1
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Jung JM, Kim YJ, Lee WJ, Won CH, Lee MW, Chang SE. Risk of incident autoimmune diseases in patients with newly diagnosed psoriatic disease: a nationwide population-based study. Sci Rep 2023; 13:16738. [PMID: 37798369 PMCID: PMC10556012 DOI: 10.1038/s41598-023-43778-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/28/2023] [Indexed: 10/07/2023] Open
Abstract
There are limited large population-based cohort studies on the risk of incident autoimmune diseases among patients with newly diagnosed psoriatic disease. The objective of this study was to assess the risk of autoimmune diseases in patients with newly diagnosed psoriatic disease. Using the Korean National Health Insurance Service database, patients with newly diagnosed psoriatic disease between 2007 and 2019 were included. Comparators were randomly selected and matched according to age and sex. A total of 321,354 patients with psoriatic disease and 321,354 matched comparators were included in this study. Patients with psoriatic disease had a significantly higher risk of Crohn's disease [adjusted hazard ratio (aHR), 1.95; 95% confidence interval (CI) 1.42-2.67], ulcerative colitis (aHR, 1.65; 95% CI 1.39-1.96), systemic lupus erythematosus (aHR, 1.86; 95% CI 1.34-2.57), rheumatoid arthritis (aHR, 1.63; 95% CI 1.52-1.76), ankylosing spondylitis (aHR, 2.32; 95% CI 1.95-2.77), alopecia areata (aHR, 1.41; 95% CI 1.35-1.46), and type 1 diabetes (aHR, 1.23; 95% CI 1.11-1.37). However, the risk of Graves' disease, Hashimoto's disease, Sjögren's syndrome, and systemic sclerosis was not significantly different between the groups. In conclusion, patients with newly diagnosed psoriatic disease may have a significantly increased risk of incident autoimmune diseases.
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Affiliation(s)
- Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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2
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Bieber T. Disease modification in inflammatory skin disorders: opportunities and challenges. Nat Rev Drug Discov 2023; 22:662-680. [PMID: 37443275 DOI: 10.1038/s41573-023-00735-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/15/2023]
Abstract
Progress in understanding of the mechanisms underlying chronic inflammatory skin disorders, such as atopic dermatitis and psoriasis vulgaris, has led to new treatment options with the primary goal of alleviating symptoms. In addition, this knowledge has the potential to inform on new strategies aimed at inducing deep and therapy-free remission, that is, disease modification, potentially impacting on associated comorbidities. However, to reach this goal, key areas require further exploration, including the definitions of disease modification and disease activity index, further understanding of disease mechanisms and systemic spillover effects, potential windows of opportunity, biomarkers for patient stratification and successful intervention, as well as appropriate study design. This Perspective article assesses the opportunities and challenges in the discovery and development of disease-modifying therapies for chronic inflammatory skin disorders.
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Affiliation(s)
- Thomas Bieber
- Department of Dermatology and Allergy, University Hospital, Bonn, Germany.
- Christine Kühne - Center for Allergy Research and Education, Davos, Switzerland.
- Davos Biosciences, Davos, Switzerland.
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3
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Perche PO, Cook MK, Feldman SR. The relative weak way and the absolute strong way to communicate risk information. J DERMATOL TREAT 2021; 33:1205-1207. [PMID: 34666590 DOI: 10.1080/09546634.2021.1995982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Patrick O Perche
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Madison K Cook
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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4
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Gundogan B, Dowlut N, Rajmohan S, Borrelli MR, Millip M, Iosifidis C, Udeaja YZ, Mathew G, Fowler A, Agha R. Assessing the compliance of systematic review articles published in leading dermatology journals with the PRISMA statement guidelines: A systematic review. JAAD Int 2021; 1:157-174. [PMID: 34409336 PMCID: PMC8361930 DOI: 10.1016/j.jdin.2020.07.007] [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] [Accepted: 07/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background Reporting quality of systematic reviews and meta-analyses is of critical importance in dermatology because of their key role in informing health care decisions. Objective To assess the compliance of systematic reviews and meta-analyses in leading dermatology journals with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. Methods This review was carried out in accordance with PRISMA guidelines. Included studies were reviews published across 6 years in the top 4 highest-impact-factor dermatology journals of 2017. Records and full texts were screened independently. Data analysis was conducted with univariate multivariable linear regression. The primary outcome was to assess the compliance of systematic reviews and meta-analyses in leading dermatology journals with the PRISMA statement. Results A total of 166 studies were included and mean PRISMA compliance across all articles was 73%. Compliance significantly improved over time (β = .016; P = <.001). The worst reported checklist item was item 5 (reporting on protocol existence), with a compliance of 15% of articles. Conclusion PRISMA compliance within leading dermatology journals could be improved; however, it is steadily improving.
