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Almuhanna N, Aljughayman M, Fidler L, Alhusayen R. Risk of respiratory diseases among hospitalized patients with hidradenitis suppurativa. Int J Dermatol 2024. [PMID: 38634645 DOI: 10.1111/ijd.17182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/20/2024] [Accepted: 03/29/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a systemic disorder associated with various metabolic and inflammatory comorbidities. Although HS shares risk factors and pathogenic pathways with various respiratory conditions, few studies have explored the relationship between HS and respiratory disease. METHODS This is a cross-sectional, case-control, population-based study that examined the United States National Inpatient Sample database from January 1, 2002, to December 31, 2012. HS was identified using ICD-9-CM codes during hospital admissions. Multivariable logistic regression was used to evaluate for adjusted associations between HS and respiratory diagnoses as compared to matched controls. RESULTS Twenty-three thousand seven hundred and sixty-seven hospital admissions for HS were compared with 95,068 age- and sex-matched controls. HS patients had significantly higher adjusted odds of asthma (OR: 1.233; 95% CI: [1.170-1.299]; P < 0.001), chronic airway obstruction (OR: 1.532; 95% CI: [1.419-1.651]; P < 0.001), sarcoidosis (OR: 1.601; 95% CI: [1.157-2.214]; P < 0.001), and sleep apnea (OR: 1.274; 95% CI: [1.182-1.374]; P < 0.001). CONCLUSION HS is associated with several common forms of respiratory disease. Knowledge of these associations may allow for better recognition of respiratory disease in HS patients.
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Affiliation(s)
- Nouf Almuhanna
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Dermatology, Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Lee Fidler
- Division of Respirology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Raed Alhusayen
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
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2
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Alarfaj AA. Unraveling the Power of Topical Inhaled Steroids in Treating Laryngeal Granulomas: A Systematic Review. Life (Basel) 2023; 13:1984. [PMID: 37895366 PMCID: PMC10608710 DOI: 10.3390/life13101984] [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: 08/25/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
The efficacy of inhaled steroids in the treatment of airway laryngeal granuloma is an important topic of research, given the increasing prevalence of this condition. In this systematic review, we aimed to evaluate the existing evidence on the effectiveness of inhaled steroids in treating airway granuloma. The search was performed in several electronic databases including PubMed, Embase, and the Cochrane Library. We included all relevant studies that were published in the English language between 2005 and 2021. A total of nine studies were eligible for inclusion in our systematic review, including one randomized controlled trial, one case-control study, and seven retrospective studies. The results of our review suggest that inhaled steroids may be effective in treating airway granuloma, but more research is needed to confirm these findings. The limitations of the included studies, such as small sample sizes, inconsistent study designs, and a lack of long-term follow-up, suggest that additional research is needed to confirm the effectiveness of inhaled steroids in treating airway granuloma. Overall, this systematic review highlights the need for further studies to confirm the effectiveness of inhaled steroids in treating airway granuloma.
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Affiliation(s)
- Abdullah A Alarfaj
- Otolaryngology Unit, Department of Surgery, King Faisal University, Al Ahsa 31982, Saudi Arabia
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Ouchene L, Muntyanu A, Assayag D, Veilleux È, Abril A, Ferrara G, Yacyshyn E, Pineau CA, O'Brien E, Baron M, Osman M, Gniadecki R, Netchiporouk E. Skin disorders and interstitial lung disease: Part II-The spectrum of cutaneous diseases with lung disease association. J Am Acad Dermatol 2023; 88:767-782. [PMID: 36228940 DOI: 10.1016/j.jaad.2022.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/30/2022] [Accepted: 09/07/2022] [Indexed: 11/06/2022]
Abstract
Part 2 of this 2-part CME introduces dermatologists to noninfectious inflammatory skin diseases associated with pulmonary involvement. In many cases, dermatologists may be the first physicians recognizing respiratory complications associated with these diagnoses. Because pulmonary involvement is often the leading cause of morbidity and mortality, dermatologists should be comfortable screening and monitoring for lung disease in high-risk patients, recognizing cutaneous stigmata of lung disease in these patients and referring to pulmonary specialists, when appropriate, for prompt treatment initiation. Some treatments used for skin disease may not be appropriate in the context of lung disease and hence, choosing a holistic approach is important. Interstitial lung disease and pulmonary hypertension are the most common pulmonary complications and a significant cause of mortality in autoimmune connective tissue diseases, especially systemic sclerosis, dermatomyositis, and mixed connective tissue disease. Pulmonary complications, notably interstitial lung disease, are also common and life-threatening in sarcoidosis and vasculitis, while they are variable in neutrophilic and autoimmune blistering diseases.
