This is a case of a 20-year-old female with no known comorbidities presenting with verrucous plaques arranged in a unilateral blaschkoid distribution at birth. Biopsy was consistent with epidermal nevus hence patient was diagnosed as systematized epidermal nevus, Nevus Unius Lateris type. Gold standard treatment is full thickness surgical excision however, due to the extensive involvement, treatment of this condition remains a challenge. Hence, non-surgical combination of ablative CO2 laser and topical tretinoin 0.1% were done. Thinner lesions (1-3 mm) showed lower recurrence (50%) as compared to thicker lesions (>3 mm) showing 100% recurrence after six months. Hence, another CO2 laser session is needed. Quality of life was measured using the Dermatologic Life Quality Index (DLQI) with noted 35% improvement post-treatment.
CO2 laser ; lasers, gas ; tretinoin ; retinoids

INTRODUCTION

Oral isothretinoin is the treatment of choice in moderate to severe acne vulgaris. The most common adverse effect is mild mucocutaneous symptoms and the most seious risk is related to teratogenecity. Hyperuricemia and gouty arthritis are rarely associated with isotretinoin therapy.

We report a case of a 26-year-old female patient with no known comorbidities who was started on isotretinoin therapy for acne vulgaris. The patient presented with baseline hyperuricemia with no joint pains or swelling. Two and a half weeks later after initiation of isotretinoin therapy, the patient developed pain and swelling on the left wrist, hence was started on urate-lowering medications and maintained on isotretinoin tharapy. The patient had no recurrence of joint pains and remains symptom-free for six months later.

Acne vulgaris is a very common condition affecting up of about 80% to 90% of adolescents. The patients with acne have been shown to be adversely impacted by the effect of acne on their quality of life. Four factors are believed to play a key role in the development of acne lesions: excess sebum production, disturbed keratinization within the follicle, colonization of the pilosebaceous duct by Propionibacterium acnes, and the release of inflammatory mediators into the skin. Consequently, the target for acne therapy is these well-known pathogenic factors responsible for this disease state. Topical retinoids correct abnormal keratinization, but it should be applied cautiously because of irritation. Benzoyl peroxide is an effective bactericidal agent against P. acnes. Main topical antibiotics are erythromycin and clindamycin. Fixed combination topical products with retinoids, benzoyl peroxide and antibiotics have been introduced. Use of systemic antibiotics, including tetracyclines and macrolides rapidly improves inflammatory acne lesions. Oral isotretinoin is effective against all of the main pathogenic features of acne but is contraindicated in pregnant women and has been associated with cheilitis and dry skin. Hormonal therapy has been found to improve acne in some selective patients and should be considered for appropriate candidates. This review will present the general aspects of the pharmacological treatments for acne.
Acne Vulgaris ; Adolescent ; Anti-Bacterial Agents ; Benzoyl Peroxide ; Cheilitis ; Clindamycin ; Colon ; Drug Therapy ; Erythromycin ; Female ; Humans ; Isotretinoin ; Macrolides ; Pregnant Women ; Propionibacterium acnes ; Quality of Life ; Retinoids ; Sebum ; Skin ; Tetracyclines

BACKGROUND: Hidradenitis suppurativa is a chronic inflammatory skin disease showing recurrent painful nodules and abscesses. Many treatment modalities, such as topical antibiotics, systemic antibiotics, retinoids, immunomodulators, biologics, and surgical treatment are used to treat the disease, but there is no single effective treatment for hidradenitis suppurativa. OBJECTIVE: We conducted this study to compare the clinical outcomes of treatment with systemic antibiotics and systemic retinoids. METHODS: We analyzed the clinical features, treatment modalities, and clinical outcomes of patients with hidradenitis suppurativa and compared the clinical outcomes of treatment modalities. RESULTS: A total of 77 patients were enrolled. Male patients were predominant, and the mean age was 28.1 years. Buttock (42.0%) was the most commonly affected site and 63 patients (81.8%) had lesions at Hurley stage I. Forty-eight patients (62.3%) were treated with systemic antibiotics and 29 (37.7%) with systemic retinoid. Seventy-one patients (92.2%) showed improvement after a mean treatment duration of 8.3 weeks, and 69 (89.6%) experienced recurrence after improvement. Systemic antibiotics showed a relatively high improvement rate, short mean treatment duration, and low recurrence rate compared with systemic retinoids, but the differences were not statistically significant. Among systemic antibiotics, both tetracycline and macrolide showed good therapeutic effects for HS, but the differences were also not statistically significant. CONCLUSION: In this study, systemic antibiotics were associated with superior treatment outcomes compared to systemic retinoids, though without statistical significance. In the case of mild lesions, treatment with systemic retinoids appears to show comparable effectiveness to systemic antibiotics.
Abscess ; Anti-Bacterial Agents* ; Biological Products ; Buttocks ; Hidradenitis Suppurativa* ; Hidradenitis* ; Humans ; Immunologic Factors ; Isotretinoin ; Male ; Recurrence ; Retinoids* ; Skin Diseases ; Tetracycline ; Therapeutic Uses

