PubMed · 12981458
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P J MICHEL. 1952-08-05. [Ether dermatites].. https://pubmed.ncbi.nlm.nih.gov/12981458/
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Pellagra defines systemic disease as resulting from a marked cellular deficiency of niacin. It is characterized by 4 "D's": diarrhea, dermatitis, dementia, and death. Diagnosis of pellagra is difficult in the absence of the skin lesions, and is often facilitated by the presence of characteristic ones. The dermatitis begins as an erythema. Acute pellagra resembles sunburn in its first stages, but tanning occurs more slowly than typically in sunburn. Exacerbation follows re-exposure to sunlight. In this work we review the findings of this once mysterious disorder, one that still challenges clinicians world-wide.
A heterogenic group The dermatoses specifically associated with pregnancy are generally benign, even if they lead to great discomfort. Some of them require appropriate management because of the risk of maternal or foetal complications. Pruritus of pregnancy Corresponds to intra-hepatic cholestasis of pregnancy, present in 1 to 2% of pregnant women, it may place the foetus at risk of delayed growth, prematurity or even death in utero. Treatment relies on cholestyramine. Pemphigoid gestationis or herpes gestationis This is an autoimmune disease of pregnancy occurring in multiparous women between the 28th and 32nd week of amenorrhoea (once out of 5 times within the first 7 days postpartum). Diagnosis is confirmed by histological examination of a bullous lesion. The disease usually regresses spontaneously after delivery, generally within a period of 1 to 17 months. Relapses, earlier on and more severe than during the initial episode, occur in 50 to 70% of subsequent pregnancies. Treatment is essentially based on corticosteroids: local Class II for the pauci-bullous and/or limited forms and general corticosteroid therapy for the severe forms. Polymorphic dermatitis of pregnancy This regroups various and similar entities described during pregnancy. They start during the third trimester of pregnancy, their clinical aspects are similar, their histology is non specific, the biological explorations are normal, direct immunofluorescence is negative, the progression is favourable for the mother and the child and the pathogenesis is unknown. Impetigo herpetiformis This exceptional dermatosis affects the primiparous woman in 80% of cases and the eruption usually appears during the 3rd trimester of pregnancy, or even after delivery. Relapses are constant during subsequent pregnancies.
Recent findings have shed new light on the role of peripheral nerves in the skin and established a modern concept of cutaneous neurobiology. Closely related monodirectional and/or bidirectional pathways exist in which the central and peripheral nervous system, the endocrine and immune system, and almost all skin cells are involved. Information is emerging about the factors involved in these immunomodulatory mechanisms, which are defined as neuropeptides, neurotransmitters, neurotrophins, and neurohormones. The interaction between peripheral nerves and the immune system is mediated by different types of cutaneous nerve fibers that release neuromediators and activate specific receptors on target cells in the skin such as keratinocytes, mast cells, Langerhans cells, microvascular endothelial cells, fibroblasts, and infiltrating immune cells. These interactions influence a variety of physiologic and pathophysiologic functions including cellular development, growth, differentiation, immunity, vasoregulation, leukocyte recruitment, pruritus, and wound healing. A variety of mechanisms lead to the termination of cellular responses to released neuropeptides under physiologic circumstances. Herein, we highlight some of the recent advances of neurocutaneous biology and discuss the role of nerves in mediating cutaneous inflammation. Understanding the mechanisms and the factors controlling neuromediators and their receptors and degrading enzymes will lead to the identification of novel therapeutic targets for the treatment of cutaneous diseases.