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Tacrolimus, a macrolide with immunosuppressive properties through the inhibition of T-lymphocyte activation, was approved as a second line topical treatment for atopic dermatitis, but has been largely used with beneficial effects in other dermatological conditions that involve a disregulation of the cellular immune response. Oral lichen planus is a T-cell�mediated autoimmune disease in which autocytotoxic CD8+ T cells trigger apoptosis of oral epithelial cells. Our study aimed to analyze the clinical efficacy of tacrolimus 0.03% and 0.1% in orabase as monotherapy on oral erosive lesions of lichen planus, in a group of 20 patients consulted in the Dermatology Clinic of the University C.F. Hospital Iasi during a period of five years. Our results show total or partial remission of oral erosive lesions in most patients at 3 months follow-up. However, after treatment discontinuation relapses are common, which is why intermittent use of topical tacrolimus is needed for longer periods to prevent recurrences. Further large scale studies are necessary to establish efficacy and safety profile of prolonged use of tacrolimus on mucosal membranes, as well as the most appropriate vehicle and concentration.

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.

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.

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.

Acne treatment during pregnancy is challenging and should be adapted to the clinical form, the lesions severity and their impact on the patient�s quality of life. The therapeutic decision in such cases need to be based on the risk / benefit ratio and to take into account the FDA categories of drugs used during pregnancy and breastfeeding. Iodine solution is a valuable formula useful for the treatment of different dermatological diseases due to its immunomodulatory features. Even actually, it is less frequent used in dermatologic prescriptions, the purpose of this article is to highlight the benefits of topical treatment with iodine solution at pregnant women with severe acne.We present the management issues raised by a severe, conglobated acne in a 29-year-old woman in 22 weeks of pregnancy with a history of vulgar acne predominantly inflammatory since 16 years of age. Systemic treatment consisted in oral clindamycin for 7 days associated with oral dexamethasone (8 mg/day). Topical treatment was represented by metronidazole B and iodine solutions and was continued after the withdraw of antibiotic and corticosteroid therapy At 30 weeks of pregnancy the acne was significantly improved and fetal biological status was normal.

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).

Dermoscopy is a non-invasive in vivo technique to help visualize morphological structures on the surface and subsurface of the skin, non-visible with the naked eye. It is tipically used to improve the diagnostic accuracy of pigmented skin lesions and skin tumors, but in recent years its use has been extended to other dermatological conditions. The use of polarized light in dermoscopy allows a better visualization of vascular structures and other changes in the dermis such as collagen depositin and fibrosis, which would make it a good tool for clinical orientation in inflammatory conditions such as cutaneous lupus erythematosus and morphea, considered in the spectrum of autoimmune connective tissue diseases, with diverse clinical cutaneous manifestations. Up to date studies of dermoscopic clues in these two entities are still scarce and results are not uniform. We performed a retrospective analysis of dermoscopic images in patients with pathological confirmation of the clinical diagnosis in order to find the common features and clues for dermoscopic diagnosis.

Skin cancer of the head and neck may involve the parotid gland or parotid lymph nodes either by direct invasion or by lymphatic/hematogenous spread.

Lichen planus is considered a complex immunological disorder, potentially correlated with systemic inflammation. Abnormal serum concentrations of proinflammatory cytokines in patients with lichen planus and their correlation with metabolic syndrome parameters and peripheral insulin resistance are an argument for an increased cardiovascular risk in these patients. We studied serum levels of the proinflammatory cytokine IL6 and compared these with metabolic syndrome parameters (blood glucose, serum triglycerids and cholesterol) and serum insulin concentrations in 18 patients with oral lichen planus compared to a control group of 18 patients with other inflammatory conditions of the oral mucosa. Results showed a direct correlation between IL6 and insulin, glucose and cholesterol serum levels, especially in the erosive and atropho-erosive clinical forms of oral lichen planus.

Cardiovascular involvement (arterial hypertension, stroke, myocardial infarction) is common in patients with psoriasis. Echocardiography is a frequently used test that allows identifying heart abnormalities. The aim of the study was to evaluate echocardiographic changes in patients with psoriasis vulgaris compared to a control group of sex- and age-matched patients without psoriasis. Our study was carried out on 31 psoriatic patients with cardiovascular comorbidities admitted to the hospital dermatology department and referred to the echocardiography laboratory. Echocardiography study was done in all patients, by using the standard methods. All patients were found to have left ventricular systolic function preserved but in the psoriatic patients, diastolic dysfunction was characterized by impaired relaxation. Wall motion abnormalities and valvular disorders were correlated with the severity and duration of the disease and provide important information in order to guide the therapy and to improve outpatients prognosis.