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Hypersensitivity reactions affecting the oral mucosa present a significant clinical challenge due to their diverse manifestations and the wide range of potential allergens involved. This article explores the types of allergic reactions commonly observed in the oral cavity, including contact allergies and systemic allergic reactions, emphasising their clinical presentations and diagnostic approaches. Common allergens such as metals and resin-based dental materials are highlighted, discussing their impact on oral health. Diagnostic strategies, including clinical examination, history taking, cutaneous patch testing and histopathological evaluation, are assessed for their efficacy in establishing the diagnosis of an allergic reaction and in identifying specific allergens. Management and treatment options are also reviewed, focusing on allergen avoidance, pharmacological interventions, and the selection of hypoallergenic dental materials. This article underscores the importance of a multidisciplinary approach in improving diagnostic accuracy and therapeutic outcomes for patients with oral mucosal allergies. [ABSTRACT FROM AUTHOR]

Erosive oral lichen planus (EOLP) represents a significant challenge in dental and medical management due to its chronic inflammatory nature, painful symptoms, and impact on quality of life. This study aims to evaluate the current diagnostic approach with novel non-invasive techniques, such as dermoscopy, and also the landscape of treatment options for EOLP, focusing on its efficacy, safety, and the challenges that it present in clinical practice. Through a comprehensive literature review, we explored the use of topical corticosteroids, systemic immunosuppressants, biologics, and Janus kinase (JAK) inhibitors in treating EOLP, alongside examining patient compliance, psychological impacts, and the risk of adverse effects and recurrence. Our findings reveal that while topical corticosteroids are the cornerstone of EOLP treatment, offering symptomatic relief, their long-term use is limited by side effects and tolerance development. Systemic therapies and biologics provide alternatives for refractory cases but necessitate careful adverse effect monitoring. JAK inhibitors show promise as an innovative treatment avenue but require more evidence on long-term safety and efficacy. This study highlights the necessity of personalized treatment approaches due to the variable disease course and response to treatment, underscoring the importance of a multidisciplinary strategy in managing EOLP. The complexity of EOLP treatment, compounded by its psychological and quality of life impacts, demands ongoing research into targeted therapies, the establishment of standardized treatment protocols, and the development of effective outcome measures to improve patient care and treatment outcomes. [ABSTRACT FROM AUTHOR]

This article presents a study that analyzed potentially malignant lesions in the oral cavity. The study examined data from 62 patients in Romania and found that older adults, particularly those over 50 years old, had a higher prevalence of these lesions. There was also a gender disparity, with actinic cheilitis being more common in males. The study emphasizes the importance of early detection and regular monitoring to prevent malignant transformation. The study also suggests the potential use of laser treatments as therapeutic alternatives. [Extracted from the article]

This article explores the use of Janus Kinase (JAK) inhibitors for the treatment of oral lichen planus (OLP), a chronic inflammatory condition. It discusses the role of the JAK-STAT pathway in the development of OLP and examines the current landscape of topical JAK inhibitors. The article highlights recent clinical trials and observational studies that suggest the potential of these agents in managing OLP. However, more research is needed to establish their efficacy and safety profiles. JAK inhibitors offer new hope for OLP patients, but further investigation is necessary. [Extracted from the article]

Telogen effluvium is a common form of hair loss characterized by diffuse thinning of hair on the scalp due to early entry of hair into the telogen phase. It often occurs as a reaction to physical or psychological stress, hormonal changes, or certain medications and can affect individuals of all ages and genders. This paper aims to explore the psychological impact of telogen effluvium, a frequently overlooked aspect of this condition. We investigate how this form of hair loss affects mental health, self-esteem, and overall quality of life. The review utilizes a comprehensive literature search in databases such as PubMed, MEDLINE, and PsycINFO. We included studies focusing on telogen effluvium and its psychological consequences, prioritizing recent publications and high-quality evidence. The review highlights a significant association between telogen effluvium and psychological distress, including increased risks of anxiety, depression, and social phobia. The condition profoundly impacts self-image and can lead to decreased social interaction and diminished quality of life. Understanding the psychological impact of telogen effluvium is crucial for effective patient management. A holistic approach, incorporating both medical and psychological interventions, is recommended to address the comprehensive needs of these patients. [ABSTRACT FROM AUTHOR]

