Pruritus or itching is an unpleasant sensation well know to all of us which provokes the desire to scratch, usually lasting for minutes in hours and related to cutaneous diseases. However, generalized idiopathic pruritus may affect large areas, last longer, from months to years. Generalized pruritus can often be the primary manifestation of systemic diseases. Pruritus shares many features and pathways with pain but is a separate sensation from pain with its own precipitants and blockers. For example, loss of touch sensitivity dose not stop itching(e.g.,tabes dorsalis), however, in an area insensitive to pain, itching does not occur(e.g.,syringomyelia, leprosy). Unlike pain, specific receptors for pruritus and clear pathways for its transmission have not yet been identified. Until now, it has not been possible to isolate a universal mediator to explain pruritus. There are a wide variety of chemical substances known to be the mediators of pruritus. Well known among these is histamine, but in most cases of generalized pruritus is is not the main cases of generalized pruritus it is not the main mediatro. Our lack of understanding of the mechanism of pruritus is reflected by the inefficiency of many of the available antipruritic agents. I herein present an update review of the pathophysiology of pruritus, possible causes of generalized pruritus, the differential diagnosis and the basic principles of treatment.
Antipruritics ; Diagnosis, Differential ; Histamine ; Pruritus* ; Sensation

BACKGROUND: The large surfaces of the skin are often initial site of contact between microorganism and human. The skin are coated with epidermis and epithelial cells can recognize microorganism and mount a fast defense through the production of various inducible antibiotic peptides. This leads to chracteristic broad spectrum of antimicrobial activity against bacteria, fungi, and viruses. Recent studies introduce us new peptides with antimicrobial activity such as P,-defensins and cathelicidins. They are expressed on the epithelia and polymorphonuclear leukocytes, which are first lines of defence from various invasive environments. Futhermore, they are considered very interesting and important endogenous antibiotics. Our previous study has shown that the expression of human defensin(hBD-2) mRNA, which is potent antibiotic peptide against Gram-negative bacteria(P. aeruginosa), was upregulated with ultraviolet(UV) irradiation, tumor necrosis factor-α(TNF-α) and lipopolysaccharide(LPS) in HaCaT cells. A novel hBD-3, 5-kDa, nonhemolytic antimicrobial peptide, was demonstrated a salt-insensitive broad spectrum of potent antimicrobial activity against many potentially pathogenic microbes in especially, multiresistant S. aureus. We have analyzed the expression patterns of hBD-3 in HaCaT cell lines. OBJECTIVE: This research have done in order to evaluate the expression and regulation of hBD-3 mRNA in human keratinocyte cell lines. METHODS: HaCaT cell lines were used to all culture experiments. Cultured human keratinocytes were stimulated with UV irradiation or TNF-α or LPS to determine whether hBD-3 mRNA production occurred. Reverse transcription-polymerase chain reaction (RT-PCR) was per-formed to amplify hBD-3 cDNA from stimulated keratinocytes in a time dependant manner, and densitometry was used to verify the specificity of RT-PCR amplication products. RESULTS: Expression of hBD-3 was upregulated with UV irradiation, TNF-α and LPS in Ha-CaT cells compared to control CONCLUSIONS: Human keratinocytes are capable to induce hBD-3 mRNA, as well as hBD-2, in response to UV irradiation, TNF-α and LPS. suggesting that these cells could play an important role against the bacterial infection and UV light damage in human skin.
Anti-Bacterial Agents ; Bacteria ; Bacterial Infections ; Cathelicidins ; Cell Line* ; Densitometry ; DNA, Complementary ; Epidermis ; Epithelial Cells ; Fungi ; Humans* ; Keratinocytes ; Necrosis ; Neutrophils ; Peptides ; RNA, Messenger ; Sensitivity and Specificity ; Skin ; Ultraviolet Rays

A 6-year-old male patient had been suffering from angular cheilitis and paronychia with fragmentation and dystrophic change of the finger nails. Laboratory findings showed low serum iron level and anemia. Immunologic studies revealed defects in cell mediated immunity. KOH examination and culture of specimens from the lesions showed hyphal elements and growth of Candida albicans respectively. Concomitantly itraconazole and iron sulfate were administered. Four months after treatment he was free of any clinical evidence of the disease.
Anemia ; Candida albicans ; Candidiasis, Chronic Mucocutaneous* ; Cheilitis ; Child ; Fingers ; Humans ; Immunity, Cellular ; Iron ; Itraconazole ; Male ; Paronychia

