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Romiti R, Hirayama ALDS, Porro AM, Gonçalves HDS, Miot LDB, Durães SMB, Marques SA. Infections in the era of immunobiologicals. An Bras Dermatol 2024; 99:167-180. [PMID: 38238209 PMCID: PMC10943328 DOI: 10.1016/j.abd.2023.08.004] [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: 04/05/2023] [Revised: 08/15/2023] [Accepted: 08/27/2023] [Indexed: 03/11/2024] Open
Abstract
Immunobiologicals represent an innovative therapeutic option in dermatology. They are indicated in severe and refractory cases of different diseases when there is contraindication, intolerance, or failure of conventional systemic therapy and in cases with significant impairment of patient quality of life. The main immunobiologicals used in dermatology basically include inhibitors of tumor necrosis factor-alpha (anti-TNF), inhibitors of interleukin-12 and -23 (anti-IL12/23), inhibitors of interleukin-17 and its receptor (anti-IL17), inhibitors of interleukin-23 (anti-IL23), rituximab (anti-CD20 antibody), dupilumab (anti-IL4/IL13) and intravenous immunoglobulin. Their immunomodulatory action may be associated with an increase in the risk of infections in the short and long term, and each case must be assessed individually, according to the risk inherent to the drug, the patient general condition, and the need for precautions. This article will discuss the main risks of infection associated with the use of immunobiologicals, addressing the risk in immunocompetent and immunosuppressed patients, vaccination, fungal infections, tuberculosis, leprosy, and viral hepatitis, and how to manage the patient in the most diverse scenarios.
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Affiliation(s)
- Ricardo Romiti
- Department of Dermatology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Adriana Maria Porro
- Department of Dermatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Heitor de Sá Gonçalves
- State Health Secretariat of Ceará, Centro de Dermatologia Dona Libânia, Fortaleza, CE, Brazil
| | - Luciane Donida Bartoli Miot
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Sandra Maria Barbosa Durães
- Department of Internal Medicine, Dermatology Unit, Faculty of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Silvio Alencar Marques
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
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2
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Abstract
Patients living with HIV may experience a variety of inflammatory dermatoses, ranging from exacerbations of underlying conditions to those triggered by HIV infection itself. This article presents a current literature review on the etiology, diagnosis and management of atopic dermatitis, psoriasis, pityriasis rubra pilaris, lichen planus, seborrheic dermatitis, eosinophilic folliculitis, pruritic papular eruption and pruritus, in patients living with HIV.
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Affiliation(s)
- Robert Bobotsis
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Shakira Brathwaite
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Panteha Eshtiaghi
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Fabian Rodriguez-Bolanos
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Philip Doiron
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada.
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3
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Liu S, He M, Jiang J, Duan X, Chai B, Zhang J, Tao Q, Chen H. Triggers for the onset and recurrence of psoriasis: a review and update. Cell Commun Signal 2024; 22:108. [PMID: 38347543 PMCID: PMC10860266 DOI: 10.1186/s12964-023-01381-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/02/2023] [Indexed: 02/15/2024] Open
Abstract
Psoriasis is an immune-mediated inflammatory skin disease, involving a complex interplay between genetic and environmental factors. Previous studies have demonstrated that genetic factors play a major role in the pathogenesis of psoriasis. However, non-genetic factors are also necessary to trigger the onset and recurrence of psoriasis in genetically predisposed individuals, which include infections, microbiota dysbiosis of the skin and gut, dysregulated lipid metabolism, dysregulated sex hormones, and mental illness. Psoriasis can also be induced by other environmental triggers, such as skin trauma, unhealthy lifestyles, and medications. Understanding how these triggers play a role in the onset and recurrence of psoriasis provides insights into psoriasis pathogenesis, as well as better clinical administration. In this review, we summarize the triggers for the onset and recurrence of psoriasis and update the current evidence on the underlying mechanism of how these factors elicit the disease. Video Abstract.
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Grants
- No.82173423, No.81974475, No.82103731 the National Natural Science Foundation of China
- No.82173423, No.81974475, No.82103731 the National Natural Science Foundation of China
- No.82173423, No.81974475, No.82103731 the National Natural Science Foundation of China
- Basic Research Project, No. JCYJ20190809103805589 Shenzhen Natural Science Foundation
- Basic Research Project, No. JCYJ20190809103805589 Shenzhen Natural Science Foundation
- Basic Research Project, No. JCYJ20190809103805589 Shenzhen Natural Science Foundation
- Key Project, No.2019003 Shenzhen Nanshan District Science and Technology Project
- Key Project, No.2019003 Shenzhen Nanshan District Science and Technology Project
- Key Project, No.2019003 Shenzhen Nanshan District Science and Technology Project
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Affiliation(s)
- Suwen Liu
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Mengwen He
- Department of Dermatology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, China
| | - Jian Jiang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiaoru Duan
- Department of Rheumatology and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bao Chai
- Department of Dermatology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, China
- Department of Dermatology, The 6th Affiliated Hospital of Shenzhen University Medical School, Shenzhen, 518052, China
| | - Jingyu Zhang
- Department of Dermatology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, China
- Department of Dermatology, The 6th Affiliated Hospital of Shenzhen University Medical School, Shenzhen, 518052, China
| | - Qingxiao Tao
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hongxiang Chen
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Department of Dermatology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, China.
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4
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Agharbi FZ, Basri G, Nejjari S, Chiheb S. Erythrodermic Psoriasis Following SARS-CoV-2 Infection. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T202-T203. [PMID: 38048941 DOI: 10.1016/j.ad.2022.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/14/2022] [Indexed: 12/06/2023] Open
Affiliation(s)
- F Z Agharbi
- Department of Dermatology, Sheikh Khalifa Hospital, Faculty of Medicine, Mohamed VI University of Health Sciences, Casablanca, Marruecos.
| | - G Basri
- Department of Dermatology, Sheikh Khalifa Hospital, Faculty of Medicine, Mohamed VI University of Health Sciences, Casablanca, Marruecos
| | - S Nejjari
- Department of Dermatology, Sheikh Khalifa Hospital, Faculty of Medicine, Mohamed VI University of Health Sciences, Casablanca, Marruecos
| | - S Chiheb
- Department of Dermatology, Sheikh Khalifa Hospital, Faculty of Medicine, Mohamed VI University of Health Sciences, Casablanca, Marruecos
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5
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Agharbi FZ, Basri G, Nejjari S, Chiheb S. Erythrodermic Psoriasis Following SARS-CoV-2 Infection. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:202-203. [PMID: 35868545 PMCID: PMC9296225 DOI: 10.1016/j.ad.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 10/28/2022] Open
Affiliation(s)
- F Z Agharbi
- Department of Dermatology, Sheikh Khalifa Hospital, Faculty of Medicine, Mohamed VI University of Health Sciences, Casablanca, Morocco.
| | - G Basri
- Department of Dermatology, Sheikh Khalifa Hospital, Faculty of Medicine, Mohamed VI University of Health Sciences, Casablanca, Morocco
| | - S Nejjari
- Department of Dermatology, Sheikh Khalifa Hospital, Faculty of Medicine, Mohamed VI University of Health Sciences, Casablanca, Morocco
| | - S Chiheb
- Department of Dermatology, Sheikh Khalifa Hospital, Faculty of Medicine, Mohamed VI University of Health Sciences, Casablanca, Morocco
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6
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Man AM, Orăsan MS, Hoteiuc OA, Olănescu-Vaida-Voevod MC, Mocan T. Inflammation and Psoriasis: A Comprehensive Review. Int J Mol Sci 2023; 24:16095. [PMID: 38003284 PMCID: PMC10671208 DOI: 10.3390/ijms242216095] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Psoriasis is an immune-mediated disease with a strong genetic component that brings many challenges to sick individuals, such as chronic illness, and which has multiple associated comorbidities like cardiovascular disease, metabolic syndrome, inflammatory bowel disease, and psychological disorders. Understanding the interplay between the innate and adaptative immune system has led to the discovery of specific cytokine circuits (Tumor Necrosis Factor-alpha (TNF-α), IL-23, IL-17), which has allowed scientists to discover new biomarkers that can be used as predictors of treatment response and pave the way for personalized treatments. In this review, we describe the footprint psoriasis leaves on the skin and beyond, key pathophysiological mechanisms, current available therapeutic options, and drawbacks faced by existing therapies, and we anticipate potential future perspectives that may improve the quality of life of affected individuals.