Psoriasis and depression are prevalent and often co-occurring disorders, yet the molecular basis of their association remains inadequately understood. This review aims to synthesize current knowledge on the molecular links between psoriasis and depression, highlighting potential common pathways and mechanisms.We conducted a comprehensive literature search, examining studies that explored the molecular aspects of psoriasis and depression, with a specific focus on research identifying shared molecular pathways and markers.Our review reveals significant intersections in the molecular pathways of psoriasis and depression, particularly in the realms of inflammation, immune response, and genetic predispositions. Key findings include the role of pro-inflammatory cytokines, which are elevated in both conditions, and genetic markers that may predispose individuals to both disorders. Understanding the molecular interplay between psoriasis and depression can offer valuable insights into new therapeutic approaches and the potential for personalized medicine. This review underscores the need for integrated management strategies in patients suffering from both conditions and highlights areas for future research. [ABSTRACT FROM AUTHOR]

This article from the Romanian Journal of Oral Rehabilitation discusses the use of salivary markers in detecting oral cancer. Saliva contains biomarkers that can indicate the presence and progression of oral squamous cell carcinoma (OSCC), providing a non-invasive method for screening and monitoring the disease. The article explores the current understanding of salivary markers in oral cancer, their advantages over traditional biopsy techniques, limitations, and the need for further research. It concludes by outlining the potential future applications of salivary biomarkers in oral cancer detection and management. This article is a valuable resource for those researching oral biology and related fields. [Extracted from the article]

This article from the Romanian Journal of Oral Rehabilitation explores the effects of menopause on oral health in women. Menopause, which typically occurs around the age of 51, involves the permanent cessation of menstruation and a decrease in estrogen hormone levels. The article highlights the oral health issues that can arise during menopause, including dryness, decreased saliva production, burning sensation, altered taste, and increased vulnerability to pain and neurological disorders. Dentists and general practitioners should be aware of these changes and focus on managing oral health during this stage. The article also discusses two specific conditions associated with menopause: Burning Mouth Syndrome (BMS) and neurological disorders. BMS is characterized by a burning sensation in the mouth, particularly on the tongue, and is more common in peri- or postmenopausal women. The exact cause of BMS is unknown, but hormonal changes, psychological factors, and local irritations may contribute. Neurological disorders, such as trigeminal neuralgia, Alzheimer's disease, and atypical facial pain, are also more prevalent in postmenopausal women. Proper diagnosis and treatment for these conditions are crucial, as they can significantly impact a woman's overall health and well-being during menopause. Overall, the article emphasizes the importance of oral health awareness and proper management during menopause. [Extracted from the article]

Psoriasis and vitiligo are two autoimmune, multi-factorial, chronic diseases with an increased prevalence worldwide. Although the clinical characteristics are different, multiple associations are observed between the two conditions. The literature describes numerous directions regarding management focused on either psoriasis or vitiligo, seen as two separate entities. For this reason, current studies related to this association are converging towards new horizons that allow the use of a single therapy, personalized and equally focused on both conditions. The aim of this paper is to formulate an overview of the current knowledge regarding psoriasis and vitiligo and to determine a possible relation between them. [ABSTRACT FROM AUTHOR]

Both cutaneous melanoma (CM) and uveal melanoma (UM) represent important causes of morbidity and mortality. In this review, we evaluate the available knowledge on the differences and similarities between cutaneous melanoma and uveal melanoma, focusing on the epidemiological aspects and risk factors. Uveal melanoma is a rare condition but is the most prevalent primary intra-ocular malignant tumor in adults. Cutaneous melanoma, on the other hand, is significantly more common. While the frequency of cutaneous melanoma has increased in the last decades worldwide, the incidence of uveal melanoma has remained stable. Although both tumors arise from melanocytes, they are very distinct entities biologically, with complex and varied etiologies. Both conditions are encountered more frequently by individuals with a fair phenotype. ultraviolet-radiation is an important, well-documented risk factor for the development of CM, but has shown not to be of specific risk in UM. Although cutaneous and ocular melanomas seem to be inherited independently, there are reported cases of concomitant primary tumors in the same patient. [ABSTRACT FROM AUTHOR]

