Selective Localization or Sparing of Skin Disorders in Neurologically Injured Areas: An Underestimated Connubium
Identifieur interne : 002552 ( Pmc/Corpus ); précédent : 002551; suivant : 002553Selective Localization or Sparing of Skin Disorders in Neurologically Injured Areas: An Underestimated Connubium
Auteurs : Vincenzo Piccolo ; Teresa Russo ; Eleonora Ruocco ; Adone BaroniSource :
- Indian Journal of Dermatology [ 0019-5154 ] ; 2014.
Url:
DOI: 10.4103/0019-5154.143540
PubMed: 25484398
PubMed Central: 4248505
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Selective Localization or Sparing of Skin Disorders in Neurologically Injured Areas: An Underestimated <italic>Connubium</italic></title><author><name sortKey="Piccolo, Vincenzo" sort="Piccolo, Vincenzo" uniqKey="Piccolo V" first="Vincenzo" last="Piccolo">Vincenzo Piccolo</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Russo, Teresa" sort="Russo, Teresa" uniqKey="Russo T" first="Teresa" last="Russo">Teresa Russo</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Ruocco, Eleonora" sort="Ruocco, Eleonora" uniqKey="Ruocco E" first="Eleonora" last="Ruocco">Eleonora Ruocco</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Baroni, Adone" sort="Baroni, Adone" uniqKey="Baroni A" first="Adone" last="Baroni">Adone Baroni</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25484398</idno><idno type="pmc">4248505</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4248505</idno><idno type="RBID">PMC:4248505</idno><idno type="doi">10.4103/0019-5154.143540</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">002552</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002552</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Selective Localization or Sparing of Skin Disorders in Neurologically Injured Areas: An Underestimated <italic>Connubium</italic></title><author><name sortKey="Piccolo, Vincenzo" sort="Piccolo, Vincenzo" uniqKey="Piccolo V" first="Vincenzo" last="Piccolo">Vincenzo Piccolo</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Russo, Teresa" sort="Russo, Teresa" uniqKey="Russo T" first="Teresa" last="Russo">Teresa Russo</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Ruocco, Eleonora" sort="Ruocco, Eleonora" uniqKey="Ruocco E" first="Eleonora" last="Ruocco">Eleonora Ruocco</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Baroni, Adone" sort="Baroni, Adone" uniqKey="Baroni A" first="Adone" last="Baroni">Adone Baroni</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></analytic><series><title level="j">Indian Journal of Dermatology</title><idno type="ISSN">0019-5154</idno><idno type="eISSN">1998-3611</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Ravikumar, Bc" uniqKey="Ravikumar B">BC Ravikumar</name></author><author><name sortKey="Sinhasan" uniqKey="Sinhasan">Sinhasan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Piccolo, V" uniqKey="Piccolo V">V Piccolo</name></author><author><name sortKey="Russo, T" uniqKey="Russo T">T Russo</name></author><author><name sortKey="Bove, D" uniqKey="Bove D">D Bove</name></author><author><name sortKey="Baroni, A" uniqKey="Baroni A">A Baroni</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ruocco, V" uniqKey="Ruocco V">V Ruocco</name></author><author><name sortKey="Brunetti, G" uniqKey="Brunetti G">G Brunetti</name></author><author><name sortKey="Puca, Rv" uniqKey="Puca R">RV Puca</name></author><author><name sortKey="Ruocco, E" uniqKey="Ruocco E">E Ruocco</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ruocco, V" uniqKey="Ruocco V">V Ruocco</name></author><author><name sortKey="Ruocco, E" uniqKey="Ruocco E">E Ruocco</name></author><author><name sortKey="Piccolo, V" uniqKey="Piccolo V">V Piccolo</name></author><author><name sortKey="Brunetti, G" uniqKey="Brunetti G">G Brunetti</name></author><author><name sortKey="Guerrera, Lp" uniqKey="Guerrera L">LP Guerrera</name></author><author><name sortKey="Wolf, R" uniqKey="Wolf R">R Wolf</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Baroni, A" uniqKey="Baroni A">A Baroni</name></author><author><name sortKey="Buommino, E" uniqKey="Buommino E">E Buommino</name></author><author><name sortKey="Piccolo, V" uniqKey="Piccolo V">V Piccolo</name></author><author><name sortKey="Chessa, Ma" uniqKey="Chessa M">MA Chessa</name></author><author><name sortKey="Russo, T" uniqKey="Russo T">T Russo</name></author><author><name sortKey="Cozza, V" uniqKey="Cozza V">V Cozza</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="letter"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Indian J Dermatol</journal-id><journal-id journal-id-type="iso-abbrev">Indian J