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Affiliation(s)
- Lydia Ouchene
- Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Anastasiya Muntyanu
- Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Deborah Assayag
- Division of Pulmonary Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Èvicka Veilleux
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Andy Abril
- Division of Rheumatology, Mayo Clinic, Jacksonville, Florida
| | - Giovanni Ferrara
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Yacyshyn
- Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Christian A Pineau
- Division of Rheumatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Elizabeth O'Brien
- Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Murray Baron
- Division of Rheumatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Mohammed Osman
- Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | - Elena Netchiporouk
- Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada.
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Kusraeva DT, Olisova OY, Teplyuk NP, Grabovskaya OV, Kayumova LN, Bobkova AE, Varshavsky VA, Komleva LF, Petrenko EV, Bobrova KY. PYODERMA GANGRENOSUM MIMICKING GRANULOMATOSIS WITH POLYANGIITIS: CACE REPORT AND RIVIEW OF THE LITERATURE. VESTNIK DERMATOLOGII I VENEROLOGII 2023. [DOI: 10.25208/vdv1386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Pyoderma gangrenosum is an autoinflammatory neutrophilic dermatosis. Diagnosis of the disease remains a difficult task to date, due to the lack of a gold standard of examination and differential diagnostic signs. The primary elements in the development of PG may be papules, pustules or bullae the dissection of which subsequently leads to the formation of ulcers with irregular, violaceous, undermined borders. In rare cases, the diagnosis of the disease can also be complicated by the rapid development of internal organs damage symptoms, which must be regarded as extracutaneous manifestations of PG. Extracutaneous lesions can occur before, during or after the appearance of skin rashes, and the detection of sterile neutrophil infiltrates in the defeat of internal organs confirm the concept of PG as a multisystemic disease. The presented case of a rare course of PG with multiple skin lesions and extracutaneous manifestations, simulating systemic vasculitis, emphasizes the importance of a detailed examination of patients in order to make a correct diagnosis and prescribe timely adequate treatment.
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5
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Shayani KE, Birnbaum B, Machnicki S, Hajiyeva S, Lazzaro R, Mina B. Cough and Progressive Pleuritic Chest Pain With an Enlarging Cavity on Imaging. Chest 2022; 161:e349-e354. [PMID: 35680314 DOI: 10.1016/j.chest.2022.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/18/2021] [Accepted: 01/06/2022] [Indexed: 11/17/2022] Open
Abstract
CASE PRESENTATION A 49-year-old woman sought treatment at the hospital for evaluation of an enlarging cavitary mass of the right lung associated with worsening ipsilateral pleuritic chest pain and cough. She had recent hospitalizations for complications relating to recurrent lung abscesses, including one in which she underwent wedge resection of the right lung. She had been treated with several courses of antibiotics, which only temporarily relieved her symptoms. She did not report any fevers, chills, skin changes, diarrhea, or changes to her bowel habits. Her long-term medications included albuterol, dapsone, and prednisone 15 mg or 20 mg doses alternating daily. Her only past medical history was asthma and primary cutaneous pyoderma gangrenosum. The patient never smoked and did not report any recent sick contacts.
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Affiliation(s)
- Kevin E Shayani
- Department of Medicine, Zucker School of Medicine at Lenox Hill Hospital, New York, NY.
