Table of Contents

Volume 3, Issue 4

  October/November/December 2011

  Pages 217 - 268

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EDITOR'S CORNER

Open Access Article

Hormones and skin: A never ending love story!

Jörg Reichrath
Pages 217 - 219
http://dx.doi.org/10.4161/derm.3.4.19028
PDF




REVIEW

Open Access Article

Antimicrobial implications of vitamin D

Dima A. Youssef, Christopher W.T. Miller, Adel M. El-Abbassi, Della C. Cutchins, Coleman Cutchins, William B. Grant and Alan N. Peiris
Pages 220 - 229
http://dx.doi.org/10.4161/derm.3.4.15027
Abstract | PDF

Evidence exists that vitamin D has a potential antimicrobial activity and its deficiency has deleterious effects on general well-being and longevity. Vitamin D may reduce the risk of infection through multiple mechanisms. Vitamin D boosts innate immunity by modulating production of anti-microbial peptides (AMPs) and cytokine response. Vitamin D and its analogues via these mechanisms are playing an increasing role in the management of atopic dermatitis, psoriasis, vitiligo, acne and rosacea. Vitamin D may reduce susceptibility to infection in patients with atopic dermatitis and the ability to regulate local immune and inflammatory responses offers exciting potential for understanding and treating chronic inflammatory dermatitides. Moreover, B and T cell activation as well as boosting the activity of monocytes and macrophages also contribute to a potent systemic anti-microbial effect. The direct invasion by pathogenic organisms may be minimized at sites such as the respiratory tract by enhancing clearance of invading organisms. A vitamin D replete state appears to benefit most infections, with the possible noteworthy exception of Leishmaniasis. Antibiotics remain an expensive option, and misuse of these agents results in significant antibiotic resistance and contributes to escalating health care costs. Vitamin D constitutes an inexpensive prophylactic option and possibly therapeutic product either by itself or as a synergistic agent to traditional antimicrobial agents. This review outlines the specific antimicrobial properties of vitamin D in combating a wide range of organisms. We discuss the possible mechanisms by which vitamin D may have a therapeutic role in managing a variety of infections.




CASE REPORTS

Open Access Article

Scleroderma-like skin changes not involving the hand in a prepubertal male with type I diabetes mellitus: A case report

Pisit Pitukcheewanont, Bhavna Bali, Sinjira Somanunt and Andreas Reiff
Pages 230 - 232
http://dx.doi.org/10.4161/derm.3.4.14614
Abstract | PDF

To our knowledge there have been no reports of scleroderma-like skin changes, not affecting the hand in prepubertal patients with Type I Diabetes Mellitus (T1DM). We report a prepubertal caucasian male with T1DM, and early morphea-type skin changes of the trunk and extremities, not involving the hand.

Open Access Article

Improvement of venous leg ulcers with androgen replacement therapy in a patient with undiagnosed Klinefelter syndrome

Shwetha Thukuntla and Pratima Kumar
Pages 233 - 234
http://dx.doi.org/10.4161/derm.3.4.15333
Abstract | PDF

Klinefelter syndrome (KS) is the most common genetic form of male hypogonadism. The majority (80-90%) of patients have 47, XXY karyotype while mosaicism is seen in only 10-20% of patients. Leg ulcers may be a presenting symptom of KS with a prevalence of 6-13%. Treatment with testosterone has been reported to improve the ulcers.




REPORTS

Open Access Article

Vitamin D deficiency and sun avoidance among university students at Abu Dhabi, United Arab Emirates

Fatme Al Anouti, Justin Thomas, Laila Abdel-Wareth, Jaishen Rajah, William B. Grant and Afrozul Haq
Pages 235 - 239
http://dx.doi.org/10.4161/derm.3.4.16881
Abstract | PDF

This study offers evidence that vitamin D deficiency could be a major public health burden among young Emirati adults, mostly because of sun deprivation in a sun-blessed country. This study included a random sample of 138 females and 70 males tested for serum 25-hydroxyvitamin D [25(OH)D] status. To further evaluate the predictors of vitamin D status in this population, the study examined diet, obesity, and sun exposure. In summer, the mean serum 25(OH)D concentration for females was 20.9 ± 14.9 nmol/L, whereas that for males was 27.3 ± 15.7 nmol/L. Females scored significantly higher than males on the sun avoidance inventory (SAI), indicating that females avoid sun exposure to a greater extent than males, possibly explaining the lower vitamin D status. A significant negative correlation also existed between SAI and vitamin D status (Pearson’s r = –0.33; p < 0.01), but no significant association was evident between vitamin D status and body mass index (Pearson’s r = 0.03; p = 0.33) or low dietary intake of vitamin D–fortified foods (Pearson’s r = 0.08; p = 0.13). The mean serum 25(OH)D concentration for females tested in winter was 31.3 ± 12.3 nmol/L while in the summer, it was 20.9 ± 14.9 nmol/L. This difference was statistically significant, suggesting that seasonal variation plays an important role in vitamin D status in the United Arab Emirates. Fortification of foods and drinks with vitamin D, supplementation, and sensible sun exposure are important steps toward minimizing vitamin D deficiency.

