Introduction: Vitiligo is an acquired skin disorder characterized by depigmented maculae resulting from a reduction of the number and function of melanocytes. The etiopathogenesis of the disease is still unclear, but there is evidence that autoimmunity and endocrine disfunction may be involved. Objective: The aim of this study was to evaluate serum levels of anti-thyroglobulin antibody (anti-Tg) in vitiligo patients and control subjects, and also to assess the difference between the localized and generalized forms of the disease. Methods: In this prospective study we investigated serum level of anti-Tg in 33 patients with vitiligo and 33 healthy controls. We also examined a possible association between serum levels of anti-Tg and disease severity. Results: Comparison of median values of anti-Tg has showed that serum concentrations of anti-Tg are significantly higher (p<0.05) in serum samples of vitiligo patients in relation to control group. Statistically significant difference was also found in values of anti-Tg between patients with generalized and patients with localized vitiligo (p<0.05). Conclusion: This study shows a significant association between vitiligo and thyroid autoimmunity, and that tests to detect anti-Tg are relevant in patients with vitiligo.

Effluvium capillorum is a form of nonscarring alopecia characterized by diffuse hair shedding. This condition occurs when the normal balance of hairs in growth and rest phases is disrupted. Trichoscan is a computerized program used for digital measurement of hair growth and hair loss. This study was performed to describe the TrichoScan as a method, which combines standard epiluminiscence microscopy with automatic digital image analysis for the measurement of human hair. The study included 30 patients with effluvium capillorum (16 women and 14 men). A control group consisted of 30 generally healthy patients (14 women and 16 men). For the measurement of hair density and anagen/telogen ratio, a commercially available software (TrichoScan) was used. The results of digital image analysis from the patients showed a highly increased proportion of telogen hair roots. The authors' results indicate that TrichoScan represents a very useful tool in the evaluation of hair loss.

Thyroid disease is associated with changes in the skin, which may sometimes be the first clinical sign. A variety of cutaneous findings may present in the setting of either a hyperthyroid or hypothyroid state. There may be evidence of the effect of altered concentrations of thyroxine on the skin, with changes in texture and hair growth. Associated increases in thyroid stimulating hormone concentration may lead to pretibial myxedema. Hair follicles are particularly sensitive to concentrations of thyroid gland derived hormones. The cells of the hair matrix, due to their high degree of metabolic activity, are most profoundly influenced by the deficiency or excess of thyroid derived hormones. There is convincing evidence of a significant association between thyroid autoimmunity and skin disorders. Most commonly reported cutaneous disorders related with thyroid disease are alopecia areata and vitiligo. This review constitutes a summary and update of the cutaneous manifestation of thyroid disease.

Introduction: Psoriasis is a chronic inflammatory skin disease that affects about 2% of general population. Clinically, disease can present with cutaneous and nails lesions. Nail abnormalities can be seen in up to two-thirds of patients with psoriasis and both fingernails and toenails may be affected. Objective: The objectives of our study were to evaluate the frequency and clinical presentations of nail abnormalities in patients with psoriasis. Also, we aimed to find correlation between nail changes and some clinical parameters. Methods: One hundred and ten patients with psoriasis were included in this study. A detailed history and examination was recorded for all study subjects, including the age and gender of the patients, type of psoriasis, duration, and extent of disease. Finger and toe nails were clinically examined and nail changes were noted. In the case of clinically suspected of fungal infection, further mycological investigations were performed. Results: Nail abnormalities were present in 67 patients (60.9%) with psoriasis. Nail pitting was the most common lesion observed on fingernails, followed by discoloration of nail plate. Subungual hyperkeratosis of nail plates were significantly more frequent on the toenails. Positive mycological culture was in 14 (20.8%) psoriatic patients with nail involvement. Also, positive correlation between nail abnormalities and duration of psoriasis was found. Conclusions: Nail involvement is common in patients with psoriasis and accompanies skin lesions on the body surface. Pitting and subungual hyperkeratosis are the most frequent nail abnormality in psoriatic patients.

