Skin's innate immunity is the initial activator of immune response mechanisms, influencing the development of adaptive immunity. Some contact allergens are detected by Toll-like receptors (TLRs) and inflammasome NLR3. Keratinocytes participate in innate immunity and, in addition to functioning as an anatomical barrier, secrete cytokines, such as TNF, IL-1β, and IL-18, contributing to the development of Allergic Contact Dermatitis. Dendritic cells recognize and process antigenic peptides into T cells. Neutrophils cause pro-inflammatory reactions, mast cells induce migration/maturation of skin DCs, the natural killer cells have natural cytotoxic capacity, the γδ T cells favor contact with hapten during the sensitization phase, and the innate lymphoid cells act in the early stages by secreting cytokines, as well as act in inflammation and tissue homeostasis. The antigen-specific inflammation is mediated by T cells, and each subtype of T cells (Th1/Tc1, Th2/Tc2, and Th17/Tc17) activates resident skin cells, thus contributing to inflammation. Skin's regulatory T cells have a strong ability to inhibit the proliferation of hapten-specific T cells, acting at the end of the Allergic Contact Dermatitis response and in the control of systemic immune responses. In this review, we report how cutaneous innate immunity is the first line of defense and focus its role in the activation of the adaptive immune response, with effector response induction and its regulation.

Proteins of 165, 90, and 68 kDa are specifically recognized by antibodies present in the sera of vitiligo patients and in all patients with genetic vitiligo. Whether or not these proteins might be implicated in the destruction of melanocytes by the immune system in vitiligo remains to be evaluated.

BackgroundAllergic contact dermatitis to ion nickel (Ni+2) is an inflammatory dermatosis, common in industrialized countries. It involves the activation of nickel-specific T-cells, followed by proliferation and induction of a mixed profile of both proinflammatory and regulatory cytokines, suggesting that several T-cell subtypes (helper - Th and cytotoxic - Tc) are involved. A broader understanding of the cytokine profile may lead to new therapeutic approaches.ObjectivesThis study aimed to analyze the cytokines TNF-α, INF-γ, IL-2, IL-4, IL-10, IL-13, IL-17 and IL-23 using the immunohistochemistry technique in order to try to identify their prevalence in chronic and acute eczema of patients with allergic contact dermatitis to Ni+2.MethodsWe performed an immunohistochemical study for eight cytokines in 20 patients with Ni+2 allergic contact dermatitis, biopsied at the site of chronic eczema, triggered by the patient's daily contact with Ni+2, and at the site of acute eczema caused by nickel sulfate, 48 hours after applying the contact test.ResultsThe stained samples showed positive results for the eight cytokines studied. TNF-α, IFN-γ, IL-4, IL-13 and IL-17 had a higher prevalence in chronic eczema, IL-2 and IL-23 in acute eczema, and IL-10 presented a similar prevalence in both acute and chronic eczema. However, these prevalences were statistically significant only for IL-4 and IL-13.Study LimitationsSmall sample size.ConclusionsIn chronic and acute eczema, we observed the presence of a mixed cytokine profile of the T cell subtypes (Th/Tc), suggesting that the responses are expressed at the same time.

Endemic Pemphigus Foliaceous is a chronic autoimmune bullous skin disease. Treatment with prednisone often produces excellent results, but resistant forms exist, requiring alternative therapy. Alternative treatments have been used in cases of corticosteroid-refractory pemphigus, showing favorable results. This case study focuses on an adolescent male with a clinical-pathological diagnosis of pemphigus foliaceous with a severe clinical form of erythrodermis, unresponsive to multiple therapies, but which showed a satisfactory outcome with intravenous immunoglobulin. In this case we highlight the fact that the patient was a teenager who showed substantial clinical improvement as the result of using intravenous immunoglobulin, followed by complete remission after the fourth cycle of medication, allowing reduced doses of steroids and a consequent reduction of side effects. Keywords: Skin vesiculobullous; Intravenous immunoglobulins; PemphigusResumo: O Pênfigo Foliáceo Endêmico é doença bolhosa autoimune crônica da pele. Geralmente, o tratamento com prednisona tem excelente resposta, mas existem formas refratárias, sendo necessária terapêuti-ca alternativa. Apresentamos paciente adolescente masculino, com diagnóstico clínico-patológico de pênfi-go foliáceo, com forma clínica eritrodérmica grave e refratária a várias terapêuticas, que apresentou evolução satisfatória com imunoglobulina intravenosa. Destaca-se, neste relato, o fato de tratar-se de um paciente adolescente que obteve melhora clínica substancial com imunoglobulina intravenosa e remissão completa da doença, após o quarto ciclo da medicação, possibilitando redução da dose do corticoide e de seus efeitos colaterais. Palavras-chave: Dermatopatias vesiculobolhosas; Imunoglobulinas intravenosas; Pênfigo

