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Mansouri P, Jafari MA, Chalangari R, Roohaninasab M, Goodarzi A. Successful Treatment of Erosive Lichen Planus With Tofacitinib: A Case Series and Review of the Literature. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476241237350. [PMID: 38463136 PMCID: PMC10924541 DOI: 10.1177/11795476241237350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 02/16/2024] [Indexed: 03/12/2024]
Abstract
Lichen planus (LP) is an inflammatory disease that affects the skin, hair, nails and mucous membranes. Erosive LP is a chronic and difficult-to-treat subtype of lichen planus, characterized by lesions on mucosal surfaces, particularly in the oral and genital areas. The prevalence of erosive LP has not been determined. To date, treatment has consisted of surgical intervention, photodynamic therapy, laser therapy, and systemic or topical drugs, including steroids and immunomodulatory agents. LP usually need longer periods of treatment and are known as precancerous lesions with a 0.4% to 12% conversion rate. In addition, nearly 25% of patients who develop erosive LP of the vulva are resistant to topical corticosteroids, which are the first choice of treatment. This study reports 6 cases with a mean age of 3.33 years, who were diagnosed with erosive LP lesions and previously failed in treatment with local, intralesional, and systemic steroids, and hydroxychloroquine. These patients were then treated with 10 mg of tofacitinib per day. Interestingly, with the new treatment, the patients' mean overall satisfaction score was 9.16 out of 10 (range: 8-10), the mean pain relief score was 9.16 out of 10 (range: 9-10) and patients' symptom improvement also began an average of 1.33 months after starting treatment (range: 1-2.5 months).
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Affiliation(s)
- Parvin Mansouri
- Department of Dermatology, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohammad Amin Jafari
- Department of Dermatology, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Chalangari
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Masoumeh Roohaninasab
- Department of Dermatology, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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2
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He J, Weng T, Zhu W, Yang Y, Li C. Alleviation of isolated nail lichen planus by the JAK1/2 inhibitor Baricitinib: a case report. J DERMATOL TREAT 2023; 34:2274816. [PMID: 37919960 DOI: 10.1080/09546634.2023.2274816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Juan He
- Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Tengyu Weng
- Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wenwei Zhu
- Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yi Yang
- Department of Dermatology, The Third Medical Center of the Chinese People's Liberation Army, Beijing, China
| | - Chengxin Li
- Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing, China
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3
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Bazargan AS, Jafarzadeh A, Nobari NN. Successful treatment of resistant plantar ulcerative lichen planus with tofacitinib: A case report and comprehensive review of the literature. Clin Case Rep 2023; 11:e8066. [PMID: 37854265 PMCID: PMC10580686 DOI: 10.1002/ccr3.8066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
Key Clinical Message Ulcerative lichen planus, a challenging variant of lichen planus, has limited response to traditional treatments. Tofacitinib, a JAK-STAT pathway inhibitor, shows promise in effectively treating these lesions. Abstract Lichen planus is a mucocutaneous disease that can cause various manifestations, such as itchy erythematous papules, cicatricial alopecia, erosion, and mucocutaneous ulcers. One uncommon manifestation of this disease is the occurrence of erosion and skin ulcers in the soles of the feet, which can cause many problems for patients. Tofacitinib, a Janus Kinase (JAK) inhibitor drug, has found a special place in the field of inflammatory diseases, especially inflammatory skin diseases. In this regard, studies on the effective role of this drug in the treatment of certain forms of lichen planus, including lichen planopilaris, and erosive lichen planus have been performed. In upcoming study, we introduce a 52-year-old woman with lichen planus who complained of ulcerative lesions on the sole of her foot, for whom a diagnosis of plantar ulcerative lichen planus was proposed. After the patient did not respond therapeutically to intralesional triamcinolone acetonide injection, as well as methotrexate and cyclosporine tablets, significant improvement was finally achieved with a 5 mg twice daily dose of tofacitinib. In the following, we will comprehensively review previous articles on the role of tofacitinib in the treatment of lichen planus lesions, as well as the proposed treatment options for erosive and ulcerative lichen planus lesions specifically located on the sole of the foot. Despite limited reports of the successful treatment of mucosal erosive lesions in the oral, esophageal, genital, and ocular mucosa areas with tofacitinib, no previous study has reported the successful treatment of ulcerative lichen planus lesions of the plantar area with tofacitinib. While reporting this case, we recommend considering tofacitinib as a treatment option for plantar ulcerative lichen planus. To confirm its effectiveness, it is necessary to conduct more extensive studies with a larger sample size.
