Advances in dermatology最新文献

During inflammation, coordinated expression of cytokine-induced adhesion molecules (CAMs) on postcapillary venular endothelial cells (ECs) regulates leukocyte recruitment. During their recruitment from blood, leukocytes adhere to EC CAMs, activating signaling pathways inside ECs. In a forthcoming paradigm, leukocyte transendothelial migration requires active EC participation, with extracellular adhesive CAM functions mirrored by cytoplasmic do-main-dependent intracellular events. These events serve to reorganize the EC actin cytoskeleton. Investigators have visualized this as changes in EC shape, transient opening of EC-EC contacts, and redistribution of CAMs expressed on the luminal EC surface. In this review, we (1) summarize the overlapping extracellular adhesive properties of the 3 EC CAMs most important for leukocyte recruitment during inflammation, namely, E-selectin, vascular cell adhesion molecule, and intercellular adhesion molecule-1; (2) explore the role of these 3 CAMs as signal transducers by identifying the intracellular signals (Ca++, Rho/Rac, and phosphatidylinositol 4,5-bisphosphate) that upon leukocyte engagement, reorganize the EC cytoskeleton and redistribute these apical CAMs, thereby favoring leukocyte recruitment; and (3) describe how CAM-derived signals lead to ezrin-radixin-moesin complex formation and how this complex of plasma membrane-cytoskeleton adapter proteins coordinates CAM-driven intracellular signals with extracellular adhesive CAM functions. This literature review suggests that the cytoplasmic domains of these EC CAMs and their downstream effectors represent new and potentially beneficial intracellular therapeutic targets for treating diseases of the skin.

The vast majority of serious noninfectious skin diseases are the result of inappropriate inflammatory responses (eg, atopic dermatitis, psoriasis) or neoplastic transformation (eg, squamous cell carcinoma, melanoma, cutaneous T-cell lymphoma). T cells are critical to both of these major disease categories, playing critical roles in driving or controlling inflammation, as well as the immunosurveillance of cutaneous tumors. T cells may express either 1 of 2 major T-cell receptor (TCR) subtypes composed of heterodimeric alphabeta or gammadelta proteins. While most T cells in the blood and lymph nodes are of the alphabeta type and demonstrate vast heterogeneity, gammadelta T cells are relatively enriched in epithelial tissues and often show less TCR variability. This distinction is especially evident in mice and several other mammals, as well as in humans, albeit to a lesser degree. Recent studies in laboratory animals have indicated the capacity of gammadelta T cells to play major roles in maintenance of the epidermal barrier, regulation of cutaneous inflammation, and protection against cutaneous neoplasms. This review will expound on the biology of gammadelta T cells, their relationship to the skin, and the implications for our understanding of cutaneous disease.

RCM offers tremendous potential for the advancement of medical research and clinical care. In research, it offers benefits both ex vivo and in vivo. Ex vivo, it can allow us to sample tissue and evaluate it noninvasively to determine what further testing--on the same exact tissue--may be helpful. In vivo RCM can be used to study normal or pathophysiologic processes in real-time noninvasively and by the same technique sequentially over time. Immunologic events previously only studied ex vivo or by static images can be traced from their inception to completion (Table 1). The potential of RCM in vivo is tremendous. How would our world change if we could noninvasively diagnose skin lesions and, with the advent of new minimally invasive therapies, administer treatment and noninvasively monitor that treatment? The potential to allow better medical care based on actual visualization of therapeutic response and healing is obvious. Much like early X-ray and ultrasound imaging, RCM is in its infancy. It is only a matter of time and continued persistent research that will lead to similar success and utility for RCM.

Secondary intention, primary closure, and full thickness skin grafts can handle the majority of ear closures. Transposition flaps work nicely at the root of the helix, the preauricular area, the intertragal notch and the postauricular area. Helical rim advancements and their variations are the workhorse for repairing and restoring the natural arch of the helix. Retroauricular 2-stage pedicle flaps with or without a cartilage graft will provide a nice cosmetic result for larger defects involving the helical rim. Remember, most importantly, know your wound, know your patient, and the simplest closure is often the best one.