BACKGROUND Vitiligo is an acquired skin disorder characterized by depigmented maculae resulting from a reduction of the number and function of melanocytes. The etiopathogenesis of the disease is still unclear, but there is evidence that autoimmunity may be involved. OBJECTIVE The aim of this study was to determine the prevalence and significance of antinuclear (ANA) and thyroid peroxidase (anti-TPO) antibodies in patients with vitiligo and control group. METHODS In a prospective case-control study, we compared the frequency of antibodies (ANA and anti-TPO) in 40 patients with vitiligo and in 40 healthy volunteers. RESULTS ANA were positive in 7 (17%) patients, which was insignificantly higher than control group, 2 (5%). Anti-TPO were positive in 11 (27%) patients. In control group, only two subjects (5%) had positive anti-TPO. Compared with the control group, the frequency anti-TPO were significantly higher in those with vitiligo (p < 0.05). CONCLUSION Our findings show a significant association between vitiligo and thyroid autoimmunity, and that tests to detect anti-TPO are useful markers in patients with vitiligo. In contrary, ANA seems to have limited diagnostic relevance in routine clinical practice. Additional studies of a wider sample are warranted to confirm these findings and allow a detailed analysis.

Thyroid disorders are known to involve all the organ systems of the body and the skin is no exception. Some dermatological skin findings and diseases may be the first symptoms of thyroid disease [1]. Available data suggest that thyroid hormone plays a pivotal role in embryonic development of mammalian skin as well as in maintenance of normal cutaneous function an adult skin. Thyroid hormone stimulates epidermal oxygen consumption, protein synthesis, mitosis, and determination of epidermal thickness [2]. Thyroid hormone is an important regulator of epidermal homeostasis. In tissue culture studies using surrogates for DNA expression, T 3 has been shown to stimulate growth of both epidermal keratinocytes and dermal fibroblastes [3, 4]. In addition, thyroid hormone appears to be necessary for both the initiation and maintenance of hair growth and normal secretion of sebum.

Introduction: Alopecia areata (AA) is disease characterized by focally, nonscarring hair loss on the scalp or other parts of the body. It affects 1-2% population of both genders and occurs at all age groups. The etiology is unknown, although most evidence supports the hypothesis that AA is a T-cell-mediated autoimmune disease of the hair follicle and that cytokines play an important role. Objective: The aim of our study was to evaluate serum concentrations of IL-1α and IL-1β in patients with AA and healthy subjects and also to asses a possible association between these cytokines and duration of the disease. Methods: Forty six patients with AA and 20 healthy controls were enrolled in the study. Serum concentrations of IL-1α and IL-1β were measured using enzyme-linked immunoassay techniques. Results: The serum level of IL-1α in patients with AA was significantly higher than that in the control group (4.34±0.86 pg/mL vs 3.66±0.35 pg/mL, respectively). IL-1β levels were greater in patients with AA than in controls (2.35±0.17 pg/mL vs 2.24±0.30, respectively) but the difference was not significant (p>0.05). No correlations were found between duration of disease and the serum levels of IL-1α and IL-1β. Conclusion: Our results have demonstrated the importance of determining IL-1a concentration in serum in patients with AA. This research could contribute to the interpretation of insufficiently well known views of the pathogenesis role and significance of IL-1α in AA. Streszczenie Wstep: Łysienie plackowate to choroba charakteryzująca sie ogniskowym, niebliznowaciejącym lysieniem skory glowy lub tez innych okolic ciala. Choroba ta dotyka 1-2% populacji, bez predylekcji plci ani tez wieku. Etiologia choroby pozostaje nieznana, jednakze najwiecej dowodow potwierdza hipoteze, ze AA jest chorobą autoimmunologiczną mediowaną za pomocą komorek T, zajmującą korzen wlosa oraz ze cytokiny pelnią w tym procesie wazną role. Cel: Celem naszego badania bylo oszacowanie stezenia w surowicy interleukin: IL-1α i IL-1β u pacjentow z AA oraz u osob zdrowych by wykazac mozliwe związki pomiedzy tymi cytokinami a dlugością trwania choroby. Metody: Do badania zakwalifikowano 46 pacjentow z AA oraz 20 osob zdrowych. Stezenia cytokin IL-1α i IL-1β byly mierzone za pomocą techniki EIA. Wyniki: Poziomy IL-1α u chorych na AA byl znacznie wyzszy niz ten w grupie kontrolnej (4.34±0.86 pg/mL vs 3.66±0.35 pg/mL, odpowiednio). Poziomy IL-1β byly wieksze u pacjentow z AA niz w grupie kontrolnej (odpowiednio 2.35±0.17 pg/mL vs 2.24±0.30) jednak statystycznie nieistotne (p>0.05). Nie znaleziono korelacji pomiedzy trwaniem choroby a poziomami interleukin IL-1α i IL-1β w surowicy krwi. Wnioski: Nasze wyniki badan dowodzą wagi pomiaru stezenia IL-1a w surowicy krwi osob chorych na AA. To badanie moze przyczynic sie do nie do konca poznanej roli IL-1α w patogenezie oraz odkryciu pelnego znaczenia w Alopecia Areata.