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Affiliation(s)
- Afsaneh Sadeghzadeh Bazargan
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of MedicineIran University of Medical Sciences (IUMS)TehranIran
- Skin and Stem Cell Research CenterTehran University of Medical SciencesTehranIran
| | - Alireza Jafarzadeh
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of MedicineIran University of Medical Sciences (IUMS)TehranIran
| | - Niloufar Najar Nobari
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of MedicineIran University of Medical Sciences (IUMS)TehranIran
- Skin and Stem Cell Research CenterTehran University of Medical SciencesTehranIran
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4
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Motamed-Sanaye A, Khazaee YF, Shokrgozar M, Alishahi M, Ahramiyanpour N, Amani M. JAK inhibitors in lichen planus: A review of pathogenesis and treatments. J DERMATOL TREAT 2022; 33:3098-3103. [PMID: 35997540 DOI: 10.1080/09546634.2022.2116926] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Lichen planus (LP) is an auto-inflammatory skin disorder identified by a presence of T-cell lymphocytes at the dermal-epidermal junction. It is hypothesized that the INF-γ/CXCL10 axis fulfills a major role in the onset and persistence of chronic inflammation in LP. Since Janus kinases (JAKs) are involved in the transduction of INF-γ signals, they may be good targets for LP treatment. Several case reports and case series described the safety and efficacy of upadacitinib (2 articles), tofacitinib (6 articles), baricitinib (4 articles), and Ruxolitinib (1 Article) in the treatment of LP variants. The predominant variants that JAK inhibitors improved were lichen planopilaris, nail LP, and erosive LP. Considering the role of the JAK pathway in LP pathogenesis and the evidence provided by these reports, it seems JAK inhibitors would be effective therapeutic agents for LP treatment. Hence, these agents should be trialed and evaluated further.
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Affiliation(s)
- Ali Motamed-Sanaye
- Infectious Diseases research center, student research committee, Faculty of Medicine, Gonabad university of medical sciences, Gonabad, Iran.,Clinical Research Development Unit, Bohlool Hospital, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Yasaman Fatemeh Khazaee
- Assistant professor of pediatrics Department, School of Medicine, Gonabad University of Medical Sciences
| | | | - Maryam Alishahi
- Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Najmeh Ahramiyanpour
- Department of Dermatology, Afzalipour Hospital, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Maliheh Amani
- Department of Dermatology, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
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5
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Iorizzo M, Haneke E. Tofacitinib as Treatment for Nail Lichen Planus Associated With Alopecia Universalis. JAMA Dermatol 2021; 157:352-353. [PMID: 33404596 DOI: 10.1001/jamadermatol.2020.4555] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Eckart Haneke
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
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6
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Marlina E, Goodman RN, Mercadante V, Shephard M, McMillan R, Hodgson T, Leeson R, Porter S, Barber JA, Fedele S, Smith AM. A proof of concept pilot trial of probiotics in symptomatic oral lichen planus (CABRIO). Oral Dis 2021; 28:2155-2167. [PMID: 34464996 DOI: 10.1111/odi.14014] [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: 02/15/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To preliminary evaluate the clinical effects of probiotics in individuals with symptomatic oral lichen planus and the possible mechanisms of action. SUBJECTS AND METHODS A group of 30 individuals with symptomatic oral lichen planus were recruited in a randomised double-blind parallel group controlled (1:1) proof-of-concept pilot trial of probiotic VSL#3 vs placebo. Efficacy outcomes included changes in pain numeric rating scale, oral disease severity score and the chronic oral mucosal disease questionnaire. Adverse effects, home diary and withdrawals were assessed as feasibility outcomes. Mechanistic outcomes included changes in salivary and serum levels of CXCL10 and IFN-γ and in oral microbial composition. RESULTS The probiotic VSL#3 was safe and well tolerated. We observed no statistically significant change in pain, disease activity, quality of life, serum/salivary CXCL10 or oral microbial composition with respect to placebo. Salivary IFN-γ levels demonstrate a trend for a reduced level in the active group (p = 0.082) after 30 days of probiotic consumption. CONCLUSIONS The present proof-of-concept study provides some weak not convincing indication of biological and clinical effects of probiotic VSL#3 in individuals with painful oral lichen planus. Further research in this field is needed, with the current study providing useful information to the design of future clinical trials.