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Affiliation(s)
- Alessandra-Mădălina Man
- Physiology Department, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400126 Cluj-Napoca, Romania; (A.-M.M.); (O.-A.H.); (M.-C.O.-V.-V.)
| | - Meda Sandra Orăsan
- Physiopathology Department, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400126 Cluj-Napoca, Romania;
| | - Oana-Alina Hoteiuc
- Physiology Department, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400126 Cluj-Napoca, Romania; (A.-M.M.); (O.-A.H.); (M.-C.O.-V.-V.)
| | - Maria-Cristina Olănescu-Vaida-Voevod
- Physiology Department, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400126 Cluj-Napoca, Romania; (A.-M.M.); (O.-A.H.); (M.-C.O.-V.-V.)
| | - Teodora Mocan
- Physiology Department, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400126 Cluj-Napoca, Romania; (A.-M.M.); (O.-A.H.); (M.-C.O.-V.-V.)
- Nanomedicine Department, Regional Institute of Gastroenterology and Hepatology, 400158 Cluj-Napoca, Romania
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7
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Kiełbowski K, Bakinowska E, Ostrowski P, Pala B, Gromowska E, Gurazda K, Dec P, Modrzejewski A, Pawlik A. The Role of Adipokines in the Pathogenesis of Psoriasis. Int J Mol Sci 2023; 24:ijms24076390. [PMID: 37047363 PMCID: PMC10094354 DOI: 10.3390/ijms24076390] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Psoriasis is a chronic and immune-mediated skin condition characterized by pro-inflammatory cytokines and keratinocyte hyperproliferation. Dendritic cells, T lymphocytes, and keratinocytes represent the main cell subtypes involved in the pathogenesis of psoriasis, while the interleukin-23 (IL-23)/IL-17 pathway enhances the disease progression. Human adipose tissue is an endocrine organ, which secretes multiple proteins, known as adipokines, such as adiponectin, leptin, visfatin, or resistin. Current evidence highlights the immunomodulatory roles of adipokines, which may contribute to the progression or suppression of psoriasis. A better understanding of the complexity of psoriasis pathophysiology linked with adipokines could result in developing novel diagnostic or therapeutic strategies. This review aims to present the pathogenesis of psoriasis and the roles of adipokines in this process.
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8
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Chimbetete T, Buck C, Choshi P, Selim R, Pedretti S, Divito SJ, Phillips EJ, Lehloenya R, Peter J. HIV-Associated Immune Dysregulation in the Skin: A Crucible for Exaggerated Inflammation and Hypersensitivity. J Invest Dermatol 2023; 143:362-373. [PMID: 36549954 PMCID: PMC9974923 DOI: 10.1016/j.jid.2022.07.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 12/24/2022]
Abstract
Skin diseases are hallmarks of progressive HIV-related immunosuppression, with severe noninfectious inflammatory and hypersensitivity conditions as common as opportunistic infections. Conditions such as papular pruritic eruption are AIDS defining, whereas delayed immune-mediated adverse reactions, mostly cutaneous, occur up to 100-fold more during HIV infection. The skin, constantly in contact with the external environment, has a complex immunity. A dense, tightly junctioned barrier with basal keratinocytes and epidermal Langerhans cells with antimicrobial, innate-activating, and antigen-presenting functions form the frontline. Resident dermal dendritic, mast, macrophage, and innate lymphoid cells play pivotal roles in directing and polarizing appropriate adaptive immune responses and directing effector immune cell trafficking. Sustained viral replication leads to progressive declines in CD4 T cells, whereas Langerhans and dermal dendritic cells serve as viral reservoirs and points of first viral contact in the mucosa. Cutaneous cytokine responses and diminished lymphoid populations create a crucible for exaggerated inflammation and hypersensitivity. However, beyond histopathological description, these manifestations are poorly characterized. This review details normal skin immunology, changes associated with progressive HIV-related immunosuppression, and the characteristic conditions of immune dysregulation increased with HIV. We highlight the main research gaps and several novel tissue-directed strategies to define mechanisms that will provide targeted approaches to prevention or treatment.
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Affiliation(s)
- Tafadzwa Chimbetete
- Division of Allergology and Clinical Immunology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Chloe Buck
- Division of Allergology and Clinical Immunology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Phuti Choshi
- Division of Allergology and Clinical Immunology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Rose Selim
- Division of Allergology and Clinical Immunology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Sarah Pedretti
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Sherrie Jill Divito
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Rannakoe Lehloenya
- Division of Dermatology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Combined Drug Allergy Clinic, Groote Schuur Hospital, Cape Town, South Africa
| | - Jonny Peter
- Division of Allergology and Clinical Immunology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa; Combined Drug Allergy Clinic, Groote Schuur Hospital, Cape Town, South Africa.
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9
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Maliyar K, Lansang P, Doiron P. Use of risankizumab in two HIV-positive patients with psoriasis. JAAD Case Rep 2023; 33:54-55. [PMID: 36860809 PMCID: PMC9969266 DOI: 10.1016/j.jdcr.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
| | | | - Philip Doiron
- Correspondence to: Philip Doiron, MD, FRCPC, Derm, Division of Dermatology, Women’s College Hospital, 76 Greenville St, 5th floor, Toronto, ON, Canada M5S 1B2.
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10
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Gong J, Wu W, Qiu L, Wang X, Bao J, Wang J, Cheng L, Fu Z, Hu F. Interleukin-17A Inhibitor Secukinumab Treatment in HIV-Positive Psoriasis Patient: A Case Report. Clin Cosmet Investig Dermatol 2022; 15:2949-2956. [PMID: 36605452 PMCID: PMC9809383 DOI: 10.2147/ccid.s395348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/23/2022] [Indexed: 01/01/2023]
Abstract
Psoriasis is an immune-mediated chronic inflammatory dermatosis influenced by hereditary and environmental factors. Human immunodeficiency virus (HIV) infection affects the immune system and exacerbates psoriatic lesions. We report the case of a 33-year-old male patient diagnosed with psoriasis vulgaris, psoriatic arthritis and HIV infection. Acitretin capsules, etanercept and high-active antiretroviral therapy (HAART) were effective. Two months after etanercept was discontinued, his condition worsened. After switching to secukinumab combined with HAART, the symptoms of psoriatic arthritis resolved rapidly after four weeks, with a Disease Activity Index for Psoriatic Arthritis score of 0. The time to achieve psoriasis area and severity index 40, 75, 90, and 100 were 2, 4, 8, and 29 weeks. The treatment was maintained for 1 year with no adverse reactions. Regarding the stable CD4+ T lymphocyte count and the viral load, administering anti-IL-17 monoclonal antibodies is an effective treatment option for psoriasis patients.