Desquamative gingivitis (DG) is a clinical term that describes erythema, desquamation and erosions of the gingiva, of various etiologies. Although the clinical aspect is not specific for a certain disease, an accurate diagnosis of the underlying disorder is necessary because the disease course, prognosis and treatment vary according to the cause. DG may inflict significant oral discomfort, which is why patients typically present to the dentist for a first consultation, rendering it important for these specialists to be informed about this condition. Our paper aims to review the ethiopatogenesis and diagnostic approach of DG, focusing on the most common underlying disorders (autoimmune bullous dermatoses and lichen planus) and on the management of these patients. Potential etiological agents leading to an inflammatory immune response in the oral mucosa and DG appearance include genetic predisposition, metabolic, neuropsychiatric, infectious factors, medication, dental materials, graft-versus-host reaction and autoimmunity. A thorough anamnesis, a careful clinical examination, paraclinical explorations including histopathological exam and direct immunofluorescence are necessary to formulate an appropriate diagnosis. Proper and prompt management of these patients lead to a better prognosis and improved quality of life, and must include management in the dental office with sanitizing the oral cavity, instructing the patient for rigorous oral hygiene, periodic follow-up for bacterial plaque detection and removal, as well as topical and systemic therapy depending on the underlying disorder, based on treatment algorithms. A multidisciplinary approach for the diagnosis and follow-up of DG in the context of pemphigus vulgaris, bullous pemphigoid, cicatricial pemhigoid or lichen planus is necessary, including consultations with dermatologists, oral medicine specialists and dentists. [ABSTRACT FROM AUTHOR]

The milk blister/vesicle represents a frequent pathology occurring in the process of lactation, because of diagnostic and treatment issues and also because of the aggravating factors. The milk blister can lead to mastitis and can be easily identified by a trained eye. In the management of recurrences, the multidisciplinary team is imperious, in which a certified lactation consultant should take part [1]. [ABSTRACT FROM AUTHOR]

Non-adherence to psoriasis treatment has an important impact in controlling chronic disease evolution and the occurrence of systemic comorbidities. Biologic therapy represents a revolutionary treatment, many of the undesirable psychological and socio-economical consequences of conventional topical or systemic therapies being avoided. Nevertheless, the discontinuation of biological therapy may occur due to facts related to the patient, to the lack of good communication between the patient and the physician or to the adverse or paradoxical reactions. We studied the non-adherence reasons to anti-TNFα agents (Infliximab, Adalimumab, Etanercept) used for treating 84 cases with moderate-severe psoriasis. The results of our study over the past 10 years showed a 76.2% adherence rate, lowest in patients treated with Etanercept (70.9%). Relative to the anti-TNF agent used, the highest adherence rate was recorded in Adalimumab (80.8%), followed by Infliximab (76.5%) and Etanercept (70.9%). We have noticed differences between the rates of adhesion to therapy with different anti-TNFα agents, but with no statistical significance. The main adverse effects that occurred during anti-TNFα therapy were: local reaction to the drug, mild infectious events, allergic reactions, cardiotoxicity, alopecia areata, pancreatitis, eosinophilia, thrombocytopenia. Anti-TNF therapy was discontinued in one case of endocarditis, one case with tuberculous laryngitis and another one with polydiscitis (Adalimumab), a case of colon cancer and one of pregnancy (Etanercept) and one paradoxical reaction (Infliximab). [ABSTRACT FROM AUTHOR]

Introduction Biological therapy with anti-TNFa agents used in the treatment of psoriasis as well as other immunologically mediated pathologies has become a common therapeutic option that offers certain therapeutic benefits but is not without adverse reactions. The paradoxical ones are signs and symptoms that occur during therapy with biological agents similar to those under the pathological conditions that constitute an indication for biological therapy. The overall incidence as well as the etiopathogenic mechanism underlying these reactions are still unclear. Material and method We will present a female patient with psoriasis vulgaris and seronegative rheumatoid arthritis, who followed a treatment with an anti-TNFa biological agent for 3 years, with favourable therapeutic effect until the recurrence of severe skin lesions and an exacerbated osteo-articular algic syndrome, manifestations considered in this context as paradoxical adverse reactionstothe anti-TNFa therapy. Discussions and conclusions Paradoxical adverse reactions (PAR) are rare and unusual during anti-TNFa therapy and are not limited to agents in this class. Their management is a challenge, and prognosis depends on severity and accessibility to therapeutic alternatives. [ABSTRACT FROM AUTHOR]

Dermoscopy is a non-invasive tool to appreciate epidermal and subepidermal structures that are not visible to the naked eye. It has been used for the past two decades to improve the accuracy in the clinical diagnosis of pigmented skin lesions, but in recent years its application has extended to other inflammatory and neoplastic skin disorders. Assessing the vascularity in nonmelanoma skin cancers is useful not only to differentiate between malignant and benign conditions, but also to orientate the surgical excision with regard to the margins of tumor invasion and to evaluate the efficacy of treatment. Our study aims to analyze the morphology and distribution of blood vessels using non-contact polarized light dermoscopy on a group of 42 patients with nonmelanoma skin cancers, in order to find the most common changes associated with these tumours, that aid in the accuracy of the clinical diagnosis. In our study non-melanoma skin cancers were represented by 35 cases of basal cell carcinoma (nodular type - 27 cases, superficial type - 6 cases, cicatricial type - 1 case, pigmented type - 1 case) and 7 cases of squamous cell carcinoma. The most common vascular feature in basal cell carcinoma was arborizing vessels with irregular, clustered distribution, while in squamous cell carcinoma polymorphous vessels with irregular distribution predominated. In conclusion, vascular assessment in non-melanoma skin cancers is useful to improve accuracy of clinical diagnosis, in association with anamnestic data and clinical macroscopic appearance of the lesions. [ABSTRACT FROM AUTHOR]

