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The Essential Oil Derived from Perilla frutescens (L.) Britt. Attenuates Imiquimod–Induced Psoriasis-like Skin Lesions in BALB/c Mice. Molecules 2022; 27:molecules27092996. [PMID: 35566346 PMCID: PMC9100515 DOI: 10.3390/molecules27092996] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Psoriasis is reported to be a common chronic immune-mediated skin disease characterized by abnormal keratinocytes and cell proliferation. Perilla leaves are rich in essential oils, fatty acids, and flavonoids, which are recognized for their antioxidant and anti-inflammatory effects. In this study, the alleviating effect of essential oil (PO) extracted from Perilla frutescens stems and leaves on imiquimod (IMQ) -induced psoriasis-like lesions in BALB/c mice were investigated. Results showed that PO ameliorated psoriasis-like lesions in vivo, reduced the expression of lymphocyte antigen 6 complex locus G6D (Ly-6G), which is a marker of neutrophil activation, and inhibited the expression of inflammatory factors interleukin 1 (IL-1), interleukin 6 (IL-6), inducible nitric oxide synthase (iNOS), and cyclooxygenase 2 (COX2). In addition, PO significantly decreased the expression of cytokines such as IL-6, IL-1, interleukin 23 (IL-23), interleukin 17 (IL-17), and nuclear factor kappa-B (NF-κB). Furthermore, the down-regulation of mRNA levels of psoriasis-related pro-inflammatory cytokines, such as IL-17, interleukin 22 (IL-22), IL-23, interferon-α (IFN-α), and Interferon-γ (IFN-γ) was observed with the treatment of PO. All results show a concentration dependence of PO, with low concentrations showing the best results. These results suggest that PO effectively alleviated psoriasis-like skin lesions and down-regulated inflammatory responses, which indicates that PO could potentially be used for further studies on inflammation-related skin diseases such as psoriasis and for the treatment of psoriasis such as psoriasis natural plant essential oil resources.
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Löfvendahl S, Norlin JM, Schmitt-Egenolf M. Economic Burden of Generalized Pustular Psoriasis in Sweden: A Population-Based Register Study. Psoriasis (Auckl) 2022; 12:89-98. [PMID: 35548662 PMCID: PMC9084503 DOI: 10.2147/ptt.s359011] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Generalized pustular psoriasis (GPP), which can occur with or without psoriasis vulgaris (PV), is a severe form of pustular psoriasis with potentially life-threatening symptoms. GPP is also associated with several comorbidities, which further adds to the burden of disease. This study investigates the economic burden of disease in patients with GPP. Methods All-cause and GPP-specific healthcare resource use (inpatient stays, physician visits and drug use), as well as associated costs, were compared for year 2015 between GPP patients (n = 914) and two matched control groups representing the general population (n = 4047) and patients with PV but no GPP (n = 2556). Information on resource use for 2015 was obtained from the Swedish National Patient Register and Swedish Prescribed Drug Register, respectively. Results All-cause inpatient stays, physician visits, and use of psoriasis-related drugs were significantly more common among GPP patients compared to both control groups. This difference was reflected in total direct cost for GPP patients (5062 euros/year) which was 3.1 and 1.8 times higher (p < 0.001) compared to the general population and PV controls, respectively. For GPP patients, the share of total cost was 22% for all-cause physician outpatient visits and 40% for all-cause inpatient stays. However, only 6.3% and 11.3% of these costs, respectively, were due to GPP-specific problems. Psoriasis-related drugs constituted 27% of total costs for GPP patients of which a large fraction (86%) was represented by biologics. Conclusion This study demonstrates a higher economic burden for GPP patients compared to both the general population and patients with PV, with inpatient visits and use of biologic drugs as major cost driving factors. Only fractions of the costs for physician visits and inpatient stays were attributable to specific GPP problems, indicating a higher economic burden of GPP-consequences and complications.
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Affiliation(s)
| | - Jenny M Norlin
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
| | - Marcus Schmitt-Egenolf
- Department of Public Health and Clinical Medicine, Dermatology, Umeå University, Umeå, Sweden
- Correspondence: Marcus Schmitt-Egenolf, Department of Public Health and Clinical Medicine, Dermatology, Umeå university, Umeå, SE-901 85, Sweden, Tel +46 90 785 2875, Email
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Bhate C, Schwartz RA. Acrodermatitis continua of Hallopeau: historical perspectives and modern management. Ital J Dermatol Venerol 2022; 157:132-136. [PMID: 35391533 DOI: 10.23736/s2784-8671.21.07007-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Acrodermatitis continua of Hallopeau is a sterile pustular dermatosis primarily of the digits. Often considered a type of pustular psoriasis, it may be difficult to diagnose and even more difficult to treat. Initial involvement of a distal finger or toe may appear as erythema which should not be confused with the chilblains-like findings potentially associated with COVID-19 infection. We review the clinical manifestations of and explore potential therapeutic options for this uncommon, clinically striking dermatosis.
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Affiliation(s)
- Chinmoy Bhate
- Rutgers New Jersey Medical School, Unit of Dermatology, Newark, NJ, USA.,Rutgers New Jersey Medical School, Unit of Pathology, Newark, NJ, USA
| | - Robert A Schwartz
- Rutgers New Jersey Medical School, Unit of Dermatology, Newark, NJ, USA - .,Rutgers New Jersey Medical School, Unit of Pathology, Newark, NJ, USA
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A distinct immature low-density neutrophil population characterizes acute generalized pustular psoriasis. J Invest Dermatol 2022; 142:2831-2835.e5. [DOI: 10.1016/j.jid.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/15/2022]
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Kara Polat A, Alpsoy E, Kalkan G, Aytekin S, Uçmak D, Yasak Güner R, Topkarcı Z, Yılmaz O, Emre S, Borlu M, Türkoğlu Z, Özkök Akbulut T, Özaydın Yavuz G, Kaya Erdoğan H, Adışen E, Satılmış A, Oğuz Topal İ, Yazıcı S, Yılmaz E, Koku Aksu AE, Kartal SP, Deveci BN, Öksüm Solak E, Karadağ AS, Sarıkaya Solak S, Altunay İK, Türel Ermertcan A, Özkesici Kurt B, Kaçar NG, Ataseven A. Sociodemographic, Clinical, Laboratory, Treatment, and Prognostic Characteristics of 156 Generalized Pustular Psoriasis Patients in Turkey: A multicenter case series. J Eur Acad Dermatol Venereol 2022; 36:1256-1265. [DOI: 10.1111/jdv.18103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 03/14/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Asude Kara Polat
- University of Health Sciences Istanbul Training and Research Hospital Department of Dermatology Istanbul Turkey
| | - Erkan Alpsoy
- Akdeniz University Faculty of Medicine Department of Dermatology Antalya Turkey
| | - Göknur Kalkan
- Ankara Yıldırım Beyazıt University Faculty of Medicine Department of Dermatology Ankara Turkey
| | - Sema Aytekin
- University of Health Sciences Haydarpaşa Numune Training and Research Hospital Department of Dermatology Istanbul Turkey
| | - Derya Uçmak
- Dicle University Faculty of Medicine Department of Dermatology Diyarbakır Turkey
| | - Rukiye Yasak Güner
- Sivas Cumhuriyet University Faculty of Medicine Department of Dermatology Sivas Turkey
| | - Zeynep Topkarcı
- University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital Department of Dermatology Istanbul Turkey
| | - Oğuz Yılmaz
- Akdeniz University Faculty of Medicine Department of Dermatology Antalya Turkey
| | - Selma Emre
- Ankara Yıldırım Beyazıt University Faculty of Medicine Department of Dermatology Ankara Turkey
| | - Murat Borlu
- Erciyes University Faculty of Medicine Department of Dermatology Kayseri Turkey
| | - Zafer Türkoğlu
- Başakşehir Çam and Sakura City Hospital Department of Dermatology Istanbul Turkey
| | - Tuğba Özkök Akbulut
- University of Health Sciences Haseki Training and Research Hospital Department of Dermatology Istanbul Turkey
| | | | - Hilal Kaya Erdoğan
- Eskişehir Osmangazi University Faculty of Medicine Department of Dermatology Eskişehir Turkey
| | - Esra Adışen
- Gazi University Faculty of Medicine Department of Dermatology Ankara Turkey
| | - Ayşegül Satılmış
- Gazi University Faculty of Medicine Department of Dermatology Ankara Turkey
| | - İlteriş Oğuz Topal
- Prof. Dr. Cemil Taşcıoğlu City Hospital Department of Dermatology Istanbul Turkey
| | - Serkan Yazıcı
- Uludağ University Faculty of Medicine Department of Dermatology Bursa Turkey
| | - Ertan Yılmaz
- Akdeniz University Faculty of Medicine Department of Dermatology Antalya Turkey
| | - Ayşe Esra Koku Aksu
- University of Health Sciences Istanbul Training and Research Hospital Department of Dermatology Istanbul Turkey
| | - Selda Pelin Kartal
- University of Health Sciences Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital Department of Dermatology Ankara Turkey
| | - Beyza Nur Deveci
- University of Health Sciences Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital Department of Dermatology Ankara Turkey
| | - Eda Öksüm Solak
- Erciyes University Faculty of Medicine Department of Dermatology Kayseri Turkey