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Affiliation(s)
- Jian Gong
- Department of Integrated Traditional Chinese and Western Medicine of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China,Jiangxi Provincial Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China
| | - Weiwei Wu
- Department of Plastic and Dermatological Surgery, The Fifth People’s Hospital of Hainan Province, Haikou, Hainan, People’s Republic of China
| | - Liguo Qiu
- Department of Integrated Traditional Chinese and Western Medicine of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China,Jiangxi Provincial Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China
| | - Xi Wang
- Department of Integrated Traditional Chinese and Western Medicine of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China,Jiangxi Provincial Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China
| | - Jianwei Bao
- Department of Integrated Traditional Chinese and Western Medicine of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China,Jiangxi Provincial Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China
| | - Jinjing Wang
- Clinical School of Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, People’s Republic of China
| | - Lifang Cheng
- Department of Integrated Traditional Chinese and Western Medicine of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China,Jiangxi Provincial Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China
| | - Zhiyuan Fu
- Department of Integrated Traditional Chinese and Western Medicine of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China,Department of Pharmacy, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China,Correspondence: Zhiyuan Fu, Department of Pharmacy, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China, Tel +86 13970827820, Fax +86-0791-85207512, Email
| | - Fengming Hu
- Department of Integrated Traditional Chinese and Western Medicine of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China,Jiangxi Provincial Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China,Fengming Hu, Department of Integrated Traditional Chinese and Western Medicine of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China, Tel +86 13970935828, Fax +86-0791-85207512, Email
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11
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Macca L, Moscatt V, Ceccarelli M, Ingrasciotta Y, Nunnari G, Guarneri C. Hidradenitis Suppurativa in Patients with HIV: A Scoping Review. Biomedicines 2022; 10:2761. [PMID: 36359281 PMCID: PMC9687577 DOI: 10.3390/biomedicines10112761] [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] [Received: 09/30/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 07/25/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, debilitating skin disease of the apocrine glands. Bibliographic search revealed few studies concerning the association between HS and human immunodeficiency virus (HIV). To assess this link, we performed a systematic review of the current knowledge through a careful analysis of the relevant and authoritative medical literature in the field. Results showed that people with HIV are particularly susceptible to developing HS with the characteristic involvement of atypical sites, such as face or thighs, due to HIV-related immunosuppression. Based on the pathogenesis of both conditions and according to our review, we suggest that HIV screening should be routinely performed in suspected cases while monitoring and integrated approach in management are mandatory in the management of HIV-positive patients with HS.
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Affiliation(s)
- Laura Macca
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria 1, 98125 Messina, Italy
| | - Vittoria Moscatt
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Catania, Italy C/O ARNAS “Garibaldi”, “Nesima” Hospital, Via Palermo 636, 95122 Catania, Italy
| | - Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Catania, Italy C/O ARNAS “Garibaldi”, “Nesima” Hospital, Via Palermo 636, 95122 Catania, Italy
| | - Ylenia Ingrasciotta
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria 1, 98124 Messina, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Dermatology, University of Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria 1, 98125 Messina, Italy
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12
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Zhou S, Yao Z. Roles of Infection in Psoriasis. Int J Mol Sci 2022; 23:ijms23136955. [PMID: 35805960 PMCID: PMC9266590 DOI: 10.3390/ijms23136955] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 02/08/2023] Open
Abstract
Psoriasis is a chronic, immune-mediated disorder with cutaneous and systemic manifestations. Genetic predisposition, environmental factors, and immune dysfunction all contribute to the pathogenesis of psoriasis with host-microbe interaction governing the progression of this disease. Emerging evidence has indicated that infection is an environmental trigger for psoriasis and plays multiple roles in its maintenance as evidenced by the frequent association between guttate psoriasis onset and acute streptococcal infection. Different infectious factors act on immune cells to produce inflammatory cytokines that can induce or aggravate psoriasis. In addition to bacterial infections, viral and fungal infections have also been shown to be strongly associated with the onset or exacerbation of psoriasis. Intervention of skin microbiota to treat psoriasis has become a hot research topic. In this review, we summarize the effects of different infectious factors (bacteria, viruses, and fungi) on psoriasis, thereby providing insights into the manipulation of pathogens to allow for the identification of improved therapeutic options for the treatment of this condition.
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Affiliation(s)
- Shihui Zhou
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China;
- Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Zhirong Yao
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China;
- Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Correspondence:
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13
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Anderton H, Chopin M, Dawson CA, Nutt SL, Whitehead L, Silke N, Lalaloui N, Silke J. Langerhans cells are an essential cellular intermediary in chronic dermatitis. Cell Rep 2022; 39:110922. [PMID: 35675765 DOI: 10.1016/j.celrep.2022.110922] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/11/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022] Open
Abstract
SHARPIN regulates signaling from the tumor necrosis factor (TNF) superfamily and pattern-recognition receptors. An inactivating Sharpin mutation in mice causes TNF-mediated dermatitis. Blocking cell death prevents the phenotype, implicating TNFR1-induced cell death in causing the skin disease. However, the source of TNF that drives dermatitis is unknown. Immune cells are a potent source of TNF in vivo and feature prominently in the skin pathology; however, T cells, B cells, and eosinophils are dispensable for the skin phenotype. We use targeted in vivo cell ablation, immune profiling, and extensive imaging to identify immune populations driving dermatitis. We find that systemic depletion of Langerin+ cells significantly reduces disease severity. This is enhanced in mice that lack Langerhans cells (LCs) from soon after birth. Reconstitution of LC-depleted Sharpin mutant mice with TNF-deficient LCs prevents dermatitis, implicating LCs as a potential cellular source of pathogenic TNF and highlighting a T cell-independent role in driving skin inflammation.
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Affiliation(s)
- Holly Anderton
- The Walter and Eliza Hall Institute for Medical Research, Parkville, Melbourne, VIC 3050, Australia; Department of Medical Biology, University of Melbourne, Parkville, VIC 3050, Australia
| | - Michaël Chopin
- The Walter and Eliza Hall Institute for Medical Research, Parkville, Melbourne, VIC 3050, Australia; Department of Medical Biology, University of Melbourne, Parkville, VIC 3050, Australia
| | - Caleb A Dawson
- The Walter and Eliza Hall Institute for Medical Research, Parkville, Melbourne, VIC 3050, Australia; Department of Medical Biology, University of Melbourne, Parkville, VIC 3050, Australia
| | - Stephen L Nutt
- The Walter and Eliza Hall Institute for Medical Research, Parkville, Melbourne, VIC 3050, Australia; Department of Medical Biology, University of Melbourne, Parkville, VIC 3050, Australia
| | - Lachlan Whitehead
- The Walter and Eliza Hall Institute for Medical Research, Parkville, Melbourne, VIC 3050, Australia; Department of Medical Biology, University of Melbourne, Parkville, VIC 3050, Australia
| | - Natasha Silke
- The Walter and Eliza Hall Institute for Medical Research, Parkville, Melbourne, VIC 3050, Australia; Department of Medical Biology, University of Melbourne, Parkville, VIC 3050, Australia
| | - Najoua Lalaloui
- The Walter and Eliza Hall Institute for Medical Research, Parkville, Melbourne, VIC 3050, Australia; Department of Medical Biology, University of Melbourne, Parkville, VIC 3050, Australia
| | - John Silke
- The Walter and Eliza Hall Institute for Medical Research, Parkville, Melbourne, VIC 3050, Australia; Department of Medical Biology, University of Melbourne, Parkville, VIC 3050, Australia.