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Affiliation(s)
- Erni Marlina
- Eastman Dental Institute, University College London, London, UK.,Department of Oral Medicine, Faculty of Dentistry, Hasanuddin University, Makassar, Indonesia
| | - Richard N Goodman
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | - Roddy McMillan
- Eastman Dental Institute, University College London, London, UK.,UCLH, Eastman Dental Hospital, London, UK
| | | | - Rachel Leeson
- Eastman Dental Institute, University College London, London, UK.,UCLH, Eastman Dental Hospital, London, UK
| | - Stephen Porter
- Eastman Dental Institute, University College London, London, UK
| | | | - Stefano Fedele
- Eastman Dental Institute, University College London, London, UK.,NIHR UCLH Biomedical Research Centre, London, UK
| | - Andrew M Smith
- Eastman Dental Institute, University College London, London, UK
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7
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Hile GA, Gudjonsson JE, Kahlenberg JM. The influence of interferon on healthy and diseased skin. Cytokine 2020; 132:154605. [PMID: 30527631 PMCID: PMC6551332 DOI: 10.1016/j.cyto.2018.11.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/09/2018] [Accepted: 11/19/2018] [Indexed: 01/09/2023]
Abstract
Type I interferons (IFNs) are an immunomodulatory class of cytokines that serve to protect against viral and bacterial infection. In addition, mounting evidence suggests IFNs, particularly type I but also IFNγ, are important to the pathogenesis of autoimmune and inflammatory skin diseases, such as cutaneous lupus erythematosus (CLE). Understanding the role of IFNs is relevant to anti-viral responses in the skin, skin biology, and therapeutics for these IFN-related conditions. Type I IFNs (α and β) are produced by recruited inflammatory cells and by the epidermis itself (IFNκ) and have important roles in autoimmune and inflammatory skin disease. Here, we review the current literature utilizing a PubMed database search using terms [interferon/IFN/type I IFN AND lupus/ cutaneous lupus/CLE/dermatomyositis/Sjogrens/psoriasis/lichen planus/morphea/alopecia areata/vitiligo] with a focus on the role of IFNs in basic keratinocyte biology and their implications in the cutaneous autoimmune and inflammatory diseases: cutaneous lupus erythematosus, dermatomyositis, Sjogren's syndrome, psoriasis, lichen planus, alopecia areata and vitiligo. We provide information about genes and proteins induced by IFNs and how downstream mechanisms relate to clinical disease.
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Affiliation(s)
- Grace A Hile
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA; Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA.
| | - J Michelle Kahlenberg
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
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8
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Iorizzo M, Tosti A, Starace M, Baran R, Daniel CR, Di Chiacchio N, Goettmann S, Grover C, Haneke E, Lipner SR, Rich P, Richert B, Rigopoulos D, Rubin AI, Zaiac M, Piraccini BM. Isolated nail lichen planus: An expert consensus on treatment of the classical form. J Am Acad Dermatol 2020; 83:1717-1723. [PMID: 32112995 DOI: 10.1016/j.jaad.2020.02.056] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/22/2022]
Abstract
Lichen planus is a benign inflammatory disorder of unknown etiology that may affect the skin, mucosae, scalp, and nails. When the nails are affected, it may lead to permanent destruction with severe functional and psychosocial consequences. Therefore, prompt diagnosis and early treatment are essential, even in mild cases. There are currently no guidelines for the management of nail lichen planus and the published literature on treatment is limited. The aim of this review is to provide practical management recommendations for the classical form of nail lichen planus, especially when restricted to the nails. Topical treatment has poor short-term efficacy and may cause long-term side effects. Instead, intralesional and intramuscular triamcinolone acetonide should be considered first-line therapies. Oral retinoids are second-line choices, and immunosuppressive agents may also be considered.
