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      Geographic tongue and psoriasis: clinical, histopathological, immunohistochemical and genetic correlation - a literature review*

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          Abstract

          Geographic tongue is a chronic, inflammatory, and immune-mediated oral lesion of unknown etiology. It is characterized by serpiginous white areas around the atrophic mucosa, which alternation between activity, remission and reactivation at various locations gave the names benign migratory glossitis and wandering rash of the tongue. Psoriasis is a chronic inflammatory disease with frequent cutaneous involvement and an immunogenetic basis of great importance in clinical practice. The association between geographic tongue and psoriasis has been demonstrated in various studies, based on observation of its fundamental lesions, microscopic similarity between the two conditions and the presence of a common genetic marker, human leukocyte antigen (HLA) HLA-C*06. The difficulty however in accepting the diagnosis of geographic tongue as oral psoriasis is the fact that not all patients with geographic tongue present psoriasis. Some authors believe that the prevalence of geographic tongue would be much greater if psoriatic patients underwent thorough oral examination. This study aimed to develop a literature review performed between 1980 and 2014, in which consultation of theses, dissertations and selected scientific articles were conducted through search in Scielo and Bireme databases, from Medline and Lilacs sources, relating the common characteristics between geographic tongue and psoriasis. We observed that the frequency of oral lesions is relatively common, but to establish a correct diagnosis of oral psoriasis, immunohistochemical and genetic histopathological analyzes are necessary, thus highlighting the importance of oral examination in psoriatic patients and cutaneous examination in patients with geographic tongue.

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          Most cited references129

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          Geoepidemiology and environmental factors of psoriasis and psoriatic arthritis.

          Psoriasis and Psoriatic Arthritis (PsA) are chronic inflammatory diseases that have a major impact on health. The prevalence and incidence estimates of these two closely related diseases show ethnic and geographic variations, being generally more common in the colder north than in the tropics. In Europe the prevalence of psoriasis varies anywhere from 0.6 to 6.5%. In the USA, the estimated prevalence of diagnosed psoriasis is 3.15%. The prevalence in Africa varies depending on geographic location, being lowest in West Africa. Psoriasis is less prevalent in China and Japan than in Europe, and is entirely absent in natives of the Andean region of South America. There are fewer reports on the incidence of psoriasis, but a recent study from Rochester, USA showed an increasing trend over the last 2 decades. The prevalence of PsA also shows similar variation, being highest in people of European descent and lowest in the Japanese. Although, study methodology and case definition may explain some of the variations, genetic and environmental factors are important. Genetic epidemiologic studies have shown that both diseases have a strong genetic component. The strongest association is with HLA-Cw*06. Associations with a number of genes including IL12B and IL23R have recently been confirmed. Environmental risk factors including streptococcal pharyngitis, stressful life events, low humidity, drugs, HIV infection, trauma, smoking and obesity have been associated with psoriasis and PsA. Here we have reviewed the current literature on the epidemiology and genetics of psoriasis and PsA. Published by Elsevier Ltd.
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            Distinct clinical differences between HLA-Cw*0602 positive and negative psoriasis patients--an analysis of 1019 HLA-C- and HLA-B-typed patients.

            A major susceptibility gene for psoriasis is located in the major histocompatibility complex class I region on chromosome 6 very close to the HLA-Cw6 gene. We collected a cohort of 1,019 patients with chronic plaque psoriasis. The patients were typed for HLA-C and HLA-B. A total of 654 (64.2%) were HLA-Cw*0602 positive but 365 (35.8%) carried other HLA-C alleles. We confirmed that HLA-Cw*0602 positive patients have younger age of onset (17.5 vs 24.3 years, P<10(-10)), higher incidence of guttate and the eruptive type of psoriasis (P<0.0001), more frequent exacerbations with throat infections (P=0.01), higher incidence of the Koebner's phenomenon (P=0.01), and more extensive disease (P=0.03). A striking new finding was a diverging pattern of disease severity in HLA-Cw*0602 positive and negative patients depending on the age of onset of the disease (P=0.0006). HLA-Cw*0602 positive women also had more frequent remissions during pregnancy (P<0.0001). All types of nail changes were, however, more common in the Cw*0602 negative patients (P=0.003) and they more often had multiple types of nail lesions (P<0.0001). The three ancestral haplotypes of Cw*0602 all conferred an increase in odds ratio but showed no difference in any of the clinical features studied. Our findings indicate that the genetic factor on chromosome 6 has a strong influence on the phenotype of the disease, and underline that differences in clinical features of psoriasis may be to a large extent genetically determined.
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              Structure and function of major histocompatibility complex (MHC) class I specific receptors expressed on human natural killer (NK) cells.

              Natural killer (NK) cells express receptors that are specific for MHC class I molecules. These receptors play a crucial role in regulating the lytic and cytokine expression capabilities of NK cells. In humans, three distinct families of genes have been defined that encode for receptors of HLA class I molecules. The first family identified consists of type I transmembrane molecules belonging to the immunoglobulin (Ig) superfamily and are called killer cell Ig-like receptors (KIR). A second group of receptors belonging to the Ig superfamily, named ILT (for immunoglobulin like transcripts), has more recently been described. ILTs are expressed mainly on B, T and myeloid cells, but some members of this group are also expressed on NK cells. They are also referred to as LIRs (for leukocyte Ig-like receptor) and MIRs (for macrophage Ig-like receptor). The ligands for the KIR and some of the ILT receptors include classical (class Ia) HLA class I molecules, as well as the nonclassical (class Ib) HLA-G molecule. The third family of HLA class I receptors are C-type lectin family members and are composed of heterodimers of CD94 covalently associated with a member of the NKG2 family of molecules. The ligand for most members is the nonclassical class I molecule HLA-E. NKG2D, a member of the NKG2 family, is expressed as a homodimer, along with the adaptor molecule DAP10. The ligands of NKG2D include the human class I like molecules MICA and MICB, and the recently described ULBPs. Each of these three families of receptors has individual members that can recognize identical or similar ligands yet signal for activation or inhibition of cellular functions. This dichotomy correlates with particular structural features present in the transmembrane and intracytoplasmic portions of these molecules. In this review we will discuss the molecular structure, specificity, cellular expression patterns, and function of these HLA class I receptors, as well as the chromosomal location and genetic organization.
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                Author and article information

                Journal
                An Bras Dermatol
                An Bras Dermatol
                abd
                Anais Brasileiros de Dermatologia
                Sociedade Brasileira de Dermatologia
                0365-0596
                1806-4841
                Jul-Aug 2016
                Jul-Aug 2016
                : 91
                : 4
                : 410-421
                Affiliations
                [1 ]Universidade Federal Fluminense (UFF) - Niterói (RJ), Brazil.
                [2 ]Universidade de Marília (Unimar) - Marília (SP), Brazil.
                [3 ]Universidade do Estado do Rio de Janeiro (UERJ) - Rio de Janeiro (RJ), Brazil.
                Author notes
                Mailing address: Bruna Lavinas Sayed Picciani, Av. Nossa Senhora de Copacabana, 30 - Apto 406 - Leme, 22010-122 - Rio de Janeiro - RJ - Brazil. Email: brunapicciani@ 123456yahoo.com.br
                Article
                10.1590/abd1806-4841.20164288
                4999097
                27579734
                830be481-f810-4d70-91fc-4e1ebce467b1
                ©2016 by Anais Brasileiros de Dermatologia

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided the original work is properly cited.

                History
                : 06 December 2014
                : 26 May 2015
                Categories
                Continuing Medical Education

                arthritis, psoriatic,glossitis, benign migratory,hla antigens,immunohistochemistry,psoriasis

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