Unilateral nevoid telangiectasia (UNT) is a rare congenital or acquired vasculopathy, clinically characterized by unilateral, dermatomal superficial telangiectasia. Though exact etiopathogenesis is unclear, the most frequent hypotheses refer to hyperestrogenic status in certain physiological or pathological circumstances, estrogen and progesterone vascular receptor anomalies, or a somatic cromosomial mosaicism revealed during heightened serum levels of estrogen or other vasoactive substances. The reported case refers to a 16 years old girl with cutaneous signs compatible with acquired UNT, with a dermatomal distribution within the C4-T1 nerves area and a progressive evolution from the age of 10, without hormonal anomalies. [ABSTRACT FROM AUTHOR]

Pachyonichya congenita (PC) is a rare genodermatosis with variable phenotypic expression affecting mainly the nails, palmoplantar skin and oral mucosa. PC clinical signs and symptoms are due to mutations of genes encoding some constitutive keratins of toenails and fingernails, skin, oral mucosa and pilosebaceous unit. On the basis of a molecular genetic analysis, the disorder is classified in two distinct subtypes: PC type I (Jadassohn-Lewandowsky syndrome) caused by mutations in the KRT16 gene encoding keratins K6a and K16, and PC type II (Jackson-Lawler syndrome) due to mutations in the KRT17 gene encoding keratin17. Keratins abnormalities result in severe onychodystrophy, acral fissured and painful hyperkeratosis, oral leukokeratosis, cystic lesions and teeth anomalies. These clinical manifestations lead to an important functional impairment and a severe decrease in quality of life.We report the cases of a 37 year-old male patient and two of his four children (a 7 year-old girl and a 3 year-old boy) with PC type I, the commonest clinical form of the disorder that manifested with thickened dystrophic toenails and fingernails, important fissured and painful plantar keratoderma, oral leukokeratosis and severe impairment of life quality. [ABSTRACT FROM AUTHOR]

Angiogenesis is an important factor in tumor proliferation and metastasis in numerous solid tumors. Angiogenesis was studied in malignant melanoma using different endothelial markers and different quantifying methods, with controversial results. We performed a morphometric study of angiogenesis in 14 cases of advanced primary melanoma of the face, using a highly specific marker for tumor endothelial cells (CD105) associated with a specific marker for proliferation (Ki-67) and an automated system for image analysis. Our results showed an increased vascular area in peritumoral regions compared to intratumoral regions, with larger, regular, dilated peritumoral blood vessels and small, collapsed with thick-walled intratumoral blood vessels. Endoglin expression was high in intratumoral regions and moderate to weak in peritumoral regions. Ki-67 expression was negative in peritumoral regions and weakly positive in some cases in intratumoral regions. Endoglin may be a better marker to assess neovascularity in malignant melanoma of the face, as well as a better pronostic indicator, as it specifically binds to endothelial tumor cells, allowing to differentiate between neovascularity and pre-existing blood vessels. [ABSTRACT FROM AUTHOR]

Primary leiomyosarcoma of the inferior vena cava is a rare malignant tumor, potentially aggressive, of vascular origin. Aim: Presentation of a case of extrinsic and intrinsic primary leiomyosarcoma (with extra and intravascular evolution) of the postrenal segment of the inferior vena cava. Case report of a sixty-six years old patient, admitted for pain in the right flank (for about 11 months); ultrasonographic and echo-Doppler exploratipn and histopathology and immunohistochemistry of the tumor sections postoperative.Results: Hypoechogenic formation, solid and homogeneous, with lateral mass effect on the postrenal wall of vena cava (incomplete stenosis with hourglass lumen). Complete tumor excision was performed together with implantation site, while lateral venous reconstruction using saphenous patch angioplasty was performed. The resection sample was covered by a solid pseudocapsule with firm, homogeneous aspect, with no occlusive thrombus, and a „fish-meat” aspect in cross-section and no necrotic, hemorrhagic or degenerative cystic areas. Immunohistochemistry confirmed an extensive extra and intraluminal leiomyosarcoma with 2nd differentiation degree. Cytoplasmic labeling was positive for desmin, vimentin, SMA, CD 31, while tumor cell nuclei were positive for Ki-67 and negative for S100. Following associated chemo and radiotherapy, the patient has shown no local recurrence at 6 months. Conclusion: Primary vascular leiomyosarcoma of the retroperitoneal vena cava require radical surgery and complementary multimodal therapy (however not curative) to ensure comfortable medium and long term survival rates. Continuous surveillance is required to monitor local recurrences and metastasis. [ABSTRACT FROM AUTHOR]

