Medical Inspection – Health Blog

INTRODUCTION

Angiolymphoid hyperplasia with eosinophilia (ALHE), first described by Wells and Whimster in 1969, usually manifests as firm erythematous to brownish papules on the head and neck area, especially on the periauricular area of young adults. It can appear as a single or multiple lesions. The trunk, extremities, and perineal area can be involved. Lesions on the oral mucosa, upper lip, and inner canthus of the face have been reported. We report a patient suffering from ALHE which de­veloped as a single papule on the lower eyelid making diagnosis difficult. Read More…

Although CRP and AN are associated with obesity, they are distinct entities with different clinical fea­tures. However, a close relationship between the two is suggested by similar predisposing characteristics including young age, obese, dark-skinned persons and parallel response to weight reduction or etre- tinate therapy. A pathogenetic link between the two conditions is suggested by insulin resistance and consequent hyperinsulinemia. High levels of circulat­ing insulin have mitogenic and antiapoptotic acti­vities on keratinocytes through activation of the tyrosine kinase (TK) receptor superfamily. These activities may provide an explanation for the epidermal proliferation and papillomatosis observed in the above patients.

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Case 1

A 40-year-old female patient presented with a 10-year history of asymptomatic, symmetric, slowly progressive, skin eruptions. The eruption consisted of reticulated, brownish patches on the trunk and grayish, velvety plaques on both axillary folds (Fig. 1A). She denied any family history or personal history of similar eruptions or diabetes. However, she was on the antihypertensive medication. The results of physical, laboratory and histopathologic examinations of the patient and two other similar patients are summarized in Table 1. Based on the physical and laboratory test results, she was dia¬gnosed as having metabolic syndrome by WHO diagnostic criteria. Skin biopsy specimens were obtained from the trunk and axillae. The biopsy specimen from the trunk revealed findings such as mild hyperkeratosis and papillomatosis which are compatible with CRP, and the specimen from the axillae showed hyperkeratosis, papillomatosis and finger-like upward projection of dermal papillae which are consistent with AN (Fig. 2). Because oral minocycline was not available in our clinic, she received oral acitretin 20 mg daily. Both axillary and trunk lesions were slightly improved after 6 weeks (Fig. 1B).

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INTRODUCTION

Acanthosis nigricans (AN) is characterized by symmetric, velvety, gray-brown hypertrophied plaques most commonly on the axillae and neck. Confluent and reticulated papillomatosis (CRP) is manifested clinically by papules in the mid-chest that coalesce in the midline, and are arranged in a reticulated pattern peripherally. Even though there are some reports of CRP without papillomatosis, AN and CRP characteristically have papillomatosis, irregular acanthosis, and orthohyperkeratosis on the histo- logic exams. Read More…

However, continual overexpression of VEGF has been found to result in hemangioma-type tumors , indicating that the VEGF expression or effective dose must be tightly regulated and that the ex­pression must transiently occur only at the early stage of wound healing. Furthermore, the micro- vessels that develop from the continual over- expression of VEGF were found to be disorganized, sinusoidal and leaky because of VEFG’s additional function as a vascular permeability factor. In contrast, Ang 1 induces maturation, stabilization and remodeling of vessels and overexpression of Ang 1 does not result in vascular leakage. Therefore, Ang 1 is thought to have a wider therapeutic window and it could be a safer modality for clinical use.

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The angiogenic effect of Ang 1 has been reported in previous studies. Ang 1 and Tie 2-deficient mice had similar phenotypes that were characterized by embryonic lethality with severe vascular remodeling defects, insufficient vessel stabilization and perturbed vascular maturation. Promoted angio- genesis has been reported on for transgenic mice that overexpress Ang 1 in the skin. In addition, there have been reports that exogenous and localized Ang 1 treatment with naked DNA-mediated or adenovirus-mediated Ang 1 enhanced angiogenesis in the gastric ulcer model or the skin flap model.

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Ade-COMP-Ang 1 enhances the rate of wound healing

Analysis of the clinical wound healing rate in Ade-COMP-Ang 1-treated and Ade-LacZ-treated groups was performed via digital processing at 0, 3, 7 and 14 days after the wounding. The Ade- COMP-Ang 1-treated group showed 39.5%, 59.3%, and 91.8% reduction of the wound area at day 3, 7, and 14, respectively. On the other hand, the results in the Ade-LacZ-treated group revealed 20.4%, 46.2% and 89.0% reduction of the wound area, respectively. The differences in the results between the two groups at day 3 and 7 were statistically significant (p<0.05), however, the dif­ferences in the results at day 14 failed to show a statistical significance (Fig. 1).
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