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Hussain Z, Qi Q, Zhu J, Anderson KE, Ma X. Protoporphyrin IX-induced phototoxicity: Mechanisms and therapeutics. Pharmacol Ther 2023; 248:108487. [PMID: 37392940 PMCID: PMC10529234 DOI: 10.1016/j.pharmthera.2023.108487] [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: 04/03/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Abstract
Protoporphyrin IX (PPIX) is an intermediate in the heme biosynthesis pathway. Abnormal accumulation of PPIX due to certain pathological conditions such as erythropoietic protoporphyria and X-linked protoporphyria causes painful phototoxic reactions of the skin, which can significantly impact daily life. Endothelial cells in the skin have been proposed as the primary target for PPIX-induced phototoxicity through light-triggered generation of reactive oxygen species. Current approaches for the management of PPIX-induced phototoxicity include opaque clothing, sunscreens, phototherapy, blood therapy, antioxidants, bone marrow transplantation, and drugs that increase skin pigmentation. In this review, we discuss the present understanding of PPIX-induced phototoxicity including PPIX production and disposition, conditions that lead to PPIX accumulation, symptoms and individual differences, mechanisms, and therapeutics.
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Affiliation(s)
- Zahir Hussain
- Center for Pharmacogenetics, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Qian Qi
- Center for Pharmacogenetics, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Junjie Zhu
- Center for Pharmacogenetics, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Karl E Anderson
- Porphyria Laboratory and Center, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Xiaochao Ma
- Center for Pharmacogenetics, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Kurz B, Berneburg M, Bäumler W, Karrer S. Phototherapy: Theory and practice. J Dtsch Dermatol Ges 2023; 21:882-897. [PMID: 37485907 DOI: 10.1111/ddg.15126] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/12/2023] [Indexed: 07/25/2023]
Abstract
Despite the development of highly effective biologics for skin diseases such as psoriasis or atopic dermatitis, UVA and UVB therapy, alone or in combination, are still essential components of various guidelines. Phototherapy is not only a first-line treatment and highly effective for a number of skin diseases, but is also economical and has few side effects. The targeted use of UVA and UVB, if necessary, in combination with the photosensitizer psoralen in the context of PUVA therapy, enables the dermatologist to effectively treat a wide variety of skin diseases. Indications for phototherapy include epidermal diseases such as atopic dermatitis, psoriasis and vitiligo, as well as photodermatoses, mycosis fungoides, graft-versus-host disease and deep dermal diseases such as scleroderma. This article reviews the physical principles, molecular mechanisms, current treatment regimens, and individual indications for phototherapy and photochemotherapy.
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Affiliation(s)
- Bernadett Kurz
- Department for Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Mark Berneburg
- Department for Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Bäumler
- Department for Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Sigrid Karrer
- Department for Dermatology, University Hospital Regensburg, Regensburg, Germany
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Kurz B, Berneburg M, Bäumler W, Karrer S. Phototherapie in Theorie und Praxis. J Dtsch Dermatol Ges 2023; 21:882-898. [PMID: 37574671 DOI: 10.1111/ddg.15126_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/12/2023] [Indexed: 08/15/2023]
Abstract
ZusammenfassungDie Therapie oder Kombinationstherapie mit UV‐A‐ oder UV‐B‐Strahlen ist trotz der Entwicklung hochwirksamer Biologika bei Hauterkrankungen wie Psoriasis oder atopischer Dermatitis nach wie vor unverzichtbarer Bestandteil verschiedener Leitlinienempfehlungen. Die Phototherapie ist nicht nur eine sehr effektive Erstlinientherapie bei verschiedenen Hauterkrankungen, sondern auch kostengünstig und nebenwirkungsarm. Der gezielte Einsatz von UV‐A und UV‐B, gegebenenfalls auch in Kombination mit dem Photosensibilisator Psoralen im Rahmen einer PUVA‐Therapie, ermöglicht dem Dermatologen eine effektive Behandlung verschiedener Hautkrankheiten. Indikationen für die Phototherapie sind epidermale Erkrankungen wie die atopische Dermatitis, die Psoriasis und die Vitiligo, ferner Photodermatosen, die Mycosis fungoides, die Graft‐versus‐Host‐Erkrankung sowie tiefe dermale Erkrankungen wie die Sklerodermie. Dieser Artikel gibt einen Überblick über die physikalischen Grundlagen, die molekularen Mechanismen, die derzeitigen Behandlungsmethoden und die einzelnen Indikationen für die Phototherapie und die Photochemotherapie.