Dermatol</journal-id><journal-id journal-id-type="publisher-id">IJD</journal-id><journal-title-group><journal-title>Indian Journal of Dermatology</journal-title></journal-title-group><issn pub-type="ppub">0019-5154</issn><issn pub-type="epub">1998-3611</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25484398</article-id><article-id pub-id-type="pmc">4248505</article-id><article-id pub-id-type="publisher-id">IJD-59-612b</article-id><article-id pub-id-type="doi">10.4103/0019-5154.143540</article-id><article-categories><subj-group subj-group-type="heading"><subject>Correspondence</subject></subj-group></article-categories><title-group><article-title>Selective Localization or Sparing of Skin Disorders in Neurologically Injured Areas: An Underestimated <italic>Connubium</italic></article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Piccolo</surname><given-names>Vincenzo</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Russo</surname><given-names>Teresa</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Ruocco</surname><given-names>Eleonora</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Baroni</surname><given-names>Adone</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib></contrib-group><aff id="aff1"><italic>From the Department of Dermatology, Second University of Naples, Naples, Italy. E-mail:<email xlink:href="piccolo.vincenzo@gmail.com">piccolo.vincenzo@gmail.com</email></italic></aff><pub-date pub-type="ppub"><season>Nov-Dec</season><year>2014</year></pub-date><volume>59</volume><issue>6</issue><fpage seq="b">612</fpage><lpage>613</lpage><permissions><copyright-statement>Copyright: © Indian Journal of Dermatology</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions></article-meta></front><body><p>Sir,</p><p>We read with great interest the article by Ravikumar <italic>et al</italic>. who report a case of an extensive psoriatic eruption selectively sparing the lower limb that was previously affected by poliomyelitis.[<xref rid="ref1" ref-type="bibr">1</xref>] The authors attribute this particular distribution to Koebner phenomenon.[<xref rid="ref1" ref-type="bibr">1</xref>] They hypothesize that friction and increased weight bearing on the polio-non-affected right lower limb may be the reasons for the preponderance of psoriatic lesions on that limb.[<xref rid="ref1" ref-type="bibr">1</xref>] Although interesting, this hypothesis seems to be not thoroughly convincing. In fact, we think that a decreased local immune response due to the peripheral nerve damage might be responsible for the almost selective lack of psoriatic lesions in polio area. Our interest in this article was aroused by the possible relationship existing between neurological injuries and selective localization or, on the contrary, sparing of skin disorders on the injured areas. This association should not be limited to the fore-mentioned case, but it could be extended to further analogous clinical scenarios. In particular, in the latest years, we were mostly interested in this topic and observed a large and variegate group of cutaneous diseases, which selectively affected neurologically injured areas.[<xref rid="ref2" ref-type="bibr">2</xref>] The most striking examples are cases of <italic>papillomatosis cutis lymphostatica</italic> on polio paraplegic area, recurrent blistering of the fingertips in carpal tunnel syndrome, unilateral bullous pemphigoid on hemiplegic side after cerebral stroke, and unilateral rosacea on facial palsy.[<xref rid="ref2" ref-type="bibr">2</xref>] Although apparently different, the above-listed cases probably share a common pathogenic mechanism. In fact, in each case, the neurological damage, whichever the cause (polio paraplegic limb, carpal tunnel syndrome, hemiplegic cerebral stroke, facial palsy), could induce a local dysregulation in neuropeptide release.[<xref rid="ref2" ref-type="bibr">2</xref>] This dysequilibrium would result into a regional cutaneous immune destabilization, in turn favoring the occurrence of opportunistic skin diseases selectively confined on neurologically damaged areas. This concept could be best explained by the overarching, fast-growing pathogenic theory of the immunocompromised cutaneous district (ICD),[<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref>] which indicates a cutaneous site that, once it has previously been “marked” by a damaging clinical event, becomes prone to harboring an opportunistic skin disorder. In Ruocco's original description, ICD-inducing events included Wolf's isotopic postherpetic response, lymphedema, and otherwise damaging injuries (vaccination, radiation, burns, traumas).