Open Access Article

Low birth weight, bone metabolism and fracture risk

Jörg Dötsch
Pages 240 - 242
http://dx.doi.org/10.4161/derm.3.4.14636
Abstract | PDF

As for other diseases of higher age low birth weight was expected to be a risk factor for an altered bone metabolism and osteoporosis. One the first glance this expectation appears to be confirmed by animal data: rats with intrauterine growth restriction following maternal protein malnutrition show a reduction of bone mineral density going in line with a decrease in serum vitamin D concentrations. However, the situation is less clear in newborns with low birth weight: Some studies show a relation of birth weight and bone mineral density whereas others don’t. The older the former low birth weight patients the fainter the effect seems to be. In fact young adults with idiopathic short stature have a low bone mineral density than the low birth weight group irrespective of whether they have experienced catch-up growth or not. As a consequence low birth weight is can not be identified as a relevant risk factor for hip fractures in menopausal women. Postmenopausal women with low birth weight even show higher vitamin D concentrations than normal birth weight individuals. In conclusion, there is no consistent long term effect of low birth weight on bone mineral density or hip fracture risk later in life. Whether methodological weaknesses in the studies performed so far are causal or whether postnatal factors such as physical activity and nutrition are of higher importance can only be speculated upon at present.

Open Access Article

Solar UV Doses of Adult Americans and Vitamin D₃ Production

Dianne E. Godar, Stanley J. Pope, William B. Grant and Michael F. Holick
Pages 243 - 250
http://dx.doi.org/10.4161/derm.3.4.15292
Abstract | PDF

Background: Sunlight contains UV radiation that affects human health in both detrimental (skin cancers) and beneficial (vitamin D3) ways. An evaluation of the vitamin D status of adult Americans (22-40, 41-59, 60+ yr) show many have deficient or insufficient serum levels of 25-hydroxyvitamin D, indicating they are not getting enough from sunlight or dietary sources. Those findings are in conflict with calculated values that insist people make “ample” vitamin D3 (≥1,000 IU/day) from their “casual” or everyday outdoor exposures.
Objective: We investigated this situation using the outdoor UV doses of indoor-working adult Americans (~7,000) in the north (45°N) and south (35°N) to calculate how much vitamin D3 they produce each season of the year with and without vacationing.
Method: To do vitamin D3 calculations properly, we used action spectrum and geometric conversion factors, not previously incorporated into other calculations.
Results: Few indoor-working adults over 21 yr meet their daily vitamin D needs from everyday outdoor exposures anytime during the year, including summer. Only a few “outdoorsy” Caucasians (22-60 yr) can meet their vitamin D3 needs (~2,000 IU/day) during the summer, but only if they do not wear sunscreens except on beach vacations.
Conclusions: Most indoor-working adult Americans do not go outside enough to meet their vitamin D3 needs all year. Only some outdoor-working adults can make enough vitamin D3 without using sunscreen but other adults cannot, even with a vacation during the summer. Indoor-working African Americans can never make enough vitamin D3 during the year even with a 3-week vacation.

Open Access Article

A retrospective study of thyroid structural abnormalities in alopecia patients

Kristen Lo Sicco, Sean McGuire and Joseph C. English
Pages 251 - 254
http://dx.doi.org/10.4161/derm.3.4.16838
Abstract | PDF

Background: Thyroid dysfunction is classically associated with alopecia. Studies focusing on manual thyroid examinations, with ultrasonography of palpable abnormalities, in alopecia patients are lacking.
Objective: To examine the clinical utility of manual and sonographic evaluation of the thyroid in alopecia patients.
Methods: A retrospective chart review was performed among patients diagnosed with alopecia.
Results: We found that 20.2% (74/367) of manual thyroid exams performed were deemed abnormal and 78.8% (41/52) of patients who had an ultrasound had an abnormal finding. Twenty two of the 74 patients did not obtain the requested ultrasound. Non-scarring alopecia was associated with 36 of 41 patients with abnormal ultrasounds (Telogen effluvium 29.3%, Androgenetic alopecia 27.8%, Alopecia areata 24.4%, and Traction alopecia 9.8%). No one specific structural abnormality was associated with a specific hair loss type. Of note, 78% (32/41) of patients with an abnormal ultrasound exam had normal thyroid function tests and only 9/41 (22%) patients had both.
Limitations: These include: a retrospective study design, small sample size, use of multiple sites for laboratory and sonographic thyroid evaluation, and a high attrition rate for ultrasound evaluation.
Conclusions: This study revealed that the manual examination of the thyroid in alopecia patients may identify additional thyroid abnormalities not detected with serologic evaluation alone. Further prospective studies are required to evaluate the necessity and significance of manual thyroid palpation and subsequent ultrasound studies in this patient population.

