Flush, rosacea, alebo červenanie – pochopenie rozdielov

Výraz „flush” je označenie začervenania pokožky pri rozličných fyziologických a patologických zdravotných stavoch. Flush však môže byť spôsobený aj závažnými príčinami. Veľké množstvo pacientov s nekarcinoidovým flushom bolo odoslaných na našu kliniku pre podozrenie na karcinoid. Väčšina z pacientov už v tom čase podstúpila mnohé biochemické a rádiologické vyšetrenia, bez praktického prínosu a finančne zaťažujúce. Sme si vedomí, že rozdiel medzi karcinoidovým a nekarcinoidovým flushom je stále viac zastretý.

Ciele:
V našom prehľade sme sa zamerali na diferenciáciu karcinoidového flushu a jeho odlíšenie od iných príčin, ktoré môžu imitovať karcinoidový syndróm, najmä rosacea a menopauzálny flush. Zameriavame sa stručne na základnú patofyziológiu flushu. Cieľom prehľadu je pomôcť lekárom stretávajúcim sa s flushom. Vymyslieť užitočný diagnostický algoritmus, ktorý pomôže objasniť jeho etiológiu a určiť nutnosť použitia multidisciplinárneho postupu. Zdôrazňujeme však, že lekár by mal vždy posudzovať každého pacienta individuálne.

Výsledky:
Na odlíšenie karcinoidového a nonkarcinoidového flushu sme sa pokúsili zaviesť diagnostický algoritmus za účelom zjednodušenia manažmentu týchto pacientov. Liečba je nad rozsah tejto práce.

Kľúčové slová:
flush – karcinoid – neuroendokrinný – menopauza – rosacea – patofyziológia – algoritmus

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Doručeno:
19. 5. 2016

Přijato:
6. 6. 2016

Autoři: S. M. Agouba; P. Hyrdel; R. Hyrdel
Působiště autorů: Gastroenterology Clinic, Department of Internal Medicine, Jessenius Faculty of Medicine and University Hospital Martin, Slovak Republic
Vyšlo v časopise: Gastroent Hepatol 2016; 70(4): 346-352
Kategorie: Kapitoly z interní medicíny: přehledová práce
prolekare.web.journal.doi_sk: https://doi.org/10.14735/amgh2016346

Souhrn

Doručeno:
19. 5. 2016

Přijato:
6. 6. 2016

Zdroje

1. Bouloux PG. Sweating and flushing: evaluation and management. Presented at: ENDO 2013. June 18th, 2013. Available from: http://sessions.endocrine.org/s/2013an/endo/M58

2. Wiel L. The time of the change: menopause’s medicalization and the gender politics of aging. International Journal of Feminist Approaches to Bioethics 2014; 7(1): 74– 98. doi: 10.2979/ intjfemappbio.7.1.74.

3. Hyrdel P, Agouba S, Režňák I et al. Neuroendokrinné nádory tráviaceho traktu. Gastroenterol. prax 2014; 13(4): 209– 216.

4. National Institutes of Health. National Institutes of Health State of the Science Conference statement: management of menopause-related symptoms. Ann Intern Med 2005; 142 (12 Pt 1): 1003– 1013.

5. Rossmanith WG, Ruebberdt W. What causes hot ﬂushes? The neuroendocrine origin of vasomotor symptoms in the menopause. Gynecological Endocrinology 2009; 25(5): 303– 314.

6. Barankin B, Guenther L. Rosacea and atopic dermatitis. Two common oculocutaneous disorders. Can Fam Physician 2002; 48: 721– 724.

7. Taylor SC, David JN. Acne and Rosacea: a closer look at skin of color. [online]. Available from: http://www.medscape.org/viewarticle/770773.

8. Drake L. New studies show high incidence of rosacea and possible new causes. Rosacea Review 2007. [online]. Available from: www.rosacea.org/rr/2007/summer/article_1.php.

9. Deecher DC. Physiology of thermoregulatory dysfunction and current approaches to the treatment of vasomotor symptoms. Expert Opin Investig Drugs 2005; 14(4): 435– 448.