| | | | | | - İlknur Kıvanç Altunay
- University of Health Sciences Şişli Hamidiye Etfal Training and Research Hospital Department of Dermatology Istanbul Turkey
| | - Aylin Türel Ermertcan
- Manisa Celal Bayar University Faculty of Medicine Department of Dermatology Manisa Turkey
| | - Birgül Özkesici Kurt
- Adıyaman University Training and Research Hospital Department of Dermatology Adıyaman Turkey
| | - Nida Gelincik Kaçar
- Pamukkale University Faculty of Medicine Department of Dermatology Denizli Turkey
| | - Arzu Ataseven
- Necmettin Erbakan University Meram Faculty of Medicine Department of Dermatology Konya Turkey
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Wang L, Pan J, Jin H. Profiling and multivariate analysis of serum cytokines in patients with generalized pustular psoriasis. EUR J INFLAMM 2022. [DOI: 10.1177/20587392221076450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Generalized pustular psoriasis (GPP) is a chronic autoinflammatory disease characterized by fever, erythema, and sterile pustules occurring over large areas of the skin. The immunopathogenesis of GPP remains poorly understood. We aimed to profile serum cytokine levels in patients with GPP and analyze treatment-associated changes in cytokine levels. Methods: Twenty-four patients who were diagnosed with GPP and received drug treatment, together with 28 unaffected controls, were recruited in this study. Levels of 27 cytokines in serum samples from pre- and post-treated patients as well as unaffected controls were assessed using a Bio-Plex multiplex immunoassay. Multivariate analysis of cytokine levels and clinical parameters was conducted. Results: Serum levels of interleukins interleukin (IL)-1β, IL-1Ra, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12 (p70), IL-13, IL-17, granulocyte colony-stimulating factor (G-CSF), interferon-γ (IFN-γ), IFN-γ-induced protein 10 (IP-10), monocyte chemoattractant protein-1, tumor necrosis factor-α, and vascular endothelial growth factor were significantly elevated (p < .05) in patients with GPP compared with controls. Serum levels of IL-6, G-CSF, IL-8, IFN-γ, IL1-Ra, IL-10, IL-13, and IL-1β were correlated with GPP severity (r > 0.4, p < .001). Following treatment, serum levels of IL-6, IL-7, IL-12, IFN-γ, IL-1β, IL-4, IL-8, IL-10, IL-13, G-CSF, and IP-10 were significantly decreased (p < .05) compared with pretreatment levels. Among these cytokines, levels of IL-6, IL-7, IL-8, IL-12, IL-13, and IP-10 were reduced to normal levels. Conclusion: GPP patients exhibited markedly elevated levels of cytokines and chemokines involved in both type 1 and type 2 immune responses, suggesting hypercytokinemia occurs in GPP patients. IL-6 showed the strongest correlation with GPP disease severity and other clinical parameters such as CRP level and fever, thus representing an index for GPP severity. Our data comprehensively documented the cytokine profiles of GPP patients and may provide insights into GPP pathogenesis.
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Affiliation(s)
- Lingyan Wang
- Department of Dermatology, Beijing Jishuitan Hospital, Beijing, China
| | - Jing Pan
- Department of Dermatology, Beijing Jishuitan Hospital, Beijing, China
| | - Hongzhong Jin
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
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Megna M, Potestio L, di Caprio N, Tajani A, Fabbrocini G, Annunziata A. Acrodermatitis continua of Hallopeau: is apremilast an efficacious treatment option? Dermatol Ther 2022; 35:e15423. [PMID: 35261135 PMCID: PMC9285779 DOI: 10.1111/dth.15423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/31/2022] [Accepted: 03/05/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Nicola di Caprio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Andrea Tajani
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Gabriella Fabbrocini
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Alberto Annunziata
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II
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Duarte GV, Esteves de Carvalho AV, Romiti R, Gaspar A, Gomes de Melo T, Soares CP, Aguirre AR. Generalized pustular psoriasis in Brazil: A public claims database study. JAAD Int 2022; 6:61-67. [PMID: 35059660 PMCID: PMC8760386 DOI: 10.1016/j.jdin.2021.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 11/15/2022] Open
Abstract
Background Generalized pustular psoriasis (GPP) is a rare and severe phenotype of psoriasis characterized by sudden outbreak of widespread coalescent sterile pustules associated with a spectrum of systemic symptoms. Objective We aimed to describe the epidemiology and treatment of GPP in Brazil from the public health care system perspective. Methods This was a retrospective public claims database study, using outpatient and inpatient databases, with information from January 2018 to August 2020, based on records of health resource utilization by patients with GPP. Outpatient treatment regimens and fatal inpatient outcomes were described. Results In total, 1458 outpatients of all ages were identified, of whom 53% were women. We estimated the GPP prevalence in Brazil to be between 0.7 and 0.9 per 100,000. Acitretin was the most commonly dispensed drug. Of all the outpatients, 769 outpatients could be tracked in the inpatient database, and 151 had hospital admissions during the study period. Of them, 5.3% had a fatal outcome during hospitalization. A primary skin condition or an infection was the most frequent hospitalization cause. Limitation The International Classification of Diseases codes for GPP and psoriasis have not been previously validated in this context. Conclusion GPP is a rare disease in Brazil and affects individuals of all ages and both sexes. Hospitalizations and disease-related deaths highlight the need for its prompt diagnosis, close medical follow-up, and effective treatment.
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Affiliation(s)
| | | | - Ricardo Romiti
- Dermatology Division, University of São Paulo, São Paulo, Brazil
| | | | - Thaís Gomes de Melo
- Boehringer Ingelheim do Brasil - Avenida das Nações Unidas, São Paulo, Brazil
| | - Cinara Prata Soares
- Boehringer Ingelheim do Brasil - Avenida das Nações Unidas, São Paulo, Brazil
- Correspondence to: Cinara Prata Soares, MD, PhD, Avenida das Nações Unidas, 14171, Torre Marble 18° andar, São Paulo, SP 04794-000, Brazil.
| | - Anna Rita Aguirre
- Boehringer Ingelheim do Brasil - Avenida das Nações Unidas, São Paulo, Brazil
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Megna M, Abategiovanni L, Annunziata A, Torta G, Peduto T, Fabbrocini G, Lauro W. Generalized Pustular Psoriasis rapidly and successfully treated with Ixekizumab in a Caucasian patient. Dermatol Ther 2022; 35:e15382. [PMID: 35170168 PMCID: PMC9287034 DOI: 10.1111/dth.15382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Matteo Megna
- University of Naples Federico II, Section of Dermatology - Department of Clinical Medicine and Surgery
| | - Luisa Abategiovanni
- University of Naples Federico II, Section of Dermatology - Department of Clinical Medicine and Surgery
| | - Alberto Annunziata
- University of Naples Federico II, Section of Dermatology - Department of Clinical Medicine and Surgery
| | - Ginevra Torta
- University of Naples Federico II, Section of Dermatology - Department of Clinical Medicine and Surgery
| | - Tiziana Peduto
- University of Naples Federico II, Section of Dermatology - Department of Clinical Medicine and Surgery
| | - Gabriella Fabbrocini
- University of Naples Federico II, Section of Dermatology - Department of Clinical Medicine and Surgery
| | - Wanda Lauro
- University of Naples Federico II, Section of Dermatology - Department of Clinical Medicine and Surgery
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De Francesco MA, Caruso A. The Gut Microbiome in Psoriasis and Crohn’s Disease: Is Its Perturbation a Common Denominator for Their Pathogenesis? Vaccines (Basel) 2022; 10:vaccines10020244. [PMID: 35214702 PMCID: PMC8877283 DOI: 10.3390/vaccines10020244] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/29/2022] Open
Abstract
Psoriasis and inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), are interlinked. In fact, the prevalence of IBD is higher in patients with psoriasis, with a risk of ulcerative colitis of 1.6-times higher than in the general population. Analogously, patients with psoriasis have a greater risk of developing IBD. Furthermore, they share some clinical features and pathogenic mechanisms. Both are chronic inflammatory diseases with a relapsing-remitting condition that persists for the patient’s whole life and exhibit increased permeability of the mucosal barrier of skin and gut, allowing an increased interaction of pathogens with inflammatory receptors of the immune cells. A key element in the pathogenesis of these diseases is represented by the microbiota; in particular, the gut microbiota is an important driver of CD pathogenesis, while in psoriasis changes in gut and skin microbiota have been described without a defined pathogenic function. Furthermore, genetic predispositions or environmental factors contribute to disease manifestation, with a central role attributed to the immune responses and, in particular, to a dysregulated role played by T helper 17 cells both in psoriasis and IBD. The purpose of this review was to summarize present information about the links between psoriasis, inflammatory bowel disease, in particular Crohn’s disease, and changes in gut and/or skin microbiome.