| | - Brian Birnbaum
- Department of Pulmonary and Critical Care, Zucker School of Medicine at Lenox Hill Hospital, New York, NY
| | - Stephen Machnicki
- Department of Radiology, Zucker School of Medicine at Lenox Hill Hospital, New York, NY
| | - Sabina Hajiyeva
- Department of Pathology, Zucker School of Medicine at Lenox Hill Hospital, New York, NY
| | - Richard Lazzaro
- Department of Thoracic Surgery, Zucker School of Medicine at Lenox Hill Hospital, New York, NY
| | - Bushra Mina
- Department of Pulmonary and Critical Care, Zucker School of Medicine at Lenox Hill Hospital, New York, NY
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Xing F, Chiu KHY, Yang J, Ye H, Zhang L, Liu C, Yuen KY. Pyoderma gangrenosum with pulmonary involvement: a pulmonary special report and literature review. Expert Rev Respir Med 2022; 16:149-159. [PMID: 35034556 DOI: 10.1080/17476348.2022.2027756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Pyoderma gangrenosum (PG) is the prototypical neutrophilic dermatosis, commonly associated with inflammatory bowel disease, with pulmonary involvement being the commonest extracutaneous manifestation. PG with tracheobronchial involvement may present as upper airway obstruction and can be life-threatening. AREAS COVERED To evaluate the clinical characteristics and predictors of PG with pulmonary involvement, we reported a case of PG with tracheobronchial involvement in China, and performed a literature retrieval on PG with pulmonary involvement. Demographic data, clinical presentations, underlying diseases, radiological and histopathological findings, treatments, and clinical outcomes were collected and subjected to statistical analysis. Forty-seven cases (including ours) were identified. Diseases associated with PG with pulmonary involvement were similar. Clinical presentation of PG with pulmonary involvement was non-specific, with cough and dyspnea being the most common clinical symptoms, and pulmonary infiltrates and cavitation being the most common radiological signs. Further univariate analysis suggested stridor and young age (p < 0.01) may be predictors of tracheobronchial involvement in PG. EXPERT OPINION PG with tracheobronchial involvement can be life-threatening, with young age and stridor being possible predictors. Therefore, prompt airway assessment and management are required in younger patients with PG with pulmonary involvement presenting with stridor.
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Affiliation(s)
- Fanfan Xing
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Kelvin Hei-Yeung Chiu
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China
| | - Jin Yang
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Haiyan Ye
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Lijun Zhang
- Department of Rheumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Chenjing Liu
- Department of Pediatrics, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Kwok-Yung Yuen
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.,Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.,The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
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7
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Kraus RF, Gruber MA, Kieninger M. The influence of extracellular tissue on neutrophil function and its possible linkage to inflammatory diseases. IMMUNITY INFLAMMATION AND DISEASE 2021; 9:1237-1251. [PMID: 34115923 PMCID: PMC8589351 DOI: 10.1002/iid3.472] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/01/2021] [Accepted: 05/20/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Migration, production of reactive oxygen species (ROS), release of myeloperoxidase (MPO), and NETosis are functional immunological reactions of elementary importance for polymorphonuclear neutrophils (PMN). Unregulated inflammatory response of PMN within tissues plays a key role in the pathophysiology of several diseases. However, little is known about the behavior of PMN after migration through blood vessel walls. Therefore, we investigated the influence of the extracellular matrix (ECM) on PMN function. MATERIALS AND METHODS We established an in vitro chemotaxis model of type I and III collagen, fibrin, and herbal agarose tissues using µ-slide chemotaxis devices and N-formylmethionine-leucyl-phenylalanine (fMLP). PMN within the matrices were assessed with a fluorescent time-lapse microscope for live-cell imaging. RESULTS PMN function was obviously influenced by the ECM. Type III collagen had an inhibitory effect on PMN migration regarding track length, direction, and targeting. Type III collagen also had an accelerating effect on neutrophil ROS production. Agarose had an inhibitory effect on MPO release and fibrin a retarding effect on NETosis. CONCLUSION Because of the high abundance of type III collagen in lung and skin matrices, the interaction of PMN with the respective matrix could be an important mechanism in the pathophysiology of acute respiratory distress syndrome and pyoderma gangrenosum.