BACKGROUND: Superoxide disrnutase(SOD) provides a protective defease mechanism against potential cytotoxicity of superoxide radical in the aerobic organism. Although human skin is constantly at risk for developing acute and chronic changes by ultraviolet radiation and phototoxic reactions with exogenous and endogenously procluced photosensitizing molecules, studies in SOD in the human skin are rare. OBJECTIVE: We measured the level of SOD activities in the scar tissues and the normal human skin specimens. This study was to investigate changes of SOD activity by age, sex, and regional differences of SOD activities in the scar issues and the normal skin. METHODS: Aut,hors assayed the level of SOD activit,ies in 32 scar tissues(male 8, female 24) and 11 normal human skin specimens(male 8, female 3), which were obtaine 3 from face/neck(17 and 3 specimens), forearm(only 4 scar tissues), trunk(10 and 8 specimens), and lower extremity(only 1 scar tissue). RESULTS: First, activities of total SOD, Cu, Zn-SOD, and Mn-SOL ere 18.93+5.49, 16.97+55.31, and 1.96+0.90 units/mg proteiii respectively in the scar tissues. Second activities of total SOD, Cu, Zn-SOD, and Mn-SOD were 17.27+7.09, 13.82+6.44, and 3.45+1.07 units/mg protein respectively in the normal skin. Third, the changes of total SOD, Cu, Zn-SOD, and Mn-SOD activities by age and sex were similar each other and three were no significant, differneces between age groups in total, Cu, Zn- SOD, and Mn-SOD activities. Fourth, in sun exposed area and unexposed area there were no significant differences in the scar tissues in SOD activities. But, SOD activite.(total, Cu, Zn, and Mn-SOD) in face/neck were higher than those in trunk and lower extremity in tae normal skin(P<0.05). CONCLUSION: These findings suggest that there are no differences in the intrinsic SOD activities by age and sex in the mature scar tissues and the normal skin. Differences between exposed and unexposed area in the normal skin are due to the induction of exogenous SOD activity by sun-light generation of superoxide radicals. In wound, increased production of leukocyte derived superoxide radicals is the main factor of increased level of SOD activity.
Cicatrix* ; Female ; Humans ; Leukocytes ; Lower Extremity ; Skin ; Solar System ; Superoxide Dismutase* ; Superoxides* ; Wounds and Injuries

BACKGROUND: Superoxide dismutases (SOD) are important metallo-enzymes which scavenge and dismutase the superoxide free radical. They are thought to be the main enzymes in the antioxidant defense system. In the several cell ines the induction of Mn-SOD expression by tumor necrosis factor (TNF)-alpha which is a known inflammatory cytokine, suggests that Mn-SOD may play a role in the inflammatory process. However, this effect is occurred. OBJECTIVE: The present study was undertakento determine whether the induction of SOD expression by TNF-alpha, in the keratinocytes is occurred. METHODS: Primary keratinocyte cultures from neonatal foreskins were grown in complete MCDB 153 medium. Measurement of superoxide radical and SOD activity were performed according to Babior and Fridovich methods, respectively. RESULTS: 1. The release of superoxide radical were measured after 30, 60, 90 minutes exposure to 10ng/ms TNF-alpha, THE RESULTS SHOWS 2.94+/-0.30 NMOL/2x105, 3.55+/-0.52 NMOL/2x105, 4.13+/-0.70 nmol/2x105 respectivelyl The increase of superoxide radical release was detectable in a time dependent manner. 2. Total SOD activity without treatment of TNF-alpha at 24 hours was 18.46+/-2.85, Total SOD activities after treatment of 1, 10, 100 ng/ml TNF-alpha at 24hours were 36.47+/-6.80, 88.01+/-7.79, 94.50+/-8.97 respectively, which suggested that TNF-alpha induced increase of total SOD significantly (p<0.050. TNF-alpha stimulate total SOD induction in a dose and time dependent manner, although the effects were not outstanding. Mn-SOD activity after treatment of 100 ng/ml TNF-alpha at 48 hours was 84.12+/-14.83, which was approxdimately 10.5 fold of that of the untredated case. TNF-alpha also induced the Cu, Zn-SOD activity, but the effect was not so much as in the case of Mn -SOD. CONCLUSION: TNF-alpha induces production of total SODD activities, especially Mn-SOD in the human kerati ocytes, which may be to protect cells from inflammation mediated oxidative damage, namely production of total SOD protein, especially Mn-SOD in response to TNF-alpha induced and scavenged overproduced superoxide radical which in turn may result in protection of the keratinocytes.
Foreskin ; Humans* ; Inflammation ; Keratinocytes* ; Superoxide Dismutase* ; Superoxides* ; Tumor Necrosis Factor-alpha*