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Parveen S, Ahmed M, Baboota S, Ali J. An Innovative Approach In Nanotechnology-Based Delivery System For The Effective Management Of Psoriasis. Curr Pharm Des 2022; 28:1082-1102. [PMID: 35105284 DOI: 10.2174/1381612828666220201141915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/30/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Psoriasis is an ineradicable, non-contagious inflammatory autoimmune skin disorder exhibiting abnormal redness of the skin and flaky patches which affect the exposed body surface. It is caused by negative signals produced by the immune system, leading to excessive growth and differentiation of keratinocytes and other inflammatory reactions on the skin. The topical route is primarily preferred in treating skin disorders due to the smaller size of the drug molecule, which allows them to cross the outer layer of the skin, i.e., stratum corneum, and permeate into the deep layer, unlike transdermal and other routes. The conventional topical treatments used in the past, such as coal tar, and dithranol leads to meager patient compliance due to decreased potency, and imperfect aesthetic. In contrast, systemic therapy such as methotrexate, cyclosporine, and acitretin produce related side effects. At present, various novel carriers like liposomes, ethosomes, niosomes, nanostructured lipid carriers, etc., have shown promising results to treat psoriasis. Therefore, this review primarily concentrates on the current advancements in novel carriers for various drugs to treat psoriasis topically. Area covered: The objective of this review describes the detailed study such as pathophysiology, epidemiology, types, causes, diagnosis, and topical treatment options for psoriasis, as well as the role of the nanotechnology-based delivery system to manage psoriasis.
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Affiliation(s)
- Shaheen Parveen
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, India
| | - Musheer Ahmed
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, India
| | - Sanjula Baboota
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, India
| | - Javed Ali
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, India
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Role of Interleukin 36 in Generalised Pustular Psoriasis and Beyond. Dermatol Ther (Heidelb) 2022; 12:315-328. [PMID: 35060076 PMCID: PMC8850521 DOI: 10.1007/s13555-021-00677-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Indexed: 12/30/2022] Open
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Löfvendahl S, Norlin JM, Schmitt-Egenolf M. Prevalence and incidence of generalised pustular psoriasis in Sweden - a population-based register study. Br J Dermatol 2022; 186:970-976. [PMID: 34978071 DOI: 10.1111/bjd.20966] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Generalised pustular psoriasis (GPP) is a severe form of pustular psoriasis with generalised eruption of sterile pustules, often along with systemic symptoms. There is a scarcity of population-based estimates of GPP prevalence and incidence. OBJECTIVES To estimate i) the prevalence and incidence of GPP in the Swedish general population and ii) the prevalence of psoriasis vulgaris within the GPP population. METHODS We identified cases (2004-2015) with one ICD-10 diagnostic code (base case) for GPP within the Swedish National Patient Register, which covers inpatient and outpatient secondary care. Cases were linked to the Swedish Total Population Register and the point prevalence was estimated as on 31 December 2015. In two alternative analyses we changed case definitions to: 1) requiring two visits (strict case 1), 2) requiring two visits of which one within dermatology/internal medicine (strict case 2). RESULTS The base case point prevalence of GPP was estimated to 9.1/100 000 (women=11.2, men=7.0) and the annual prevalence in 2015 was estimated to 1.53/100 000. Among the GPP population, 43% also had a psoriasis vulgaris code. The incidence of GPP in 2015 was estimated to 0.82/100 000 (women=0.93, men=0.74). The criteria used had an impact on prevalence and incidence estimates; prevalence strict case 1) 3.8/100 000 and incidence strict case 1) 0.42/100 000. CONCLUSIONS Results indicate that the estimated GPP population in Sweden is within the range of previous published estimates. However, the estimates were sensitive to employed GPP case criteria. The findings enhance demands for studies using validated diagnostic algorithms.
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Affiliation(s)
| | - Jenny M Norlin
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
| | - Marcus Schmitt-Egenolf
- Department of Public Health and Clinical Medicine, Dermatology, Umeå university, Umeå, Sweden
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Abstract
Generalized pustular psoriasis (GPP) is a rare, potentially life-threatening disease characterized by episodes of widespread sterile macroscopic pustules, with or without systemic inflammation and/or plaque psoriasis. Multiple GPP subtypes have been described, from acute GPP of von Zumbusch to milder, annular pustular psoriasis. Generalized pustular psoriasis mainly affects adults, with a female preponderance, but juvenile GPP also occurs. Flares are a hallmark of GPP and may occur de novo or be provoked by triggers, including withdrawal of systemic corticosteroids, infections, stress, pregnancy, and menstruation. Severity of flares varies widely between patients, and between flares in an individual patient. Significant flares are often accompanied by systemic symptoms, notably fever, general malaise, and extracutaneous manifestations such as arthritis, uveitis, and neutrophilic cholangitis. Common laboratory abnormalities include neutrophilia, elevated C-reactive protein levels, hypocalcemia, and abnormal liver function tests. The clinical course of GPP is highly variable; it can be a relapsing disease with recurrent flares and no pustulation between flares or a persistent disease with perpetual mild pustulation punctuated with flares of greater severity. Patients may have multiple flares per year or a flare every few years. Most flares last 2–5 weeks and approximately 50% require hospitalization. Life-threatening complications include sepsis and renal, hepatic, respiratory, and heart failure. Reported mortality rates are 2–16%.
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Shreya K, Asati D, Rout A, Lakshman A. Novel use of tofacitinib in the recalcitrant adult generalized pustular psoriasis. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2022. [DOI: 10.4103/ijdd.ijdd_23_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Abstract
Generalized pustular psoriasis (GPP) is a severe rare skin disease characterized by widespread eruption of sterile superficial macroscopic pustules with or without systemic inflammation. Generalized pustular psoriasis flares may lead to life-threatening multiorgan complications, which highlights the need for rapid and accurate diagnosis. However, the rarity of the disease and its heterogeneous cutaneous and extracutaneous symptoms, and the resemblance of symptoms to other skin conditions, pose considerable challenges to the timely diagnosis and treatment of patients with GPP. Current laboratory tests used for GPP diagnosis are generally not GPP specific, and are mainly focused on the assessment of inflammatory markers and clinical and histopathologic features of GPP, and emerging genetic screening approaches. A differential diagnosis to distinguish GPP from other similar conditions requires careful assessment of the patient’s skin symptoms, potential disease triggers, medical history, histopathologic features, laboratory tests, and clinical disease course. The comprehensive interpretation of these assessments can be challenging owing to the lack of standardized global guidelines. While there is currently a lack of standardized international guidelines for the diagnosis of GPP, recent advances in our understanding of the genetics and pathogenesis of the disease have provided new opportunities to enhance diagnosis. In the future, defining specific GPP subtypes using genetic and histopathologic strategies will guide therapeutic decisions, allowing patients to achieve their treatment goals without delay. In this article, we provide an overview of the current diagnostic methods, differential diagnostic strategies, and future advances in the diagnosis of GPP, as well as features of GPP variants.
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Affiliation(s)
| | - Melinda Gooderham
- SKiN Centre for Dermatology and Queen's University, Peterborough, ON, Canada
| | - Ricardo Romiti
- Department of Dermatology, University of São Paulo, São Paulo, Brazil
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The Effectiveness and Safety of Probiotic Supplements for Psoriasis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Preclinical Trials. J Immunol Res 2021; 2021:7552546. [PMID: 34938815 PMCID: PMC8687811 DOI: 10.1155/2021/7552546] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/05/2021] [Accepted: 10/15/2021] [Indexed: 12/15/2022] Open
Abstract
Background Patients with psoriasis need long-term medication to control their condition. Recent studies suggest that changing the intestinal flora may be a potential treatment. Methods The databases were utilized to search the randomized controlled trials (RCTs) and preclinical trials about probiotic supplement in the treatment of psoriasis. The retrieval time is from the establishment of these databases to December 2020. RevMan5.3 was used for the risk assessment of bias and meta-analysis. This systematic review was registered in PROSPERO (CRD42021232756). Results A total of 3 RCTs involving 164 participants were included. Two RCTs showed that probiotics can improve PASI and thereby improve the condition. For inflammation-related indicators, only one RCT showed that probiotics can improve the levels of CRP and TNF-α but have no obvious improvement effect on IL6. One RCT demonstrated the total effective rate of probiotics in the treatment of psoriasis. For adverse events, one RCT showed that the incidence of adverse events of probiotic treatment was low. Preclinical studies showed that continuous intervention with oral probiotics can significantly improve the progression of psoriasis and reduce the expression of inflammatory factors. The meta-analysis showed that the PASI between two groups was of no statistical significance (SMD 1.83 [-0.41, 4.07], P = 0.11). Meanwhile, probiotics may improve skin thickness (SMD -5.87 [-11.34, -0.41], P = 0.04) in animal model. Conclusion Prebiotics may have a positive effect on alleviating the clinical symptoms of psoriasis, but a large sample of RCTs is still needed to support its therapeutic effect in psoriasis.