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14
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Romita P, Foti C, Calianno G, Chiricozzi A. Successful treatment with secukinumab in an HIV-positive psoriatic patient after failure of apremilast. Dermatol Ther 2022; 35:e15610. [PMID: 35634750 PMCID: PMC9539482 DOI: 10.1111/dth.15610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/05/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Paolo Romita
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Gianluca Calianno
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Andrea Chiricozzi
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
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15
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Papp KA, Beecker J, Cooper C, Kirchhof MG, Pozniak AL, Rockstroh JK, Dutz JP, Gooderham MJ, Gniadecki R, Hong CH, Lynde CW, Maari C, Poulin Y, Vender RB, Walmsley SL. Use of Systemic Therapies for Treatment of Psoriasis in People Living with Controlled HIV: Inference-Based Guidance from a Multidisciplinary Expert Panel. Dermatol Ther (Heidelb) 2022; 12:1073-1089. [PMID: 35445963 PMCID: PMC9110627 DOI: 10.1007/s13555-022-00722-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/30/2022] [Indexed: 11/28/2022] Open
Abstract
Background People living with human immunodeficiency virus (PLHIV) have a similar prevalence of psoriasis as the general population, though incidence and severity correlate with HIV viral load. Adequately treating HIV early renders the infection a chronic medical condition and allows PLHIV with a suppressed viral load (PLHIV-s) to live normal lives. Despite this, safety concerns and a lack of high-level data have hindered the use of systemic psoriasis therapies in PLHIV-s. Objectives We aim to provide a structured framework that supports healthcare professionals and patients discussing the risks and benefits of systemic psoriasis therapy in PLHIV-s. Our goal was to address the primary question, are responses to systemic therapies for the treatment of psoriasis in PLHIV-s similar to those in the non-HIV population? Methods We implemented an inference-based approach relying on indirect evidence when direct clinical trial data were absent. In this instance, we reviewed indirect evidence supporting inferences on the status of immune function in PLHIV. Recommendations on systemic treatment for psoriasis in PLHIV were derived using an inferential heuristic. Results We identified seven indirect indicators of immune function informed by largely independent bodies of evidence: (1) functional assays, (2) vaccine response, (3) life expectancy, (4) psoriasis manifestations, (5) rate of infections, (6) rate of malignancies, and (7) organ transplant outcomes. Conclusions Drug-related benefits and risks when treating a patient with systemic psoriasis therapies are similar for non-HIV patients and PLHIV with a suppressed viral load and normalized CD4 counts. Prior to initiating psoriasis treatment in PLHIV, HIV replication should be addressed by an HIV specialist. Exercise additional caution for patients with a suppressed viral load and discordant CD4 responses on antiretroviral therapy. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00722-0. People living with human immunodeficiency virus (PLHIV) develop psoriasis as often as everyone else. We asked: what are effective and safe treatments when PLHIV need systemic therapy (pills or injections) for their psoriasis? HIV infection attacks the immune system. When HIV is not treated, the immune system declines. A less effective immune system makes it harder for the body to fight infections and certain cancers. Psoriasis is a skin condition caused by overactive immune cells. Effective psoriasis treatments reduce immune-cell activity. There are some concerns that treatments for psoriasis may not work and could worsen infections or cancers. To answer the question, we gathered 11 dermatologists and 4 HIV specialists. We reviewed the international scientific literature on PLHIV and psoriasis. The absence of direct evidence and volume of information to review made the process challenging. The end results were worthwhile. We concluded that people who are diagnosed early and take antiretroviral therapy to control their HIV infection (PLHIV-c) can live long, healthy lives. Accordingly, we determined that PLHIV-c can likely expect the same safety and efficacy for systemic psoriasis treatments as the general population. Treatment decisions should be made on a case-by-case basis through consultation with the patient and treating physician(s). Pillars of modern medicine are evidence-based care and collaborative decision-making. Too often, neither care provider nor patient are adequately informed. We have tried to fill one information gap for PLHIV and psoriasis. This process may help answer questions in other disease populations where direct evidence is scarce or absent.
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Affiliation(s)
- Kim A Papp
- Probity Medical Research Inc., Waterloo, ON, Canada. .,K Papp Clinical Research, Waterloo, ON, Canada.
| | - Jennifer Beecker
- Probity Medical Research Inc., Waterloo, ON, Canada.,University of Ottawa, Ottawa, ON, Canada.,Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Curtis Cooper
- University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,The Ottawa Hospital and Regional Hepatitis Program, Ottawa, ON, Canada
| | - Mark G Kirchhof
- University of Ottawa, Ottawa, ON, Canada.,Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Anton L Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Jan P Dutz
- Skin Care Center, Vancouver, BC, Canada.,Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Melinda J Gooderham
- Probity Medical Research Inc., Waterloo, ON, Canada.,SKiN Centre for Dermatology, Peterborough, ON, Canada
| | - Robert Gniadecki
- Division of Dermatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Chih-Ho Hong
- Probity Medical Research Inc., Waterloo, ON, Canada.,Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Dr. Chih-Ho Hong Medical Inc., Surrey, BC, Canada
| | - Charles W Lynde
- Probity Medical Research Inc., Waterloo, ON, Canada.,Lynde Institute for Dermatology, Markham, ON, Canada
| | | | - Yves Poulin
- Centre de Recherche Dermatologique du Québec Métropolitain, Quebec, QC, Canada
| | - Ronald B Vender
- Dermatrials Research Inc., Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sharon L Walmsley
- Toronto General Hospital Research Institute, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada
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16
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Chaiyabutr C, Jiamton S, Silpa-Archa N, Wongpraparut C, Wongdama S, Chularojanamontri L. Retrospective study of psoriasis in people living with HIV: Thailand's experience. J Dermatol 2022; 49:607-614. [PMID: 35293003 DOI: 10.1111/1346-8138.16352] [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] [Received: 01/19/2022] [Revised: 02/09/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Abstract
Psoriasis in people living with HIV (PLHIV) has been reported as having particular clinical characteristics. However, most of the source data was derived from descriptive studies in Europe and the USA. This study was conducted to compare the characteristics of psoriasis in PLHIV to general psoriasis patients. We retrospectively reviewed the records of 73 cases of psoriasis in PLHIV and of 232 general psoriasis patients who visited a psoriasis clinic in Bangkok, Thailand. Psoriasis in PLHIV predominated in males (78.1%), with an older age of onset, significantly lower rates of nail involvement and psoriatic arthritis, but higher rates of co-infectious diseases than for general psoriasis patients. A low nadir CD4 T-cell count (<100 cells/μl) and CD4 T-cell count at psoriasis diagnosis were associated with a high body surface area (BSA) involvement. The mean BSA involvement in PLHIV was 24. Although 64.4% (47/73) of the PLHIV had moderate-to-high psoriasis severity, 29.8% of those (14/47) only received topical treatment. Acitretin was the most common drug used. Other therapies were rarely used, and no biologics were administered. In conclusion, psoriasis in PLHIV has several clinical features that differ from general psoriasis. PLHIV tend to receive substandard care for psoriasis, even in upper-middle-income countries.
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Affiliation(s)
- Chayada Chaiyabutr
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sukhum Jiamton
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narumol Silpa-Archa
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chanisada Wongpraparut
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supisara Wongdama
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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17
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Budd RC, Scharer CD, Barrantes-Reynolds R, Legunn S, Fortner KA. T Cell Homeostatic Proliferation Promotes a Redox State That Drives Metabolic and Epigenetic Upregulation of Inflammatory Pathways in Lupus. Antioxid Redox Signal 2022; 36:410-422. [PMID: 34328790 PMCID: PMC8982120 DOI: 10.1089/ars.2021.0078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Significance: Numerous abnormalities in T cells have been described in patients with systemic lupus erythematosus (SLE), including lymphopenia, DNA demethylation, expression of endogenous retroviruses (ERVs), increased cell death, enlarged mitochondria, production of reactive oxygen species (ROS), and the appearance of unusual CD4-CD8- T cells. Our studies propose a model in which accelerated homeostatic proliferation of T cells promotes an epigenetic and metabolic program, leading to this cluster of abnormalities. Recent Advances: Growing knowledge of the innate immune disorders in SLE has included increased mitochondrial size and ROS production that induces oligomerization of the mitochondrial antiviral signaling (MAVS) protein and type I interferon production, as well as DNA demethylation, upregulation of inflammatory genes, and expression of certain ERVs in SLE peripheral blood mononuclear cells. All these events are part of the cellular program that occurs during homeostatic proliferation of T cells. Evidence from a murine model of SLE as well as in human SLE reveals that increased T cell homeostatic proliferation may be a driving factor in these processes. Critical Issues: Despite extensive knowledge of the myriad autoantibodies in SLE and other immune abnormalities, a cogent model has been lacking to link the numerous and seemingly disparate immune aberrations. This may partly explain the general lack of new drugs specifically for SLE in over 50 years. A more coherent model of SLE would not only unify the variety of immune abnormalities is SLE but would also suggest new therapies. Future Directions: The model of augmented homeostatic proliferation leading to increased mitochondrial mass, ROS, DNA demethylation, and upregulation of inflammatory genes suggests strategic new targets for SLE, including antioxidants and certain inhibitors of metabolism. Antioxid. Redox Signal. 36, 410-422.