Reticulohistiocytoses are defined as rare benign histiocytic proliferative disorders of unknown etiology involving the skin and virtually any internal organ. The spectrum of reticulohistiocytoses includes clinical forms that are limited to the skin (reticulohistiocytoma and diffuse cutaneous reticulohitsiocytosis) and multicentric reticulohistiocytosis that usually associates a papulo-nodular skin eruption and erosive polyarthritis. We report the case of a patient with clinical, histological and immunohistochemical features of diffuse cutaneous reticulohistocytosis. We also consider the possibility of a multicentric reticulohistiocytosis with cutaneous onset. [ABSTRACT FROM AUTHOR]

Nevus comedonicus is an unusual variant of adnexal hamartoma characterized by comedo-like lesions with a linear distribution, first reported by Kofmann in 1895. We present the case of a premature female infant with staturo-ponderal hypotrophy, with multiple inflammatory nodular suppurating lesions occurring on comedo-like lesions with segmental unilateral distribution. Pathological examination confirmed the clinical diagnosis of nevus comedonicus. The inflammatory lesions had an episodic evolution with bacterial suprainfection that required surgical treatment. Topical treatment consisted of tretinoin cream 0.05% with satisfactory results on the comedo-like lesions. The long term prognosis is unpredictable because of the frequent recurrences of bacterial suprainfection in a dystrophic child, due to prematurity and associated malabsorption syndrome. [ABSTRACT FROM AUTHOR]

The ongoing COVID-19 pandemic, declared by the World Health Organisation in March 2020, with the emergence of new, possibly more contagious and more virulent strains, remains a research subject, with the complex systemic involvement better described and understood, but also with a variety of skin and mucosal lesions described in the literature. Mucocutaneous lesions associated with SARS-CoV-2 infection are still under investigation, due to their polymorphic clinical aspect and incompletely understood pathogenic mechanism. The cutaneous inflammatory, exanthematous and purpuric rashes, erythemato-purpuric enanthems, oral ulcers, lichenoid oral lesions, conjunctivitis, conjunctival pseudomembranes, or corneal lesions have been described in patients with COVID-19. Several classifications have been proposed based on the clinical pattern, histological findings, and possible pathogenic mechanisms. The pathogenic mechanism, the diagnostic criteria, the prognostic importance of these lesions are still being debated. The diverse clinical aspects of dermatological manifestations render the diagnosis difficult. However, several clinical patterns strongly associated with COVID-19, such as chilblains, papulovesicular exanthems, and febrile rash require increased awareness and changes to the investigation protocols for these conditions, to include testing for SARS-CoV-2. In the present review, the mucocutaneous findings associated with the novel coronavirus infection, reported thus far in the literature, was provided. [ABSTRACT FROM AUTHOR]

Since the introduction of modern phototherapy in 1903 by Nobel Prize-winner Niels Ryberg Finsen, the usage of this therapy in the medical field has grown, techniques have been refined and developed, and it has gained widespread acceptance. Psoriasis vulgaris, parapsoriasis, lichen planus, atopic dermatitis, neonatal jaundice, urticaria, morphea, vitiligo, granuloma annulare and cutaneous T cell lymphoma are only a few dermatological indications that come along with satisfactory results. Most often, it is a 2nd or 3rd line therapy being an alternative in more severe or refractory diseases. Despite the side effects that may occur after phototherapy, which are often minor, the benefits can be significant. Unfortunately, the absolute contraindications limit the use of this type of treatment and implicitly the management of these patients. The current review aimed to combine the recommendations of phototherapy in dermatology, the types of phototherapy that can be suitable for certain dermatological diseases and to emphasize its importance in certain conditions that are associated with significant remission rates. [ABSTRACT FROM AUTHOR]