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68
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Seervai RNH, Heberton M, Cho WC, Gill P, Murphy MB, Aung PP, Nagarajan P, Torres-Cabala CA, Patel AB, Ruiz-Bañobre J, Om A, Yamamoto T, Nikolaou V, Curry JL. Severe de novo pustular psoriasiform immune-related adverse event associated with nivolumab treatment for metastatic esophageal adenocarcinoma. J Cutan Pathol 2021; 49:472-481. [PMID: 34888886 DOI: 10.1111/cup.14185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/15/2021] [Accepted: 12/06/2021] [Indexed: 12/12/2022]
Abstract
Breakthrough targeted therapies have produced significant improvements in survival for cancer patients, but have a propensity to cause cutaneous immune-related adverse events (irAEs). Psoriasiform irAEs, representing about 4% of dermatologic toxicities associated with immune checkpoint inhibitor (ICI) therapy, are usually mild, occur in older patients and present as an exacerbation of existing psoriasis after several doses of ICI therapy. We report a case of a 58-year-old woman with metastatic esophageal adenocarcinoma and no prior history of psoriasis who developed a pustular psoriasiform irAE, beginning 3 days after initiation of nivolumab and progressing to confluent erythroderma with pustules over 2 weeks despite topical steroid use. She had concurrent acrodermatitis enteropathica, clinically diagnosed and confirmed with a low serum zinc level, that improved with supplementation. Her psoriasiform irAE was refractory to systemic steroids and acitretin, prompting discontinuation of nivolumab and treatment with ustekinumab and concomitant slow taper of acitretin and prednisone. Pustular psoriasiform irAE is a rare but severe dermatologic toxicity resulting from ICI therapy. Given the diverse morphologic types of cutaneous irAEs that can occur during ICI therapy, a clinical and histopathologic examination of dermatologic toxicities is critical to identify patients who may benefit from biologic therapy.
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Affiliation(s)
- Riyad N H Seervai
- Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas, USA.,Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas, USA.,Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
| | - Meghan Heberton
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Woo Cheal Cho
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pavandeep Gill
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mariela B Murphy
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anisha B Patel
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juan Ruiz-Bañobre
- Medical Oncology Department, University Clinical Hospital of Santiago de Compostela, CIBERONC, Santiago de Compostela, Santiago, Spain
| | - Amit Om
- Department of Dermatology, Florida State University, Tallahassee, Florida, USA
| | - Toshiyuki Yamamoto
- Dermartment of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Vasiliki Nikolaou
- Cutaneous Toxicities Clinic, Oncodermatology Department, "Andreas Sygros" Hospital for Skin Diseases, Athens, Greece
| | - Jonathan L Curry
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Daye M, Oltulu P. An AGEP case due to COVİD-19 or favipiravir or enoxaparin. J Cosmet Dermatol 2021; 21:13-15. [PMID: 34826196 DOI: 10.1111/jocd.14622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Munise Daye
- Department of Dermatology, Necmettin Erbakan University, Meram Medical School, Konya, Turkey
| | - Pembe Oltulu
- Department of Pathology, Necmettin Erbakan University, Meram Medical School, Konya, Turkey
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70
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Singh R, Koppu S, Perche PO, Feldman SR. The Cytokine Mediated Molecular Pathophysiology of Psoriasis and Its Clinical Implications. Int J Mol Sci 2021; 22:12793. [PMID: 34884596 PMCID: PMC8657643 DOI: 10.3390/ijms222312793] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/19/2021] [Accepted: 11/25/2021] [Indexed: 12/27/2022] Open
Abstract
Psoriasis is the result of uncontrolled keratinocyte proliferation, and its pathogenesis involves the dysregulation of the immune system. The interplay among cytokines released by dendritic, Th1, Th2, and Th17 cells leads to the phenotypical manifestations seen in psoriasis. Biological therapies target the cytokine-mediated pathogenesis of psoriasis and have improved patient quality of life. This review will describe the underlying molecular pathophysiology and biologics used to treat psoriasis. A review of the literature was conducted using the PubMed and Google Scholar repositories to investigate the molecular pathogenesis, clinical presentation, and current therapeutics in psoriasis. Plaque psoriasis', the most prevalent subtype of psoriasis, pathogenesis primarily involves cytokines TNF-α, IL-17, and IL-23. Pustular psoriasis', an uncommon variant, pathogenesis involves a mutation in IL-36RN. Currently, biological therapeutics targeted at TNF-α, IL-12/IL-23, IL-17, and IL-23/IL-39 are approved for the treatment of moderate to severe psoriasis. More studies need to be performed to elucidate the precise molecular pathology and assess efficacy between biological therapies for psoriasis. Psoriasis is a heterogenous, chronic, systemic inflammatory disease that presents in the skin with multiple types. Recognizing and understanding the underlying molecular pathways and biological therapeutics to treat psoriasis is important in treating this common disease.
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Affiliation(s)
- Rohan Singh
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA; (R.S.); (S.K.); (P.O.P.)
| | - Sindhuja Koppu
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA; (R.S.); (S.K.); (P.O.P.)
| | - Patrick O. Perche
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA; (R.S.); (S.K.); (P.O.P.)
| | - Steven R. Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA; (R.S.); (S.K.); (P.O.P.)
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
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71
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Romiti R, Hirayama ALDS, Arnone M, Magalhães RF. Generalized pustular psoriasis (von Zumbusch). An Bras Dermatol 2021; 97:63-74. [PMID: 34838431 PMCID: PMC8799844 DOI: 10.1016/j.abd.2021.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/03/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022] Open
Abstract
Generalized pustular psoriasis (von Zumbusch) is a rare and acute eruption characterized by multiple sterile pustules over an erythematous and edematous background, eventually associated with psoriasis vulgaris. Classically, it manifests as a potentially severe systemic picture and demands prompt diagnosis and intervention. The duration of each flare-up and intervals between the pustular episodes is extremely variable. Recently, genetic abnormalities have been identified mainly in the familial and early variants of this disease. The therapeutic arsenal is limited; however, new drugs being evaluated aim to control both pustular flare-ups and disease recurrences.
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Affiliation(s)
- Ricardo Romiti
- Department of Dermatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - André Luís da Silva Hirayama
- Department of Dermatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Marcelo Arnone
- Department of Dermatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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72
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Yan BX, Chen XY, Ye LR, Chen JQ, Zheng M, Man XY. Cutaneous and Systemic Psoriasis: Classifications and Classification for the Distinction. Front Med (Lausanne) 2021; 8:649408. [PMID: 34722555 PMCID: PMC8548430 DOI: 10.3389/fmed.2021.649408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 09/16/2021] [Indexed: 12/23/2022] Open
Abstract
Psoriasis is a chronic multisystem inflammatory disease that affects ~0.1–1.5% of the world population. The classic cutaneous manifestation of psoriasis is scaly erythematous plaques, limited or widely distributed. Moreover, psoriasis could be associated with comorbidities like psoriatic arthritis, metabolic syndrome, diabetes, cardiovascular disease, nephropathy, bowel disease, and brain diseases. In this review, we suggest that psoriasis should be classified as cutaneous psoriasis or systemic psoriasis and propose the classification for distinction. This would help to better understand and manage psoriasis.
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Affiliation(s)
- Bing-Xi Yan
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xue-Yan Chen
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li-Ran Ye
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jia-Qi Chen
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Min Zheng
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Yong Man
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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73
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Management of pediatric generalized pustular psoriasis using biologics: An evidence-based review. J Am Acad Dermatol 2021; 87:484-486. [PMID: 34695531 DOI: 10.1016/j.jaad.2021.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/06/2021] [Accepted: 10/07/2021] [Indexed: 11/21/2022]
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74
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Hadeler E, Mosca M, Hong J, Brownstone N, Liao W, Bhutani T, Shinkai K. Inpatient Management of Psoriasis: A Current Perspective and Update for Clinicians. CURRENT DERMATOLOGY REPORTS 2021. [DOI: 10.1007/s13671-021-00342-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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75
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Yu N, Peng C, Chen W, Sun Z, Zheng J, Zhang S, Ding Y, Shi Y. Circulating Metabolomic Signature in Generalized Pustular Psoriasis Blunts Monocyte Hyperinflammation by Triggering Amino Acid Response. Front Immunol 2021; 12:739514. [PMID: 34567002 PMCID: PMC8455999 DOI: 10.3389/fimmu.2021.739514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Generalized pustular psoriasis (GPP), the most grievous variant of psoriasis, is featured by dysregulated systemic inflammatory response. The cellular and molecular basis of GPP is poorly understood. Blood monocytes are key players of host defense and producers of inflammatory cytokines including IL-1β. How the immune response of monocytes is affected by metabolic internal environment in GPP remains unclear. Here, we performed a metabolomic and functional investigation of GPP serum and monocytes. We demonstrated a significant increase in IL-1β production from GPP monocytes. In GPP circulation, serum amyloid A (SAA), an acute-phase reactant, was dramatically increased, which induced the release of IL-1β from monocytes in a NLRP3-dependent manner. Using metabolomic analysis, we showed that GPP serum exhibited an amino acid starvation signature, with glycine, histidine, asparagine, methionine, threonine, lysine, valine, isoleucine, tryptophan, tyrosine, alanine, proline, taurine and cystathionine being markedly downregulated. In functional assay, under amino acid starvation condition, SAA-stimulated mature IL-1β secretion was suppressed. Mechanistically, at post-transcriptional level, amino acid starvation inhibited the SAA-mediated reactive oxygen species (ROS) formation and NLRP3 inflammasome activation. Moreover, the immune-modulatory effect of amino acid starvation was blocked by silencing general control nonderepressible 2 kinase (GCN2), suggesting the involvement of amino acid response (AAR) pathway. Collectively, our results suggested that decreased serum amino acids in GPP blunted the innate immune response in blood monocytes through AAR pathway, serving as a feedback mechanism preventing excessive inflammation in GPP.