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Affiliation(s)
| | - Antonella Tosti
- University of Miami, Miller School of Medicine, Miami, Florida
| | - Michela Starace
- Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy
| | - Robert Baran
- University of Franche-Comté, Nail Disease Center, Cannes, France
| | - C Ralph Daniel
- University of Mississippi Medical Center, Jackson, Mississippi; University of Alabama, Birmingham, Alabama
| | - Nilton Di Chiacchio
- Department of Dermatology, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | | | - Chander Grover
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Eckart Haneke
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Phoebe Rich
- Oregon Health and Science University, Portland, Oregon
| | - Bertrand Richert
- Saint Pierre - Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Dimitris Rigopoulos
- University Hospital of Venereal and Skin Diseases "A. Sygros," Athens, Athens, Greece
| | - Adam I Rubin
- Department of Dermatology, Hospital of the University of Pennsylvania, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Martin Zaiac
- Greater Miami Skin and Laser Center, Department of Dermatology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Bianca Maria Piraccini
- Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy
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9
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Damsky W, Wang A, Olamiju B, Peterson D, Galan A, King B. Treatment of severe lichen planus with the JAK inhibitor tofacitinib. J Allergy Clin Immunol 2020; 145:1708-1710.e2. [PMID: 32018031 DOI: 10.1016/j.jaci.2020.01.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/14/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
Affiliation(s)
- William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, Conn
| | - Alice Wang
- Department of Dermatology, Yale School of Medicine, New Haven, Conn
| | - Brianna Olamiju
- Department of Dermatology, Yale School of Medicine, New Haven, Conn
| | | | - Anjela Galan
- Department of Dermatology, Yale School of Medicine, New Haven, Conn; Department of Pathology, Yale School of Medicine, New Haven, Conn
| | - Brett King
- Department of Dermatology, Yale School of Medicine, New Haven, Conn.
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10
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Kumaran MS, Bishnoi A, Srivastava N, Tekumalla S, Vinay K, Bhatia A, Parsad D. Significant reduction in the expression of interleukins-17A, 22 and 23A, forkhead box p3 and interferon gamma delineates lichen planus pigmentosus from lichen planus. Arch Dermatol Res 2019; 311:519-527. [PMID: 31089878 DOI: 10.1007/s00403-019-01926-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/14/2019] [Accepted: 05/02/2019] [Indexed: 12/13/2022]
Abstract
Recent studies have noticed significant role of interleukin (IL)-17, 22, 23, Foxp3, interferon-gamma (IFN-γ) and Wnt5a in oral and cutaneous lichen planus (LP). This study was undertaken to assess whether similar expression exists in lichen planus pigmentosus (LPP). We recruited 30 patients of treatment-naïve 'LPP' (in absence of cutaneous/mucosal LP elsewhere, group 1), 10 patients having active treatment-naïve cutaneous 'LP' (group 2), 10 patients having 'post-LP' hyperpigmentation (in absence of active LP and off treatment for at least past 3 months, group 3), and 10 controls. Quantitative real-time polymerase chain reaction (qRT-PCR, peripheral blood mononuclear cells [PBMCs] and skin) and immunohistochemistry (IHC, skin) was performed. mRNA expression (in PBMCs) of IL-17A, IL-22, IL-23A, IFN-γ and Foxp3 was significantly decreased in group 1 and 3 as compared to group 2 (p < 0.05). Wnt5a expression was maximal in controls; and while there was no difference between group 1 and 2; whereas expression in group 3 was significantly lesser than group 1 and 2 (p < 0.05). qRT-PCR (skin) and IHC (skin) revealed similar results; and mRNA expression and mean fluorescence intensity of IL-17A, IL-22, IL-23A/R was significantly increased in group 2 and 3 compared to group 1 (p < 0.05). Mean fluorescence intensity and mRNA expression of IFN-γ, Foxp3 and Wnt5a were significantly increased in group 2 compared to group 1 (p < 0.05); whereas the difference between group 1 and 3 was not significant. Mean fluorescence intensity and mRNA expression of IL-17A, 1L-22 and IFN-γ showed no difference between group 2 and 3; whereas that of IL-23A/R, foxp3 and wnt5a were significantly higher in group 2 than group 3 (p < 0.05). Overall, maximal expression of IL-17A, IL-22, IL-23A, IFN-γ and Foxp3 (mRNA PBMCs) was observed in LP. Minimal expression of IL-17A, IL-22, IL-23A/R, IFN-γ and Foxp3 (mRNA skin and IHC skin) was seen in LPP patients. In contrast to LP, LPP lacks the expression of IFN-γ, Foxp3 and the cytokines representing Th17 pathway, and thus seems to have a distinct pathogenesis.
