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