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Affiliation(s)
- Ning Yu
- Department of Dermatology, Shanghai Skin Disease Hospital, Institute of Psoriasis, Tongji University, Shanghai, China
| | - Chen Peng
- Department of Dermatology, Shanghai Skin Disease Hospital, Institute of Psoriasis, Tongji University, Shanghai, China
| | - Wenjuan Chen
- Department of Dermatology, Shanghai Skin Disease Hospital, Institute of Psoriasis, Tongji University, Shanghai, China
| | - Ziwen Sun
- Department of Dermatology, Shanghai Skin Disease Hospital, Institute of Psoriasis, Tongji University, Shanghai, China
| | - Jianfeng Zheng
- Department of Dermatology, Shanghai Skin Disease Hospital, Institute of Psoriasis, Tongji University, Shanghai, China
| | - Shujie Zhang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yangfeng Ding
- Department of Dermatology, Shanghai Skin Disease Hospital, Institute of Psoriasis, Tongji University, Shanghai, China
| | - Yuling Shi
- Department of Dermatology, Shanghai Skin Disease Hospital, Institute of Psoriasis, Tongji University, Shanghai, China
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76
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Bromley M, Marsh S, Layton A. Life-threatening skin conditions presenting to critical care. BJA Educ 2021; 21:376-383. [PMID: 34567792 DOI: 10.1016/j.bjae.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - S Marsh
- Harrogate District Hospital, Harrogate, UK
| | - A Layton
- Harrogate District Hospital, Harrogate, UK
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77
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Sussman M, Napodano A, Huang S, Are A, Hsu S, Motaparthi K. Pustular Psoriasis and Acute Generalized Exanthematous Pustulosis. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1004. [PMID: 34684041 PMCID: PMC8538083 DOI: 10.3390/medicina57101004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/12/2021] [Accepted: 09/16/2021] [Indexed: 01/15/2023]
Abstract
The similarity between pustular psoriasis (PP) and acute generalized exanthematous pustulosis (AGEP) poses problems in the diagnosis and treatment of these two conditions. Significant clinical and histopathologic overlap exists between PP and AGEP. PP is an inflammatory disorder that has numerous clinical subtypes, but all with sterile pustules composed of neutrophils. AGEP is a severe cutaneous adverse reaction that is also characterized by non-follicular sterile pustules. Clinical features that suggest a diagnosis of PP over AGEP include a history of psoriasis and the presence of scaling plaques. Histologically, eosinophilic spongiosis, vacuolar interface dermatitis, and dermal eosinophilia favor a diagnosis of AGEP over PP. Importantly, PP and AGEP vary in clinical course and treatment. PP treatment involves topical steroids, oral retinoids, and systemic immunosuppressants. Newer therapies targeting IL-36, IL-23, IL-1, and PDE-4 have been investigated. The removal of the offending agent is a crucial part of the treatment of AGEP.
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Affiliation(s)
- Morgan Sussman
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; (M.S.); (S.H.); (S.H.)
| | - Anthony Napodano
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL 32610, USA;
| | - Simo Huang
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; (M.S.); (S.H.); (S.H.)
| | - Abhirup Are
- College of Medicine, University of Florida, Gainesville, FL 32606, USA;
| | - Sylvia Hsu
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; (M.S.); (S.H.); (S.H.)
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL 32610, USA;
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79
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Lv M, Shao J, Jiang F, Liu J. Curcumol may alleviate psoriasis-like inflammation by inhibiting keratinocyte proliferation and inflammatory gene expression via JAK1/STAT3 signaling. Aging (Albany NY) 2021; 13:18392-18403. [PMID: 34314383 PMCID: PMC8351666 DOI: 10.18632/aging.203287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/14/2021] [Indexed: 12/16/2022]
Abstract
Psoriasis is a chronic inflammatory skin disease characterized by abnormal proliferation and differentiation of keratinocytes. Since curcumol exhibits anti-inflammatory properties in various diseases, we investigated its anti-inflammatory potential in stimulated human keratinocytes. Our data show that curcumol significantly inhibits proliferation and induces cell cycle arrest in NHEK cells stimulated with proinflammatory cytokines (IL-1α, IL-17A, IL-22, oncostatin M, and TNF-α; mix M5). In addition, curcumol markedly ameliorates inflammatory response and promotes differentiation of M5-stimulated NHEK cells. Curcumol inhibits activity of JAK1, resulting in the inhibition of STAT3, downregulation of cyclin D2, and cell cycle arrest in stimulated NHEK cells. Together, our data show that curcumol reduces proliferation and inflammatory gene expression in stimulated keratinocytes by inhibiting the JAK1/STAT3 signaling, suggesting that it might serve as a potential therapeutic option for the treatment of psoriasis.
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Affiliation(s)
- Mingfen Lv
- Department of Dermatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, P.R. China
| | - Junyi Shao
- Department of Dermatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, P.R. China
| | - Fan Jiang
- Department of Dermatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, P.R. China
| | - Jingjing Liu
- Department of Dermatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, P.R. China
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80
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Liu Y, Cui ZY, Bao J, Zhang XL, Guo Y, Su MJ, Han JW. Metabolic syndrome-related SNPs in HLA and TNF7L2 may be risk factors for generalized pustular psoriasis in Chinese Han population. SKIN HEALTH AND DISEASE 2021; 1:e18. [PMID: 35664972 PMCID: PMC9060112 DOI: 10.1002/ski2.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 11/09/2022]
Abstract
Background Generalized pustular psoriasis (GPP) is a rare and severe type of psoriasis. Previous studies have reported that metabolic syndrome and its components have been associated with psoriasis. Objective To investigate the association of metabolic syndrome‐related single‐nucleotide polymorphisms (SNPs) and GPP in Chinese Han population. Materials and Methods One hundred and thirty‐six (136) GPP patients and 965 healthy controls were recruited in the study. Approximately, 4 ml peripheral venous blood was collected from each participant. After collection, second‐generation sequencing was used to detect genetic polymorphism of 15 SNPs. The plink 1.07 software package was used for statistical analysis. Results Rs805303 (p = 0.01, OR = 0.70) and rs3177928 (p = 3.18E−07, OR = 2.66) in HLA were significantly different between the two groups. Moreover, rs4506565 (p = 1.41E−03, OR = 2.72) and rs7901695 (p = 9.39E−04, OR = 2.82) in TCF7L2 were significantly associated with GPP in patients without a previous history of PsV. Genotype analysis of rs4506565 and rs7901695 showed that under the recessive model, genotype frequencies of rs4506565 (p = 0.00, OR = 18.52) and rs7901695 (p = 0.00, OR = 18.44) were significantly different between GPP patients and healthy controls. Conclusion Rs805303 and rs3177928 in HLA may increase the risk of GPP in the Chinese Han population. TCF7L2 may be a risk factor for GPP in patients without a previous history of PsV.