10. Freedman RR. Physiology of hot ﬂashes. Am J Hum Biol 2001; 13(4): 453– 464.

11. Charkoudian N. Skin blood ﬂow in adult human thermoregulation: how it works, when it does not, and why. Mayo Clin Proc 2003; 78(5): 603– 612.

12. Kräuchi K, Wirz-Justice A. Circadian rhythm of heat production, heart rate, and skin and core temperature under unmasking conditions in men. Am J Physiol 1994; 267 (3 Pt 2): R819– R829.

13. Boulant JA, Dean JB. Temperature receptors in the central nervous system. Annu Rev Physiol 1986; 48: 639– 654.

14. Romanovsky AA. Thermoregulation: some concepts have changed. Functional architecture of the thermoregulatory system.Am J Physiol Regul Integr Comp Physiol2007; 292(1): R37– R46.

15. Simon E. The enigma of deep-body thermosensory speciﬁcity. Int J Biometeorol 2000; 44(3): 105– 120.

16. Kyratsas C, Dalla C, Anderzhanova E. Experimental evidence for sildenafil’s action in the central nervous system: dopamine and serotonin changes in the medial preoptic area and nucleus accumbens during sexual arousal. J Sex Med 2013; 10(3): 719– 729. doi: 10.1111/ j.1743-6109.2012.03000.x.

17. Koutcherov Y, Mai JK, Paxinos G. Hypothalamus of the human fetus. J Chem Neuroanat 2003; 26(4): 253– 270.

18. Castañeyra-Perdomo A, Pérez-Delgado MM, Montagnese C et al. Brainstem projections to the medial preoptic region containing the luteinizing hormone-releasing hormone perikarya in the rat. An immunohistochemical and retrograde transport study. Neurosci Lett 1992; 139(1): 135– 139.

19. Dudas B, Merchenthaler I. Three-dimensional representation of the neurotransmitter systems of the human hypothalamus: inputs of the gonadotrophin hormone-releasing hormone neuronal system. J Neuroendocrinol 2006; 18(2): 79– 95.

20. Graham MD, Pfaus JG. Differential effects of dopamine antagonists infused to the medial preoptic area on the sexual behavior of female rats primed with estrogen and progesterone. Pharmacol Biochem Behav 2012; 102(4): 532– 539. doi: 10.1016/ j.pbb.2012.06.020.

21. Orikasa C, Sakuma Y. Estrogen configures sexual dimorphism in the preoptic area of C57BL/ 6J and ddN strains of mice. J Comp Neurol 2010; 518(17): 3618– 3629.

22. Castañeyra-Ruiz L, González-Marrero I, Castañeyra-Ruiz A. Luteinizing hormone-releasing hormone distribution in the anterior hypothalamus of the female rats. ISRN Anat 2013; 2013: 870721. doi: 10.5402/ 2013/ 870721.

23. Brück K, Zeisberger E. Adaptive changes in thermoregulation and their neuropharmacological basis. Pharmacol Ther 1987; 35(1– 2): 163– 215.

24. Gundlah C, Pecins-Thompson M, Schutzer WE et al. Ovarian steroid effects on serotonin 1A, 2A and 2C receptor mRNA in macaque hypothalamus. Brain Res Mol Brain Res 1999; 63(2): 325– 339.

25. Bethea CL, Lu NZ, Gundlah C et al. Diverse actions of ovarian steroids in the serotonin neural system. Front Neuroendocrinol 2002; 23(1): 41– 100.

26. Karkanias GB, Ansonoff MA, Etgen AM. Estradiol regulation of alpha 1b-adrenoceptor mRNA in female rat hypothalamus-preoptic area. J Neuroendocrinol 1996; 8: 449– 455.

27. Martin GR. Vascular receptors for 5-hydroxytryptamine: distribution, function and classiﬁcation. Pharmacol Ther 1994; 62(3): 283– 324.

28. Morissette M, Le Saux M, D’Astous M. Contribution of estrogen receptors alpha and beta to the effects of estradiol in the brain. J Steroid Biochem Mol Biol 2008; 108(3– 5): 327– 338.

