Clinical features and mechanistic insights regarding IgG4-related dacryoadenitis and sialoadenitis: a review

Publication date: Available online 25 January 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): T. Maehara, S. Pillai, J.H. Stone, S. Nakamura

Abstract

Immunoglobulin G4-related disease (IgG4-RD), recognized only recently as a single diagnostic entity, is a chronic inflammatory condition of unknown etiology. The diagnosis of IgG4-RD relies heavily on histopathological analysis and the correlation of histology findings with clinical, serological, and radiological data. CD4⁺ T and B cells, including IgG4-expressing plasmablasts, constitute the major inflammatory cell populations in IgG4-RD and are believed to cause organ damage and tissue fibrosis. Patients with IgG4-RD, who have active, untreated disease, exhibit marked expansion of IgG4-secreting plasmablasts in the blood. Important mechanistic insights correlated with the pathogenesis of IgG4-RD have been disclosed in recent years through the application of novel molecular biology approaches, including next-generation and single-cell RNA sequencing. Exploration of the interactions between these CD4⁺ T cells and cells of the B lymphocyte lineage is critical to understanding the pathophysiology of IgG4-RD. The establishment of pathogenic T cell clones and the identification of antigens specific to these clones constitute the first steps in determining the pathogenesis of this disease. This review focuses on clinical features and mechanistic insights regarding IgG4-related dacryoadenitis and sialoadenitis, from a perspective suitable for oral and maxillofacial surgeons.

http://bit.ly/2G0377W

Are tattoos associated with negative health‐related outcomes and risky behaviors?

Abstract

Background

Tattoos have reached broadening mainstream acceptance. Medical professional societies have noted that tattoos may co‐occur with high risk behaviors.

Methods

Using a variety of statistical models applied to a sample of 2,008 adults residing in the United States via Amazon's Mechanical Turk, we estimate the associations between tattoo characteristics, three health‐related outcomes (overall health status, ever diagnosed with a mental health issue, sleep problems), and three risky behaviors (current smoking, ever spent time in jail or prison, and number of sex partners).

Results

We find that the presence, number, and specific features of tattoos are positively correlated with two of the health‐related outcomes (ever diagnosed with a mental health issue and trouble sleeping) and all three of the risky behaviors (P < .05). Magnitudes are larger for those with multiple, visible, and offensive tattoos.

Conclusions

Our results suggest that individuals with tattoos are more likely to engage in risky behaviors relative to their non‐tattooed counterparts, which may lead to health consequences. Dermatologists, healthcare providers, and public health advocates should recognize that having a tattoo(s) is a potential marker for mental health issues and risky behaviors.

http://bit.ly/2Ufls4M

Alopecia areata in Tunisia: epidemio‐clinical aspects and comorbid conditions. A prospective study of 204 cases

Abstract

Background

Alopecia areata (AA) is an autoimmune condition that usually presents as patchy, nonscarring hair loss. Autoimmune disorders and atopy are reported as comorbid conditions. We aimed to investigate the demographics, clinical characteristics, and associations of AA in Tunisian patients.

Methods

Demographic data, pattern of alopecia, age of onset, and associations were evaluated in 204 patients from January 2012 to June 2016.

Results

Two hundred and four cases of AA were seen. The male to female ratio was 0.68. The mean age at presentation was 23 years old. Positive family history was noticed in 22.1% of patients. Personal history of atopy was associated with AA in 18.1%. Associated autoimmune diseases were thyroid disorders (12.7%), vitiligo (1.5%), psoriasis (three cases), type 1 diabetes (two cases), autoimmune polyendocrinopathy‐candidiasis‐ectodermal dystrophy (APECED) syndrome (two cases), lichen sclerosus atrophicus (one case), and pemphigus vulgaris (one case). Patchy AA was the most common manifestation (49.5%) followed by alopecia universalis (27.5%), alopecia ophiasis (12.7%), and alopecia totalis (10.3%). Nail changes consisting of pitting, trachyonychia, and longitudinal ridging were reported in 24.8%. AA patterns were more severe in females (P = 0.049). Severe forms showed more persistent disease duration (P = 0.005), earlier onset (P = 0.001), and more recurring episodes (P = 0.002) and were significantly associated with nail involvement (P < 0.001).