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Affiliation(s)
- Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Niharika Srivastava
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Sindhuja Tekumalla
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Alka Bhatia
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
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11
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Bishnoi A, Vinay K, Parsad D, Kumaran MS. Exaggerated epidermal pigmentation in acquired dermal macular hyperpigmentation: an important finding. Clin Exp Dermatol 2019; 44:e211. [PMID: 30963620 DOI: 10.1111/ced.13978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2019] [Indexed: 11/30/2022]
Affiliation(s)
- A Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - K Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - D Parsad
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - M S Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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12
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Ciechanowicz P, Rakowska A, Sikora M, Rudnicka L. JAK-inhibitors in dermatology: current evidence and future applications. J DERMATOL TREAT 2018; 30:648-658. [DOI: 10.1080/09546634.2018.1546043] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Piotr Ciechanowicz
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82a, Warsaw 00-008, Poland
| | - Adriana Rakowska
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82a, Warsaw 00-008, Poland
| | - Mariusz Sikora
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82a, Warsaw 00-008, Poland
| | - Lidia Rudnicka
- Department of Neuropeptides, Mossakowski Medical Research Centre Polish Academy of Science, Warsaw, Poland
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13
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Level-Specific Differences in Systemic Expression of Pro- and Anti-Inflammatory Cytokines and Chemokines after Spinal Cord Injury. Int J Mol Sci 2018; 19:ijms19082167. [PMID: 30044384 PMCID: PMC6122077 DOI: 10.3390/ijms19082167] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 07/23/2018] [Accepted: 07/23/2018] [Indexed: 11/17/2022] Open
Abstract
While over half of all spinal cord injuries (SCIs) occur in the cervical region, the majority of preclinical studies have focused on models of thoracic injury. However, these two levels are anatomically distinct—with the cervical region possessing a greater vascular supply, grey-white matter ratio and sympathetic outflow relative to the thoracic region. As such, there exists a significant knowledge gap in the secondary pathology at these levels following SCI. In this study, we characterized the systemic plasma markers of inflammation over time (1, 3, 7, 14, 56 days post-SCI) after moderate-severe, clip-compression cervical and thoracic SCI in a rat model. Using high-throughput ELISA panels, we observed a clear level-specific difference in plasma levels of VEGF, leptin, IP10, IL18, GCSF, and fractalkine. Overall, cervical SCI had reduced expression of both pro- and anti-inflammatory proteins relative to thoracic SCI, likely due to sympathetic dysregulation associated with higher level SCIs. However, contrary to the literature, we did not observe level-dependent splenic atrophy with our incomplete SCI model. This is the first study to compare the systemic plasma-level changes following cervical and thoracic SCI using level-matched and time-matched controls. The results of this study provide the first evidence in support of level-targeted intervention and also challenge the phenomenon of high SCI-induced splenic atrophy in incomplete SCI models.
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14
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Stoffel E, Maier H, Riedl E, Brüggen MC, Reininger B, Schaschinger M, Bangert C, Guenova E, Stingl G, Brunner PM. Analysis of anti-tumour necrosis factor-induced skin lesions reveals strong T helper 1 activation with some distinct immunological characteristics. Br J Dermatol 2018; 178:1151-1162. [PMID: 29143979 DOI: 10.1111/bjd.16126] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psoriasiform and eczematous eruptions are the most common dermatological adverse reactions linked to anti-tumour necrosis factor (TNF)-α therapy. Yet, a detailed characterization of their immune phenotype is lacking. OBJECTIVES To characterize anti-TNF-α-induced inflammatory skin lesions at a histopathological, cellular and molecular level, compared with psoriasis, eczema (atopic dermatitis) and healthy control skin. METHODS Histopathological evaluation, gene expression (quantitative real-time polymerase chain reaction) and computer-assisted immunohistological studies (TissueFAXS) were performed on 19 skin biopsies from patients with inflammatory bowel disease (n = 17) and rheumatoid arthritis (n = 2) with new-onset inflammatory skin lesions during anti-TNF-α-therapy. RESULTS Although most biopsies showed a psoriasiform and/or spongiotic (eczematous) histopathological architecture, these lesions were inconsistent with either psoriasis or eczema on a molecular level using an established chemokine (C-C motif) ligand 27/inducible nitric oxide synthase classifier. Despite some differences in immune skewing depending on the specific histopathological reaction pattern, all anti-TNF-α-induced lesions showed strong interferon (IFN)-γ activation, at higher levels than in psoriasis or eczema. IFN-γ was most likely produced by CD3/CD4/Tbet-positive T helper 1 lymphocytes. CONCLUSIONS New-onset anti-TNF-α-induced eruptions previously classified as psoriasis or spongiotic dermatitis (eczema) exhibit a molecular profile that is different from either of these disorders.
