our initial findings indicate an HPV-specific effect, which could be also of interest for the treatment of other HPV-induced lesions. Larger studies are now needed to further investigate the potential of IM in different HPV tumors.
The authors present a case of a 78-year-old man, who presented with arteritis temporalis like symptoms. In his previous laboratory findings elevated eosinophil count was seen, imaging studies ruled out inflammatory diseases and malignancy. During the surgical diagnostic biopsy a thin white worm was removed, microscopically Dirofilaria repens was diagnosed. According to the patient’s history, an infected mosquito bite is most likely while hiking along Drava River, and the host animal could be the golden jackal. The authors briefly review the biology, clinical symptoms, diagnosis and treatment of D. repens. Finally they give a short historical overview of D. repens human infections in Hungary
In the past 10 years, significant progress has been made in the treatment of hydradenitis suppurativa worldwide, including the Department of Dermatology, Venereology and Oncodermatology, University of Pécs. In our hydradenitis outpatient clinic, 100-120 patients a year have been treated in cooperation with dermatologist and surgeons. In mild cases topical treatment and deroofing technique is the first choice of therapy, in severe cases biological treatment and/or major surgical approaches are recommended. Based on the author’s experiences, deroofing surgeries resulted in a long-lasting improvement in mild cases, while in severe hydradenitis, wide excision shows final resolution of the disease
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