Anders Vahlquist – Excerpta from Volume 96 of ActaDV
in the environment of BCC( 3). T-regs suppress conventional T cells maintaining immunological tolerance. The impact of T-regs on skin malignancy is already well documented in malignant melanoma and SCC, but their role in BCC is poorly understood. This study compared T-reg density of facial BCC within peritumoural skin and non-UV-exposed skin. The results provide preliminary evidence for the existence of an immunosuppressed niche in facial skin surrounding BCCs, which may have consequences for the malignant development.
Immunological factors affecting skin cancer are also discussed by Trapp et al.( 4), although this time in relation to various stress coping strategies in patients with melanoma. In an exploratory case control study, the Austrian group investigated the lymphocyte subpopulations and stress coping strategies in 18 non-metastatic melanoma patients and 18 controls with benign skin diseases. In melanoma patients significant positive correlations between certain lymphocyte populations( positive for CD3, CD4, CD19 and CD45) were found with regards to coping strategies characterized by diversion of stress and focusing on stress-compensating situations. In the authors ´ view, this field of research deserves further multi-professional investigations in order to provide new therapeutic approaches in the treatment and understanding of melanoma patients.
The efficacy of various topical treatment options for actinic keratosis( AK) are evaluated in a systematic review by Stockfleth, Sibbring and Alarcon from Germany, UK and Spain( 5). They focus on 0.5 % 5-fluorouracil in 10 % salicylic acid( 5-FU / SA), ingenol mebutate( IMB) and imiquimod 2.5 %/ 3.75 %( IMI). Eleven publications, relating to 7 randomized controlled studies met the inclusion criteria. Complete clinical clearance was higher for 5-FU / SA( 55 %) than for IMB( 43 %) and IMI( 25 / 31 %), and the former drug was also associated with less recurrences. However to corroborate these findings, the authors call for new, long-term trials with comparable outcome measures.
Psoriasis
In a review article by Professor Wolf-Henning Boehncke, Geneva( 6) the relationship between psoriasis( PsO) and psoriatic arthritis( PsA) is discussed under the title: Flip Sides of the Coin? The issue of whether PsO and PsA are distinct entities, or part of the spectrum of a“ psoriatic disease” is again ventilated, this time based on new results from genetic studies, animal models and clinical research. The strongest arguments for PsO and PsA being distinct entities come from recent genetic studies, so called dense genotyping, and by the fact that the disease activities in PsO and PsA do not seem to correlate. Arguments favouring the idea of PsO and PsA being variants of the same disease are that key immunological components driving PsO and PsA appear to be the same, and that most systemic treatments for psoriasis work equally well in both diseases. However the final answer to“ Flip sides of the coin?” is still in the air and will probably remain so forever.
A long suspected PsO-aggravating factor is streptococcal throat infections. In a study by Thorleifsdottir et al.( 7), 275 psoriasis patients were examined and 72 % of those with confirmed streptococcal infection reported aggravation of psoriasis. Notably, women and patients with early onset psoriasis were more likely to report aggravation, and 49 % of patients reported improvement after tonsillectomi.
Another precipitation factor in psoriasis is the interplay between itch and psyche, also involving Köbnerisation due to scratching. In an update on this topic, Reich et al.( 8) discuss the complex interaction between depression, poor psychosocial well-being, itch and psoriasis, together creating a vicious circle of aggravating factors.
Fortunately there are now many effective drugs available for psoriasis. In a systematic review, Zweegers et al.( 9) compare the effectiveness of biological and conventional systemic therapies in daily practice in adults with plaque psoriasis. The literature was searched for trials on adalimumab, eternacept, infliximab and ustekinumab, acitretin, cyclosporine, fumarates and methotrexate. Although large ranges were noted in the percentage of patients reaching PASI75, especially for the 2 first drugs, the results were generally quite good. Combination therapy of biologics with conventional systemic agents, and dose adjustment of biologics were frequent strategies to enhance the treatment response, which may explain the large range in improvement between cohorts.
Needless-to-say, making a correct diagnosis of psoriasis is a sine qua non for prescribing optimal treatment, but is not always so easy to accomplish. Erythroderma is one example of a difficult-to-diagnose condition that can be caused by psoriasis, eczema, T-cell lymphoma, drug reactions, as well as several other rare diseases. It is of interest therefore that Braegelmann et al.( 10) have now identified interleukin-36( IL-1F9) as a good immunohistochemical marker for psoriasis erythroderma, thus helping to exclude other causes( Fig. 2).
Psychodermatology
As already exemplified above, an increasing number of studies concerning psychological aspects of skin and venereal disease is now published in ActaDV, being the official journal of the European Society for Dermatology and Psychiatry( ESDaP). This collaboration is further highlighted by supplement 217,“ Frontiers in Psychocutaneous Diseases: Selected Writings in Psychosomatics, Psycho-dermatology and Psycho-neuro-endocrine-immunology”( Fig. 3), dedicated to the memory of Professor Emiliano Panconesi, the first President of ESDaP and
90 Info from the Editor of ActaDV
Forum for Nord Derm Ven 2016, Vol. 21, No. 4