Background: Pemphigus vulgaris was almost fatal before the advent of glucocorticoids. Unfortunately, the high doses and prolonged administration of glucocorticoids, which often needed to control the disease, result in numerous adverse effects many of which are serious. Aims: To evaluate the patients with pemphigus vulgaris on treatment in respect of osteoporosis and to compare the frequency of osteoporosis in these patients with the healthy ones. Methods: The study consisted of 40 patients with pemphigus vulgaris and 34 healthy controls. Bone mineral density measurements were obtained by dual- energy X-ray absorptiometry. Blood serum, bone parameters, and biochemical hormonal measurements were examined in both groups. Results: When the bone mineral density values of patients with pemphigus vulgaris were compared with those of the control group, there was no significant difference between hip bone mineral density values, while lumbar region T and Z scores were found significantly low in the patient group (p = 0.034 and p = 0.006, respectively). Osteoporosis, osteopenia, and normal dual-energy X-ray absorptiometry rates in the patient group were found to be 32.5%, 32.5%, and 35%, respectively. These rates were found to be 18%, 23%, and 59% in control group, respectively. There were more fractures in the patient group and the difference was statistically significant (p = 0.004). Conclusion: An increase in osteoporosis frequency and secondary fracture to osteoporosis in the patients with pemphigus vulgaris was detected.
[Show abstract][Hide abstract] ABSTRACT: Systemic and topical glucocorticoids (GC) can cause significant adverse effects not only on the dermis, but also on epidermal structure and function. In epidermis, a striking GC-induced alteration in permeability barrier function occurs that can be attributed to an inhibition of epidermal mitogenesis, differentiation and lipid production. Since prior studies in normal hairless mice demonstrated that topical applications of a flavonoid ingredient found in citrus, hesperidin, improve epidermal barrier function by stimulating epidermal proliferation and differentiation, we assessed here whether its topical applications could prevent GC-induced changes in epidermal function in murine skin, and the basis for such effects. When hairless mice were co-treated topically with GC and 2% hesperidin twice-daily for 9 days, hesperidin co-applications prevented the expected GC-induced impairments of epidermal permeability barrier homeostasis and stratum corneum (SC) acidification. These preventive effects could be attributed to a significant increase in filaggrin expression, enhanced epidermal β-glucocerebrosidase activity and accelerated lamellar bilayer maturation, the last two likely attributable to a hesperidin-induced reduction in stratum corneum pH. Furthermore, co-applications of hesperidin with GC largely prevented the expected GC-induced inhibition of epidermal proliferation. Finally, topical hesperidin increased epidermal glutathione reductase mRNA expression, which could counteract multiple functional negative effects of GC on epidermis. Together, these results show that topical hesperidin prevents GC-induced epidermal side effects by divergent mechanisms.This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: Background and Design: Pemphigus vulgaris (PV) is an autoimmune blistering skin disease. The aim of this study was to compare the levels of T helper 1 (Th1), T helper 2 (Th2) and T helper 17 (Th17) type cytokines in PV patients and healthy controls. Materials and Methods: The study population included 37 patients with PV and 35 healthy individuals. The patients were grouped into mild, moderate and severe disease groups according to the severity of skin and mucosal involvement. Serum interleukin (IL)-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-17A and interferon (IFN)-aγ levels were assessed using the enzyme-linked immunosorbent assay method. Serum cytokine levels were compared between patients and controls and between patient subgroups. Analysis of data was done using SPSS 15.0. Results: Serum IL-2, IL-4, IL-6 levels were significantly higher in the patient group compared to the control group (p<0.001, p<0.001, p<0.001, respectively). IL-6 levels were found to be correlated with the severity of disease (r=0.490, p=0.003). There was no statistically significant difference in serum cytokine levels between the patient subgroups. Conclusion: Th2 type cytokines were found to be increased in serum of patients with pemphigus vulgaris. These results support that the Th2 cytokine response plays a major role in the etiopathogenesis of pemphigus vulgaris.
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