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Affiliation(s)
- E Stoffel
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - H Maier
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria
| | - E Riedl
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria
| | - M-C Brüggen
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
| | - B Reininger
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
| | - M Schaschinger
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
| | - C Bangert
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
| | - E Guenova
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - G Stingl
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
| | - P M Brunner
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria.,Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, U.S.A
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15
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Affiliation(s)
| | - Antonella Tosti
- Fredric Brandt Endowed Professor of Dermatology - Miller School of Medicine, University of Miami, Miami, FL, USA
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16
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Ke Y, Dang E, Shen S, Zhang T, Qiao H, Chang Y, Liu Q, Wang G. Semaphorin4D Drives CD8 + T-Cell Lesional Trafficking in Oral Lichen Planus via CXCL9/CXCL10 Upregulations in Oral Keratinocytes. J Invest Dermatol 2017; 137:2396-2406. [PMID: 28760660 DOI: 10.1016/j.jid.2017.07.818] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/12/2017] [Accepted: 07/10/2017] [Indexed: 12/26/2022]
Abstract
Chemokine-mediated CD8+ T-cell recruitment is an essential but not well-established event for the persistence of oral lichen planus (OLP). Semaphorin 4D (Sema4D)/CD100 is implicated in immune dysfunction, chemokine modulation, and cell migration, which are critical aspects for OLP progression, but its implication in OLP pathogenesis has not been determined. In this study, we sought to explicate the effect of Sema4D on human oral keratinocytes and its capacity to drive CD8+ T-cell lesional trafficking via chemokine modulation. We found that upregulations of sSema4D in OLP tissues and blood were positively correlated with disease severity and activity. In vitro observation revealed that Sema4D induced C-X-C motif chemokine ligand 9/C-X-C motif chemokine ligand 10 production by binding to plexin-B1 via protein kinase B-NF-κB cascade in human oral keratinocytes, which elicited OLP CD8+ T-cell migration. We also confirmed using clinical samples that elevated C-X-C motif chemokine ligand 9/C-X-C motif chemokine ligand 10 levels were positively correlated with sSema4D levels in OLP lesions and serum. Notably, we determined matrix metalloproteinase-9 as a new proteolytic enzyme for the cleavage of sSema4D from the T-cell surface, which may contribute to the high levels of sSema4D in OLP lesions and serum. Our findings conclusively revealed an amplification feedback loop involving T cells, chemokines, and Sema4D-dependent signal that promotes OLP progression.
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Affiliation(s)
- Yao Ke
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China; Department of Oral Medicine, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Erle Dang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shengxian Shen
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Tongmei Zhang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Hongjiang Qiao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yuqian Chang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Qing Liu
- Department of Oral Medicine, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
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17
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Damsky W, King BA. JAK inhibitors in dermatology: The promise of a new drug class. J Am Acad Dermatol 2017; 76:736-744. [PMID: 28139263 PMCID: PMC6035868 DOI: 10.1016/j.jaad.2016.12.005] [Citation(s) in RCA: 301] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/30/2016] [Accepted: 12/06/2016] [Indexed: 12/12/2022]
Abstract
New molecularly targeted therapeutics are changing dermatologic therapy. Janus kinase-signal transducer and activator of transcription (JAK-STAT) is an intracellular signaling pathway upon which many different proinflammatory signaling pathways converge. Numerous inflammatory dermatoses are driven by soluble inflammatory mediators, which rely on JAK-STAT signaling, and inhibition of this pathway using JAK inhibitors might be a useful therapeutic strategy for these diseases. Growing evidence suggests that JAK inhibitors are efficacious in atopic dermatitis, alopecia areata, psoriasis, and vitiligo. Additional evidence suggests that JAK inhibition might be broadly useful in dermatology, with early reports of efficacy in several other conditions. JAK inhibitors can be administered orally or used topically and represent a promising new class of medications. The use of JAK inhibitors in dermatology is reviewed here.
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Affiliation(s)
- William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Brett A King
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.
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