Background: Alopecia areata (AA) is a common form of localized, nonscarring hair loss. It is characterized by the loss of hair in patches, total loss of scalp hair (alopecia totalis, AT), or total loss of body hair (alopecia universalis, AU). The cause of AA is unknown, although most evidence supports the hypothesis that AA is a T-cell-mediated autoimmune disease of the hair follicle and that cytokines play an important role. Aims: The aim of the study was to compare the serum levels of tumor necrosis factor-alpha (TNF-α) in patients with AA and the healthy subjects and also to investigate the difference between the localized form of the disease with the extensive forms like AT and AU. Materials and Methods: Sixty patients with AA and 20 healthy controls were enrolled in the study. Forty-six patients had localized AA (LAA), and 14 patients had AT, AU, or AT/AU. The serum levels of TNF-α were measured using enzyme-linked immunoassay techniques. Results: Serum levels of TNF-α were significantly higher in AA patients than in controls (10.31 ± 1.20 pg ml vs 9.59 ± 0.75 pg/ml, respectively). There was no significant difference in serum levels of TNF-α between patients with LAA and those with extensive forms of the disease. Conclusion: Our findings support the evidence that elevation of serum TNF-α is associated with AA. The exact role of serum TNF-α in AA should be additionally investigated in future studies.

Background. Vitiligo is a common skin disorder characterized by macular depigmentation of the skin. The etiopathogenesis of the disease is still unclear, but there is evidence that autoimmunity and endocrine disfunction may be involved. Objective. The aim of this study was to determine whether vitiligo is statistically associated with thyroid autoimmunity. Method. In a prospective case-control study, we compared the frequency of thyroid autoantibodies (thyroglobulin antibody, anti-Tg and thyroid peroxidase antibody, and anti-TPO) in 33 patients with vitiligo and in 33 healthy volunteers. Thyroid autoantibodies and thyroid hormones (thyroxine (T4), triiodothyronine (T3), and thyroid stimulating hormone (TSH) were measured in all subjects. Results. Thyroid functional abnormalities were found in 6 (18.18%) patients. Anti-Tg and anti-TPO were positive in 9 (27.27%) and 8 (24.24%) patients, respectively. In control group, only one subject (3.03%) had abnormalities in thyroid hormonal status, and two subjects had positive thyroid autoantibodies. Compared with the control group, the frequency of both anti-Tg and anti-TPO was significantly higher in those with vitiligo (P < .05). Conclusion. This study shows a significant association between vitiligo and thyroid autoimmunity, and that tests to detect thyroid autoantibodies are relevant in patients with vitiligo.

BACKGROUND AND OBJECTIVES Differences in prevalence, clinical and histological manifestations between seborrheic dermatitis (SD) in immunocompetent and immunocompromised patients suggest that these two populations might also differ in a spectrum of isolated Malassezia species. The purpose of our study was to analyse the prevalence of Malassezia species in immunocompromised and non-immunocompromised patients with SD and to examine if the range of isolated yeasts varies between these two study groups. PATIENTS AND METHODS Specimens were taken from 50 patients with SD: 30 without any underlying disease and 20 with confirmed immunosuppression. The samples were obtained by scraping the skin surface of the scalp and trunk lesions of all subjects and then incubated on modified Dixon agar. The yeasts isolated were identified by their morphological and physiological properties according to Guillot et al method. RESULTS In both groups, the most commonly isolated species from the scalp lesions were Malassenzia restricta and Malassenzia globosa, the later being the most common species isolated from lesional trunk skin. No significant differences were found between immunocompromised and immunocompetent patients from both sampled sites. CONCLUSIONS There is no difference in the distribution of Malassezia species isolated from SD lesions between immunocompetent and immunocompromised patients. However, the much higher percentage of positive cultures in immunocompromised patients confirms that impaired cellular immunity may facilitate fungal survival on the skin.