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Affiliation(s)
- Ralph C Budd
- Department of Medicine, Vermont Center for Immunology and Infectious Diseases, Larner College of Medicine, The University of Vermont, Burlington, Vermont, USA
| | - Christopher D Scharer
- Department of Microbiology and Immunology, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Ramiro Barrantes-Reynolds
- Department of Microbiology and Molecular Genetics, Larner College of Medicine, The University of Vermont, Burlington, Vermont, USA
| | - Scott Legunn
- Department of Medicine, Vermont Center for Immunology and Infectious Diseases, Larner College of Medicine, The University of Vermont, Burlington, Vermont, USA
| | - Karen A Fortner
- Department of Medicine, Vermont Center for Immunology and Infectious Diseases, Larner College of Medicine, The University of Vermont, Burlington, Vermont, USA
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18
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Kidron A, Nguyen H, Nguyen H. Triumvirate Presentation and Treatment of Psoriasis in the Setting of HIV and Treponema pallidum Infection. Cureus 2022; 14:e22129. [PMID: 35308705 PMCID: PMC8920797 DOI: 10.7759/cureus.22129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/10/2022] [Indexed: 11/08/2022] Open
Abstract
Psoriasis is an autoimmune condition in which the immune system attacks healthy skin cells, causing the accelerated formation of new skin characterized by scaly patches or plaques. These lesions are formed due to the formation of new skin underneath dead skin that has yet to be shed. Although the cause of psoriasis is not completely understood, it has been associated with infections that may trigger or exacerbate the condition. Syphilis, a highly infectious sexually transmitted disease, may trigger a psoriasis outbreak; because syphilis is known as “the great imitator”, it can present as many other chronic dermatoses and therefore often makes it very difficult to diagnose. Here, we describe a case of a 17-year-old Vietnamese male from Dong Nai Province who was initially diagnosed with psoriasis and later diagnosed with syphilis and HIV infection upon further investigation and testing.
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19
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Psoriasis in Patients Attending a Large HIV Clinic in Trinidad. Med Sci (Basel) 2022; 10:medsci10010009. [PMID: 35225942 PMCID: PMC8883907 DOI: 10.3390/medsci10010009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/29/2022] Open
Abstract
The data on psoriasis in persons infected with HIV in the Caribbean is sparse. A cross-sectional study was conducted on patients attending the HIV Clinic diagnosed with psoriasis where sociodemographic data and data on the pattern of psoriasis were collected and analysed using SPSS version 25. Over the period April 2002–December 2018, 37 persons attending the HIV clinic were diagnosed with psoriasis, age range at psoriasis diagnosis 13–70 years, mean age at diagnosis 37.7 years and 32 (86.5%) were male. Over the study period, 8916 patients were registered at the HIV Clinic and the prevalence of psoriasis among these patients was 0.42% which is less than the reported prevalence of psoriasis among persons infected with HIV of 2–3% in other studies. Severe/generalised psoriasis was present in 7 (18.9%) patients while 30 (81.1%) patients had mild/moderate psoriasis. A family history of psoriasis was present in 1 (2.7%) patient, psoriatic arthritis was present in 2 (5.4%) patients and 31 (83.8%) patients reported that there was improvement in the psoriasis with the topical therapy provided. The study makes an original contribution in the determination of the prevalence and pattern of psoriasis among patients attending a HIV Clinic in Trinidad.
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20
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Motolese A, Ceccarelli M, Macca L, Li Pomi F, Ingrasciotta Y, Nunnari G, Guarneri C. Novel Therapeutic Approaches to Psoriasis and Risk of Infectious Disease. Biomedicines 2022; 10:biomedicines10020228. [PMID: 35203438 PMCID: PMC8869084 DOI: 10.3390/biomedicines10020228] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 01/22/2023] Open
Abstract
Psoriasis is a chronic immune-mediated skin and joint disease, with a plethora of comorbidities, characterized by a certain genetic predisposition, and a complex pathogenesis based on the IL-23/IL-17 pathway. There is no doubt that the patients affected by psoriasis are more susceptible to infections as well as that the risk of infection is higher in psoriatic subjects than in the general population. The advent of biotechnological agents on the therapeutic arsenal actually available for the treatment of moderate-to-severe patients, given the fact that the severity of the disease is a predictor of the level of infectious risk, has raised the question of whether these ‘new’ drugs could be considered a safer option and how they can be used in selected cases. Old and newer strategies in cases of chronic infectious conditions are reviewed under the light of clinical trials and other studies present in literature.
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Affiliation(s)
- Alfonso Motolese
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98125 Messina, Italy; (A.M.); (L.M.); (F.L.P.)
| | - Manuela Ceccarelli
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Catania, Catania, Italy C/O ARNAS “Garibaldi”, “Nesima” Hospital, via Palermo 636, 95122 Catania, Italy;
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Infectious Diseases, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98125 Messina, Italy
| | - Laura Macca
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98125 Messina, Italy; (A.M.); (L.M.); (F.L.P.)
| | - Federica Li Pomi
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98125 Messina, Italy; (A.M.); (L.M.); (F.L.P.)
| | - Ylenia Ingrasciotta
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Pharmacology, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98125 Messina, Italy;
| | - Giuseppe Nunnari
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98124 Messina, Italy;
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Dermatology, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98125 Messina, Italy
- Correspondence: ; Tel.: +39-090-2212-894; Fax: +39-09-029-27691
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21
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Patel A, Venter F, Grewal K, Sharma R, Petersen G, Heidari A. Erythrodermic Psoriasis and Staph-Infective Endocarditis—A Conundrum in Succession. J Investig Med High Impact Case Rep 2022; 10:23247096221105243. [PMID: 35726179 PMCID: PMC9218485 DOI: 10.1177/23247096221105243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Erythrodermic psoriasis is a rare subtype of psoriasis vulgaris that presents with diffuse erythema and desquamation over greater than 75% of the body’s surface area. We present a case of a 57-year-old male who was admitted with a diffuse, erythematous scaly rash covering his entire body, with associated subjective fevers. Skin biopsy revealed erythrodermic psoriasis, and blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Echocardiogram revealed a mitral valve vegetation. Clinical improvement was achieved with intravenous antibiotic administration and topical corticosteroids without the use of immunomodulators.
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Affiliation(s)
- Arti Patel
- Department of Internal Medicine, Kern Medical, Bakersfield, CA, USA
| | - Frederick Venter
- Department of Internal Medicine, Kern Medical, Bakersfield, CA, USA
| | - Kulraj Grewal
- Department of Internal Medicine, Kern Medical, Bakersfield, CA, USA
| | - Rupam Sharma
- Department of Internal Medicine, Kern Medical, Bakersfield, CA, USA
| | - Greti Petersen
- Department of Internal Medicine, Kern Medical, Bakersfield, CA, USA
| | - Arash Heidari
- Department of Internal Medicine, Kern Medical, Bakersfield, CA, USA
- Division of Infectious Disease, Kern Medical, Bakersfield, CA, USA
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22
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The impact of external factors on psoriasis. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Psoriasis is one of the most common chronic inflammatory skin diseases, constituting a significant health and socioeconomic problem. Despite numerous therapeutic options, the results of treatment very often remain insufficient. It is extremely important to remember that many external factors impact the effectiveness of therapy. This article discusses the importance of emollients in therapy and the influence of infectious agents and injuries on the course of psoriasis. Understanding the above-mentioned factors in the treatment of psoriasis is critical to achieve satisfactory therapeutic effects.