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Affiliation(s)
- Richard F Kraus
- Department of Anaesthesiology, University Medical Centre Regensburg, Regensburg, Germany
| | - Michael A Gruber
- Department of Anaesthesiology, University Medical Centre Regensburg, Regensburg, Germany
| | - Martin Kieninger
- Department of Anaesthesiology, University Medical Centre Regensburg, Regensburg, Germany
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Hooton TA, Hanson JF, Olerud JE. Recalcitrant cutaneous pyoderma gangrenosum with pulmonary involvement resolved with treatment of underlying plasma cell dyscrasia. JAAD Case Rep 2021; 9:28-30. [PMID: 33604440 PMCID: PMC7873383 DOI: 10.1016/j.jdcr.2020.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Tyler A Hooton
- University of Washington, School of Medicine, Seattle, Washington
| | - Josiah F Hanson
- University of Washington, School of Medicine, Seattle, Washington
| | - John E Olerud
- University of Washington, School of Medicine, Seattle, Washington
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9
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[Is pyoderma gangrenosum exclusively a skin disease?]. Hautarzt 2021; 72:451-452. [PMID: 33479789 DOI: 10.1007/s00105-021-04758-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
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10
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Singer TG, Bray MA, Chan A, Ikeda S, Walters B, Fuller MY, Falco C. Chronic Ulcers and Malnutrition in an African Patient. Pediatrics 2020; 146:peds.2020-1717. [PMID: 33115794 PMCID: PMC8061712 DOI: 10.1542/peds.2020-1717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2020] [Indexed: 11/24/2022] Open
Abstract
An 11-year-old girl with a congenitally malformed left hand, sickle cell trait, asthma, and history of appendicitis was transferred from Zambia for evaluation and treatment of widespread suppurative and ulcerative skin lesions that typically appeared after trauma to her skin. The ulcers first presented 3 years earlier but had markedly worsened in the 9 months before transfer, spreading circumferentially on her extremities and abdomen at the site of an appendectomy. They were painful and did not resolve with multiple courses of intravenous antibiotics and close management by a pediatric infectious disease specialist working for a nongovernmental organization (NGO) in her home country. Per NGO records, she had previously been average weight-for-age. On presentation after international transfer, she was severely malnourished, with lesions covering ∼35% of her body. In initial workup, leukocytosis of 21 × 103 cells per μL (79% neutrophils), hemoglobin of 6.1 g/dL, and mean corpuscular volume of 66 fL were found. Iron studies revealed an iron level of 18 μg/dL, ferritin level of 55 ng/mL, total iron binding capacity of 222 μg/dL, and transferrin saturation of 8%. Inflammatory markers were elevated, C-reactive protein was 20.1 mg/dL, and the erythrocyte sedimentation rate was 131 mm/h. A chest computed tomography scan revealed bilateral pulmonary nodules, the largest in her left upper lobe measuring 2.4 × 2.0 × 1.9 cm. Our panel of experts reviews the evaluation and treatment of this patient with extensive suppurative and ulcerative skin lesions and the factors considered in offering charity care to international patients.
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Affiliation(s)
- Timothy G. Singer
- Global Child Health Residency, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Monica A. Bray
- Pediatric Rheumatology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Audrey Chan
- Pediatric Dermatology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Saki Ikeda
- Pediatric Infectious Disease, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Brittany Walters
- International and Destination Medicine, Texas Children’s Hospital, Houston, TX USA
| | - Maren Y. Fuller
- Pathology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
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Salem I, Kimak M, Conic R, Bragazzi NL, Watad A, Adawi M, Bridgewood C, Pacifico A, Santus P, Rizzi M, Petrou S, Colombo D, Fiore M, Pigatto PDM, Damiani G. Neutrophilic Dermatoses and Their Implication in Pathophysiology of Asthma and Other Respiratory Comorbidities: A Narrative Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7315274. [PMID: 31281845 PMCID: PMC6590566 DOI: 10.1155/2019/7315274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/14/2019] [Indexed: 01/20/2023]
Abstract
Neutrophilic dermatoses (ND) are a polymorphous group of noncontagious dermatological disorders that share the common histological feature of a sterile cutaneous infiltration of mature neutrophils. Clinical manifestations can vary from nodules, pustules, and bulla to erosions and ulcerations. The etiopathogenesis of neutrophilic dermatoses has continuously evolved. Accumulating genetic, clinical, and histological evidence point to NDs being classified in the spectrum of autoinflammatory conditions. However, unlike the monogenic autoinflammatory syndromes where a clear multiple change in the inflammasome structure/function is demonstrated, NDs display several proinflammatory abnormalities, mainly driven by IL-1, IL-17, and tumor necrosis factor-alpha (TNF-a). Additionally, because of the frequent association with extracutaneous manifestations where neutrophils seem to play a crucial role, it was plausible also to consider NDs as a cutaneous presentation of a systemic neutrophilic condition. Neutrophilic dermatoses are more frequently recognized in association with respiratory disorders than by chance alone. The combination of the two, particularly in the context of their overlapping immune responses mediated primarily by neutrophils, raises the likelihood of a common neutrophilic systemic disease or an aberrant innate immunity disorder. Associated respiratory conditions can serve as a trigger or may develop or be exacerbated secondary to the uncontrolled skin disorder. Physicians should be aware of the possible pulmonary comorbidities and apply this knowledge in the three steps of patients' management, work-up, diagnosis, and treatment. In this review, we attempt to unravel the pathophysiological mechanisms of this association and also present some evidence for the role of targeted therapy in the treatment of both conditions.