29. Woolley CS, McEwen BS. Roles of estradiol and progesterone in regulation of hippocampal dendritic spine density during the estrous cycle in the rat. J Comp Neurol 1993; 336(2): 293– 306.

30. Schwarz JM, Nugent BM, McCarthy MM.Developmental and hormone-induced epigenetic changes to estrogen and progesterone receptor genes in brain are dynamic across the life span. Endocrinology 2010; 151(10): 4871– 4881. doi: 10.1210/ en.2010-0142.

31. Malik KF, Feder HH, Morrell JI. Estrogen receptor immunostaining in the preoptic area and medial basal hypothalamus of estradiol benzoate- and prazosin-treated female guinea-pigs. J Neuroendocrinol 1993; 5(3): 297– 306.

32. Deecher DC, Dorries K. Understanding the pathophysiology of vasomotor symptoms (hot flushes and night sweats) that occur in perimenopause, menopause, and postmenopause life stages. Arch Womens Ment Health 2007; 10(6): 247– 257.

33. McEwen BS, Alves SE. Estrogen actions in the central nervous system. Endocr Rev 1999; 20(3): 279– 307.

34. Gould E, Woolley CS, Frankfurt M et al. Gonadal steroids regulate dendritic spine density in hippocampal pyramidal cells in adulthood. J Neurosci 1990; 10(4): 1286– 1291.

35. Liu X, Shi H. Regulation of estrogen receptor α expression in the hypothalamus by sex steroids: implication in the regulation of energy homeostasis. Int J Endocrinol 2015; 2015: 949085. doi: 10.1155/ 2015/ 949085.

36. Lu NZ, Bethea CL. Ovarian steroid regulation of 5-HT1A receptor binding and G protein activation in female monkeys. Neuropsycho-pharmacology 2002; 27(1): 12– 24.

37. Serova LI, Maharjan S, Huang A et al. Response of tyrosine hydroxylase and GTP cyclohydrolase I gene expression to estrogen in brain catecholaminergic regions varies with mode of administration. Brain Res 2004; 1015(1– 2): 1– 8.

38. Karkanias GB, Etgen AM. Estradiol reduction of the agonist high afﬁnity form of the alpha 2-adrenoceptor in the hypothalamus of female rats: identiﬁcation as the alpha 2D subtype. Mol Pharmacol 1994; 45(3): 509– 516.

39. Gundlah C, Lu NZ, Bethea CL. Ovarian steroid regulation of monoamine oxidase-A and -B mRNAs in the macaque dorsal raphe and hypothalamic nuclei. Psychopharmacology (Berl) 2002; 160(3): 271– 282.

40. Casper RF, Yen SS, Wilkes MM. Menopausal ﬂushes: a neuroendocrine link with pulsatile luteninizing hormone secreation. Science 1979; 205(4408): 823– 825.

41. Family Allergy & Asthma Care of Montana. Do you experience flushing? Is it dry or wet flushing? [online]. Available from: www.familyallergyasthmacare.com/2014/01/do-you-experience-flushing-is-it-dry-or-wet-flushing.

42. Tebbi CK. Carcinoid tumor. [online]. Available from: http://emedicine.medscape.com/article/986050-overview.

43. Aldrich LB, Moattari AR, Vinik AI. Distinguishing features of idiopathic flushing and carcinoid syndrome. Arch Intern Med 1988; 148(12): 2614– 2618.

44. Geppetti P, Renzi D, Caleri C et al. Increase of plasma substance P- and neurokinin A-like immunoreactivity during carcinoid flushing. In: Henry JL, Couture R, Cuello AC (eds). Substance P and Neurokinins. New York: Springer-Verlag 1987: 220– 222.

45. Yip J, Loris A Chahl. Localization of NK1 and NK3 receptors in guinea-pig brain. Regulatory Peptides 2001; 98(1– 2): 55– 62. doi: 10.1016/ S0167-0115(00)00228-7.