Chronic obstructive pulmonary disease (COPD) is a critical condition with high morbidity and mortality. Although several medications are available, there are no definite treatments. However, recent advances in the understanding of stem and progenitor cells in the lung, and molecular changes during re-alveolization after pneumonectomy, have made it possible to envisage the regeneration of damaged lungs. With this background, numerous studies of stem cells and various stimulatory molecules have been undertaken, to try and regenerate destroyed lungs in animal models of COPD. Both the cell and drug therapies show promising results. However, in contrast to the successes in laboratories, no clinical trials have exhibited satisfactory efficacy, although they were generally safe and tolerable. In this article, we review the previous experimental and clinical trials, and summarize the recent advances in lung regeneration therapy for COPD. Furthermore, we discuss the current limitations and future perspectives of this emerging field.
Cell- and Tissue-Based Therapy ; Drug Therapy ; Emphysema ; Lung* ; Models, Animal ; Mortality ; Pneumonectomy ; Pulmonary Emphysema ; Pulmonary Disease, Chronic Obstructive* ; Regenerative Medicine ; Retinoids ; Stem Cells

BACKGROUND: Evidence regarding the vascular endothelial growth factor A (VEGFA) as a potent mediator of angiogenesis and inflammation in psoriasis has revealed variations in this gene as surrogate markers of psoriasis. OBJECTIVE: VEGFA gene polymorphisms (-1540 C/A, -1512 Ins18, -460 T/C, and +405 C/G) in psoriasis susceptibility in Turkish population were investigated. METHODS: A total of 200 age, sex and ethnicity-matched psoriatic and healthy individuals were examined for clinical type, response to therapy, serum VEGFA and its receptor levels, genotypes and haplotypes. RESULTS: The +405 GG, +405 CG, -1540 CA, and -1512 +Ins18 genotypes conferred a significant risk for developing psoriasis. The C-InsTC haplotype in the controls and C+InsTG, A+InsTC, and A-InsTG haplotypes in psoriatic patients were observed to be significantly high. Increased serum levels of VEGFA were detected in psoriatic patients with the C-InsTC haplotype than that in the controls. The +405 GG genotype was significantly more frequent in psoriatic patients with a positive family history, and the moderate form of psoriasis was more frequent among C+InsTG haplotype carriers than that among the other patients. The +405 GG genotype was found to be more frequent in patients responding to oral retinoids. Serum VEGFR1/FLT1 and VEGFR2/KDR levels were not significantly different when psoriatic patients and controls were stratified based on the risk polymorphic variants. CONCLUSION: VEGFA gene +405 GG and CG, -1512+Ins18, and -1540 CA genotypes are associated with an increased risk of psoriasis in Turkish population. The G allele at +405 and an 18-bp insertion at -1512 are primarily the risk factors for psoriasis, and this risk is potentiated by the presence of the A allele at the -1540 locus.
Alleles ; Biomarkers ; Genotype ; Haplotypes ; Humans ; Inflammation ; Psoriasis* ; Retinoids ; Risk Factors* ; Vascular Endothelial Growth Factor A*

OBJECTIVETo investigate the expression of the peripheral blood retinoid-related orphan receptor gamma t (RORgamma t) and 4-1BB/4-1BBL mRNA in oral lichen planus (OLP) patients.

METHODSThe expression levels of peripheral blood' RORyt mRNA and 4-1BB/4-1BBL mRNA of 30 samples of OLP patients and 30 cases of healthy human were detected using real-time fluorescent quantitative-polymerase chain reaction (FQ-PCR) technology.