Open Access Article

Idiopathic chronic urticaria and thyroid autoimmunity: Experience of a single center

Vicenzo Nuzzo, Libuse Tauchmanova, Paola Colasanti, Alfonso Zuccoli and Annamaria Colao
Pages 255 - 258
http://dx.doi.org/10.4161/derm.3.4.17066
Abstract | PDF

Urticaria is one of the most frequent dermatosis, being its prevalence in general population estimated about 20%. This prospective case-control study was aimed at determining the prevalence of thyroid autoimmune disorders in a cohort of patients with chronic urticaria (CU), all living within an area with mild-to-moderate iodine deficiency. Fifty four consecutive patients affected by CU were recruited and compared to 108 healthy controls. Assessment of the thyroid function included measurement of serum concentrations of TSH, FT3, FT4, anti-thyreoglobulin (anti-TG) and anti-peroxidase (anti-TPO) antibodies. Ultrasound scan of the thyroid gland was performed in all subjects using a 7.5 MHz linear transducer. All subjects were followed up for 6 months. The prevalence of thyroid antibodies was significantly higher in our cohort of patients with CU than in controls (22% vs. 6.5 %). Hashimoto’s thyroiditis was also more frequent in patients than controls (18.5% vs. 1.8%). These frequencies do not differ from those previously reported by some other authors and confirm the association between CU and thyroid autoimmunity also in the area of iodine deficiency. However, presence of antibodies or thyroiditis does not seem to influence clinical course of CU. These results suggest that screening for thyroid function may be useful in all the patients with CU.

Open Access Article

Reciprocal responses of fibroblasts and melanocytes to α-MSH depending on MC1R polymorphisms

Hedwig Stanisz, Markus Seifert, Wolfgang Tilgen, Thomas Vogt and Knuth Rass
Pages 259 - 265
http://dx.doi.org/10.4161/derm.3.4.17454
Abstract | PDF

The melanocortin 1-receptor (MC1R) exhibits several variants in form of single nucleotide polymorphisms (SNPs) which are known to differentially regulate melanocyte function. However, whether and how MC1R polymorphisms also affect fibroblast function, has not been investigated so far. Therefore we measured intracellular cyclic adenosine monophosphate (cAMP) concentrations (cAMP-EIA) and cellular proliferation (CellTiter-Blue) upon stimulation with alpha-melanocyte stimulating hormone (α-MSH) in eight different human fibroblast and melanocyte cell lines with wild type and different MC1R SNPs. We found that fibroblasts, as well as melanocytes, show differences in MC1R function depending on the MC1R genotype. MC1R stimulation with α-MSH in wild type (MC1R_wt) melanocytes results in an increase of intracellular cAMP and cellular proliferation. In contrast, MC1R_wt fibroblasts react with a decrease of intracellular cAMP and proliferation. In MC1R polymorphic fibroblasts (R163Q, R151C and V60L) both effects are significantly alleviated. Similar, but inverse effects could be found in MC1R polymorphic melanocytes (R142H and V92M) with a significantly lower cAMP increase and proliferation rate compared to MC1R_wt melanocytes. Our results indicate that the MC1R displays reciprocal growth responses in melanocytes and fibroblasts, depending on the MC1R genotype. Thus, the MC1R seems to be not solely important for the skin pigmentary system, but also for the fibroblast function, and might influence different processes of the dermal compartment like wound healing, fibrosis and keloid formation.




COMMENTARY

Open Access Article

Eccrine angiomatous hamartoma with sudden enlargement and pain in an adolescent girl after menarche

Ayuko Kikuzawa, Masahiro Oka, Kumiko Taguchi, Hideki Shimizu, Makoto Kunisada and Chikako Nishigori
Pages 266 - 268
http://dx.doi.org/10.4161/derm.3.4.15365
Abstract | PDF

Eccrine angiomatous hamartoma (EAH) is a rare, benign cutaneous lesion characterized histologically by a proliferation of eccrine glands and vascular structures—generally capillaries—in the middle and deep dermis. Sudden enlargement of EAH lesions with or without pain has been noted during puberty and pregnancy and has been attributed to hormonal stimulation. We herein describe a case of EAH that became symptomatic in an adolescent girl. A 13-year-old girl presented with pain associated with a sudden enlargement of a previously asymptomatic swelling on her right second toe. She had an 8-year history of an asymptomatic swelling on her right second toe, and the symptoms appeared approximately 1 year after menarche. Physical examination revealed swelling of the plantar surface of her right second toe. The overlying surface was erythematous with a small amount of fine scales. The biopsied tissue showed a nodular proliferation of eccrine glands intimately admixed with numerous small vessels in the deep dermis and subcutaneous fat tissue. Mucin deposition was present in the stroma surrounding the proliferating eccrine coils and ducts and in the upper dermis. A diagnosis of EAH was made. We suggest that hormonal changes during puberty may have played a role in the rapid growth and pain in the present case.