[<xref rid="ref3" ref-type="bibr">3</xref>] Subsequently, the list of potentially inciting factors able to make a given cutaneous site an immunodestabilized one has progressively expanded, also including neurological injuries.[<xref rid="ref2" ref-type="bibr">2</xref>] This immune alteration, depending on the neuropeptides each time involved, can be either defective or excessive.[<xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref5" ref-type="bibr">5</xref>] In fact, while the selective localization of an immune-mediated skin disorder, such as bullous pemphigoid or rosacea, on a neurologically impaired area can be explained by a local activation of immunity, the selective sparing of polio area by the generalized psoriasis in the case presented by Ravikumar <italic>et al</italic>.,[<xref rid="ref1" ref-type="bibr">1</xref>] could ensue from a local reduction of immunity. The reason why a similar injuring event could result in such opposite clinical consequences still remains obscure and further investigations are necessary to better clarify this knowledge gap. We are sure that the ICD pathogenic concept may be a good guidance for investigators to increasingly comprehend the complex pathomechanisms involved in these singular phenomena.</p></body><back><ref-list><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ravikumar</surname><given-names>BC</given-names></name><name><surname>Sinhasan</surname><given-names></given-names></name></person-group><article-title>Psoriasis sparing the polio-affected limb: Is it merely the koebner phenomenon?</article-title><source>Indian J Dermatol</source><year>2014</year><volume>59</volume><fpage>505</fpage><lpage>6</lpage><pub-id pub-id-type="pmid">25284862</pub-id></element-citation></ref><ref id="ref2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Piccolo</surname><given-names>V</given-names></name><name><surname>Russo</surname><given-names>T</given-names></name><name><surname>Bove</surname><given-names>D</given-names></name><name><surname>Baroni</surname><given-names>A</given-names></name></person-group><article-title>Segmental immune disorders resulting from neurologic injuries</article-title><source>Clin Dermatol</source><year>2014</year><volume>32</volume><fpage>628</fpage><lpage>32</lpage><pub-id pub-id-type="pmid">25160104</pub-id></element-citation></ref><ref id="ref3"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ruocco</surname><given-names>V</given-names></name><name><surname>Brunetti</surname><given-names>G</given-names></name><name><surname>Puca</surname><given-names>RV</given-names></name><name><surname>Ruocco</surname><given-names>E</given-names></name></person-group><article-title>The immunocompromised district: A unifying concept for lymphoedematous, herpes-infected and otherwise damaged sites</article-title><source>J Eur Acad Dermatol Venereol</source><year>2009</year><volume>23</volume><fpage>1364</fpage><lpage>73</lpage><pub-id pub-id-type="pmid">19548975</pub-id></element-citation></ref><ref id="ref4"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ruocco</surname><given-names>V</given-names></name><name><surname>Ruocco</surname><given-names>E</given-names></name><name><surname>Piccolo</surname><given-names>V</given-names></name><name><surname>Brunetti</surname><given-names>G</given-names></name><name><surname>Guerrera</surname><given-names>LP</given-names></name><name><surname>Wolf</surname><given-names>R</given-names></name></person-group><article-title>The immunocompromised district in dermatology: A unifying pathogenic view of the regional immune dysregulation</article-title><source>Clin Dermatol</source><year>2014</year><volume>32</volume><fpage>569</fpage><lpage>76</lpage><pub-id pub-id-type="pmid">25160098</pub-id></element-citation></ref><ref id="ref5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Baroni</surname><given-names>A</given-names></name><name><surname>Buommino</surname><given-names>E</given-names></name><name><surname>Piccolo</surname><given-names>V</given-names></name><name><surname>Chessa</surname><given-names>MA</given-names></name><name><surname>Russo</surname><given-names>T</given-names></name><name><surname>Cozza</surname><given-names>V</given-names></name><etal></etal></person-group><article-title>Alterations of skin innate immunity in lymphedematous limbs: Correlations with opportunistic diseases</article-title><source>Clin Dermatol</source><year>2014</year><volume>32</volume><fpage>592</fpage><lpage>8</lpage><pub-id pub-id-type="pmid">25160100</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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