T Helper 1 and T Helper 2 Cytokines Differentially Modulate Expression of Filaggrin and its Processing Proteases in Human Keratinocytes

Background： Atopic dermatitis （AD） is characterized by defective skin barrier and imbalance in T helper 1/T helper 2 （Th 1/Th2） cytokine expression.Filaggrin （FLG） is the key protein to maintaining skin barrier function.Recent studies indicated that Th1/Th2 cytokines influence FLG expression in keratinocytes.However, the role ofThl/Th2 cytokines on FLG processing is not substantially documented.Our aim was to investigate the impact ofThl/Th2 cytokines on FLG processing.Methods： HaCaT cells and normal human keratinocytes were cultured in low and high calcium media and stimulated by either interleukin （IL）-4, 13 or interferon-γ（IFN-γ）.FLG, its major processing proteases and key protease inhibitor lymphoepithelial Kazal-type-related inhibitor （LEKTI） were measured by both real-time quantitative polymerase chain reaction and Western blotting.Their expression was also evaluated in acute and chronic AD lesions by immunohistochemistry.Results： IL-4/13 significantly reduced, while IFN-γsignificantly up-regulated FLG expression.IL-4/13 significantly increased, whereas IFN-γsignificantly decreased the expression ofkallikreins 5 and 7, matriptase and channel-activating serine protease 1.On the contrary, IL-4/13 significantly decreased, while IFN-γincreased the expression of LEKTI and caspase-14.Similar trends were observed in AD lesions.Conclusions： Our results suggested that Th1/Th2 cytokines differentially regulated the expression of major FLG processing enzymes.The imbalance between Th1 and Th2 polarized immune response seems to extend to FLG homeostasis, through the network of FLG processing enzymes.

High Staphylococcus epidermidis Colonization and Impaired Permeability Barrier in Facial Seborrheic Dermatitis

Background：Seborrheic dermatitis （SD） is a common inflammatory skin condition.The etiology is unclear,although overgrowth of Malassezia on the skin has been suggested to cause SD.This study investigated whether colonization with Staphylococcus plays a role in facial SD,which was not well addressed previously.Methods：The study was conducted from September 1,2011 to February 20,2012 in the First Hospital of China Medical University.In the first phase,the study evaluated the level of transepidennal water loss （TEWL） and the number of colony-forming units （CFU） of Staphylococcus in defined skin areas of SD patients who were human immunodeficiency virus （HIV） seropositive （HIV [＋] SD [＋] group,n =13）,classical SD （HIV [-] SD [＋] group,n =24） patients,H IV seropositive-non-SD （HIV [＋] SD [-] group,n =16） patients,and healthy volunteers （HIV [-] SD [-] group,n 16）.In the second phase,we enrolled another cohort of HIV （-） SD （＋） patients who applied topical fusidic acid （n =15）,tacrolimus （n =16）,or moisturizer （n =12）.Changes in the Seborrheic Dermatitis Area Severity Index （SDASI）,TEWL,and Staphylococcus density were evaluated 2 weeks later.Comparisons of each index were performed using analysis of variance （ANOVA） and least significant difference method.Results：The level of TEWL was greater through lesional sites in the HIV （＋） SD （＋） group than that in HIV （＋） SD （-） and HIV （） SD （-） groups （95% confidence interval [CI]：18.873-47.071,P 〈 0.001 and 95% CI：28.755-55.936,P 〈 0.001,respectively）.The number of CFU of Staphylococcus was greater in the HIV （＋） SD （＋） group than that in HIV （＋） SD （-） and HIV （-） SD （-） groups （95% CI：37.487-142.744,P =0.001 and 95% CI：54.936-156.400,P 〈 0.001,respectively）.TEWL was significantly more improved in patients treated with tacrolimus and fusidic acid than that in those treated with moisturizers （95% CI：7.560 38.987,P =0.004 and 95% CI：4.659-37.619,P =0.01 1,respectively）.Topical tacrolimus and fusidic acid were significantly associated with decreased SDASI as compared with moisturizer （95% CI：0.03-0.432,P =0.025 and 95% CI：0.033 0.44,P =0.024,respectively）.Conclusions：High colonization with Staphylococcus epidermidis,along with impaired skin permeability barrier function,contributes to the occurrence of SD.

Proteomic Analysis of the Serum of Patients with Stable Vitiligo and Progressive Vitiligo

To the Editor： Vitiligo is not a fatal disease; however, it can have strong social and psychological impacts on the patients. Genetic susceptibility, autoimmunity, neural dysregulation, melanin self-destruction, and oxidative stress may be involved in the pathogenesis of vitiligo.

A 10-year-old Girl with Metastatic Unclassified Sarcoma with Epithelioid Features

To the Editor： A 10-year-old girl presented with an asymptomatic ulcerated tumor on her right forearm for 18 months [Figure 1a]. The minor initially was inconspicuous and then gradually enlarged with painless ulceration in its center [Figure 1b]. Three months later, she developed three nontender new nodules on her right arm, proximal to the initial ulcerated nodule. Her general condition was good. Skin examination revealed a 4 cm × 4 cm tumor, with central ulceration and raised margins. Three diameters in 3-5 cm,