94 children and 25 adolescents, 42% male and 58% female, aged predominantly between
six and ten years old (40%) were studied at the Martagão Gesteira Childcare and
Pediatrics Institute (Rio de Janeiro Federal University) between 2005 and 2011. The
prevalent clinical form of vitiligo was the generalized type (34%). Although the
clinical response was similar between the treatment modalities, we decided for low
and high power topical steroids in our routine. Halo nevi were found in seven (5.9%)
cases. Thirty (25%) patients underwent specialized evaluation and 18 (60%) reported
some relevant psychological situation.
Resumo: O Acinetobacter baumanni é patógeno oportunista antigamente considerado de baixa virulência. Atualmente está envolvido em processos infecciosos que acometem pacientes imunocomprometidos, grandes queimados e pacientes em unidades de terapia intensiva que fazem uso de ventilação mecânica. Esse relato de caso chama atenção para infecção cutânea rara por essa bactéria em paciente imunocompetente. Palavras-chave: Abscesso; Acinetobacter baumannii; Infecção
Abstract: Acinetobacter baumannii is an oportunistic pathogen that used to be considered as having low virulence; however, it is currently known to be involved in infectious processes in patients with immunosuppression, large burns and those under mechanical ventilation in intensive care units. This case report emphasizes the possibility of cutaneous infection by A. baumanni in immunocompetent patients.
Background
Scalp pruritus is a common symptom in Dermatomyositis (DM) patients. There are indications that small nerve fibers neuropathy could be involved in this symptom, however the etiology of scalp pruritus is not fully understood.
Objectives
To assess epidermal nerve fiber (ENF) density of dermatomyositis patients with scalp pruritus by biopsy by confocal microscopy and immunohistochemistry with subsequent imaging analysis.
Methods
DM patients with severe scalp pruritus from the dermatology outpatient clinic were compared to healthy volunteers. Two 4‐mm scalp skin biopsies were obtained above the right ear in the parietal region and below the occipital protuberance in the occipital region. Biopsy specimens were incubated with primary antibodies to protein gene product (PGP 9.5), calcitonin gene–related peptide (CGRP), substance P (SP) were used to visualize nerve fibers (ENF) and collagen IV was used to label the epidermal basement membrane. The number of ENFs per millimeter was counted and recorded as the mean of ± SD of counts in 16 images at two micrometer increments/sections, two from each of the samples. ENF densities were compared between groups and a multiple linear regression model was applied to associated factors with ENF density.
Results
Fifteen DM patients with severe scalp pruritus and 12 healthy volunteers were included in the study. The mean number of ENF/mm in occipital region of DM group was 16.0 ± 13.9 while the control group in the same region was 99.8 ± 33.1. In parietal region the number of ENF/mm of DM group was 18.0 ± 20.7 while in control group was 50.4 ± 17.4 (p < 0.001).
Conclusion
DM patients with pruritus could have some impairment of small nerve fiber density that could explain their recalcitrant scalp pruritus.
Patients with moderate-to-severe atopic dermatitis (AD) have a high unmet need for safe chronic therapies. IL-22 was suggested to have a pathogenic role in AD, but human data are lacking. In a proof-of-concept, randomized placebo-controlled phase 2a trial in 60 patients, an anti-IL-22mAb (fezakinumab/ILV-094) showed clinical benefit in severe AD. Progressive clinical improvements extended beyond the last dose (10wks) until end-of-study (20wks). Skin biopsy analyses were performed at 0, 4, 12wks, by transcriptomic and immunohistochemistry analyses. Changes in the AD transcriptome were estimated by differentially expressed genes/DEGs criteria of 2-fold change and false discovery rate <0.05 in lesional vs. non-lesional skin. Greater changes in the AD gene-fingerprinting were seen with fezakinumab, as compared to placebo (25.3% and 65.5% vs 10.5% and 13.9% at 4 and 12wks, respectively). Since IL-22 blockade only shows significant efficacy in severe AD, we used median IL-22 expression at baseline to stratify for high (n¼30) and low (n¼29) IL-22expression groups. Much stronger mean transcriptomic improvements were seen with fezakinumab in the IL-22-high drug-group (82.8% and 139.4% at 4 and 12wks, respectively), than in the respective IL-22-high placebo (39.6% and 56.3% at 4 and 12wks; p<10 -9 drug vs placebo). Significant downregulations of key inflammatory axes, including Th1/CXCL9, Th2/ CCL18, CCL22, Th17/CCL20, DEFB4A, and Th22/IL-22, S100As-related markers were restricted to the high-IL-22 group (p<0.05). We also defined a set of baseline predictors of response, mostly involving T-cell and dendritic-cell genes. This is the first human report showing profound effects of IL-22 blockade in AD skin, particularly in patients with high-IL-22. These data suggest a central role for IL-22 in AD, and the need for a precision medicine approach for improving therapeutic outcomes.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.