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Affiliation(s)
- Iman Salem
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
| | - Mark Kimak
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
| | - Rosalynn Conic
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
| | - Nicola L. Bragazzi
- Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy
| | - Abdulla Watad
- Department of Medicine “B”, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Mohammad Adawi
- Padeh and Ziv Hospitals, Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Charlie Bridgewood
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | | | - Pierachille Santus
- Department of Biomedical Sciences L. Sacco, University of Milan, Milan, Italy
- Respiratory Unit, Center for Sleep and Respiratory Disorders, “Luigi Sacco” University Hospital, Milan, Italy
| | - Maurizio Rizzi
- Respiratory Unit, Center for Sleep and Respiratory Disorders, “Luigi Sacco” University Hospital, Milan, Italy
| | - Stephen Petrou
- Emergency Medicine, Good Samaritan Hospital Medical Center, New York, USA
| | - Delia Colombo
- Department of Pharmacology, University of Milan, Milan, Italy
| | - Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Paolo D. M. Pigatto
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Giovanni Damiani
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Young Dermatologists Italian Network, Centro Studi GISED, Bergamo, Italy
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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12
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Ben Abdallah H, Fogh K, Bech R. Pyoderma gangrenosum and tumour necrosis factor alpha inhibitors: A semi-systematic review. Int Wound J 2019; 16:511-521. [PMID: 30604927 PMCID: PMC7949186 DOI: 10.1111/iwj.13067] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/12/2018] [Accepted: 12/18/2018] [Indexed: 12/13/2022] Open
Abstract
Pyoderma gangrenosum (PG) is a rare ulcerative skin disease that presents a therapeutic challenge. Tumour necrosis factor alpha (TNFα) inhibitors have been reported to successfully control PG. Our aim was to systematically evaluate and compare the clinical effectiveness of TNFα inhibitors in adults with PG. A literature search including databases such as PubMed, Embase, Scopus, and Web of Science was conducted, using search terms related to PG and TNFα inhibitors. Studies and case reports were included if patients were diagnosed with PG, over the age of 18 and administered TNFα inhibitor. A total of 3212 unique citations were identified resulting in 222 articles describing 356 patients being included in our study. The study we report found an 87% (95% CI: 83%-90%) response rate and a 67% (95% CI: 62%-72%) complete response rate to TNFα inhibitors. No statistically significant differences in the response rates (P = 0.6159) or complete response rates (P = 0.0773) to infliximab, adalimumab, and etanercept were found. In our study TNFα inhibitors demonstrated significant effectiveness with response and complete response rates supporting the use of TNFα inhibitors to treat PG in adults. Our study suggests that there is no significant difference in effectiveness among infliximab, adalimumab, and etanercept.
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Affiliation(s)
- Hakim Ben Abdallah
- Institute of Clinical Medicine, Aarhus Faculty of Health SciencesAarhus UniversityAarhusDenmark
| | - Karsten Fogh
- Department of DermatologyAarhus University HospitalAarhusDenmark
| | - Rikke Bech
- Department of DermatologyAarhus University HospitalAarhusDenmark
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13
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Extracutaneous involvement of pyoderma gangrenosum. Arch Dermatol Res 2019; 311:425-434. [PMID: 30923901 DOI: 10.1007/s00403-019-01912-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/31/2018] [Accepted: 03/21/2019] [Indexed: 12/19/2022]
Abstract
Pyoderma Gangrenosum (PG) is an inflammatory neutrophilic dermatosis (ND) associated with underlying chronic inflammation and/or malignancy. Diagnosis remains to be challenging as a gold standard diagnostic test is lacking. Initial manifestations may include papules, vesicles, or pustules that subsequently develop into ulceration with features of undermining and violaceous borders. Timely recognition of pyoderma gangrenosum is impeded by clinical findings shared with other etiologies, such as granulomatosis with polyangiitis, polyarteritis nodosa, and antiphospholipid syndrome. As with any other ND, extracutaneous involvement may also occur preceding, during, or following the appearance of skin lesions. Sterile neutrophilic infiltrates have been found to affect internal organs supporting the concept of PG being a systemic disease, with lung being the most common extracutaneous manifestation followed by ocular and visceral compromise. Therefore, in this review, we describe the current knowledge of extracutaneous involvement of PG and its respective clinical manifestations to aid dermatologists in diagnosis, management, and determining prognosis.
