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Vats V, Makineni P, Hemaida S, Haider A, Subramani S, Kaur N, Butt AN, Scott-Emuakpor R, Zahir M, Mathew M, Iqbal J. Gluten Intolerance and Its Association With Skin Disorders: A Narrative Review. Cureus 2023; 15:e44549. [PMID: 37790051 PMCID: PMC10544948 DOI: 10.7759/cureus.44549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
Gluten sensitivity is defined as a chronic intolerance to gluten ingestion in genetically predisposed individuals. The etiology is thought to be immune-mediated and has a variable dermatologic presentation. Celiac disease (CD) is one of the most common forms of gluten intolerance and encompasses a wide range of extra-intestinal pathology, including cutaneous, endocrine, nervous, and hematologic systems. Psoriasis, another long-term inflammatory skin condition, has been linked to significant symptomatic improvement with a gluten-free diet (GFD). Palmoplantar pustulosis (PP), a variant of psoriasis, and aphthous stomatitis, which causes recurrent oral ulcers, have also exhibited beneficial results after the dietary elimination of gluten. In addition to this, dermatitis herpetiformis (DH), another immune-mediated skin disorder, is genetically similar to CD and has, therefore, shown tremendous improvement with a GFD. Another highly prevalent long-term skin condition called atopic dermatitis (AD), however, has revealed inconsistent results with gluten elimination and would require further research in the future to yield concrete results. Hereditary angioedema (HA) has shown an association with gluten intolerance in some patients who had symptomatic benefits with a GFD. Similarly, vitiligo and linear IgA bullous dermatosis have also shown some clinical evidence of reversal with a GFD. On the contrary, rosacea enhances the risk of developing CD. This narrative review emphasizes the potential impact of gluten intolerance on different cutaneous conditions and the potential therapeutic effect of a GFD on various symptomatic manifestations. There is a need for additional clinical and observational trials to further expand on the underlying pathophysiology and provide conclusive and comprehensive recommendations for possible dietary interventions.
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Affiliation(s)
- Vaibhav Vats
- Internal Medicine, Smt. Kashibai Navale Medical College and General Hospital, Mumbai, IND
| | - Pallavi Makineni
- Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | | | - Anum Haider
- Internal Medicine, Bahria University Medical & Dental College, Karachi, PAK
| | | | - Navjot Kaur
- Medicine, Government Medical College, Amritsar, Amritsar, IND
| | - Amna Naveed Butt
- Medicine/Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | | | - Mohammad Zahir
- Medicine, Ayub Medical College, Abottabad, Abottabad, PAK
| | - Midhun Mathew
- Internal Medicine, Pennsylvania Hospital, Philadelphia, USA
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Gao Y, Jin H. Rivaroxaban for treatment of livedoid vasculopathy: A systematic review. Dermatol Ther 2021; 34:e15051. [PMID: 34197012 DOI: 10.1111/dth.15051] [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] [Received: 02/04/2021] [Accepted: 06/29/2021] [Indexed: 12/24/2022]
Abstract
Rivaroxaban is a direct inhibitor of activated coagulation factor X and competitively targets factor Xa via reversible binding. We conducted a systematic review of the efficacy and safety of rivaroxaban for treatment of livedoid vasculopathy (LV) by searching the PubMed, Cochrane and Embase databases. A total of 22 articles and 1 registered clinical trial were identified in the search of which 13 were included. The studies included 73 LV patients receiving rivaroxaban therapy (10-20 mg per day). Overall, 60 patients (82.2%) had responses to therapy, achieving remission of both pain and ulceration. Few adverse effects were observed. Thus, the consensus of the clinical evidence is that rivaroxaban is a well-tolerated and effective treatment for LV. However, this still needs to be confirmed by large prospective and/or case control studies.