No abstract available.
Dermatitis, Exfoliative ; Phototherapy ; Psoriasis

Basaloid follicular hamartoma (BFH) is a benign adnexal tumor with a wide spectrum of clinical appearance and is characterized histologically by the presence of branching cords and thin strands of undifferentiated anasomosing, basaloid proliferations that are embedded in a fibrous stroma. It has been often misdiagnosed and treated as basal cell carcinoma. We report a 57-year-old woman with BFH on the face which is similar to basal cell carcinorna clinically that turned out to be a solitary BFH histologically. There has been no recurrence during one year of follow up after excisional biopsy.
Biopsy ; Carcinoma, Basal Cell ; Female ; Follow-Up Studies ; Hamartoma* ; Humans ; Middle Aged ; Recurrence

Hypereosinophilic syndrome represents a heterogenous group filisorders with the common features of idiopathic prolonged eosinophilia of undetectable cause and orgar, system dysfunction. We experienced a case af hypereosinophilic syndrome in a 58 year old man who has been suffered from fever, chilling, generelized exfoliative dermatitis, periorbital sngioedema and oral ulcer for 3 weeks duration. The blood eosinophil count was 7436/mm and skin, liver, bone marrow biopsy revealed marked infiltration of eosinophils. We treated him with co ticosteroid, but 5 months later, he died due to hepatoencephalopathy, hepatorenal syndrome, dissernimted intravascular coagulopathy and acute respiratory distress syndrome.
Biopsy ; Bone Marrow ; Dermatitis, Exfoliative ; Eosinophilia ; Eosinophils ; Fever ; Hepatorenal Syndrome ; Humans ; Hypereosinophilic Syndrome* ; Liver ; Middle Aged ; Oral Ulcer ; Respiratory Distress Syndrome, Adult ; Skin

We conducted this cohort analytic study to determine whether women with unexplained elevations of maternal serum hCG at 15-18 weeks' gestation are at increased risk for pregnancy complications and adverse perinatal outcomes. The inclusion criteria were a singleton gestation, a confirmed gestational age, and an hCG level greater than 2.0 multiples of the median (MoM). The exclusion criteria were fetal anomalies, an abnormal karyotype, molar pregnancy, and an MSAFP level greater than 2.5 multiples of the median (MoM). A group of randomly selected women with hCG levels under 2.0 MoM served as controls. Patients with elevated levels of hCG had a significantly higher risk for PIH (17.9% versus 4.5%; P <.05) and preterm delivery (17.9% versus 3.5%; P<, 05) than control. But no significant differences were observed in the incidence of intrauterine growth restriction and low birth weight and in the newborn weight. We suggested that pregnancies with unexplained elevated hCG levels should be regarded as high-risk pregnancies. And these patients require careful monitoring with adequate obstetric management.
Abnormal Karyotype ; Chorionic Gonadotropin* ; Cohort Studies ; Female ; Gestational Age ; Humans* ; Hydatidiform Mole ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome* ; Pregnancy* ; Pregnancy, High-Risk

Desmoplastic malignant melanoma (DMM) is an uncommon variant of malignant melanoma featuring a proliferation of spindle cells with pronounced desmopaasia. DMM commonly occurs on the sun-damaged skin such as head and neck in older persons, and it can be associated with lentigo maligna. We report an unusual case of desmoplastic malignant melanoma that developed de novo on the trunk in a young patient.
Head ; Humans ; Hutchinson's Melanotic Freckle ; Melanoma* ; Neck ; Skin