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14
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Xu P, Cai Y, Ying X, Shi S, Song W. A case of persistent fever, cutaneous manifestations and pulmonary and splenic nodules: clinical experience and a literature review. Intern Med J 2019; 49:247-251. [PMID: 30754076 PMCID: PMC6849849 DOI: 10.1111/imj.14201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/13/2018] [Accepted: 08/17/2018] [Indexed: 11/27/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare and recurrent ulcerating, non‐infectious, inflammatory dermatosis, with occasional concomitant extracutaneous manifestations. The pathogenesis and aetiology of PG are unknown. Moreover, early diagnosis is challenging because there are several visceral manifestations that may occur prior to the skin findings, such that misdiagnosis of PG as an infection is common. Here, we present a case of PG in which pulmonary and spleen lesions preceded the cutaneous manifestations. The correct diagnosis was made 6 months after multiple nodules were detected in the lung and spleen, based on the development of skin wound ulcers. To the best of our knowledge, this is the first report of PG in which pulmonary and splenic involvement preceded the appearance of skin lesions, without systemic disease. The patient was followed up for 5 years, during which time complete clinical and radiographic resolution was confirmed. This case demonstrates the challenges in the diagnosis of PG and the importance of using multiple diagnostic methods to determine the cause of unexplained clinical manifestations.
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Affiliation(s)
- Ping Xu
- Department of Respiratory, Peking University Shenzhen Hospital, Shenzhen, Gangdong, China
| | - Yazhou Cai
- Department of Respiratory, Peking University Shenzhen Hospital, Shenzhen, Gangdong, China
| | - Xiaona Ying
- Department of Respiratory, Peking University Shenzhen Hospital, Shenzhen, Gangdong, China
| | - Shiqiao Shi
- Department of Diagnostic Radiology, Peking University Shenzhen Hospital, Shenzhen, Gangdong, China
| | - Weidong Song
- Department of Respiratory, Peking University Shenzhen Hospital, Shenzhen, Gangdong, China
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McKenzie F, Cash D, Gupta A, Cummings LW, Ortega-Loayza AG. Biologic and small-molecule medications in the management of pyoderma gangrenosum. J DERMATOL TREAT 2018; 30:264-276. [PMID: 30051737 DOI: 10.1080/09546634.2018.1506083] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pyoderma gangrenosum (PG) is an uncommon inflammatory skin disorder characterized by neutrophil dysfunction. There are currently no FDA-approved drugs for the treatment of this disease, and treatment has typically relied on traditional immunosuppressive medications such as prednisone or cyclosporine. The efficacy of biologics in the treatment of other pro-inflammatory conditions such as psoriasis, rheumatoid arthritis, and inflammatory bowel disease is well-documented in the literature. Therefore, the use of biologic medications for the treatment of rarer inflammatory skin conditions, such as PG, is a compelling topic for investigation. Biologic and small-molecule therapies allow physicians to target specific pro-inflammatory mediators that underlie PG pathogenesis. This review provides an update on the use of biologic and small-molecule medications for the treatment of PG and summarizes the latest data on the clinical efficacy and pharmacology of these treatments.
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Affiliation(s)
- Fatima McKenzie
- a Department of Dermatology , Oregon Health & Science University , Portland , OR , USA
| | - Devin Cash
- b School of Medicine , Virginia Commonwealth University , Richmond , VA , USA
| | - Angela Gupta
- b School of Medicine , Virginia Commonwealth University , Richmond , VA , USA
| | - Laurel W Cummings
- b School of Medicine , Virginia Commonwealth University , Richmond , VA , USA
| | - Alex G Ortega-Loayza
- a Department of Dermatology , Oregon Health & Science University , Portland , OR , USA
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16
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Alavi A, French LE, Davis MD, Brassard A, Kirsner RS. Pyoderma Gangrenosum: An Update on Pathophysiology, Diagnosis and Treatment. Am J Clin Dermatol 2017; 18:355-372. [PMID: 28224502 DOI: 10.1007/s40257-017-0251-7] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic disorder with prototypical clinical presentations. Its pathophysiology is complex and not fully explained. Recent information regarding the genetic basis of PG and the role of auto-inflammation provides a better understanding of the disease and new therapeutic targets. PG equally affects patients of both sexes and of any age. Uncontrolled cutaneous neutrophilic inflammation is the cornerstone in a genetically predisposed individual. Multimodality management is often required to reduce inflammation, optimize wound healing, and treat underlying disease. A gold standard for the management of PG does not exist and high-level evidence is limited. Multiple factors must be taken into account when deciding on the optimum treatment for individual patients: location, number and size of lesion/ulceration(s), extracutaneous involvement, presence of associated disease, cost, and side effects of treatment, as well as patient comorbidities and preferences. Refractory and rapidly progressive cases require early initiation of systemic therapy. Newer targeted therapies represent a promising pathway for the management of PG, and the main focus of this review is the management and evidence supporting the role of new targeted therapies in PG.