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Affiliation(s)
- Yimeng Gao
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, 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 Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
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Gao Y, Jin H. Livedoid vasculopathy and its association with genetic variants: A systematic review. Int Wound J 2021; 18:616-625. [PMID: 33686673 PMCID: PMC8450804 DOI: 10.1111/iwj.13563] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/29/2022] Open
Abstract
Livedoid vasculopathy (LV) is considered a disease of hypercoagulability. Association of LV with genetic variants is poorly characterised and large‐scale genetic association studies have not been performed. The aim of the study was to systematically review variants in LV patients and to analyse the available clinical data. A systematic search of the literature in PubMed and Embase databases was performed to identify articles investigating genetic variation in LV patients. Thirty studies or case reports were identified that reported 265 LV patients tested for at least one out of six genetic variations. Among them, PAI‐1 ‐675 4G/5G was the most common, accounting for 85.26% (81/95). Heterozygous 4G/5G was the major genotype. PAI‐1 A844G, MTHFR C677T, and MTHFR A1298C were the second, third, and fourth most common variants in LV patients. Prothrombin G20210A and Factor V G1691A were mainly present in LV patients from Europe, North America, and South America. This review highlights the associations between LV and genetic variants. The distribution of variants may be geographically or ethnicity dependent; however, large sample case‐control studies are needed to clarify associations.
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Affiliation(s)
- Yimeng Gao
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongzhong 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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Martínez Pallás I, García García M, Torrubia Pérez C, Ara Martín M. Vasculitis leucocitoclástica secundaria a nuevos anticoagulantes orales. Rev Clin Esp 2020; 220:390-392. [DOI: 10.1016/j.rce.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 01/28/2020] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
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Gao Y, Jin H. Efficacy of an anti-TNF-alpha agent in refractory livedoid vasculopathy: a retrospective analysis. J DERMATOL TREAT 2020; 33:178-183. [PMID: 32116074 DOI: 10.1080/09546634.2020.1737634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Livedoid vasculopathy is a recurrent thrombo-occlusive vasculopathy of cutaneous blood vessels and its standard or first-line therapy is still controversial. Besides hypercoagulability, inflammatory factors may also play a secondary role in the pathogenesis of this disease. Monotherapy of thrombolytics cannot achieve satisfactory results because of concomitant inflammation.Objective: This pilot study aimed to determine the efficacy of an anti-TNF-alpha agent in patients with refractory livedoid vasculopathy.Methods: We studied five patients with livedoid vasculopathy who were resistant to steroids, antiplatelets, or danazol therapy, and were treated with etanercept 25-50 mg once a week for 12 consecutive weeks. We assessed clinical characteristics, laboratory findings, and etanercept's efficacy on skin lesions, pain, and quality of life.Results: Etanercept therapy resulted in fast relief of pain in a mean time of 2 weeks. The median duration for the disappearance of erythema and ulcer healing was 8.8 weeks and 10.6 weeks, respectively. There was a reduction in pain by 34.3% after 12 consecutive weeks of etanercept treatment. Disease severity and quality of life significantly improved.Conclusions: In refractory livedoid vasculopathy patients, etanercept therapy is efficient for skin lesions and pain, and improvement of quality of life, especially in rapid relief of pain.
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Affiliation(s)
- Yimeng Gao
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongzhong 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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Brandy-García AM, Coto-Hernández R, Caminal-Montero L. Saturday night vasculitis. Med Clin (Barc) 2019; 152:e37-e38. [PMID: 30146357 DOI: 10.1016/j.medcli.2018.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Anahy M Brandy-García
- Servicio de Reumatología, Hospital Universitario San Agustín, Avilés, Asturias, España.
| | - Rubén Coto-Hernández
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Luis Caminal-Montero
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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Tacoronte Pérez S, Cerón Navarro J, Pastor Colom A, Morcillo Aixelá A. Chylothorax due to Venous Thrombosis in a Double-Lung Transplant Patient. Arch Bronconeumol 2018; 55:381-382. [PMID: 30541670 DOI: 10.1016/j.arbres.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Sergio Tacoronte Pérez
- Servicio de Cirugía Torácica, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - Jose Cerón Navarro
- Servicio de Cirugía Torácica, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Amparo Pastor Colom
- Servicio de Cirugía Torácica, Hospital Universitario y Politécnico La Fe, Valencia, España
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Cutaneous and Mucosal Manifestations Associated with Celiac Disease. Nutrients 2018; 10:nu10070800. [PMID: 29933630 PMCID: PMC6073559 DOI: 10.3390/nu10070800] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 12/12/2022] Open
Abstract
Celiac disease (CD) is an immune-mediated, gluten-induced enteropathy that affects predisposed individuals of all ages. Many patients with CD do not report gastrointestinal symptoms making it difficult to reach an early diagnosis. On the other hand, CD is related to a wide spectrum of extra-intestinal manifestations, with dermatitis herpetiformis (DH) being the best characterized. These associated conditions may be the clue to reaching the diagnosis of CD. Over the last few years, there have been multiple reports of the association between CD and several cutaneous manifestations that may improve with a gluten-free diet (GFD). The presence of some of these skin diseases, even in the absence of gastrointestinal symptoms, should give rise to an appropriate screening method for CD. The aim of this paper is to describe the different cutaneous manifestations that have been associated with CD and the possible mechanisms involved.