Conclusions

Our study aimed to review epidemio‐clinical characteristics and comorbid conditions of AA in Tunisian patients. More severe cases with a pejorative value of early‐onset AA, long disease duration, and nail involvement were seen in our study.

http://bit.ly/2DwZQuR

Pre-auricular Sinus with Post-auricular Extension: An Uncommon Variant

Abstract

Pre-auricular sinus usually presents in front of the auricle without any diagnostic dilemma. But confusion arises when it presents with post-auricular swelling, abscess or discharging sinus. Here we describe series of pre-auricular sinus with post-auricular extension, a "variant type" of pre-auricular sinus and their management. A prospective study was done in the department of ENT in a tertiary care hospital of West Bengal from April 2015 to March 2018. After control of infection and proper pre-operative investigations patients, sinus was excised using bi-directional approach. The sinus tract along with a thin rim of conchal cartilage and pre and post-auricular cuff of skin was excised in toto. Among 76 cases of pre-auricular sinus, seven had "variant type". There were five males and two females in the variant group. Five patients were in the first decade of life and two patients were in the second decade of life. Four patients presented with post-auricular scar, two patients presented with post-auricular discharging sinus and one patient presented with post-auricular abscess. Wound healing was perfectly normal in all patients. None had recurrence till 1 year follow up. Pre-auricular sinus may present as "variant type" with post-auricular abscess or discharging sinus. So when a patient presents with post-auricular abscess or discharging sinus, pre-auricular region and pinna should be examined carefully. This helps to avoid unnecessary investigations and interventions which only complicate future management of these patients.

http://bit.ly/2FNGsw8

Comparison of Functional Organ Preservation by Concomitant Boost Radiotherapy Versus Concurrent Chemoradiation in Locally Advanced Carcinoma of Larynx or Hypopharynx: A Prospective Randomized Study

Abstract

Functional organ preservation is a major challenge in management of advanced laryngeal and hypopharyngeal carcinoma. Although ideal approach is a subject of much debate, radiotherapy with or without chemotherapy is most commonly used modality. This randomized study was conducted to compare functional organ preservation by chemoradiation (CRT) versus concomitant boost radiotherapy (CBRT). A total of 40 patients with advanced (stage III/stage IVa) laryngeal and hypopharyngeal cancer were randomized to receive either CRT (n = 20) to a dose of 66 Gy in 33 fractions over 6.5 weeks with concurrent cisplatin (100 mg/m² on days 1, 22 and 43) or CBRT (n = 20) to a dose of 67.5 Gy in 40 fractions over 5 weeks. Patients were assessed for organ preservation rate, toxicities, voice and swallowing functions utilizing Voice Related Quality of Life (VRQOL) and MD Anderson Dysphagia Inventory (MDADI) scores, respectively, for minimum follow up of 6 months. Organ preservation rate (intact disease free larynx) at 6 months post treatment was observed in 100% in CRT arm and 95% in CBRT arm. There was no significant difference in mucositis and dermatitis in two arms (p = 0.82 and 0.78, respectively). Dysphagia was observed more in CRT arm (n = 12 vs n = 6). Late toxicities grade 3 xerostomia, grade 2 dysguesia, were seen significantly more in CRT arm. There was no statistical difference between the two arms in terms of VRQOL (p = 0.55) and MDADI scores (p = 0.13). In CRT arm 13 patients complete response and in CBRT arm 12 patients had complete response. Accelerated fractionation with concomitant boost schedule is as effective as CRT in anatomical and functional preservation of larynx. The toxicities, voice and dysphagia related quality of life is comparable.

http://bit.ly/2G0xBXs

Dermoscopic features of nonpigmented eccrine poroma

http://bit.ly/2HsZVUB

Localisation of treatment‐resistant areas in patients on biologics

Summary

Background

Traditionally, psoriasis in certain body sites such as the scalp, nails, palms, soles, and the intertriginous areas has been acknowledged as difficult‐to‐treat.

Objective

To investigate the body location of treatment‐resistant psoriasis in patients treated with biologic agents in real‐world clinical practice, and to study the association between localisation and the quality of life.

Methods

In this observational study we investigated the skin and/or nail location of treatment‐resistant psoriasis in patients with moderate‐to‐severe psoriasis treated for > 6 months with biologic agents with a partial or good response to treatment defined as having a PASI ≥ 1 and ≤ 5. Experienced PASI assessors used a uniform data collection form in which the body area was divided into 26 regions and 20 nails.

Results

We included 146 patients with chronic plaque‐type psoriasis (74·7% men, mean [SD] age 49·8 [13·7] years, with a median PASI score of 2·4 (IQR 1·2‐3·2). The median PASI reduction from treatment initiation was 86·1% (IQR 78·1‐91·3).

The most common site of recalcitrant psoriasis was the anterior lower leg (49·3%; 95% confidence interval (CI): 41·2–57·4). Further common sites of recalcitrant psoriasis were the posterior lower leg (24·7%; 95% CI: 17·7‐31·6), the elbow (35·6%; 95% CI: 27·8‐43·4), and the scalp (19·2%; 95% CI: 12·8‐25·6%). No association between DLQI and specific areas of recalcitrant psoriasis were observed.

Conclusion

In real‐world clinical practice, the most common sites of recalcitrant psoriasis in patients treated with biologic agents are the anterior lower leg, the posterior lower leg, and the elbows. Recalcitrant psoriasis in no specific area caused a greater impact on quality of life than any other area.

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http://bit.ly/2RZvQQH