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17
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Cosgarea R, Senilă SC, Badea R, Ungureanu L. Pyoderma gangrenosum with spleen involvement. Review of the literature and case report. J Dermatol Case Rep 2016; 10:26-31. [PMID: 27900062 DOI: 10.3315/jdcr.2016.1230] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/04/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pyoderma gangrenosum is a rare, ulcerative, destructive, non-infectious dermatologic disease and it is one clinical entity within the spectrum of neutrophilic dermatoses. Visceral involvement, manifesting as sterile neutrophilic infiltrates in sites other than skin and, is infrequent. Splenic involvement is very rare. MAIN OBSERVATIONS We present a case of a 58-year-old woman with pyoderma gangrenosum with spleen involvement and review all reports of similar cases.We have found nine reported cases, our case being the tenth. CONCLUSION Our review showed that spleen involvement in the course of pyoderma gangrenosum can occur at any age. It is slightly more frequent in men. An underlying or associated neutrophilic disorder is present in almost half of the patients. Skin manifestations were usually present before splenic involvement. In most cases the disese responds well to glucocorticosteroids.
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Affiliation(s)
- Rodica Cosgarea
- Iuliu Hațieganu University of Medicine and Pharmacy, Department of Dermatology, Cluj-Napoca, Romania
| | - Simona Corina Senilă
- Iuliu Hațieganu University of Medicine and Pharmacy, Department of Dermatology, Cluj-Napoca, Romania
| | - Radu Badea
- Ultrasonography Laboratory, Imaging and Radiology Department, "Octavian Fodor" Gastroenterology and Hepatology Regional Institute, Cluj-Napoca, Romania
| | - Loredana Ungureanu
- Iuliu Hațieganu University of Medicine and Pharmacy, Department of Dermatology, Cluj-Napoca, Romania
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18
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Scherlinger M, Guillet S, Doutre MS, Beylot-Barry M, Pham-Ledard A. Pyoderma gangrenosum with extensive pulmonary involvement. J Eur Acad Dermatol Venereol 2016; 31:e214-e216. [DOI: 10.1111/jdv.13976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- M. Scherlinger
- Dermatology Department; CHU de Bordeaux; Bordeaux France
| | - S. Guillet
- Dermatology Department; CHU de Bordeaux; Bordeaux France
| | - M.-S. Doutre
- Dermatology Department; CHU de Bordeaux; Bordeaux France
| | | | - A. Pham-Ledard
- Dermatology Department; CHU de Bordeaux; Bordeaux France
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19
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Be M, Cha HJ, Park C, Park Y, Jung H, Lee Y, Jegal Y. Multiple pulmonary cavitary nodules with pyoderma gangrenosum in patient with rheumatoid arthritis. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:39. [PMID: 26889492 DOI: 10.3978/j.issn.2305-5839.2016.01.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare ulcerative neutrophilic disorder of skin. Its pulmonary manifestations are uncommon and only less than forty cases have been reported in the literature previously. PG is associated with variable systemic diseases, most commonly inflammatory bowel disease and hematologic malignancies. It reported rarely in rheumatoid arthritis (RA). We report a case of PG lung involvement in patient with RA associated interstitial lung disease. A 66-year-old woman presented with productive cough and recurrent ulcerative lesion on her left ankle. She had a 15-year history of RA associated interstitial lung disease and treated with methotrexate, sulfasalazine, hydroxychloroquine and methylprednisolone. On physical examination, there were a few tender, erythematous subcutaneous nodules ranging from 1 to 3 cm in diameter on her left thigh and left elbow. Anti-neutrophil cytoplasmic antibodies (ANCAs) are negative. Her chest CT scan demonstrated multifocal cavitary consolidations on the background of reticular opacity and honeycombing. Punch biopsy of erythematous nodule on thigh showed neutrophilic abscess with necrotic debris. The skin and lung lesions were rapidly improved with 0.5 mg/kg/day of prednisolone.