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23
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Feng B, Li JH. Erythematous plaques on the skin folds. Assoc Med J 2021. [DOI: 10.1136/bmj-2021-068621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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24
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Speth P, Jargosch M, Seiringer P, Schwamborn K, Bauer T, Scheerer C, Protzer U, Schmidt-Weber C, Biedermann T, Eyerich S, Garzorz-Stark N. Immunocompromised Patients with Therapy-Refractory Chronic Skin Diseases Show Reactivation of Latent Epstein‒Barr Virus and Cytomegalovirus Infection. J Invest Dermatol 2021; 142:549-558.e6. [PMID: 34480891 DOI: 10.1016/j.jid.2021.07.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/24/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022]
Abstract
Reactivation of latent Epstein‒Barr virus (EBV) and/or Cytomegalovirus (CMV) infection is a dreaded complication in immunocompromised patients receiving hematopoietic stem cell transplantation. Evidence is sparse on whether subclinical reactivation of viral infection may also be of clinical relevance in dermatological patients. We screened patients (N = 206) suffering from chronic skin diseases for subclinical reactivation of EBV and CMV infection. We found that immunocompromised patients with therapy-refractory chronic skin diseases showed higher rates of subclinical reactivation of CMV and EBV infection (6.7% vs. 0% for EBV and 16.7% vs. 5.6% for CMV) and a higher prevalence of virus-specific DNA in skin tissue (30.8% vs. 0% for EBV and 21.4% vs. 0% for CMV) than nonimmunocompromised patients with chronic skin diseases. T cells isolated from lesional skin exhibited up to 14-fold increased proliferation with production of T helper type 1 and T helper type 17 cytokines on stimulation with viral proteins, providing evidence for possible aggravation of the underlying skin diseases by viral infection. Improvement of skin lesions in patients with reactivation of CMV infection (n = 4) was observed on antiviral treatment. Our data suggest that subclinical reactivation of EBV and/or CMV infection is an under-recognized condition in the dermatological patient population with chronic skin diseases.
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Affiliation(s)
- Philipp Speth
- Department of Dermatology and Allergology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Manja Jargosch
- Department of Dermatology and Allergology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Peter Seiringer
- Department of Dermatology and Allergology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kristina Schwamborn
- Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Tanja Bauer
- Institute of Virology, Technical University/Helmholtz Center Munich, Munich, Germany
| | - Cora Scheerer
- Department of Dermatology and Allergology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Ulrike Protzer
- Institute of Virology, Technical University/Helmholtz Center Munich, Munich, Germany
| | - Carsten Schmidt-Weber
- Center of Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Munich, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefanie Eyerich
- Center of Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Munich, Germany
| | - Natalie Garzorz-Stark
- Department of Dermatology and Allergology, School of Medicine, Technical University of Munich, Munich, Germany; Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
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25
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Haberman RH, Jaros BD, Scher JU. Editorial: Rheumatology at the center of coronavirus disease 2019: pathogenesis, treatment, and clinical care. Curr Opin Rheumatol 2021; 33:409-411. [PMID: 34175865 PMCID: PMC8373389 DOI: 10.1097/bor.0000000000000813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Brian D. Jaros
- Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
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26
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Maharaj AB, Adebajo A. Psoriatic arthritis in Africa. Clin Rheumatol 2021; 40:3411-3418. [PMID: 34180027 DOI: 10.1007/s10067-021-05841-1] [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: 10/19/2020] [Revised: 06/07/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022]
Abstract
Psoriatic arthritis is a chronic immune-mediated inflammatory arthritis associated with the skin condition psoriasis. Although there is a large body of evidence regarding epidemiology, outcomes, and response to therapy from the Western world, there is a dearth of published literature from the African continent. There are many challenges responsible for this. Lack of resources, both human and financial, an enormous disease burden, and a focus on communicable diseases leave an unmet need for this important disease. This review explores and identifies these challenges and proposes ways to improve and overcome these deficiencies. We discuss the epidemiology of psoriatic arthritis in Africa, postulating the role of genetic and environmental factors, looking at the role of HLA-B 23, HLA-B 17, and HLA-B 8. Dietary intake as a contributing factor to the low prevalence of psoriatic arthritis and psoriasis is also discussed. Challenges on the African continent regarding limited access to specialised units/specialists, delay in diagnosis, limited attention by healthcare authorities to non-communicable diseases, and the difficulties in implementing international recommendations on the African continent are discussed. We also discuss a relative lack of data from the African continent, the cost of specialised medication in resource-poor countries, and comorbidities of psoriatic arthritis. The lack of validated questionnaires relevant to the African continent is also important and discussed. Finally, we discuss a proposed research agenda that will improve care, quality of life, and outcomes for patients with psoriatic arthritis on the African continent.
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Affiliation(s)
- Ajesh B Maharaj
- Department of Internal Medicine, Prince Mshiyeni Memorial Hospital, Nelson R Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa.
| | - Adewale Adebajo
- Faculty of Medicine, Dentistry, and Health, University of Sheffield, South Yorkshire, UK
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Cincinelli G, Di Taranto R, Orsini F, Rindone A, Murgo A, Caporali R. A case report of monoarthritis in a COVID-19 patient and literature review: Simple actions for complex times. Medicine (Baltimore) 2021; 100:e26089. [PMID: 34114992 PMCID: PMC8202614 DOI: 10.1097/md.0000000000026089] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/25/2021] [Accepted: 05/06/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE COVID-19 presentation is multifaceted and up to 44% of patients affected by COVID-19 experience musculoskeletal complaints, mostly in the form of diffuse aspecific arthromyalgias. Nevertheless, only a few cases of arthritis following SARS-CoV2 infection are reported. PATIENT CONCERNS A 27-year-old man affected by nail psoriasis presented with monoarthritis 2 weeks after being diagnosed with COVID-19. DIAGNOSES Diagnostic work-up and differential diagnosis were made difficult by patient isolation, absence of lab tests, and his visit via telemedicine, even though signs of first metacarpophalangeal joint involvement were clear. INTERVENTIONS Due to the inefficacy of acetaminophen and nonsteroidal anti-inflammatory drugs, the patient was prescribed oral steroids with a rapid benefit. OUTCOMES The patient's response to oral steroid was prompt and maintained even after therapy tapering. Even so, a formal diagnosis was not possible due to a difficult diagnostic work-up and lack of a long-term follow-up. LESSONS Like many other viral diseases, SARS-CoV2 can play as a causative agent or as a trigger for inflammatory arthritis development in predisposed individuals.
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Affiliation(s)
- Gilberto Cincinelli
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano
| | - Raffaele Di Taranto
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano
| | - Francesco Orsini
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano
| | - Andrea Rindone
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano
| | - Antonella Murgo
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, Milan, Italy
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, Milan, Italy
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Abstract
Psoriasis is a chronic inflammatory skin condition with regional and ethnic differences in its prevalence and clinical manifestations. Human leukocyte antigen (HLA)-Cw6 is the disease allele conferring the greatest risk to psoriasis, but its prevalence is lower in Asian individuals. Recent studies have found associations between HLA-Cw1 and some Asian populations with psoriasis, especially Southern Chinese. HLA-Cw6 was associated with type I early-onset psoriasis, guttate psoriasis, Koebner phenomenon, and better response to methotrexate, interleukin (IL)-12/23, IL-17, and IL-23 targeting drugs. In contrast, HLA-Cw1 positivity has been associated with erythrodermic psoriasis, pustular psoriasis, and the axial type of psoriatic arthritis. Furthermore, HLA-Cw1 was more frequently associated with high-need patients who did not respond to conventional therapies. No known trigger factor nor autoantigen has been identified for HLA-Cw1 positivity. However, HLA-Cw1 has been linked to some viral agents. For example, cytotoxic T lymphocytes recognize multiple cytomegalovirus pp65-derived epitopes presented by HLA alleles, including HLA-C*01:02. In addition, cytomegalovirus can lead to severe exacerbation of psoriatic skin disease. The proposed interaction between viral infection, HLA-Cw1, and psoriasis is through the killer cell immunoglobulin-like receptors of natural killer cells. Given the diverse nature of psoriasis pathogenesis and the difference in HLA-Cw prevalence in different racial groups, more studies are needed to confirm the role of HLA-Cw1 in psoriasis.