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Ranugha PSS, Betkerur J. Antihypertensives in dermatology Part II - Cutaneous adverse reactions to antihypertensives. Indian J Dermatol Venereol Leprol 2018; 84:137-147. [DOI: 10.4103/ijdvl.ijdvl_992_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Moreno Martínez MJ, Palma Sánchez D, Peñas Martínez E, Haro Martínez A, Mayor González M. Vasculitis leucocitoclástica e infección. A propósito de un caso. ACTA ACUST UNITED AC 2017; 13:297-298. [DOI: 10.1016/j.reuma.2016.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/06/2016] [Accepted: 04/08/2016] [Indexed: 10/21/2022]
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Puno MIBL, Dimagiba MTE, Jamora MJJ, Montinola FL, Tinio PT. Granulomatous slack skin presenting as diffuse poikiloderma and necrotic ulcers, with features of granulomatous vasculitis and response to oral prednisone, acitretin, and oral psoralen plus ultraviolet light therapy-A case report. JAAD Case Rep 2017; 3:294-300. [PMID: 28748211 PMCID: PMC5512183 DOI: 10.1016/j.jdcr.2017.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | | | | | - Patricia Ty Tinio
- Makati Medical Center Department of Dermatology, Quezon City, Philippines
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Dorado-Fernández M, Brufau-Redondo C, Pastor-Quirante F, Ruiz-Martínez J, Hernández-Gil Sánchez J. [Painful erythematous macular lesion in the ankle of a young woman]. Semergen 2016; 43:338-340. [PMID: 27670735 DOI: 10.1016/j.semerg.2016.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/18/2016] [Accepted: 07/18/2016] [Indexed: 12/01/2022]
Affiliation(s)
- M Dorado-Fernández
- Servicio de Dermatología, Hospital General Universitario Reina Sofía, Murcia, España.
| | - C Brufau-Redondo
- Servicio de Dermatología, Hospital General Universitario Reina Sofía, Murcia, España
| | - F Pastor-Quirante
- Servicio de Anatomía Patológica, Hospital General Universitario Reina Sofía, Murcia, España
| | - J Ruiz-Martínez
- Servicio de Dermatología, Hospital General Universitario Reina Sofía, Murcia, España
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Lima RSA, Maquiné GÁ, Talhari C, Encarnação ICL, Schettini APM, Santos M. Livedoid vasculopathy as a marker of systemic disease: report of two cases. An Bras Dermatol 2014; 89:822-4. [PMID: 25184928 PMCID: PMC4155967 DOI: 10.1590/abd1806-4841.20142897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/14/2013] [Indexed: 11/22/2022] Open
Abstract
The livedoid vasculopathy is an obstructive vascular process of etiology not yet
fully known, being possibly associated with several prothrombotic events. It is
clinically characterized by the presence of painful and recurring purpuric lesions,
which usually suffer ulceration and evolve with formation of white atrophic scars
usually located in the lower limbs. Two cases are here reported of painful ulcerated
lesions on the lower limbs, in which the identification of VL enabled the diagnosis
of systemic diseases.
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15
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Response to Comment on the Article «Cutaneous Vasculitis». ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Pulido-Pérez A, Avilés-Izquierdo J, Suárez-Fernández R. Réplica a: «Vasculitis cutáneas». ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.ad.2012.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sais G, Vidaller A. Cutaneous Vasculitis. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sais G, Vidaller A. Vasculitis cutáneas. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:754; author reply 755. [DOI: 10.1016/j.ad.2012.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 04/26/2012] [Indexed: 10/28/2022] Open
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