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Affiliation(s)
- Miae Be
- 1 Department of Internal Medicine, 2 Department of Pathology, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Korea
| | - Hee Jeong Cha
- 1 Department of Internal Medicine, 2 Department of Pathology, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Korea
| | - Chanho Park
- 1 Department of Internal Medicine, 2 Department of Pathology, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Korea
| | - Yongtae Park
- 1 Department of Internal Medicine, 2 Department of Pathology, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Korea
| | - Hwasik Jung
- 1 Department of Internal Medicine, 2 Department of Pathology, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Korea
| | - Yoeunim Lee
- 1 Department of Internal Medicine, 2 Department of Pathology, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Korea
| | - Yangjin Jegal
- 1 Department of Internal Medicine, 2 Department of Pathology, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Korea
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20
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Atteintes extracutanées d’une dermatose neutrophilique. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.169] [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]
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21
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Twu O, Mednik S, Scumpia P, Doaty S, Worswick S. Use of Becaplermin for nondiabetic ulcers: pyoderma gangrenosum and calciphylaxis. Dermatol Ther 2015; 29:104-8. [PMID: 26556220 DOI: 10.1111/dth.12318] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Large difficult to heal ulcers of various etiologies carry a high morbidity and mortality rate. Becaplermin is a recombinant platelet-derived growth factor approved for treatment of diabetic ulcers. In this two-case series, we report the use of becaplermin in the treatment of ulcers due to (i) calciphylaxis, an often fatal condition resulting from systemic calcification and thrombosis of vessels and (ii) pyoderma gangrenosum (PG), a neutrophilic dermatosis. We also report that topical collagenase worsened PG ulcers, consistent with pathergy. Becaplermin can be used to help treat ulcers resulting from calciphylaxis and PG. These encouraging results lend support for the utilization of becaplermin in the treatment of nondiabetic chronic ulcers of various etiologies.
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Affiliation(s)
| | | | | | - Sarah Doaty
- Division of Rheumatology, University of California, Los Angeles, California
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22
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Kolios A, Maul J, Meier B, Kerl K, Traidl‐Hoffmann C, Hertl M, Zillikens D, Röcken M, Ring J, Facchiano A, Mondino C, Yawalkar N, Contassot E, Navarini A, French L. Canakinumab in adults with steroid‐refractory pyoderma gangrenosum. Br J Dermatol 2015; 173:1216-23. [DOI: 10.1111/bjd.14037] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2015] [Indexed: 12/30/2022]
Affiliation(s)
- A.G.A. Kolios
- Department of Dermatology Zürich University Hospital Gloriastraße 31 8091 Zürich Switzerland
- Department of Immunology Zürich University Hospital Gloriastraße 31 8091 Zürich Switzerland
| | - J.‐T. Maul
- Department of Dermatology Zürich University Hospital Gloriastraße 31 8091 Zürich Switzerland
| | - B. Meier
- Department of Dermatology Zürich University Hospital Gloriastraße 31 8091 Zürich Switzerland
| | - K. Kerl
- Department of Dermatology Zürich University Hospital Gloriastraße 31 8091 Zürich Switzerland
| | - C. Traidl‐Hoffmann
- Department of Dermatology and Allergy Biederstein Technische Universität Mönchen Munich Germany
| | - M. Hertl
- Departments of Dermatology and Allergology Philipps University Marburg Marburg Germany
| | - D. Zillikens
- Department of Dermatology University of Lübeck Lübeck Germany
| | - M. Röcken
- Department of Dermatology Eberhard Karls University of Tübingen Tübingen Germany
| | - J. Ring
- Department of Dermatology and Allergy Biederstein Technische Universität Mönchen Munich Germany
| | - A. Facchiano
- Istituto Dermopatico dell'Immacolata IDI‐IRCCS Rome Italy
| | - C. Mondino
- Ospedale Regionale di Bellinzona e Valli Bellinzona Switzerland
| | - N. Yawalkar
- Department of Dermatology Bern University Hospital Bern Switzerland
| | - E. Contassot
- Department of Dermatology Zürich University Hospital Gloriastraße 31 8091 Zürich Switzerland
| | - A.A. Navarini
- Department of Dermatology Zürich University Hospital Gloriastraße 31 8091 Zürich Switzerland
| | - L.E. French
- Department of Dermatology Zürich University Hospital Gloriastraße 31 8091 Zürich Switzerland
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