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Van de Wijer L, van der Heijden WA, Ter Horst R, Jaeger M, Trypsteen W, Rutsaert S, van Cranenbroek B, van Rijssen E, Joosten I, Joosten L, Vandekerckhove L, Schoofs T, van Lunzen J, Netea MG, Koenen HJPM, van der Ven AJAM, de Mast Q. The Architecture of Circulating Immune Cells Is Dysregulated in People Living With HIV on Long Term Antiretroviral Treatment and Relates With Markers of the HIV-1 Reservoir, Cytomegalovirus, and Microbial Translocation. Front Immunol 2021; 12:661990. [PMID: 33953724 PMCID: PMC8091964 DOI: 10.3389/fimmu.2021.661990] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/29/2021] [Indexed: 12/26/2022] Open
Abstract
Long-term changes in the immune system of successfully treated people living with HIV (PLHIV) remain incompletely understood. In this study, we assessed 108 white blood cell (WBC) populations in a cohort of 211 PLHIV on stable antiretroviral therapy and in 56 HIV-uninfected controls using flow cytometry. We show that marked differences exist in T cell maturation and differentiation between PLHIV and HIV-uninfected controls: PLHIV had reduced percentages of CD4+ T cells and naïve T cells and increased percentages of CD8+ T cells, effector T cells, and T helper 17 (Th17) cells, together with increased Th17/regulatory T cell (Treg) ratios. PLHIV also exhibited altered B cell maturation with reduced percentages of memory B cells and increased numbers of plasmablasts. Determinants of the T and B cell composition in PLHIV included host factors (age, sex, and smoking), markers of the HIV reservoir, and CMV serostatus. Moreover, higher circulating Th17 percentages were associated with higher plasma concentrations of interleukin (IL) 6, soluble CD14, the gut homing chemokine CCL20, and intestinal fatty acid binding protein (IFABP). The changes in circulating lymphocytes translated into functional changes with reduced interferon (IFN)- γ responses of peripheral blood mononuclear cells to stimulation with Candida albicans and Mycobacterium tuberculosis. In conclusion, this comprehensive analysis confirms the importance of persistent abnormalities in the number and function of circulating immune cells in PLHIV on stable treatment.
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Affiliation(s)
- Lisa Van de Wijer
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wouter A van der Heijden
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rob Ter Horst
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Martin Jaeger
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wim Trypsteen
- HIV Cure Research Center, Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Sofie Rutsaert
- HIV Cure Research Center, Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Bram van Cranenbroek
- Laboratory for Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Esther van Rijssen
- Laboratory for Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Irma Joosten
- Laboratory for Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Leo Joosten
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Linos Vandekerckhove
- HIV Cure Research Center, Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University and Ghent University Hospital, Ghent, Belgium
| | | | | | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands.,Department for Genomics & Immunoregulation, Life and Medical Sciences 12 Institute (LIMES), University of Bonn, Bonn, Germany
| | - Hans J P M Koenen
- Laboratory for Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - André J A M van der Ven
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Quirijn de Mast
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
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Agarwal A, Panda M, Ray A. Complete remission of Psoriatic erythroderma using modified low dose etanercept in a HIV positive patient: A case report with review of literature. Dermatol Ther 2021; 34:e14922. [PMID: 33641225 DOI: 10.1111/dth.14922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Akash Agarwal
- Department of Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha
| | - Maitreyee Panda
- Department of Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha
| | - Arunima Ray
- Department of Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha
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Srivastava AK, Chand Yadav T, Khera HK, Mishra P, Raghuwanshi N, Pruthi V, Prasad R. Insights into interplay of immunopathophysiological events and molecular mechanistic cascades in psoriasis and its associated comorbidities. J Autoimmun 2021; 118:102614. [PMID: 33578119 DOI: 10.1016/j.jaut.2021.102614] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 02/07/2023]
Abstract
Psoriasis is an inflammatory skin disease with complex pathogenesis and multiple etiological factors. Besides the essential role of autoreactive T cells and constellation of cytokines, the discovery of IL-23/Th17 axis as a central signaling pathway has unraveled the mechanism of accelerated inflammation in psoriasis. This has provided insights into psoriasis pathogenesis and revolutionized the development of effective biological therapies. Moreover, genome-wide association studies have identified several candidate genes and susceptibility loci associated with this disease. Although involvement of cellular innate and adaptive immune responses and dysregulation of immune cells have been implicated in psoriasis initiation and maintenance, there is still a lack of unifying mechanism for understanding the pathogenesis of this disease. Emerging evidence suggests that psoriasis is a high-mortality disease with additional burden of comorbidities, which adversely affects the treatment response and overall quality of life of patients. Furthermore, changing trends of psoriasis-associated comorbidities and shared patterns of genetic susceptibility, risk factors and pathophysiological mechanisms manifest psoriasis as a multifactorial systemic disease. This review highlights the recent progress in understanding the crucial role of different immune cells, proinflammatory cytokines and microRNAs in psoriasis pathogenesis. In addition, we comprehensively discuss the involvement of various complex signaling pathways and their interplay with immune cell markers to comprehend the underlying pathophysiological mechanism, which may lead to exploration of new therapeutic targets and development of novel treatment strategies to reduce the disastrous nature of psoriasis and associated comorbidities.
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Affiliation(s)
- Amit Kumar Srivastava
- Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India
| | - Tara Chand Yadav
- Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India
| | - Harvinder Kour Khera
- Tata Institute for Genetics and Society, Centre at InStem, Bangalore, 560065, Karnataka, India; Division of Biological Sciences, University of California, San Diego, La Jolla, CA, 92093, United States
| | - Purusottam Mishra
- Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India
| | - Navdeep Raghuwanshi
- Vaccine Formulation & Research Center, Gennova (Emcure) Biopharmaceuticals Limited, Pune, 411057, Maharashtra, India
| | - Vikas Pruthi
- Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India
| | - Ramasare Prasad
- Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India.
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Mahlangeni GM, Tod BM, Jordaan HF, Schneider JW. Clinicopathological Features of Seborrheic-Like Dermatitis in HIV-Infected Adults: A Single Institutional Descriptive Cross-Sectional Study. Am J Dermatopathol 2021; 43:27-34. [PMID: 32379092 DOI: 10.1097/dad.0000000000001670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Atypical and severe clinical presentations of seborrheic-like dermatitis (SLD) are associated with HIV infection, correlating with advanced disease or low CD4 counts. Previous studies documented histological findings characteristic of seborrheic dermatitis in HIV-positive patients. OBJECTIVE To expand current knowledge of the clinicopathological characteristics of SLD in South African HIV-seropositive individuals. METHODS This prospective study included HIV-seropositive adult patients presenting with SLD to a dermatology clinic from March 2017 to April 2018. A dermatologist established the diagnosis of SLD and the severity of the disease. Detail about antiretroviral therapy (ART), the latest CD4 count, and the viral load was retrieved from the patients' clinical records. Histopathological assessment of the patients' skin biopsies was recorded using standardized data sheets and semiquantifiable grades. RESULTS This study included 13 women and 17 men. Fifty percent of patients showed severe or very severe SLD. Six (20.0%) patients presented with erythroderma. Statistical analysis did not show a significant correlation between severity of disease and CD4 count, viral load, or ART, respectively. This study confirmed that the presence of confluent parakeratosis, necrotic keratinocytes, plasma cells, neutrophils with leukocytoclasia, and leukoexocytosis are histopathological clues to SLD occurring in HIV-seropositive patients. CONCLUSION SLD in HIV patients may present with varying clinical severity, including erythroderma. The association between the prevalence and severity of SLD with CD4 count, viral load, and ART requires further studies with larger patient populations. The presence of specific histopathological features in a skin biopsy of SLD is a clue to the diagnosis of HIV.