RESULTSIn the OLP group, the expression level of RORgamma t, 4-1BB, 4-1BBL mRNA were higher than those in the control group (P < 0.05). After the conversion of the 2-delta delta CT, the expression levels of three kinds of mRNA in the OLP group were 3.087, 3.320 and 4.005 times of the control group respectively. In the OLP group, the expression levels of RORgamma t mRNA and 4-1BB mRNA had no obvious correlation (P > 0.05), the expression levels of 4-1BB and 4-1BBL mRNA had a positive correlation (r = 0.455 0, P < 0.05).

CONCLUSIONThe abnormal expression of RORyt, 4-1BB and 4-1BBL mRNA may play certain roles in the pathogenesis of OLP.

Retinoids regulate not only various cell functions including proliferation and differentiation but also glucose and lipid metabolism. After we observed a marked up-regulation of cellular retinol-binding protein-I (CRBP-I) in the liver of hepatitis B virus x antigen (HBx)-transgenic (HBx Tg) mice which are prone to hepatocellular carcinoma (HCC) and fatty liver, we aimed to evaluate retinoid pathway, including genes for the retinoid physiology, CRBP-I protein expression, and retinoid levels, in the liver of HBx Tg mice. We also assessed the effect of chronic metformin treatment on HCC development in the mice. Many genes involved in hepatic retinoid physiology, including CRBP-I, were altered and the tissue levels of retinol and all-trans retinoic acid (ATRA) were elevated in the liver of HBx Tg mice compared to those of wild type (WT) control mice. CRBP-I protein expression in liver, but not in white adipose tissue, of HBx Tg mice was significantly elevated compared to WT control mice while CRBP-I protein expressions in the liver and WAT of high-fat fed obese and db/db mice were comparable to WT control mice. Chronic treatment of HBx Tg mice with metformin did not affect the incidence of HCC, but slightly increased hepatic CRBP-I level. In conclusion, hepatic CRBP-I level was markedly up-regulated in HCC-prone HBx Tg mice and neither hepatic CRBP-I nor the development of HCC was suppressed by metformin treatment.
Adipose Tissue, White ; Animals ; Carcinoma, Hepatocellular* ; Fatty Liver ; Hepatitis B virus ; Incidence ; Lipid Metabolism ; Liver* ; Metformin* ; Mice ; Mice, Transgenic* ; Retinoids ; Retinol-Binding Proteins, Cellular* ; Trans-Activators ; Tretinoin ; Up-Regulation ; Vitamin A

Retinoid acid is a metabolite of vitamin A and functions as an important factor in cell survival, differentiation and death. Most previous studies on retinoid metabolism have focused on its association with cancer, hematologic and dermatologic disorders. Given the special concern over the recent increase in the prevalence of diabetes worldwide, the role of retinoid metabolism on glucose metabolism and insulin resistance in the human body is of marked importance. Therefore, in this issue, we review the literature on the association of retinoid metabolism with glucose tolerance, with regard to insulin secretion, pancreatic autoimmunity, insulin sensitivity and lipid metabolism. Further, we tried to assess the possibility of using retinoids as a novel therapeutic strategy for diabetes.
Autoimmunity ; Cell Survival ; Diabetes Mellitus ; Glucose ; Human Body ; Insulin ; Insulin Resistance ; Lipid Metabolism ; Prevalence ; Retinoids ; Vitamin A

Current treatments for hidradenitis suppurativa (HS) include prolonged courses of antibiotics, retinoids, immunosuppressants, and biologics. Severe cases that are resistant to prolonged medical treatment pose a therapeutic challenge. We propose radical excision and lateral thoracic flap reconstruction as a treatment option for such cases. In our experience with two patients, good aesthetic and functional outcomes were achieved, with a high level of patient satisfaction. The availability of suitable flap coverage allows for wide resection of all of the hair-bearing skin, leading to a low incidence of residual disease and subsequent recurrence. Following excision of the affected tissue, the ideal reconstructive method in the axilla provides suitable coverage without unacceptable donor site morbidity and also avoids axillary contractures. A long lateral thoracic flap with delay has excellent coverage with minimal donor tissue sacrifice. With a suitable flap coverage option, the management paradigm of intractable HS should shift from prolonged medical treatment to allow decisive radical excision, which will improve the quality of life for patients.
Anti-Bacterial Agents ; Axilla ; Biological Agents ; Contracture ; Hidradenitis ; Hidradenitis Suppurativa ; Humans ; Immunosuppressive Agents ; Incidence ; Patient Satisfaction ; Quality of Life ; Recurrence ; Retinoids ; Skin ; Surgical Flaps ; Tissue Donors