Scalp involvement is a prominent and often the initial presentation in patients with psoriasis. Hair growth may be impaired with a hair loss and an increased telogen/anagen ratio. The aim of this study was to investigate the hair density and anagen/telogen ratio in psoriatic patients, using epiluminescence microscopy combined with digital image analysis (TrichoScan). Thirty psoriatic patients with scalp involvement and the same number of clinically healthy individuals were included in the study. For the measurement of hair density, anagen/telogen ratio and number of terminal and vellus hairs, a commercially available software TrichoScan was used. Hair density measurements did not show significant difference between patients and controls (P=0.05). The anagen ratio was significantly lower and telogen ratio significantly higher in psoriasis patients than in controls (P<0.01 both). There was no correlation between hair parameters and patient age or duration of disease. Study results support the evidence that scalp psoriasis is associated with an increased telogen/anagen ratio.

Alopecia areata (AA) is a heterogeneous disease characterized by nonscarring hair loss on the scalp or other parts of the body. A wide range of clinical presentations can occur-from a single patch of hair loss (alopecia unilocularis, AUl), multiple patches (alopecia multilocularis, AM) to complete loss of hair on the scalp (alopecia totalis, AT) or the entire body (alopecia universalis, AU). The cause ofAA is unknown although most evidence supports the hypothesis that AA is a T-cell mediated autoimmune disease of the hair follicle and that cytokines play an important role. The aim of the study was to evaluate serum concentrations of interferon-gamma (IFN-g) in patients with AA and the healthy subjects and also to assess a possible association between IFN-g and clinical type and duration of the disease. Sixty patients with AA and 20 healthy controls were enrolled in the study. Serum concentrations of IFN-g were determined by ELISA method. The serum concentration of IFN-g in patients with AA was significantly higher than that in the control group (10.62 +/- 1.09 pg/mL vs 10.02 +/- 0.62 pg/mL, respectively). Significantly elevated serum IFN-g were noticed in patients with AU type (11.81 +/- 1.11 pg/mL), expecialy those suffering from AT (12.30 +/- 0.93 pg/mL), compared with both patients with AUl (10.20 +/- 0.59 pg/mL) and patients with AM clinical type (10.21 +/- 0.78 pg/mL). There was no significant difference in serum IFN-g concentration between patients with AUl and AM group, as well as between patients with AT and AU. No correlations were found between duration of disease and the serum levels of IFN-g. Our findings confirm previously published data that the Th1 type cytokine IFN-g is elevated in the serum of AA patients.

Psoriasis is a common cutaneous disorder characterized by inflammation and abnormal epidermal proliferation. Its severity ranges from a chronic plaque psoriasis (CPP) to generalized psoriatic erythroderma (PE). The cause of psoriasis is unknown although most evidence supports the hypothesis that psoriasis is an immunologically mediated disease. The aim of the study was to compare serum levels of total immunoglobulin E (IgE) between patients with psoriasis and healthy subjects, and to asses the difference between localized form (CPP) and extensive form of disease (PE). Fifty patients with psoriasis and 30 healthy subjects were included in this study. Serum levels of IgE were measured using nephelometric method. Serum levels of total IgE were significantly higher in patients than in controls (42% vs 10%; p < 0.05). The exact role of serum IgE in psoriasis should be additionally investigated in future studies.