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Affiliation(s)
- Bernadett Kurz
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| | - Mark Berneburg
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| | - Wolfgang Bäumler
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| | - Sigrid Karrer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
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Kim JH, Kim HJ, Yoo DW, Park KD, Kwon HJ, Seo JW, Kim TH, Yoon JH, Seong SH, Jang MS, Kim KH. A postulated model for photoimmunopathogenesis of chronic actinic dermatitis around adaptive immunity, including Th17 cells, Tregs, TRMs, cytotoxic T cells, and/or common-γ chain receptor+ cells. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2023; 39:147-154. [PMID: 36461152 DOI: 10.1111/phpp.12848] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND/PURPOSE The pathogenesis of chronic actinic dermatitis (CAD) is more complicated than other photodermatoses. However, the relationship between the clinical severity of CAD and the offending photocontact or contact allergens or both, and the correlations of CAD immunopathogenesis with the immunoregulatory molecules involved in adaptive immunity are yet to be investigated. METHODS We performed phototesting with broad-spectrum ultraviolet (UV) B, UVA, and visible light to establish the presence of photosensitivity in 121 patients with CAD, together with photopatch and contact patch testing. Nine patients with CAD were selected according to their clinical severity score for CAD (CSS-CAD), and triple direct immunofluorescence analysis was performed with paraffin-embedded skin biopsy samples. RESULTS As CSS-CAD was closely correlated with the multiplicity of photo(contact) allergens, particularly photoallergens, three or more photoallergens were detected in the severe CAD group (52.5%); less in the moderate group (32.8%); and only one in the mild group (14.8%; P = .025). In the groups showing greater severity of disease, the absolute numbers of IFN-γ+ , IL-17+ , CD4+, CD8+, common-γ chain receptor (common-γCR)+ , and CD69+ tissue-resident memory cells increased on average; there was also an increase in the CD4+/CD8+ cell ratio, with the more severely affected groups. However, the levels of TNF-α+ and FoxP3+ regulatory T (Treg) cells and the mean IL-17/IFN-γ cell ratio decreased in the more severely affected CSS-CAD subgroups. CONCLUSIONS Based on the clinical analysis and immunopathogenic results, avoidance of excessive sun exposure, and topical and systemic blocking agents for photo(contact) allergens are recommended. Additionally, conventional immunomodulators and emerging agents including JAK-STAT inhibitors may be administered for CAD treatment in the future.
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Affiliation(s)
- Jung-Hwan Kim
- Departments of Dermatology, Dong-A University College of Medicine, Busan, South Korea
| | - Ho-Jin Kim
- Departments of Dermatology, Dong-A University College of Medicine, Busan, South Korea
| | - Dong-Wha Yoo
- Departments of Dermatology, Dong-A University College of Medicine, Busan, South Korea
| | - Kyung-Deok Park
- Departments of Dermatology, Dong-A University College of Medicine, Busan, South Korea
| | - Hyeok-Jin Kwon
- Departments of Dermatology, Dong-A University College of Medicine, Busan, South Korea
| | - Jung-Wan Seo
- Departments of Dermatology, Dong-A University College of Medicine, Busan, South Korea
| | - Tae-Hoon Kim
- Departments of Dermatology, Dong-A University College of Medicine, Busan, South Korea
| | - Jung-Ho Yoon
- Departments of Dermatology, Dong-A University College of Medicine, Busan, South Korea
| | - Seol-Hwa Seong
- Kosin University College of Medicine, Busan, South Korea
| | - Min-Soo Jang
- Kosin University College of Medicine, Busan, South Korea
| | - Ki-Ho Kim
- Departments of Dermatology, Dong-A University College of Medicine, Busan, South Korea