Psoriasis is one of the most common immune-mediated chronic inflammatory skin disorders, involving hyperproliferative keratinocytes and infiltration of T cells, dendritic cells, macrophages, and neutrophils. Multiple factors appear to play important roles in the pathogenesis of psoriasis. These environmental (e.g., infectious agents and trauma), genetic, and immunologic factors are reviewed in this article. Although the pathogenesis of psoriasis remains to be established, data suggesting immune cell dysregulation in the skin are available. The involvement of the immune system, particularly T cells, in the etiopathogenesis of psoriasis is discussed in this review, indicating a potential justification for innovative treatment intervention. Besides describing pathogenic T cells, the aim of the review was to assess the function of newly identified antimicrobial peptides (AMPs), interleukin (IL)-23, IL-17, and tissue resident memory cells (TRMs), and their role in psoriasis. Furthermore, new insights were presented regarding TRMs, a recently identified subset of memory T cells, and the role they play in the local memory of disease, making them a potential new therapeutic target in psoriasis. Finally, current developments in T-cell research and cytokine-targeted therapy for psoriasis treatment are reviewed. [ABSTRACT FROM AUTHOR]

Acne is a chronic inflammatory condition affecting the pilosebaceous unit that was traditionally viewed as a disease of the adolescence. However, over the past several years, an increasing number of adult women have been reported to suffer from this condition. The prevalence of adult female acne ranges between 12 and 54%. Two clinical types can be distinguished in this population, a 'retentional' and an 'inflammatory' type, which usually tend to overlap. In terms of evolution, three main subtypes can be identified: Persistent acne, which is the most frequent subtype, late-onset acne and recurrent acne. This type of acne is mainly mild-to-moderate in severity and may be refractory to conventional treatment. The etiopathogenesis is complex and has yet to be fully elucidated. It appears to involve an interaction among genetic predisposition, hormonal factors, and chronic activation of the innate immune system overlapping with external factors, such as daily stress, Western-type diet, use of tobacco and cosmetics. The treatment may be challenging and a holistic approach is required, with special attention to the individual needs and particularities of adult women. Both topical and systemic treatments are available, with hormonal therapies being of special value in this population. The aim of the present article was to provide up-to-date, evidence-based information on the clinical presentation, etiopathogenesis and treatment of adult female acne. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic inflammatory and immune-mediated condition, which is no longer considered as being limited to the skin, but may affect the entire body. Epidemiological studies have shown that certain disorders, including obesity, diabetes, liver abnormalities, elevated lipid levels in the blood and metabolic syndrome, may occur more frequently in patients with psoriasis compared with the general population. As psoriasis is a chronic disease, the frequently associated comorbidities must be identified early to ensure timely treatment and, possibly, their prevention. Comorbidities often manifest clinically 1-2 years after the onset of psoriasis and are commonly seen in patients with severe forms of the disease. The association between psoriasis and its comorbidities is not coincidental, but rather based on common pathophysiological mechanisms and risk factors that underlie the increased frequency of comorbidities in patients with psoriasis. The aim of the present review was to emphasize the important role of dermatologists in the early recognition of comorbidities in patients with psoriasis, with a focus on metabolic comorbidities, precisely because the dermatologists are usually the first medical contact due to the predominance of skin lesions. Therefore, these specialists have the responsibility to inform patients on the association between psoriasis and possible multiple comorbidities, devise prevention and treatment plans, or even redirect patients to other specialists. [ABSTRACT FROM AUTHOR]

Long considered a skin-limited condition, psoriasis is currently defined as a chronic, immune-mediated inflammatory disease, presenting, besides the skin changes, important systemic manifestations, the most common being: psoriatic arthritis, cardiovascular disease, metabolic syndrome, diabetes, inflammatory bowel disease and nonalcoholic steatohepatitis. It is a disease with a strong psycho-emotional and social impact, both through skin changes such as pruritic, scaly erythematous plaques, and through the association of comorbidities that influence morbidity and mortality. It has been shown that psoriasis is an independent cardiovascular risk factor, with patients developing ischemic heart disease/acute coronary syndrome, hypertension, peripheral arterial disease, or stroke. The chronic inflammatory status of psoriasis and the production of specific cytokines may be the etiopathogenic link to atherosclerosis and cardiovascular disease. Biological therapy may affect atherosclerosis, leading to the arrest of the evolution or even regressing the changes in the atheromatous plaque. The aim of this review was to re-evaluate the current knowledge regarding the cardiovascular comorbidities associated with psoriasis for optimal management of the patients. [ABSTRACT FROM AUTHOR]