Editor Although the paraneoplastic nature of a subset of dermatomyositis (DM) cases is unquestionable, the factors that indicate the coexisting cancer still remain unclear. Several predictive signs have been postulated as a marker of underlying malignancy: older age, male gender, rapid onset of the disease, presence of cutaneous necrosis, increased erythrocyte sedimentation rate (ESR), and increase or normality of creatine phosphokinase (CPK).1–8 In order to identify potential risk factors for associated cancer in patients with DM, we reviewed clinical and laboratory data of 32 patients with DM (17 females and 15 males, aged 11–78 years), who have been treated during a 23-year period (1985–2007). Diagnosis of DM was based on the criteria of Bohan and Peter.9 Typical cutaneous signs and muscular involvement (proximal muscle weakness and/or elevated muscle enzymes and/or electromyography findings and/or muscle histology) were observed in all patients. The main recorded data included an association with a cancer, age at the time of the diagnosis, gender, a rapid onset of symptoms (considered if the diagnosis was made within 3 months after the appearance of initial symptoms), signs of severity (presence of dysphonia, dyspnoea and/or dysphagia), some clinical features such as cutaneous necrosis (defined as cutaneous and/or mucosal necrotic lesions or ulcerations) and periungual erythema, evaluated ESR (superior to 40 mm during the first hour), serum muscle enzymes levels – CPK, lactate dehydrogenase (LDH), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) – as well as presence of antinuclear autoantibodies. Statistical analysis using Fisher’s exact test for qualitative data and Mann-Whitney’s test for quantitative data were performed to investigate differences between patients with and without associated malignancy. The difference was considered significant at P < 0.05. Malignant tumours were detected in 8 patients (25%), with equal number of female and male patients. Malignancies included colon cancer (2 patients), ovarian cancer (2 patients) and the remaining cancers were those of lung, breast, pancreas and prostate. The prevalence of predicting factors of malignancy is listed in Table 1. Cutaneous necrosis was presenting sign in 76% of our patients with cancer and in only 8.3% of the patients without cancer. Some previously published studies have pointed out that cutaneous necrosis is highly predictive of an associated cancer.3–6 Including our trial, cutaneous necrosis is thought to increase the probability of occult malignancies in 27 (61%) of cases associated with cancer, opposite to 7 (8%) cases of DM without cancer. Since there is no clear definition for the term ‘cutaneous necrosis’, as this skin sign comprises a wide range of symptoms, from small digital necrosis to extensive skin and mucosal necrosis, these results, as pointed out by Burnouf et al.,4 must be analysed with reserve. In our study, elevated muscle enzyme levels were also associated with underlying malignancy, especially elevated level of CPK. The validity of this criterion has been confirmed by most formerly published trials1,4 but is in contrary to some studies that normal muscle enzyme levels tend to be a risk factor in developing cancer.7,8 The observations that the same antigens are expressed at high levels in several cancers known to be associated with the development of inflammatory myopathy, but not in corresponding normal tissue, suggest that the link between malignancy and myositis relates to the expression of common autoantigens between cancer tissue and muscle tissue in patients with DM.10 We can confirm that factors predictive of concomitant malignancy are the presence of cutaneous necrosis and elevation of the muscular enzymes. These parameters, which are easy to evaluate by clinicians, justify the inclusion of an extensive malignancy search that should be orientated by the most frequent localization of cancer.

© 2008 The Authors JEADV 2009, 23, 169–243 Journal compilation © 2008 European Academy of Dermatology and Venereology planus, vitiligo, leg ulcers, pyoderma gangrenosum and steroidinduced rosacea.3 It inhibits cytosine transcription, activates T cells by binding to immunophilins and blocks calcineurin phosphatase activity in the same way as cyclosporin but with a 10–100 times higher potency.4 It also blocks release of histamine from mast cells and penetrates human skin to mediate its activity akin to mid potency topical steroids without any effects on blood vessels. In steroid-induced rosacea, tacrolimus probably mediates its effects through its potent immunosuppressive action and also inhibiting local humoral and cellular immune mechanisms induced by increased microbial counts.4,5 Tacrolimus probably improves rosacea through its strong immunosuppressive effects, as it lacks any significant vascular effects, which may directly counteract vascular disturbances of rosacea.6 This non-steroidal potent topical immunomodulatory agent without inherent adverse effects of topical corticosteroids holds a good promise as an alternative in conditions like rosacea where immunosuppressive effects are required but topical steroids are contraindicated. Further studies having a double-blind and placebo-controlled design are required to ascertain the effective concentration, formulation and duration of therapy with tacrolimus in rosacea.