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Kurz B, Arndt S, Unger P, Ivanova I, Berneburg M, Hellerbrand C, Karrer S. Association of polymorphous light eruption with NOD-2 and TLR-5 gene polymorphisms. J Eur Acad Dermatol Venereol 2022; 36:2172-2180. [PMID: 35748133 DOI: 10.1111/jdv.18364] [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: 01/20/2022] [Accepted: 05/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Polymorphous light eruption (PLE) is a common, immunologically mediated, photosensitive skin disease. After ultraviolet-B (UV-B) irradiation, patients with PLE show reduced Langerhans cell (LC) depletion in the epidermis, which results in a non-suppressive microenvironment in the skin. Interestingly, severe acute graft-versus-host-disease (aGvHD) occurred in stem cell transplanted patients that showed no or incomplete depletion of LCs after UVB-irradiation. Genetic variation in nucleotide-binding oligomerization domain 2 (NOD-2) and toll-like receptor 5 (TLR-5) genes also confers susceptibility to aGvHD. OBJECTIVES We hypothesized that PLE is associated with genetic variation in the NOD-2 and TLR-5 genes. METHODS We investigated single nucleotid polymorphisms (SNPs) of NOD-2 (R702W, G908R, 3020Cins) and TLR-5 (A592S, P616L, N392STOP) in skin biopsies of PLE-patients (n=143) and in healthy controls (n=104) using restriction fragment-length polymorphism analysis. RESULTS The frequency of NOD-2 alleles with the SNP R702W was significantly higher in PLE than in controls (31.8% vs 6.3%; p<0.0001), and homozygous carriers of this mutation were more common in PLE (27.9% vs 0%; p<0.0001). For SNP 3020Cins, the allele frequency (7.3% vs 0.7%; p=0.0025) and the number of heterozygotes (14.7% vs 1.3%; p=0.0019) were higher in PLE. The frequency of alleles with the N392STOP SNP of the TLR5 gene, which is associated with a truncated, non-functional receptor, was significantly higher in PLE (21% vs 5%; 7% vs 1% homozygotes, 28% vs 8% heterozygotes; p<0.0001). The other SNPs did not differ significantly. CONCLUSIONS This study yielded a high frequency of functional SNPs in the NOD-2 and TLR-5 genes in PLE. The same SNPs are associated with aGvHD and there are similarities in the reaction of LCs after UVB-irradiation between aGvHD and PLE. This leads to the hypothesis that PLE-patients may be more susceptible to developing GvHD after stem-cell transplantation, an assumption that needs to be investigated further.
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Affiliation(s)
- B Kurz
- Department of Dermatology, University Hospital Regensburg, D-93042, Regensburg, Germany
| | - S Arndt
- Department of Dermatology, University Hospital Regensburg, D-93042, Regensburg, Germany
| | - P Unger
- Department of Dermatology, University Hospital Regensburg, D-93042, Regensburg, Germany
| | - I Ivanova
- Department of Dermatology, University Hospital Regensburg, D-93042, Regensburg, Germany
| | - M Berneburg
- Department of Dermatology, University Hospital Regensburg, D-93042, Regensburg, Germany
| | - C Hellerbrand
- Institute of Biochemistry, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054, Erlangen, Germany
| | - S Karrer
- Department of Dermatology, University Hospital Regensburg, D-93042, Regensburg, Germany
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Kurz B, Berneburg M, Singer S. [Sun protection of human skin: from A to Z]. Hautarzt 2022; 73:251-256. [PMID: 35146544 DOI: 10.1007/s00105-022-04953-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Abstract
Solar radiation contains about 6.8% ultraviolet (UV) radiation. UV radiation is still regarded as one of the most important risk factors for both nonmelanoma skin cancer (NMSC; predominantly basal cell carcinoma and squamous cell carcinoma) and malignant melanoma (MM). To avoid induction and persistence of UV-induced mutations, our skin is armed with an arsenal of endogenous protective mechanisms such as induction of cell cycle arrest, repair mechanisms, immunosurveillance and the initiation of various types of cell death. Exogenous sun protection includes a range of behaviors such as avoiding extensive sun exposure, wearing UV-proof clothing and appropriate application of topical sunscreens.
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Affiliation(s)
- B Kurz
- Klinik und Poliklinik für Dermatologie, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - M Berneburg
- Klinik und Poliklinik für Dermatologie, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - S Singer
- Klinik und Poliklinik für Dermatologie, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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Bastos EL, Baptista MS. Editorial: Special issue on endogenous photosensitizers and their roles in skin photodamage and photoprotection. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY 2021. [DOI: 10.1016/j.jpap.2021.100085] [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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