BackgroundChronic urticaria is defined as repeated episodes of wheals lasting for 6 weeks or longer. Nowadays, the role of vitamin D in various chronic diseases is a matter of great interest, but limited data is available on the vitamin D status in patients with chronic urticaria.ObjectiveThe goal of this study was to investigate the relationship between vitamin D status and clinical characteristics of chronic urticaria.MethodsThe clinical records of 72 patients with chronic urticaria, 26 with acute urticaria and 26 with atopic dermatitis, along with 72 healthy controls, were retrospectively reviewed.ResultsThe serum 25-(OH)D3 level was found to be significantly reduced in patients with chronic urticaria compared to those in the other groups. In particular, the proportion of patients with critically low vitamin D levels (<10 ng/ml) was significantly higher in the chronic urticaria group than in the other groups. The serum vitamin D levels showed significant negative associations with urticaria activity score and disease duration. In addition, serum vitamin D levels were significantly lower in subjects with a positive autologous serum skin test than in subjects with a negative result.ConclusionIn conclusion, the serum vitamin D level was more likely to be critically low in patients with chronic urticaria, and an inverse relationship with disease severity and disease duration was observed. These findings may open up the possibility of the clinical use of vitamin D as a contributing factor in the pathogenesis of chronic urticaria and a predictive marker for disease activity in chronic urticaria.
Chronic kidney disease-associated pruritus (CKD-aP) is a troublesome symptom in patients with end-stage renal disease (ESRD). Recently, vitamin D deficiency has been known to be one of the possible etiologic factors in CKD-aP. However, limited data is available on whether topical vitamin D treatment is effective for relieving CKD-aP. Therefore, the purpose of this study is to evaluate the effectiveness of topically vitamin D for CKD-aP. Twenty-three patients with CKD-aP were enrolled in a single center, open-label study. Patients were instructed to apply a topical vitamin D (calcipotriol) agent (Daivonex solution; LEO Pharma) or vehicle solution twice daily for a month. We assessed the efficacy and safety of topical vitamin D on CKD-aP using clinical and dermoscopic photographs, and questionnaires including the validated modified pruritus assessment score (VMPAS) and visual analog scale (VAS) every 2 weeks. Dry dermoscopic findings showed significant improvement of scale (dryness) on the skin of topical vitamin D-treated patients compared with those of the vehicle group. Both VMPAS and VAS were significantly decreased after 2 and 4 weeks of the topical vitamin D treatment compared with the vehicle, respectively (P < 0.05). No significant side-effects were observed. Topical vitamin D may be one of the safe and effective therapeutic candidates for CKD-aP.
The safety and efficacy of Poly-L-lactic acid (PLLA) as an injectable facial volumizer for the treatment of lipoatrophy and facial rejuvenation has been widely proven. We experienced a remarkable case of deep-seated nodules on both the cheeks of 57-year-old female 18-months after administration of PLLA filler injection for cosmetic purpose and performed a skin biopsy. With hematoxylin and eosin stain, the nodule showed non-caseating granulomas consisting of histiocytes with central foreign bodies in the dermis. This case report represents the late-onset foreign body reaction due to PLLA facial injections.
A 15-year-old woman presented with a 4-year history of enlarging, tender, verrucous plaque involving the nailfolds of the thumbs (a). Histopathological examination revealed moderate dysplasia of the squamous epithelium with perinuclear haloes, suggesting Bowen disease related to viral infection (c, d). 1 HPV16 positivity appeared in the human papillomavirus (HPV) genotyping polymerase chain reaction test. She was treated with cryosurgery (three freeze-thaw cycles for 30 s, two sessions with a 1-month interval) and HPV vaccine injection (Gardasil â) with no sign of recurrence for 6 months (b). Few cases of HPV-associated Bowen disease of the nail apparatus have been reported. 1,2 We report a case of HPV16 + Bowen disease on the periungual area with favourable outcome following cryosurgery and vaccination.
the epidermal collarette is derived from both adnexal epithelium and epidermis.Furthermore, the mechanism of formation of the epidermal collarette in BCC is unclear. It is well known that epidermal collarette is observed in pyogenic granuloma, which develops over weeks. 4 The rapid growth may be one reason. As for BCC, Adachi et al. 2 suggested that rapid growth caused an epidermal collarette. The proliferative index of Ki-67 in 51 cases of BCC was reported to range 1-61% and with mean of 12.3%. 5 Although rapid growth was not obvious clinically, a higher proliferative index of Ki-67 was observed in our case, which suggests that rapid growth is one of the significant factors for the formation of the epidermal collarette in BCC.ACKNOWLEDGMENT: The authors would like to thank Ms Yuko Tsukamoto for her help with immunohistochemical analysis. REFERENCES 1 Jacoby RA, Ackerman AB. Is the so-called epidermal collarette formed by epidermal or adnexal epithelium? Am J Dermatopathol 1982; 4(2): 117-124. 2 Adachi K, Miyamoto T, Yoshida Y, Yamamoto O. Basal cell carcinoma with an epidermal collarette. J Dermatol 2007; 34: 844-845. 3 Kiyohara T, Ido T, Hatta N, Kawami K, Kumakiri M. Basal cell carcinoma with an epidermal collarette and ductal differentiation on the dorsal foot.Letters to the Editor has never been reported, and EMN with satellite lesions are also uncommon findings. Therefore, we suggest that the injections of insulin in pediatric patients with type 1 DM could induce the multiple EMN by stimulating a-MSH as one of the adverse effects.
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