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Affiliation(s)
- Y Liu
- Department of Dermatology Affiliated Hospital of Inner Mongolia Medical University Hohhot Inner Mongolia China
| | - Z-Y Cui
- Department of Dermatology Affiliated Hospital of Inner Mongolia Medical University Hohhot Inner Mongolia China
| | - J Bao
- Department of Dermatology Affiliated Hospital of Inner Mongolia Medical University Hohhot Inner Mongolia China
| | - X-L Zhang
- Department of Dermatology Affiliated Hospital of Inner Mongolia Medical University Hohhot Inner Mongolia China
| | - Y Guo
- Department of Dermatology Affiliated Hospital of Inner Mongolia Medical University Hohhot Inner Mongolia China
| | - M-J Su
- Department of Dermatology Affiliated Hospital of Inner Mongolia Medical University Hohhot Inner Mongolia China
| | - J-W Han
- Department of Dermatology Affiliated Hospital of Inner Mongolia Medical University Hohhot Inner Mongolia China
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Abstract
Risankizumab is a humanized immunoglobulin (Ig) G1 monoclonal antibody developed and approved for the treatment of moderate-to-severe plaque psoriasis at a dose of 150 mg administered subcutaneously at weeks 0 and 4, and every 12 weeks thereafter. Ongoing trials are investigating the use of risankizumab in other inflammatory autoimmune diseases. Risankizumab exhibits linear pharmacokinetics when administered intravenously (0.01 mg/kg–1200 mg) or subcutaneously (0.25 mg/kg–300 mg), with a long terminal half-life of approximately 28 days. Following subcutaneous administration, peak plasma concentration was reached approximately 3–14 days after dosing, with an estimated bioavailability of 89%. Population pharmacokinetic analyses identified bodyweight, high titers of antidrug antibodies occurring in < 2% of evaluated subjects, baseline serum albumin, baseline high-sensitivity C-reactive protein, and baseline serum creatinine to be statistically correlated with risankizumab clearance, but none of them had a clinically meaningful impact on risankizumab efficacy in psoriasis patients following the clinical dosing regimen. Exposure–response analyses in psoriasis patients demonstrated that the maximum efficacy was achieved with the clinically approved regimen and there was no apparent correlation between risankizumab exposure and safety. A dedicated drug interaction cocktail study in patients with psoriasis demonstrated a lack of therapeutic protein–drug interaction potentials for risankizumab and various cytochrome P450 substrates. In this article, we review the clinical pharmacology data available to date for risankizumab, which supported the clinical development program and ultimately regulatory approvals for risankizumab in the treatment of patients with moderate-to-severe plaque psoriasis.
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82
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Griffiths CEM, Armstrong AW, Gudjonsson JE, Barker JNWN. Psoriasis. Lancet 2021; 397:1301-1315. [PMID: 33812489 DOI: 10.1016/s0140-6736(20)32549-6] [Citation(s) in RCA: 824] [Impact Index Per Article: 274.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/07/2020] [Accepted: 11/13/2020] [Indexed: 12/19/2022]
Abstract
Psoriasis is a common, chronic papulosquamous skin disease occurring worldwide, presenting at any age, and leading to a substantial burden for individuals and society. It is associated with several important medical conditions, including depression, psoriatic arthritis, and cardiometabolic syndrome. Its most common form, chronic plaque or psoriasis vulgaris, is a consequence of genetic susceptibility, particularly in the presence of the HLA-C*06:02 risk allele, and of environmental triggers such as streptococcal infection, stress, smoking, obesity, and alcohol consumption. There are several phenotypes and research has separated pustular from chronic plaque forms. Immunological and genetic studies have identified IL-17 and IL-23 as key drivers of psoriasis pathogenesis. Immune targeting of these cytokines and of TNFα by biological therapies has revolutionised the care of severe chronic plaque disease. Psoriasis cannot currently be cured, but management should aim to minimise physical and psychological harm by treating patients early in the disease process, identifying and preventing associated multimorbidity, instilling lifestyle modifications, and employing a personalised approach to treatment.
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Affiliation(s)
- Christopher E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester, UK.
| | - April W Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Jonathan N W N Barker
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, London, UK
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83
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Post H, Magnolo N, Böhm M. [Successful treatment of generalized pustular psoriasis with certolizumab]. Hautarzt 2021; 72:992-995. [PMID: 33687481 DOI: 10.1007/s00105-021-04784-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 11/28/2022]
Abstract
Generalized pustular psoriasis is a rare, often relapsing and usually severe inflammatory skin disease with concomitant systemic symptoms in many cases. The disease is in part due to mutations in the gene of the interleukin-36 receptor antagonist (IL36RN) explaining the autoinflammatory nature of this condition. Here, we report on a 39-year-old pregnant woman who stopped her medication with secukinumab due to her pregnancy. Subsequently, she suffered from severe exacerbation of her disease and was admitted to our hospital. The patient had a known mutation in the IL36RN (Ser113Leu) gene. At the 33rd week of her pregnancy therapy with certolizumab was initiated and resulted in a rapid remission within a few weeks. After the patient gave birth, remission could be maintained under the given therapy with this biologic.
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Affiliation(s)
- Hannah Post
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
| | - Nina Magnolo
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
| | - Markus Böhm
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland.
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84
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Kromer C, Loewe E, Schaarschmidt ML, Pinter A, Gerdes S, Herr R, Poortinga S, Moessner R, Wilsmann-Theis D. Drug survival in the treatment of generalized pustular psoriasis: A retrospective multicenter study. Dermatol Ther 2021; 34:e14814. [PMID: 33497511 DOI: 10.1111/dth.14814] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/10/2021] [Accepted: 01/20/2021] [Indexed: 01/03/2023]
Abstract
Generalized pustular psoriasis (GPP) is a rare, potentially life-threatening inflammatory skin disease. Our aim was to assess patient and disease characteristics and analyze drug survival rates in the treatment of GPP in a real-life setting. In this retrospective study, 201 treatment series of 86 patients with GPP treated at five University Medical Centers were analyzed. Overall, excellent response was reached in 41.3% of all treatment courses, partial response in 31.4%, and nonresponse in 27.3%. Biological treatment was significantly more effective than non-biological therapies (excellent response: 47.4% vs 35.9%; P = .02). Overall, the median drug survival was 14.0 months (biologicals: 36.0 months vs nonbiologicals: 6.0 months; P < .001). The crude probability of survival was highest for secukinumab (hazard ratio [HR] of drug discontinuation compared with acitretin: 0.22), followed by ixekizumab and ustekinumab (HR: 0.38 each), adalimumab (HR: 0.59), etanercept (HR: 0.62), infliximab (HR: 0.69), cyclosporine (HR: 1.00), acitretin (reference for HR), fumaric acid esters (HR: 1.06), methotrexate (HR: 1.26), and apremilast (HR: 3.44); no drug discontinuation with guselkumab. Our results reveal high efficacy and drug survival, particularly for IL-17 and IL-(12)/23 antagonists. Thus, these biologics may be considered early in the therapeutic algorithm of GPP.
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Affiliation(s)
- Christian Kromer
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany
| | - Emilia Loewe
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany
| | | | - Andreas Pinter
- Department of Dermatology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Sascha Gerdes
- Psoriasis-Center, Department of Dermatology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Raphael Herr
- Mannheim Institute of Public Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sietske Poortinga
- Department of Dermatology and Allergy, University Bonn, Bonn, Germany
| | - Rotraut Moessner
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany
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85
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Inoue S, Watanabe R, Ishitsuka Y, Nakamura Y, Fujisawa Y, Okiyama N, Fujimoto M. Successful Treatment of Acrodermatitis Continua of Hallopeau with an Anti-IL-17A Agent. Indian J Dermatol 2021; 66:225. [PMID: 34188305 PMCID: PMC8208285 DOI: 10.4103/ijd.ijd_584_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sae Inoue
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. E-mail:
| | - Rei Watanabe
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. E-mail:
| | - Yosuke Ishitsuka
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. E-mail:
| | - Yoshiyuki Nakamura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. E-mail:
| | - Yasuhiro Fujisawa
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. E-mail:
| | - Naoko Okiyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. E-mail:
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. E-mail:
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86
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Nowowiejska J, Baran A, Flisiak I. Mutual Relationship Between Sleep Disorders, Quality of Life and Psychosocial Aspects in Patients With Psoriasis. Front Psychiatry 2021; 12:674460. [PMID: 34295272 PMCID: PMC8290261 DOI: 10.3389/fpsyt.2021.674460] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/08/2021] [Indexed: 12/13/2022] Open
Abstract
Psoriasis is a chronic, autoimmune skin disease affecting about 2-4% of the worldwide population. It is now perceived as a systemic disease because of the complex pathogenesis and multiple comorbidities. It leads to decreased quality of life and productivity of patients. Nowadays, sleep disorders are investigated as well in relation to psoriasis as another possible comorbidity. This review focuses on possible negative effects of sleep deprivation, decreased quality of life, and psychosocial status in patients with psoriasis and highlights their mutual, complex relationship of divergent consequences. The relationship between sleep disorders and psychosocial status in patients with psoriasis is bidirectional and resembles a vicious circle, one abnormality triggering the other. Sleep disorders additionally increase the risk of metabolic and psychiatric diseases in psoriatic patients who are already at increased risk of developing such disorders. There should be measures taken to screen patients with psoriasis for sleep disorders in order to diagnose early and treat.