FUNDAMENTOS: O pênfigo foliáceo endêmico é doença auto-imune, cutânea, bolhosa, com incidência maior na região Centro-Oeste do Brasil e menor em alguns países sul-americanos. Embora tenha sido demonstrado seu caráter auto-imune pela presença de auto-anticorpos e a importância da predisposição genética, não estão ainda claramente estabelecidos os fatores ambientais intervenientes. OBJETIVOS: Conhecer as características sociodemográficas da doença, bem como sua distribuição no Estado de Goiás. MÉTODOS: Foram analisados 210 prontuários com diagnóstico estabelecido no período de1996 a 2001. As informações demográficas foram correlacionadas com as da população do estado, e a incidência da doença, determinada em cada uma de suas microrregiões. RESULTADOS: Maior incidência da doença na terceira década e na zona rural, leve ocorrência familiar e sem predileção por sexo. O maior contingente (74,3%) de pacientes foi do Estado de Goiás, e a maior incidência, nas microrregiões de Anicuns, Chapada dos Veadeiros, Rio Vermelho, Vale do Rio dos Bois, Iporá e Aragarças. CONCLUSÕES: Houve predomínio da doença na terceira década e naqueles com domicílio ou atividade na zona rural. Foram detectadas, pelo cálculo do coeficiente de incidência, áreas de concentração da doença em algumas microrregiões, principalmente na zona central do Estado de Goiás. Novas pesquisas são necessárias para esclarecer as causas dessa concentração ecológica.

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Background and Aims The search for new serum biomarkers of cardiovascular risk and mortality in patients with CKD is relevant to improve the monitoring of these patients. Copeptin is a glycopeptide that is released equimolarly with arginine-vasopressin. GDF-15 is a cytokine involved in macrophage activation processes and is a marker of response to oxidative stress, and IL-6 as a marker of systemic inflammation. Objective: To study the serum levels of copeptin, GDF-15 and IL-6 in patients with advanced CKD. Method Cross-sectional study in 32 patients with advanced CKD. In all patients, the estimated glomerular filtration rate (eGFR) was determined by CKD-EPI, the albumin/creatinine ratio (CrAI) and the serum concentrations of copeptin (immunofluorescence, Thermo Fisher), GDF-15 (chemiluminescence, Roche Diagnostics International) and IL-6 (Siemens Healthineers). Results were compared to laboratory reference values (RVs) for copeptin (VN<4.2 pmol/L) and IL-6 (VN<4.4 pg/mL). The VR of GDF-15 (708±227 pg/ml) corresponds to own data from 10 Blood Bank donors. Results for copeptin and GDF-15 (normal distribution) are shown as mean ± SD. IL-6 results (without normal distribution) as median and interquartile range. Results In CKD we observed an increase in copeptin (26.9±22 pmol/l, 90% >4.2 VR) and GDF-15 (4703±2683 pg/ml p<0.0001 vs. control population). Median IL6 3.2 pg/ml (IQR: 2.7-5.1, 35% >4.4 VR). We did not find differences in the levels of copeptin, GDF-15 or IL-6 based on age, sex and presence or absence of diabetes. A significant correlation was found between GDF15 levels and eGFR (r=-0.54 p<0.002). Conclusion Serum levels of copeptin and GDF-15, but not IL6, are increased in CKD patients. Our data suggest a significant inverse relationship between GDF15 and eGFR. More studies are needed to know the possible role of GDF-15 on the progression of kidney damage and cardiovascular complications in patients with CKD.