Cytokine profile in patients with true and infectious (microbial) eczema

Abstract

Aim. Determination of the cytokine spectrum in patients with true and infectious (microbial) forms of eczema. Materials and methods. We observed 53 patients with eczema (28 men and 25 women) aged 18 to 62 years. Sixteen of them were diagnosed with the true, and 25 - with infectious (microbial) form of dermatosis. In another 12 patients, a variant of infectious (microbial) eczema - infectious (fungal) eczema - was identified. The control group consisted of 30 healthy individuals, comparable in sex and age. True eczema was characterized by the presence of erythematous-vesicular and erosive-wetting elements of the rash, located symmetrically in the face, hands, and forearms areas and having blurred boundaries with the surrounding skin. In 3 patients bubbles with a dense cover, and some erosions were formed on the palms and soles. Eflorescences tended to merge. In 2 patients, foci of hyperkeratosis with separate superficial cracks were observed on the palms and soles. Infectious (microbial) eczema was characterized by the presence of single or multiple erosive-ulcerative foci on the torso and extremities, covered with purulent crusts, and separated from the surrounding skin by a border of exfoliated epidermis. Polymorphic rashes, represented by vesicles, papules, pustules, and crusts, were observed around these lesions. In 4 patients with varicose veins of the legs, several ulcers up to 2-3 cm in size were formed, surrounded by an infiltration zone and perifocal erythema. Vesicles and papules were present around such foci. The pathological process was located in the middle and lower thirds of the legs. In infectious (mycotic) eczema, papulo-vesicular and erosive elements of the rash, often covered with serous crusts, were observed in the areas of the interdigital folds of the feet. Multiple bubbles and nodules were observed on the back surface of the feet, legs, thighs, and hands. In all patients, the diagnosis was confirmed by positive results of mycological examination. In 6 patients, T.rubrum was isolated, and in 2 - its association with T. mentagrophytes (var. Interdigitale). In 3 patients the composition of yeast-like fungi C. albicans and mold microflora (aspergillus, mucor, penicillin) was isolated, and in 1 - a combination of T.rubrum, Er. floccosum and T. mentagrophytes (var. interdigitale). The levels of IL-1b, IL-2, IL-4, IL-6, IL-8, IL-10, and TNFa in the blood medium were recognized in all observed patients using test systems of LLC "Protein Contour" on the "STAT-FAX -303 PLUS " device at a wavelength of 492nm. The concentration of IL was measured in pkg / ml. Results and Discussion. It was found that in patients with eczema, regardless of the clinical form of dermatosis, there is a reliable increase in the content of both pro-inflammatory (interleukins -1b, -6, -8 and tumor necrosis factor a) and anti-inflammatory (interleukins -4, -10) cytokines. However, the interleukin-2 levels, in contrast, decreased. This reflects a certain imbalance of pro-inflammatory potential, which unfolds with eczema development. The increase in the concentration of anti-inflammatory cytokines (interleukins -4 and -10) should be considered as a manifestation of the compensatory response of the macroorganism. The use of a standardized immunomodulatory agent - glucosaminylmuramyl dipeptide ("Lycopid"), 2 mg 3 times a day for 2-3 weeks in the observed patients, did not achieve the desired corrective effect on the cytokine profile. In particular, if the concentration of interleukins -1b, -2, -8, and tumor necrosis factor a decreased reliably, while nevertheless remaining outside the amplitude of control fluctuations, the levels of interleukin -6 did not exceed the values registered in patients before treatment. The content of interleukins -4 and -10 did not change reliably either. It should be noted that these processes did not significantly depend on the clinical form of dermatosis. The clinical efficacy of standardized therapy has not proved to besufficient either. In particular, "clinical remission" was achieved only in 18.8% of patients with the true form of eczema and in 8.0% - with infectious (microbial) form, and recurrences of the pathological process were observed only in 87.5% and 84.0% of patients, respectively. This proves a certain role of cytokine imbalance in the development of overt manifestations of dermatosis. Thus, given the ramifications of changes in the cytokine profile during the development of both true and infectious (microbial) eczema, therapeutic strategies of such patients should be based on the activity of its individual components. Given the affinity of immunological disorders in these forms of dermatosis, the focus should be on finding unified means of correction with a wide range of immunomodulatory effects. Conclusions. In patients with eczema, the components of the cytokine profile should be determined in order to assess the depth and direction of the emerging immunological changes. Complex therapy of patients with eczema should include drugs with a wide range of immunomodulatory effects. The concentration of interleukins - 1b, -2, -4, -6, -8, -10 and of tumor necrosis factor a may be one of the criteria for the effectiveness of the prescribed pathogenetic treatment.

Keywords

• eczema, clinical forms, cytokines, immunomodulatory effect