Pemphigus represents a group of chronic inflammatory disorders characterized by autoantibodies that target components of desmosomes, leading to the loss of intercellular adhesion between keratinocytes and causing intraepithelial blistering. The pemphigus group consists of four main clinical types with several variants: pemphigus vulgaris (with pemphigus vegetans and pemphigus herpetiformis as variants), pemphigus foliaceus, paraneoplastic pemphigus and IgA pemphigus (with two clinical variants: intraepidermal neutrophilic IgA dermatosis and subcorneal pustular dermatosis). Genetic factors are involved in the pathogenesis, with HLA-DR4 (DRB1*0402) and HLA-DRw6 (DQB1*0503) allele more common in patients with pemphigus vulgaris, HLA class II DRB1*0344 and HLA Cw*1445 correlated with paraneoplastic pemphigus, and HLA-DRB1*04:01, HLA-DRB1*04:06, HLA-DRB1*01:01, HLA-DRB1*14, associated with a higher risk of developing pemphigus foliaceus. Autoantibodies are conducted against structural desmosomal proteins in the skin and mucous membranes, mainly desmogleins, desmocollins and plakins. Cell-mediated immunity may also play a role, especially in paraneoplastic pemphigus. Patients may present erythema, blisters, erosions, and ulcers that may affect the skin, as well as mucosal surfaces of the oral cavity, eyes, nose, leading to severe complaints including pain, dysphagia, and fetor. Oral mucosal postbullous erosive lesions are frequently the first sign of disease in pemphigus vulgaris and in paraneoplastic pemphigus, without skin involvement, making the diagnosis difficult. Treatment options classically include immunosuppressive agents, such as corticosteroids and corticosteroid-sparing agents such as azathioprine, mycophenolate mofetil, cyclophosphamide, methotrexate or dapsone. Newer therapies focus on blocking cell signaling events induced by pathogenic autoantibodies and/or targeting specific autoantibodies. The disease evolution is conditioned by the treatment with maximum doses of corticosteroids and the side effects associated with long-term immunosuppressive therapy, which is why patients need a multidisciplinary approach in following the treatment. In this review, we provide a comprehensive overview of the epidemiology, pathophysiology, clinical aspect, diagnosis and management of the main intraepidermal blistering diseases from the pemphigus group. [ABSTRACT FROM AUTHOR]

Oral lichen planus (OLP) is a complex chronic inflammatory disorder in which autocytotoxic CD8+ T cells, locally present in the affected tissue, induce basal keratinocyte apoptosis, through the release of several cytokines, such as interleukin-6 (IL-6). IL-6 is a proinflammatory cytokine that is related to alterations in lipid metabolism in psoriasis patients. Impaired lipid metabolism together with high serum levels of triglycerides have been found in association with OLP. However, the correlation between serum levels of IL-6 and dyslipidemia has not yet been studied in this disorder. The present study aimed to demonstrate the association between OLP, systemic inflammation through increased release of inflammation mediators such as IL-6 and alteration of lipid metabolism, in order to support the concept of OLP as a marker of systemic inflammation and a potential risk factor of cardiovascular morbidities. For this purpose, we designed a case-control study using a cohort of 18 patients with different clinical forms of OLP compared with 18 control group patients with other oral conditions, to identify a potential correlation between serum levels of IL-6 and serum lipid levels. High plasma serum levels of IL-6 were found to be correlated with cholesterol, high density lipoprotein cholesterol and triglyceride serum levels in the patients with OLP. There was a significant association between erosive and atrophic clinical forms of OLP and the pathological serum values of IL-6 and triglycerides, respectively, making these two parameters good predictive factors of the clinical form of OLP. Further studies of other biomarkers of systemic inflammation using larger cohorts of OLP patients are necessary in order to consider LP as a marker of systemic inflammation and to support the screening of these patients for lipid metabolism changes and treatment with specific antagonists in order to prevent cardiovascular events. [ABSTRACT FROM AUTHOR]

Colchicine has been known and used for over a millennium for its anti-inflammatory properties, being the treatment of choice for gout and familial Mediterranean fever. A tricyclic alkaloid extracted from the herbaceous plant, Colchicum autumnale, colchicine blocks multiple inflammatory pathways, and has antimitotic and antifibrotic action. Although there are insufficient data on the beneficial mechanism of action, colchicine is a widely used treatment in dermatology, one of the morbid conditions with more evidence of efficacy being recurrent aphthous stomatitis (RAS), a disorder with incompletely known etiopathogenesis and, consequently, with poorly defined treatment. Colchicine is considered as the first therapeutic line in complex or severe aphthoses, significantly relieving pain, decreasing the number of lesions, increasing the free interval between eruptive episodes, without inducing noticeable side effects. We examined the treatment efficacy of colchicine in two cases of chronic, severe RAS, evolving in different morbid contexts, who did not respond to other therapeutic measures. The two cases presented with recurrent aphthous stomatitis with herpetiform aphthae; one patient with Turner syndrome and one patient with major Sutton ulcers. [ABSTRACT FROM AUTHOR]

