Background: The structures currently available for the care of patients with chronic inflammatory dermatoses are inadequate to meet the needs and specific problems of patients suffering from these diseases. This work describes an interdisciplinary pilot project carried out for ambulant neighborhood rehabilitation and training of atopic dermatitis and psoriasis vulgaris patients as an alternative to conventional care arrangements. Patients and Methods: From 1997 to 2000, adult patients suffering from atopic dermatitis (n = 36) and psoriasis vulgaris (n = 27) and parents of children with atopic dermatitis (n = 42) took part in an ambulant neighborhood rehabilitation and training program. Questionnaires and scoring systems (SCORAD and PASI) were used to determine the quality of the procedures and the results; the overall rehabilitation program and the training were evaluated separately. Results: The quality of process used in the overall rehabilitation program and in the training course were rated as very good by the patients in all 3 groups, with both SCORAD and PASI showing significant downward trends. Although the training course brought distinct improvement in the patients’ knowledge and understanding of their disease and in their ability to cope with it, it did little to induce behavioral changes. Conclusions: Current experience with training and the ambulant neighborhood rehabilitation program indicates that both can have a valuable place in the care of atopic dermatitis and psoriasis vulgaris patients. It seems reasonable to upgrade the status of these models in the future. This would be helped by the introduction of comparable concepts and the implementation of scientific studies nationwide.
The Transient Receptor Potential Vanilloid 1 (TRPV1) and Ankyrin 1 (TRPA1) are non-selective cation channels predominantly localized on capsaicin-sensitive sensory neurons; however both receptors have been described in non-neuronal tissues. It has been published that both receptors upregulated in peritoneal endometriosis in humans. Our research group demonstrated that TRPA1 and TRPV1 expression is elevated in human deep infiltrating endometriosis (DIE) lesions and the receptors have an estrogen-dependent expression pattern in rat endometrium. Here, we investigated the expression changes of TRPA1/V1 and the role of the capsaicin-sensitive sensory-nerve endings in a rat model of peritoneal endometriosis. Peritoneal endometriosis was surgically induced in 8-week-old female rats (n=7-7) for 2-weeks (acute condition) and 8-weeks (chronic condition). TRPA1/V1 mRNAs were quantified with quantitative polymerase chain reaction (qPCR). The expression levels were compared with the results obtained earlier from human DIE samples. The blockade of the TRPA1/V1 expressing capsaicin-sensitive nerve endings was induced with resiniferatoxin (RTX), followed by the measurement of the weight and size of the endometriosis lesions. We detected TRPV1 and TRPA1 mRNA in normal rat endometrium, their expression was not altered in sham-operated animals. In chronic, but not in acute endometriosis the expression was significantly elevated in the lesions, which results are consistent with our previous findings in human DIE. The elimination of capsaicin-sensitive nerve endings decreased the weight of the endometriosis lesions while the size of the ectopic tissue was not altered. Taken together, our results obtained from the rat endometriosis model are consistent with the previous human results, therefore this model is considered to have translational significance and it is suitable for functional analysis of the ion channels. The local, non-neuronal TRPA1 and TRPV1 might play a role in inflammation and sensory neuronal activation in endometriosis related pain, which is mediated by a broad range of pro-inflammatory molecules.
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