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Affiliation(s)
- Julia Nowowiejska
- Department of Dermatology and Venereology, Medical University of Bialystok, Bialystok, Poland
| | - Anna Baran
- Department of Dermatology and Venereology, Medical University of Bialystok, Bialystok, Poland
| | - Iwona Flisiak
- Department of Dermatology and Venereology, Medical University of Bialystok, Bialystok, Poland
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87
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Wang H, Wang S, Li L, Wang X, Liu C, Lu M, Xia Y, Liu Y. Involvement of the cytokine TWEAK in the pathogenesis of psoriasis vulgaris, pustular psoriasis, and erythrodermic psoriasis. Cytokine 2020; 138:155391. [PMID: 33302223 DOI: 10.1016/j.cyto.2020.155391] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/01/2020] [Accepted: 11/26/2020] [Indexed: 12/25/2022]
Abstract
Psoriasis is a common chronic inflammatory dermatitis in which various cytokines play a detrimental role. The cytokine tumor necrosis factor-related weak inducer of apoptosis (TWEAK) is involved in the pathogenesis of multiple inflammatory disorders. However, the potential role of TWEAK in various subtypes of psoriasis has not been studied in depth. To investigate whether the levels of TWEAK are associated with clinical traits and the levels of some known psoriasis-related cytokines, such as interleukin (IL)-17A, IL-22, interferon (IFN)-γ, and IL-36γ, 20 patients with psoriasis vulgaris (PV), 8 patients with pustular psoriasis (PP), 8 patients with erythrodermic psoriasis (EP), and 20 healthy controls (HCs) were recruited into this study. The levels of serum cytokines were detected by commercial enzyme-linked immunosorbent assay kits. The average levels of TWEAK, IL-17A, IL-22, IFN-γ, and IL-36γ were significantly higher in the psoriasis groups than in the HC group. Furthermore, there was a statistically significant correlation between TWEAK and IL-17A/IFN-γ in PV and IL-36γ in EP, but there was no correlation between TWEAK and IL-22 in any subtype of psoriasis. This study suggests that TWEAK may have a role in the pathogenesis of PV, PP, and EP via synergy with IL-17A, IFN-γ, or IL-36γ, but not with IL-22.
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Affiliation(s)
- Huixia Wang
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Sijia Wang
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Liang Li
- Department of Thoracic Surgery, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xiuying Wang
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Chengfei Liu
- Cancer Centre, The Second Hospital of Shandong University, Jinan, China
| | - Mei Lu
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yumin Xia
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
| | - Yale Liu
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
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88
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Taguchi R, Takamura S, Teraki Y. Combination therapy with biologic and colchicine for generalized pustular psoriasis. Int J Dermatol 2020; 59:e400-e402. [PMID: 32492187 DOI: 10.1111/ijd.14959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/13/2020] [Accepted: 04/28/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Ryokichi Taguchi
- Department of Dermatology, Saitama Medical University, Saitama Medical Center, Saitama, Japan
| | - Saori Takamura
- Department of Dermatology, Saitama Medical University, Saitama Medical Center, Saitama, Japan
| | - Yuichi Teraki
- Department of Dermatology, Saitama Medical University, Saitama Medical Center, Saitama, Japan
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89
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Latour-Álvarez I, Torrelo A. Cutaneous clues to diagnose autoinflammatory diseases. GIORN ITAL DERMAT V 2020; 155:551-566. [PMID: 33070568 DOI: 10.23736/s0392-0488.20.06652-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systemic autoinflammatory diseases (AIDs) are a group of disorders characterized by recurrent episodes of systemic inflammation. Suspecting the diagnosis can be difficult and many of the clinical manifestations are common to different diseases. Although most of the cutaneous manifestations are non-specific, it is important to know them because sometimes they can lead to the diagnosis. The purpose of this review was to synthesize the main cutaneous lesions of autoinflammatory diseases to aid in their diagnosis.
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Affiliation(s)
| | - Antonio Torrelo
- Department of Dermatology, Niño Jesús University Hospital, Madrid, Spain -
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90
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Zhang Y, Zhang H, Jiang B, Yan S, Lu J. A promising therapeutic target for psoriasis: Neuropeptides in human skin. Int Immunopharmacol 2020; 87:106755. [PMID: 32736190 DOI: 10.1016/j.intimp.2020.106755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/04/2020] [Accepted: 06/26/2020] [Indexed: 11/29/2022]
Abstract
Psoriasis is a chronic inflammatory skin disease featured by excessive proliferation of keratinocytes, clearly defined round erythema and dry, scaly plaques, long-term inflammatory cells infiltration in skin lesions. However, the physiopathological mechanism of psoriasis is still not clearly understood. Neuropeptides, a class of peptides secreted by the nervous system, may play important roles in promoting excessive proliferation of keratinocyte, enhancing angiogenesis, vasodilation, plasma extravasation and chemotaxis of inflammatory cells during the development of psoriasis. To understand the pathogenesis of neuropeptides in psoriasis, we summarized the function of several common neuropeptides in psoriasis and hypothesize neuropeptides may serve as therapeutic potential novel targets in psoriasis.
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Affiliation(s)
- Yue Zhang
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Hanyi Zhang
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Boyue Jiang
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Siyu Yan
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Jianyun Lu
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
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91
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Abstract
INTRODUCTION Pustular psoriasis is a group of skin diseases characterized by neutrophil infiltration in the epidermis and formation of sterile pustules. Conventional treatments, such as retinoids and immunosuppressive drugs, have improved the clinical manifestations; however, many patients suffer from drug-related toxicity or are resistant to therapy. AREAS COVERED In this review, the authors focus on the efficacy and safety of these biologics, including anti-IL-1β (gevokizumab and canakinumab), anti-IL-1 R (anakinra), anti-IL-36 R (BI 655130), anti-tumor necrosis factor-α (etanercept, infliximab, and adalimumab), anti-IL-12/23 (ustekinumab), anti-IL-17A (secukinumab and ixekizumab), anti-IL-17RA (brodalumab), anti-IL-2 R (basiliximab), anti-IL-6 R (tocilizumab), and anti-IL-23 (risankizumab and guselkumab), for treating pustular psoriasis. EXPERT OPINION Patients with pustular psoriasis treated with biologics demonstrated positive responses. Anti-TNF-α is the most available biologics for the treatment of pustular psoriasis, and anti-IL-12/23 and anti-IL-17A might be considered as the first- or second-line therapy for moderate-to-severe and refractory pustular psoriasis. Anti-IL-17A can be used in the pustular psoriasis patients who failed to respond to anti-TNF agents and anti-IL-12/23. Therapeutic efficacy of biologics in pustular psoriasis might have no association with IL-36 RN mutation status.
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Affiliation(s)
- Wen-Ming Wang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Hong-Zhong Jin
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
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92
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Noguchi N, Sato T, Adachi H, Nagai T, Tomura Y, Toyoshima A, Takahashi T, Manabe M, Osada SI. Infant case of generalized pustular psoriasis preceded by interstitial lung disease. J Dermatol 2020; 47:e322-e324. [PMID: 32594579 DOI: 10.1111/1346-8138.15465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Natsuko Noguchi
- Departments of, Department of, Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Takahiko Sato
- Departments of, Department of, Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroyuki Adachi
- Department of, Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Takuya Nagai
- Departments of, Department of, Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yayoi Tomura
- Departments of, Department of, Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Aya Toyoshima
- Departments of, Department of, Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Tsutomu Takahashi
- Department of, Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Motomu Manabe
- Departments of, Department of, Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Shin-Ichi Osada
- Departments of, Department of, Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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93
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Watanabe T, Yamaguchi Y, Watanabe Y, Takamura N, Aihara M. Increased level of high mobility group box 1 in the serum and skin in patients with generalized pustular psoriasis. J Dermatol 2020; 47:1033-1036. [PMID: 32613742 DOI: 10.1111/1346-8138.15467] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/07/2020] [Accepted: 05/20/2020] [Indexed: 12/21/2022]
Abstract
High-mobility group box 1 (HMGB-1) is a highly abundant pro-inflammatory protein associated with the pathogenesis of inflammatory and autoimmune diseases. HMGB-1 expression level increases in patients with psoriasis vulgaris (PV). However, HMGB-1 expression in patients with generalized pustular psoriasis (GPP) is unknown. In this study, we investigated HMGB-1 expression in GPP. HMGB-1 expression levels were examined in the skin and serum of patients with GPP, PV, atopic dermatitis (AD) and healthy controls (HC) using enzyme-linked immunosorbent assay and immunohistochemistry. The elevation in HMGB-1 expression was significantly higher in GPP patients than in PV, AD and HC patients. In addition, patients with GPP had elevated serum HMGB-1 levels compared with those with AD and HC. Furthermore, serum HMGB-1 levels were significantly decreased after systemic treatment. In the correlation analysis, a significant positive correlation was detected between serum HMGB-1 levels and the Japanese severity score for GPP. HMGB-1 may be involved in the pathogenesis of GPP and can be useful to evaluate disease severity and the effectiveness of GPP treatment.