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Affiliation(s)
- Buket Gundogan
- University College London Hospital, London, United Kingdom
| | - Naeem Dowlut
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Mimi R Borrelli
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Mirabel Millip
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Christos Iosifidis
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Yagazie Z Udeaja
- Luton and Dunstable University Hospital NHS Foundation Trust, Luton, United Kingdom
| | - Ginimol Mathew
- University College London Medical School, Gower Street, London, United Kingdom
| | | | - Riaz Agha
- Bart's Health NHS Foundation Trust, London, United Kingdom
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5
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Pandher K, Ghamrawi RI, Heron CE, Feldman SR. Controversial cardiovascular and hematologic comorbidities in atopic dermatitis. Arch Dermatol Res 2021; 314:317-324. [PMID: 33973062 DOI: 10.1007/s00403-021-02240-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 04/24/2021] [Accepted: 04/30/2021] [Indexed: 01/17/2023]
Abstract
Atopic dermatitis' (AD) systemic involvement is wide-reaching. The cardiovascular and hematological comorbidities of AD have potential for considerable economic and physical burden; however, data surrounding the association between these comorbidities and AD is controversial. This review discusses the cardiovascular and hematological comorbidities of AD, detailing the conflicting evidence, pathophysiology, and connection to medications. A PubMed search was conducted for studies detailing the association of cardiovascular and hematological comorbidities with AD, providing approximately 30 results. Additional searches were conducted for studies discussing the pathophysiology of these comorbidities and possible connections to AD medications. Various studies highlight either positive, negative, or no association of AD with hypertension, stroke, myocardial infarction, heart failure, and thrombosis. Coronary heart disease, angina, peripheral artery disease, and anemia are consistently positively associated with AD. However, the attributable risks of AD for stroke, myocardial infarction, heart failure, and atrial fibrillation are low (25 per 100,000 persons [99% CI 6-44], 12 per 100,000 persons [99% CI - 4-27], 40 per 100,000 persons [99% CI 22-57], and 37 per 100,000 persons [99% CI 15-55]), respectively. The pathophysiology underlying these potential associations is not entirely clear. Corticosteroids, cyclosporine, and antimetabolites, all used to treat AD, may also be associated with many of these comorbidities. AD's controversial associations with cardiovascular and hematological diseases complicates management as it is difficult to define recommendations for screening of these comorbidities. A better understanding may help lessen the economic and physical burden of these comorbidities in AD patients.
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Affiliation(s)
- Karan Pandher
- Department of Dermatology, Wake Forest School of Medicine, Center for Dermatology Research, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA.
| | - Rima I Ghamrawi
- Department of Dermatology, Wake Forest School of Medicine, Center for Dermatology Research, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
| | - Courtney E Heron
- Department of Dermatology, Wake Forest School of Medicine, Center for Dermatology Research, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
| | - Steven R Feldman
- Department of Dermatology, Wake Forest School of Medicine, Center for Dermatology Research, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Dermatology, University of Southern Denmark, Odense, Denmark
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6
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Huang WW, Feldman SR. The next quantum leap forward? Bimekizumab for psoriasis. Lancet 2021; 397:446-448. [PMID: 33549176 DOI: 10.1016/s0140-6736(21)00269-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 01/27/2021] [Indexed: 01/09/2023]
Affiliation(s)
- William W Huang
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27157-1071, USA
| | - Steven R Feldman
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27157-1071, USA.
