Verruca Plana - Een Overzicht van Huidziekten

Systemic Implications and Complications

In rare cases and especially in elderly people, SK may show a sudden appearance and the growth of numerous lesions in association with a malignant tumor of internal organs. This has been referred to as Leser-Trelat syndrome. About one-third of these patients have concomitant acanthosis nigricans, and nearly half of the patients report pruritus.

The most frequent underlying malignancies are adenocarcinomas of the stomach and colon, but other malignant tumors may be found as well. Disappearance of the multiple SK after successful therapy of the cancer has been reported, as well as reappearance after tumor relapse. In general, the Leser-Trelat syndrome is observed in advanced stages of the cancer and therefore has an unfavorable prognosis with a median survival of 11 months.

It is assumed that this rare paraneoplastic syndrome is caused by soluble growth factors secreted by the tumor. In all cases with a sudden appearance of numerous SK a Leser-Trelat syndrome should be taken into account and cancer of internal organs should be excluded.

Discussion

NK cells are critical components of the innate immune system and do not express the T-cell receptor, they function in nonspecific cytotoxicity to virus-infected cells and cancer cells. NK cell receptors consist of activating and inhibitory receptors that determine susceptibility to virus infection. Inhibitory receptors recognize MHC-class I and, upon binding, will prevent cytotoxicity. Since virus-infected cells and cancer cells show down-regulated MHC-class I, NK cells attack target cells. One study found the percentages of NK cells were significantly decreased in patients with gastric cancer, and the percentages of tumor-infiltrating NK cells were positively correlated with survival and disease progression [4]. Brodalumab is an anti-IL-17RA antibody and hampers IL-17 signaling by blocking its receptor. IL-17 not only plays an oncogenic role in tumorigenesis by regulating tumor angiogenesis and enhancing tumor immune evasion but also exerts anti-tumor functions by enhancing NK cells and cytotoxic T lymphocyte (CTL) activation [5]. In the second case, brodalumab may have contributed to the measured reduction in NK cell activity.

Immune status is evaluated by checking CBC including white blood cells, but we often encounter viral infections such as cytomegalovirus in patients receiving anti-cancer drugs even with normal CBC. In these two cases, the CBC was within the normal range, but NK cell activity was low. By measuring NK cell activity, we noticed the fatal risk of lung infection in the first case, and we suspected seborrheic verruca related to lung cancer in the second case. Although CBC is normal, NK cell activity may be low in patients with abrogative skin rash, suggesting the importance of measuring NK cell activity.

Seborrheic Keratosis (verruca senilis, senile wart, verruca seborrhoica, seborrheic wart, basal cell acanthoma, basal cell papilloma, benign acanthokeratoma)

Seborrheic keratosis (SK) is a very frequent benign epithelial skin tumor. It usually is asymptomatic, but occasionally itching, bleeding, pain, redness and crusting is observed after trauma or irritation. In most cases patients will ask for removal of SK due to aesthetic reasons.

• Characteristic findings on physical examination

SK can be found anywhere on the body with the exception of palms, soles and mucous membranes. However, this lesion has been reported on the conjunctiva. The back, chest, head and neck represent the most commonly affected areas. In intertriginous areas pedunculated SK may they occur. SK can present as single lesions but usually occur disseminated in larger numbers (Figure 1), with sometimes 100 or more lesions. In some cases, the multiple SK on the back are arranged according to a “Christmas tree” pattern.

In most cases, the diagnosis of SK can be made by their typical clinical appearance. In doubtful cases, dermatoscopy can be helpful. SK are characterized by the following dermatoscopic features:

– horn cysts or pseudocysts (visible as yellow spots)

– gyrus sulcus pattern

– opaque yellow-brown or gray-brown color

– possibly streak-like densities, which are not clearly demarcated in contrast to melanocytic lesions

– superficial serpiginous vascular structures

Other histologic subtypes include clonal SK (showing the Borst-Jadassohn phenomenon), bowenoid SK, and irritated SK. The last is presumably identical with the inverted follicular keratosis and shows squamous eddies.

Flachwarzen

Martina Feichter hat in Innsbruck Biologie mit Wahlfach Pharmazie studiert und sich dabei auch in die Welt der Heilpflanzen vertieft. Von dort war es nicht weit zu anderen medizinischen Themen, die sie bis heute fesseln. Sie ließ sich an der Axel Springer Akademie in Hamburg zur Journalistin ausbilden und arbeitet seit 2007 für NetDoktor (zwischenzeitlich als freie Autorin).

Flachwarzen (Verrucae planae juveniles) entstehen vor allem bei Kindern und Jugendlichen. Sie sind wenig erhaben, rundlich und hautfarben oder durchscheinend und befinden sich oft im Gesicht oder an den Händen. Auslöser sind humane Papillom-Viren (HPV). Sie bilden sich meist von allein zurück, eine Behandlung ist deshalb oft nicht nötig. Lesen Sie hier mehr zum Thema Flachwarzen.