46. Gobbi G, Cassano T, Radja F et al. Neurokinin 1 receptor antagonism requires norepinephrine to increase serotonin function. Eur Neu-ropsychopharmacol 2007; 17(5): 328– 338. doi: 10.1016/ j.euroneuro. 2006.07.004.

47. Bossaller C, Reither K, Hehlert-Friedrich C et al. In vivo measurement of endothelium-dependent vasodilation with substance P in man. Herz 1992; 17(5): 284– 290.

48. Columbo M, Horowitz EM, Kagey-Sobotka A et al. Substance P activates the release of histamine from human skin mast cells through a pertussis toxin-sensitive and protein kinase C-dependent mechanism. Clin Immunol Immunopathol 1996; 81(1): 68– 73.

49. Wong BJ, Tublitz NJ, Minson CT. Neurokinin-1 receptor desensitization to consecutive microdialysis infusions of substance P in human skin. J Physiol 2005; 568(3): 1047– 1056. doi: 10.1113/ jphysiol.2005.095 372.

50. Bouloux PM. What to do about flushing and sweating disorders. [online]. Available from: http://press.endocrine.org/doi/full/10.1210/MTP4.9781936704941.ch32.

51. Greaves MW. Flushing and flushing syndromes, rosacea and perioral dermatitis. In: Champion RH, Burton JL, Burns T et al (eds). Rook/Wilkinson/Ebling Textbook of Dermatology. 6th ed. Oxford: Blackwell Scientific 1998: 2099– 2104.

52. Izikson L, English JC 3rd, Zirwas MJ. The ﬂushing patient: differential diagnosis, workup, and treatment. J Am Acad Dermatol 2006; 55(2): 193– 208.

53. Nasr C. Flushing. [online]. Available from: www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/flushing/.

54. Scheinfeld NS. Rosacea. Skinmed 2006; 5(4): 191– 194.

55. Al Balbeesi AO, Halawani MR. Unusual features of rosacea in saudi females with dark skin. Ochsner J 2014; 14(3): 321– 327.

56. Pray WS, Pray JJ. Differentiating between rosacea and acne. US Pharmacist 2004; 29(4). [online]. Available from: www.medscape.com/viewarticle/475331.

57. Perrot-Applanat M. Effect of estrogens on vascular proliferation. Therapie 1999; 54(3): 333– 337.

58. Laing W. Chronic venous disease of the leg. London: Office of Health Economics 1992: 10– 12.

59. Özcan S, Tezcan O, Kurt T et al. Serum estradiol/ free testosterone ratio precipitate recurrent varicose veins in men. Int Angiol 2015; 34(6): 576– 581.

60. Yamasaki K, Gallo RL. The molecular pathology of rosacea. J Dermatol Sci 2009; 55(2): 77– 81.

61. Steinhoff M, Buddenkotte J, Aubert Jet al. Clinical, cellular, and molecular aspectsin the pathophysiology of rosacea. J Investig Dermatol Symp Proc 2011; 15(1): 2– 11.doi: 10.1038/ jidsymp.2011.7.

62. Coda AB, Hata T, Miller J et al. Cathelicidin, kallikrein 5, and serine protease activity is inhibited during treatment of rosacea with azelaic acid 15% gel. J Am Acad Dermatol 2013; 69(4): 570– 577. doi: 10.1016/ j.jaad.2013.05.019.

63. Nielsen PG. Metronidazole treatment in rosacea. Int J Dermatol 1988; 27(1): 1– 5.

64. Utaş S, Ozbakir O, Turasan A. Helicobacter pylori eradication treatment reduces the severity of rosacea. J Am Acad Dermatol 1999; 40(3): 433– 435

65. Gravina A, Federico A, Ruocco E. Helicobacter pylori infection but not small intestinal bacterial overgrowth may play a pathogenic role in rosacea. United European Gastroenterol J 2015; 3(1): 17– 24.

66. Bonnar E, Eustace P, Powell FC. The Demodex mite population in rosacea. J Am Acad of Dermatol 1993; 28(3): 443– 448.

67. Gollnick H. Current concepts of the pathogenesis of acne: implications for drug treatment. Drugs 2003; 63(15): 1579– 1596.