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7
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Squamous Cell Carcinoma of the Hand: A Retrospective Study in Immunosuppressed and Immunocompetent Individuals. Dermatol Surg 2021; 46:1014-1020. [PMID: 32028479 DOI: 10.1097/dss.0000000000002336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (SCC) of the hand presents a treatment challenge because of the anatomical complexity of this location. Immunosuppressed patients are disproportionately affected by cutaneous SCC. Existing data on SCC of the hand are primarily presented in the orthopedic literature, and may thus be affected by referral bias. OBJECTIVE Characterization of epidemiology and treatment outcomes for hand versus nonhand cutaneous SCC in immunosuppressed versus immunocompetent patients, across all clinical departments. MATERIALS AND METHODS Single-institution retrospective cohort study of cutaneous SCC evaluated over 3 years and hand SCC over an additional 5 years. RESULTS A cohort of 522 hand SCC cases (1,746 total SCC) was ascertained among 1,064 patients, of whom 175 were immunosuppressed. Occurrence on the hand was more common for SCC arising in immunosuppressed versus immunocompetent patients (38% vs 24% of cases respectively). Hand SCC cases demonstrated balanced laterality and comparable spectra of differentiation regardless of immunosuppression. No cases of hand SCC metastasis were observed over greater than 2 years' mean follow-up, and digital amputation was only required in approximately 1% of hand SCCs. CONCLUSION In our cohort, assessment of hand SCC across all clinical departments suggests more favorable prognosis than reflected in the previous literature.
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8
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Senthilnathan A, Feldman SR. Do increased risks of cancer mean we need to change our approach to treatment? J DERMATOL TREAT 2020; 32:1-2. [PMID: 32997562 DOI: 10.1080/09546634.2020.1830930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Aditi Senthilnathan
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Dermatology, University of Southern Denmark, Odense, Denmark
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9
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Senthilnathan A, Feldman SR. Do increased risks of cancer mean we need to change our approach to treatment? J DERMATOL TREAT 2020:1-4. [PMID: 33143499 DOI: 10.1080/09546634.2020.1846843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Aditi Senthilnathan
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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10
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Li Y, Lin P, Wang S, Li S, Wang R, Yang L, Wang H. Quantitative analysis of differentially expressed proteins in psoriasis vulgaris using tandem mass tags and parallel reaction monitoring. Clin Proteomics 2020; 17:30. [PMID: 32817748 PMCID: PMC7425065 DOI: 10.1186/s12014-020-09293-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/06/2020] [Indexed: 12/29/2022] Open
Abstract
Background Psoriasis vulgaris (PV) is a chronic autoimmune inflammatory disease with epidermal hyperkeratosis and parakeratosis. Methods The study was to elucidate the pathogenesis of PV by quantitative proteomic analysis of skin lesion biopsies of PV and healthy tissues with tandem mass tags (TMTs) coupled with liquid chromatography–mass spectrometry (LC–MS)/MS. Results A total of 4562 differentially expressed proteins (DEPs) between PV lesional tissues (n = 11) and healthy tissues (n = 11) were identified, of which 299 were upregulated and 206 were downregulated using |fold change| > 1.3 as the cutoff threshold. The Gene Ontology (GO) annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis revealed that the DEPs were mainly enriched in the activation of immune cells (drug metabolism pathway, NOD-like pathway, and IL-17 pathway), cell proliferation (ribosomal pathway, DNA replication pathway, and base replication pathway), metabolism-related pathways (fatty acid biosynthesis and metabolism, PPAR pathway, glycerophospholipid metabolism, and cortisol synthesis and breakdown), and glandular secretion (saliva secretion, gastric acid secretion, and pancreatic fluid secretion). Thirteen DEPs that were relatively highly expressed in the drug metabolism pathway were validated with parallel reaction monitoring (PRM), of which MPO, TYMP, IMPDH2, GSTM4, and ALDH3A1 were highly expressed in PV, whereas CES1, MAOB, MGST1, and GSTT1 were less expressed in PV. Conclusions These findings confirmed that these proteins participate in the drug metabolism-other enzyme pathways and play crucial roles in the activation and proliferation of immune cells in the pathogenesis of PV.
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Affiliation(s)
- Yu Li
- Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Peng Lin
- Shenzhen Luohu District Hospital of Traditional Chinese Medicine, Shenzhen, Guangdong People's Republic of China
| | - Siyao Wang
- Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Shuang Li
- Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Rui Wang
- Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Lin Yang
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, People's Republic of China
| | - Hongmei Wang
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, People's Republic of China
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11
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Biondo G, Cerroni L, Brunasso AMG, Sola S, Cota C, Javor S, Massone C. Risk of mycosis fungoides in psoriatic patients: a critical review. J Eur Acad Dermatol Venereol 2020; 34:1186-1195. [PMID: 31856345 DOI: 10.1111/jdv.16160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/26/2019] [Indexed: 12/18/2022]
Abstract
Psoriasis has been controversially associated with risk of non-Hodgkin lymphoma (NHL) and mycosis fungoides (MF). Also patients who developed MF after systemic treatment for psoriasis have been reported, and some authors suggested that the association between MF and psoriasis is not infrequent. We performed an extensive literature review in order to examine the risk of developing MF in psoriatic patients with a systematic search of the English-language databases. An increased risk for lymphoma overall in psoriatic patients has been found only by three out of seven studies. The risk of developing MF in psoriatic patients has been investigated by different studies in different populations and with different methodologies presenting bias and limitations, and it seems reasonable that misclassification between psoriasis and MF may explain the association reported. In contrast to the large number of psoriatic patients treated with biologicals, only 27 case reports of MF after biological therapy for psoriasis have been reported, and in 10 cases, the initial psoriasis diagnoses were then revised as MF. A true association between MF and psoriasis is possible, but the real incidence and prevalence are still unknown. The reported higher risk of developing MF in psoriatic patients should be reconsidered in the light of the bias of misclassification and the low magnitude reported in previous studies. There is not enough evidence to support a causal relation among biological therapies and MF in psoriatic patients.
