Anders Vahlquist – Excerpta from Volume 96 of ActaDV
Fig . 4 . Endoplasmic reticulum ( ER ) stress-centred working model of rosacea pathogenesis . Upregulated ER stress via transcription factor 4 ( ATF4 ) and S1P activates p38 mitogen-activated protein kinase ( p38 MAPK ) that phosphorylates and activates CCAAT / enhancer-binding protein-α ( C / EBPα ). C / EBPα increases the expression of cutaneous antimicrobial peptides ( CAMP ) and osteopontin ( OSN ) stimulating inflammation , angiogenesis , fibrosis and granuloma formation . S1P induces skin hypersensitivity and causes vasodilation and flushing . Toll-like receptor 2 ( TLR2 ) increases the activity of kallikrein 5 ( KLK5 ) enhancing the proteolytic cleavage of CAMP . Upregulation of TLR2 on peripheral neurones increases the susceptibility for pain . Bioactive peptide of CAMP ( LL-37 ) activates caspase-1 , the key enzyme of the NLRP3 inflammasome producing interleukin-1β ( IL-1β ), which activates Th17 cells . ( Text modified from ref 15 ; with permission from Acta Derm Venereol ). therapies which inhibit the stress mediators and down-regulate TLR in the skin . Another example of the current focus on skin inflammation is the paper by Steinhoff et al ( 16 ), reviewing the pathoaetiology and treatment options in facial erythema of rosacea .
Sexually transmitted infections
Syphilis , once the biggest simulator in Medicine , is becoming increasingly common again but is still occasionally difficult to diagnose and treat , especially in immunosuppressed patients . In a study from Copenhagen , Salado-Rasmussen et al . ( 17 ) investigate the serological response to treatment with doxycycline compared with penicillin in 202 HIV-infected individuals . They conclude that doxycycline is a favourable option in this group of patients .
Another rare occurrence which should not be forgotten is disseminated goncococcal infection , typically presenting with fever , pustular skin lesions and joint involvement , and usually responding quickly to antibiotics . However , in a report from Gothenburg , Rehnström et al . ( 18 ) describe two cases of gonococcal osteomyelitis resulting in permanent sequelae because of a delayed diagnosis and treatment ( Fig . 5 ).
Lastly some comforting news about STI and concurrent treatment with biologicals . There has been suspicion that anogenital HPV infections might be enhanced by treatment with immunosuppressive drugs , including TNF-a inhibitors . If so this would be of special concern in psoriasis patients who have a higher incidence of anogenital HPV infections than , for example , patients with inflammatory bowel disease ( IBD ), who are also candidates for biologics . However , a study of Handisurya et al . from Austria ( 19 ) now shows in 222 patients with psoriasis or IBD that there is no increased prevalence of anogenital HPV during treatment with TNF-inhibitors .
Fig . 5 . ( A ) X-ray of the left knee joint showing reduction in height of the cartilage laterally and medially ( arrows ), fissures on the tibial articulate surface and general osteopaenia . ( B ) X-ray of the left hand showing that adjacent edges of the articulate surfaces in the 3 rd metacarpophalangeal joint ( arrows ) are irregular and sclerotic , corresponding to status post-septic arthritis . ( From ref 18 with permission from Acta Derm Venereol ).
References
1 . Harwood C , Proby CM , Inman GJ , Leigh IM . The promise of genomics and the development of targeted therapies for cutaneous squamous cell carcinoma . Acta Derm Venereol 2016 ; 96 : 3 – 16 . 2 . Ratour-Bigot C , Chemidling M , Montlahuc C , Abirached G ,
Madjlessi N , Bullier C , et al . squamous cell carcinoma following
92 Info from the Editor of ActaDV
Forum for Nord Derm Ven 2016 , Vol . 21 , No . 4