In the group of head and neck cancers, oropharyngeal cancer presents an increased incidence especially in the young population. Unlike head and neck cancers related to smoking cancers that usually occur in the 6th decade of life, oropharyngeal cancers with viral etiology associated with HPV infection have a favorable prognosis. Long time survivals and the curable potential of this entity have led to the necessity of toxicity reduction strategies to improve the quality of life of these patients. Radiotherapy is most often used for the treatment of head and neck tumors as an independent method or in combination with surgery and chemotherapy, the multidisciplinary approach being the therapeutically standard in locally advanced cancers. Although modern radiotherapy techniques IMRT and VMAT have greatly reduced the dose received by the radiosensitive organs, the oral mucosa is close to the target volumes or even partially included in these volumes irradiated with high doses leading to acute and late toxicities: oral inflammation, loss of taste, dry mouth syndrome caused by xerostomia and secondary infections. Most commons late effects are dental caries, trismus and osteoradionecrosis. The aim of the study is to evaluate the doses received by organs at risk (the oral cavity, the parotid glands and the mandible) for 20 cases of multimodal treated oropharyngeal cancers and to discuss these data in relation to treatment toxicity. [ABSTRACT FROM AUTHOR]

Objective: Mast cells' role in normal angiogenesis is supported by the release of a variety of factors and cytokines, such as heparin and tryptase, transforming growth factor β, tumor necrosis factor α and vascular endothelial growth factor. An adequate vascular supply is essential for tumor survival and progression. Our aim was to determine whether mast cells contribute to tumor angiogenesis in invasive cutaneous melanomas. Methods: Fourteen excision biopsy tissue samples from patients with advanced primary cutaneous malignant melanoma were sectioned and double immunostained with monoclonal murin anti-CD34 antibody for endothelial cells and mast cell tryptase monoclonal murin antibody to visualize mast cells. We used hot spot method to assess microvessel density and mast cells count in normal tissue, peritumoral and intratumoral areas. Pearson correlation test and paired samples T-test were used for statistical analysis. Results: The highest statistically significant correlation between microvessel density and mast cells count was found in peritumoral areas (76.9%, p<0.01), followed by normal tissue (76.5%, p<0.01). Intratumoral mast cells count was lower and the correlation with microvessel density did not reach statistical significance (66.4%, p=0.01). In tumoral areas, however, mast cells were larger and predominantly found in intensely pigmented sections. In areas with immature vessels mast cells were in contact with endothelial cells. Conclusion: The significant correlation between mast cells' count and microvessel density around tumor edges and their proximity to immature microvessels advocate for mast cells' role in invasive cutaneous malignant melanoma angiogenesis. [ABSTRACT FROM AUTHOR]

Sneddon syndrome is defined by the association of livedo racemosa and recurrent cerebrovascular ischemic lesions. The annual incidence is 4/1,000,000. This syndrome particularly affects young women, some reports suggesting a family predisposition. It is a chronic, progressive, arterio-occlusive disease of unknown etiology that involves small and medium-sized arteries. It is usually associated with antiphospholipid antibodies. We report the case of a female patient with Sneddon syndrome with significant family history, personal history of stroke, epilepsy, migraine, cardiovascular involvement, three miscarriages, cognitive decline, noncompliant to therapy, in the absence of antiphospholipid antibodies. This paper aims to analyze the main characteristic features and management of Sneddon syndrome by conducting a literature review related to a clinical case.

Generalized pruritus is a common symptom in elderly, patients, with severe impact on the quality of life. The diagnosis of senile idiopathic pruritus is made after the exclusion of a systemic disease such as chronic renal disease, hepatobilliary disease with cholestasis, thyroid dysfunctions, drug-induced hypersensitivity reactions, visceral or hematological neoplasia, and primitive dermatological distinct conditions. The pathophysiological mechanisms are still unclear. A critical role is considered to be played by changes related to skin aging, cutaneous nerve supply and other nervous system components. The clinical approach requires a thorough assessment of general health status. In primary skin conditions, a biopsy and direct immunofluorescence (DIF) are required, while in pruritus associated with a systemic disorder, the assessment of hematological, biochemical and immunological parameters and imaging are necessary. The treatment of a patient with chronic pruritus is often palliative and individualized, with emollients, sedating and non-sedating antihistamines, tricyclic antidepressants, gabapentinum, and narrow-band UVB phototherapy. Pruritus associated with systemic disease may be alleviated by etiologic treatment.