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Affiliation(s)
- G Biondo
- Dermatology Unit, Galliera Hospital, Genoa, Italy
| | - L Cerroni
- Research Unit Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria
| | | | - S Sola
- Surgical Pathology, Galliera Hospital, Genoa, Italy
| | - C Cota
- Dermatology Unit, IRCCS INRCA, Ancona, Italy
| | - S Javor
- Dermatology Unit, Galliera Hospital, Genoa, Italy
| | - C Massone
- Dermatology Unit, Galliera Hospital, Genoa, Italy
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12
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Zhang LJ. Type1 Interferons Potential Initiating Factors Linking Skin Wounds With Psoriasis Pathogenesis. Front Immunol 2019; 10:1440. [PMID: 31293591 PMCID: PMC6603083 DOI: 10.3389/fimmu.2019.01440] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/07/2019] [Indexed: 12/18/2022] Open
Abstract
Psoriasis is a chronic autoimmune skin disease that can often be triggered upon skin injury, known as Koebner phenomenon. Type 1 interferons (IFNα and IFNβ), key cytokines that activate autoimmunity during viral infection, have been suggested to play an indispensable role in initiating psoriasis during skin injury. Type 1 IFN-inducible gene signature has been identified as one of the major upregulated gene signatures in psoriatic skin. Type 1 IFNs treatments often directly induce or exacerbate psoriasis, whereas blocking type 1 IFNs signaling pathway in animal models effectively inhibits the development of T cell-mediated skin inflammation and psoriasis-like inflammatory diseases. Epidermal keratinocytes (KCs) occupy the outermost position in the skin and are the first responder to skin injury. Skin injury rapidly induces IFNβ from KCs and IFNα from dermal plasmacytoid dendritic cells (pDCs) through distinct mechanisms. Host antimicrobial peptide LL37 potentiates double-stranded RNA (dsRNA) immune pathways in keratinocytes and single-stranded RNA or DNA pathways in pDCs, leading to production of distinct type 1 IFN genes. IFNβ from KC promotes dendritic cell maturation and the subsequent T cell proliferation, contributing to autoimmune activation during skin injury and psoriasis pathogenesis. Accumulating evidences have indicated an important role of this dsRNA immune pathway in psoriasis pathogenesis. Together, this review describes how skin injury induces type 1 IFNs from skin cells and how this may initiate autoimmune cascades that trigger psoriasis. Targeting keratinocytes or type 1 IFNs in combination with T cell therapy may result in more sustainable effect to treat auto-inflammatory skin diseases such as psoriasis.