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Affiliation(s)
- Tomoya Watanabe
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yukie Yamaguchi
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yuko Watanabe
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Naoko Takamura
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Michiko Aihara
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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94
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Schwartz RA, Janniger CK. Generalized pustular figurate erythema: A newly delineated severe cutaneous drug reaction linked with hydroxychloroquine. Dermatol Ther 2020; 33:e13380. [PMID: 32253799 PMCID: PMC7235477 DOI: 10.1111/dth.13380] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 12/19/2022]
Abstract
A severe cutaneous drug reaction resembling acute generalized exanthematous pustulosis resulting from ingestion of hydroxychloroquine has been documented. It is distinguishable by its longer incubation period, more varied morphology with initially urticarial and later targetoid and arcuate plaques, recalcitrance to therapy and longer duration. Given the anticipated surge in the use of hydroxychloroquine due to its reported benefits in those with coronavirus disease 2019, specific recognition of this entity is pivotal. We delineate it as generalized pustular figurate erythema.
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95
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Takeichi T, Akiyama M. Generalized Pustular Psoriasis: Clinical Management and Update on Autoinflammatory Aspects. Am J Clin Dermatol 2020; 21:227-236. [PMID: 31813117 DOI: 10.1007/s40257-019-00492-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Generalized pustular psoriasis (GPP) is a chronic, systemic inflammatory disease accompanied by high fever and general malaise. Diffuse erythema and swelling of the extremities occur, with multiple sterile pustules all over the body in GPP patients. GPP often relapses over the lifetime and can be life-threatening. Recent discoveries of the underlying molecular genetic basis of many cases of this disorder have provided major advances to clinicians and researchers towards an understanding of the pathomechanism of GPP. However, the therapeutic management of GPP still faces many challenges and much uncertainty, and an evidence-based review summarizing the available clinical data on the management of this heterogeneous disease is needed. The present review addresses challenges regarding the precise clinical diagnosis and evaluation of clinical symptoms in GPP. In addition, we update and briefly summarize the current understanding of molecular pathomechanisms behind GPP as an autoinflammatory keratinization disease. Recent publications have clarified the genetic backgrounds of patients with GPP and ethnic differences in predisposing factors. Although there are ethnic differences in the prevalences of these pathogenic alleles, from recent reports, at most 60.5% (IL36RN), 5.9% (CARD14), and 10.8% (AP1S3) of GPP patients have the mutations/variations of these genes. All the reported biologics studied seemed effective and relatively well tolerated. Although it is difficult to evaluate therapeutic efficacy from studies on just a few cases, recent findings suggest that biologics can be a useful, powerful tool for controlling skin and systemic inflammation in GPP and for improving the quality of life of GPP patients.
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96
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Yu N, Li Y, Ding Y, Shi Y. Combination therapy with acitretin and glycyrrhizin in generalized pustular psoriasis with liver test abnormalities: A case series. Dermatol Ther 2020; 33:e13318. [PMID: 32182382 DOI: 10.1111/dth.13318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 12/15/2022]
Abstract
Liver test abnormalities (LTA) are a frequent extracutaneous manifestation in generalized pustular psoriasis (GPP). Due to possible hepatotoxicity of systemic monotherapy, it is challenging to simultaneously achieve clinical remission and LTA normalization. However, evidence for therapy is lacking. The aim of this study was to assess the effectiveness of combination therapy of acitretin and glycyrrhizin in nine GPP patients with LTA. During the acute phase of GPP, a combination of acitretin (0.5 mg/kg/d PO) and glycyrrhizin (80 mg/d intravenous) was initiated. After 2 weeks, all the patients promptly achieved at least 77% improvement in the severity score of GPP, as well as a significant reduction of liver enzymes. The patients were continuously treated with tapered doses of acitretin (20-30 mg/d PO) and glycyrrhizin (150 mg/d PO), and presented stable conditions during the 12-month follow-up. In conclusion, we consider that the combination of acitretin plus glycyrrhizin is an effective and safe therapy in GPP patients with LTA.
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Affiliation(s)
- Ning Yu
- Department of Dermatology, Shanghai Skin Disease Hospital, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Ying Li
- Department of Dermatology, Shanghai Skin Disease Hospital, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Yangfeng Ding
- Department of Dermatology, Shanghai Skin Disease Hospital, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Yuling Shi
- Department of Dermatology, Shanghai Skin Disease Hospital, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
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97
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Yang H, Tan Q, Chen GH, Chen JS, Fu Z, Ren FL, Luo XY, Wang H. Plasma retinol as a predictive biomarker of disease activity and response to acitretin monotherapy in children with generalized pustular psoriasis. J Eur Acad Dermatol Venereol 2020; 34:e270-e272. [PMID: 31991497 DOI: 10.1111/jdv.16244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- H Yang
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Q Tan
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - G H Chen
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - J S Chen
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Z Fu
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - F L Ren
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - X Y Luo
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - H Wang
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
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98
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Zhao L, Sun C, Li M, Wang Q, Long FQ. Tumor necrosis factor -238A is associated with pediatric-onset generalized pustular psoriasis in Han patients in Eastern China. J Dermatol 2019; 46:1031-1034. [PMID: 31436328 DOI: 10.1111/1346-8138.15066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/31/2019] [Indexed: 11/28/2022]
Abstract
The correlation between polymorphisms at the tumor necrosis factor (TNF) gene and generalized pustular psoriasis (GPP) has rarely been reported. The goal of this study is to investigate whether TNF polymorphisms (-238 A/G, -308 A/G, -857C/T) are associated with susceptibility to GPP in a Han population from Eastern China and to perform subgroup analysis to explore the influence of age onset. Polymorphisms were assessed by polymerase chain reaction amplification and resequencing in 91 GPP patients and 102 healthy controls. The frequencies of the TNF -238A allele and GA+AA genotypes were significantly higher in GPP patients than in those of healthy controls. The subgroup analysis revealed that these significant associations were still present between -238A variants and pediatric-onset GPP patients who developed GPP at less than 18 years old (PGPP), but not for patients with adult-onset GPP who developed GPP at 18 years old or more. There were no significant differences in genotype or allele frequencies of TNF -308 A/G and -857C/T polymorphisms between GPP and controls. In conclusion, individuals carrying TNF -238A may be more susceptible to PGPP.
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Affiliation(s)
- Lishi Zhao
- STD Institute, Shanghai Dermatology Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Sun
- College of Life Sciences, Shaanxi Normal University, Xi'an, China
| | - Ming Li
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qianqiu Wang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Fu-Quan Long
- STD Institute, Shanghai Dermatology Hospital, Tongji University School of Medicine, Shanghai, China
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99
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Suleiman AA, Khatri A, Oberoi RK, Othman AA. Exposure–Response Relationships for the Efficacy and Safety of Risankizumab in Japanese Subjects with Psoriasis. Clin Pharmacokinet 2019; 59:575-589. [DOI: 10.1007/s40262-019-00829-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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100
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Liggins MC, Li F, Zhang LJ, Dokoshi T, Gallo RL. Retinoids Enhance the Expression of Cathelicidin Antimicrobial Peptide during Reactive Dermal Adipogenesis. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2019; 203:1589-1597. [PMID: 31420464 PMCID: PMC9233297 DOI: 10.4049/jimmunol.1900520] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2023]
Abstract
A subset of dermal fibroblasts undergo rapid differentiation into adipocytes in response to infection and acutely produce the cathelicidin antimicrobial peptide gene Camp Vitamin A and other retinoids inhibit adipogenesis yet can show benefit to skin disorders, such as cystic acne, that are exacerbated by bacteria. We observed that retinoids potently increase and sustain the expression of Camp in preadipocytes undergoing adipogenesis despite inhibition of markers of adipogenesis, such as Adipoq, Fabp4, and Rstn Retinoids increase cathelicidin in both mouse and human preadipocytes, but this enhancement of antimicrobial peptide expression did not occur in keratinocytes or a sebocyte cell line. Preadipocytes undergoing adipogenesis more effectively inhibited growth of Staphylococcus aureus when exposed to retinoic acid. Whole transcriptome analysis identified hypoxia-inducible factor 1-α (HIF-1α) as a mechanism through which retinoids mediate this response. These observations uncouple the lipid accumulation element of adipogenesis from the innate immune response and uncover a mechanism, to our knowledge previously unsuspected, that may explain therapeutic benefits of retinoids in some skin disorders.
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Affiliation(s)
- Marc C Liggins
- Department of Dermatology, University of California, San Diego, La Jolla, CA 92093; and
| | - Fengwu Li
- Department of Dermatology, University of California, San Diego, La Jolla, CA 92093; and
| | - Ling-Juan Zhang
- Department of Dermatology, University of California, San Diego, La Jolla, CA 92093; and
- School of Pharmaceutical Sciences, Xiamen University, Xiamen 361102, China
| | - Tatsuya Dokoshi
- Department of Dermatology, University of California, San Diego, La Jolla, CA 92093; and
| | - Richard L Gallo
- Department of Dermatology, University of California, San Diego, La Jolla, CA 92093; and
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