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Affiliation(s)
- Ling-Juan Zhang
- School of Pharmaceutical Sciences, Xiamen University, Xiamen, China.,Department of Dermatology, University of California, San Diego, La Jolla, CA, United States
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13
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Li YL, Du ZY, Li PH, Yan L, Zhou W, Tang YD, Liu GR, Fang YX, Zhang K, Dong CZ, Chen HX. Aromatic-turmerone ameliorates imiquimod-induced psoriasis-like inflammation of BALB/c mice. Int Immunopharmacol 2018; 64:319-325. [DOI: 10.1016/j.intimp.2018.09.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 12/11/2022]
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14
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Tjahjono LA, Cline A, Huang WW, Feldman SR. Use of absolute risk measurements in observational dermatology studies: important information for decision-making is frequently absent. Br J Dermatol 2018; 180:678-679. [PMID: 30328103 DOI: 10.1111/bjd.17266] [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)
- L A Tjahjono
- Mayo Clinic School of Medicine, Rochester, MN, U.S.A
| | - A Cline
- Center for Dermatology Research, Department of Dermatology, Winston-Salem, NC, U.S.A
| | - W W Huang
- Center for Dermatology Research, Department of Dermatology, Winston-Salem, NC, U.S.A
| | - S R Feldman
- Center for Dermatology Research, Department of Dermatology, Winston-Salem, NC, U.S.A.,Department of Pathology, Winston-Salem, NC, U.S.A.,Division of Public Health Sciences - Wake Forest School of Medicine, Winston-Salem, NC, U.S.A
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15
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Rademaker M, Rubel DM, Agnew K, Andrews M, Armour KS, Baker C, Foley P, Gebauer K, Goh MS, Gupta M, Marshman G, Prince HM, Sullivan J. Psoriasis and cancer. An Australian/New Zealand narrative. Australas J Dermatol 2018; 60:12-18. [PMID: 29992535 DOI: 10.1111/ajd.12889] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/16/2018] [Indexed: 12/16/2022]
Abstract
Patients with psoriasis have an increased risk of cancer, which may be due to impaired immune surveillance, immune modulatory treatments, chronic inflammation and/or co-risk factors such as obesity. The increase in treatment-independent solid cancers, including urinary/bladder cancers, oropharynx/larynx, liver/gallbladder and colon/rectal cancers, seem to be linked to alcohol and smoking. Lung cancer and nonmelanoma skin cancer are also increased in patients with psoriasis. The risk of nonmelanoma skin cancer increases with age and severity of psoriasis. It is also higher in men, particularly for squamous cell carcinoma, which may reflect previous exposure to PUVA and/or ciclosporin. The risk of cutaneous T-cell lymphoma is substantially higher in patients with moderate-to-severe psoriasis. Biologic therapies are independently associated with a slight increase risk of cancer, but this is less than ciclosporin, with the risk confounded by disease severity and other co-risk factors. The risk of cancer from low-dose methotrexate is likely minimal. In contrast, acitretin is likely protective against a variety of solid and haematological malignancies. The data on small molecule therapies such as apremilast are too immature for comment, although no signal has yet been identified. The decision whether to stop psoriasis immune modulatory treatments following a diagnosis of cancer, and when to resume, needs to be considered in the context of the patients' specific cancer. However, there is no absolute need to stop any treatment other than possibly ciclosporin, unless there is a concern over an increased risk of serious infection or drug-drug interaction with cancer-directed therapies, including radiotherapy.
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Affiliation(s)
- Marius Rademaker
- Waikato Clinical School, Auckland University Medical School, Hamilton, New Zealand
| | - Diana M Rubel
- Woden Dermatology, Phillip, Australian Capital Territory, Australia.,Australian National University, Canberra, Australian Capital Territory, Australia
| | - Karen Agnew
- Dermatology Department, Greenlane Clinical Centre & Starship Children's Hospital, Auckland, New Zealand
| | | | | | - Christopher Baker
- Skin & Cancer Foundation Inc., Carlton, Victoria, Australia.,St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Foley
- St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Fitzroy and Probity Medical Research, Skin & Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Kurt Gebauer
- University of Western Australia, Perth, Western Australia, Australia.,Probity Medical Research, Freemantle, Western Australia, Australia
| | - Michelle Sy Goh
- Skin & Cancer Foundation Inc., Carlton, Victoria, Australia.,St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Monisha Gupta
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,The Skin Hospital, Darlinghurst, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Gillian Marshman
- Flinders Medical Centre, Flinders University Medical School, Adelaide, South Australia, Australia
| | - H Miles Prince
- Epworth Healthcare and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - John Sullivan
- Kingsway Dermatology, Miranda, New South Wales, Australia
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16
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Arnold DL, Feldman SR. Comment on "Serious infections among a large cohort of subjects with systemically treated psoriasis". J Am Acad Dermatol 2018; 78:e113-e114. [PMID: 29309819 DOI: 10.1016/j.jaad.2017.10.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 10/22/2017] [Indexed: 11/27/2022]
Affiliation(s)
- David L Arnold
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina.
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Saleem MD, Feldman SR. Comorbidities in patients with psoriasis: The role of the dermatologist. J Am Acad Dermatol 2017; 77:191-192. [PMID: 28619566 DOI: 10.1016/j.jaad.2017.01.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/11/2017] [Accepted: 01/31/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Mohammed D Saleem
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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