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Affiliation(s)
- Gcina M Mahlangeni
- Division of Dermatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa; and
| | - Bianca M Tod
- Division of Dermatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa; and
| | - Hendry Francois Jordaan
- Division of Dermatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa; and
| | - Johann W Schneider
- Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Academic Hospital, Cape Town, South Africa
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Watanabe Y, Yamaguchi Y, Watanabe Y, Asami M, Takamura N, Watanabe T, Kato H, Aihara M. HIV-associated psoriasis with fasciitis and arthritis successfully treated using antiretroviral therapy. J Dermatol 2020; 47:e386-e387. [PMID: 32770863 DOI: 10.1111/1346-8138.15535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yukihiko Watanabe
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yukie Yamaguchi
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yuko Watanabe
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Miho Asami
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Naoko Takamura
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tomoya Watanabe
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hideaki Kato
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Michiko Aihara
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Management of psoriatic patients in biologic treatment associated with infectious comorbidities. Postepy Dermatol Alergol 2020; 37:417-421. [PMID: 32792886 PMCID: PMC7394172 DOI: 10.5114/ada.2020.96155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/17/2018] [Indexed: 12/28/2022] Open
Abstract
Introduction Psoriasis is a chronic inflammatory disease affecting about 2% of population, involving both acquired and innate immunity. Psoriasis affects mainly skin, presenting multiple co-morbidities; among them infective ones. Re-activation of tuberculosis or viral hepatitis (HBV and HCV) still represents a therapeutic challenge in patients receiving treatment with biological drugs, as well as HIV infection. For this reason, a multidisciplinary approach with global treatment resulting from active collaboration of different specialists is highly recommended. Aim To investigate the most common infective diseases as co-morbidities associated with psoriasis and to provide algorithms for screening, follow-up and therapeutic management in psoriatic patients. Material and methods We examined the main infectious comorbidities that can affect moderate to severe psoriatic patients, influencing the therapeutic choice as during the biological treatment both viral and tuberculosis re-activation may occur. We have therefore evaluated the main diseases (TB, Hepatitis B and C, HIV) and the monitoring of patients during treatment with biological agents. Results Regular monitoring of psoriatic patients is recommended during long-term treatment with biological drugs in order to identify cases of re-activation of the latent infective agent or de novo acquired infection. Conclusions Here we report the state of art regarding management of psoriatic patients with these co-morbidities suggesting a specific screening and management for infectious diseases in patients with moderate to severe plaque psoriasis.
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Erythroderma: a prospective study of 309 patients followed for 12 years in a tertiary center. Sci Rep 2020; 10:9774. [PMID: 32555205 PMCID: PMC7300014 DOI: 10.1038/s41598-020-66040-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 05/14/2020] [Indexed: 02/08/2023] Open
Abstract
Erythroderma is characterized by erythema and scaling affecting more than 80% of the body surface area. It is potentially life-threatening, and diagnosis of the underlying disease is a challenge. Despite laboratory improvements, many cases remain idiopathic. We aimed to analyze clinical and laboratory findings of 309 erythrodermic patients to find clues to the etiologic diagnosis. We performed a prospective study at the University of São Paulo Medical School, from 2007 to 2018, with patients with acquired erythroderma. Clinical, laboratory, histology, and molecular biology data were collected. The median age at diagnosis was 57 years, with a male-to-female ratio of 2.2. Eczema was the most frequent etiology (20.7%), followed by psoriasis (16.8%), Sézary syndrome (12.3%), drug eruption (12.3%), atopic dermatitis (8.7%), and mycosis fungoides (5.5%). Other diagnoses (6.8%) included pemphigus foliaceous, paraneoplastic erythroderma, adult T-cell leukemia/lymphoma, dermatomyositis, pityriasis rubra pilaris, lichen planus, bullous pemphigoid, and leprosy. In 52 patients (16.8%), it was not possible to elucidate erythroderma etiology. Atopic dermatitis developed erythroderma at an earlier age (median 25 years; P = 0.0001). Acute onset was associated with drug reactions and atopic dermatitis (median time from erythroderma to diagnosis of 1 and 1.5 months, respectively; P = 0.0001). Higher immunoglobulin E levels were observed in atopic dermatitis (median 24,600 U/L; P = 0.0001). Histopathology was helpful and was consistent with the final diagnosis in 72.4%. Monoclonal T-cell proliferation in the skin was observed in mycosis fungoides (33.3%) and Sézary syndrome (90.9%). At the last assessment, 211 patients (69.3%) were alive with disease, 65 (21.7%) were alive without disease, and 27 (9.1%) died with active disease. Erythroderma is a challenging syndrome with a difficult diagnostic approach. Younger age and higher immunoglobulin E levels are associated with atopic dermatitis; acute onset is observed in drug eruptions and atopic dermatitis. Histopathology and molecular biology tests are essential tools in the investigation of erythroderma.
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Factors associated with psoriasis in a French Nationwide HIV cohort: the independent role of HLA-B*57:01. AIDS 2020; 34:1057-1063. [PMID: 32167971 DOI: 10.1097/qad.0000000000002519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Psoriasis is a T-cell-mediated inflammatory disease with genetic factors involved in its etiopathogenesis. In non-HIV populations, HLA-B57:01 has been associated with a higher risk of psoriasis. The aim of this study was to investigate demographic and immunovirological characteristics associated with psoriasis, and to assess whether HLA-B57:01 is associated with psoriasis among people living with HIV (PLHIV) followed in a large French multicenter Dat'AIDS cohort. METHODS All PLHIV followed up from January 2000 to December 2018 with an available result for HLA-B57:01 were included. Logistic regression models were used to identify associations between psoriasis (outcome variable) and explanatory variables. RESULTS Among 31 076 PLHIV, the overall prevalence of psoriasis and HLA-B57:01 were 2.25 and 4.73%, respectively and varied according to ethnicity. By multivariate analysis, male gender [OR 1.81 (95% CI 1.46-2.24), P < 10], positive HLA-B57:01 [OR 2.66 (95% CI 2.12-3.33), P < 10], nadir CD4 cell count less than 200 cells/μl [OR 1.41 (95% CI 1.19-1.67), P < 10] and positive HCV serology [OR 1.45 (95% CI 1.20-1.76), P < 10] were significantly associated with a higher risk of psoriasis. Being born in West and Central Africa [OR 0.15 (95% CI 0.10-0.25), P < 10], the Caribbean islands [OR 0.14 (95% CI 0.05-0.45), P = 0.0008] or Latin America [OR 0.31 (95% CI 0.14-0.69), P = 0.004] was associated with a lower risk of psoriasis compared with patients born in mainland France. CONCLUSION PLHIV carrying HLA-B57:01 have around a three-fold increased risk of psoriasis. This association might provide a possible explanation for the observed differences in psoriasis prevalence between ethnic groups.
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Vega LE, Espinoza LR. Human immunodeficiency virus infection (HIV)-associated rheumatic manifestations in thepre- and post-HAART eras. Clin Rheumatol 2020; 39:2515-2522. [PMID: 32297034 PMCID: PMC7159285 DOI: 10.1007/s10067-020-05082-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 12/29/2022]
Abstract
Rheumatic manifestations remain an important clinical manifestation associated to HIV. To date after 4 decades of the onset of the HIV/AIDS pandemic, almost 37 million individuals are living with the infection, including close to 2 million of newly infected individuals. The status, however, of a considerable proportion of HIV/AIDS patients has changed from a near fatal disorder secondary to opportunistic infections to a chronic disease in which renal cardiovascular, diabetes, malignancy, and autoimmune co-morbid disorders have become prevalent and relevant. In addition, the spectrum of rheumatic disorders also has changed since the introduction of HAART and its diagnosis and treatment represents a challenge. The purpose of this review is to define and discuss the HIV-related rheumatic manifestations in the pre- and post-HAART eras.
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Affiliation(s)
- Luis E Vega
- Section of Rheumatology, Air Force Hospital, Aramburú Ave 2nd block, Lima, Peru.
| | - Luis R Espinoza
- Louisiana State University Health Sciences Center, 433 Bolivar St, New Orleans, LA, 70112, USA
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38
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Lewis D, Feldman S. Cutaneous manifestations of human immunodeficiency virus/acquired immunodeficiency syndrome: A comprehensive review. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2020. [DOI: 10.4103/jdds.jdds_75_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Micali G, Verzì AE, Giuffrida G, Panebianco E, Musumeci ML, Lacarrubba F. Inverse Psoriasis: From Diagnosis to Current Treatment Options. Clin Cosmet Investig Dermatol 2019; 12:953-959. [PMID: 32099435 PMCID: PMC6997231 DOI: 10.2147/ccid.s189000] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 12/04/2019] [Indexed: 12/14/2022]
Abstract
Inverse psoriasis represents a clinical variant of psoriasis that is sometimes difficult to diagnose due to its clinical similarity with other skin disorders involving the folds, mainly including mechanical intertrigo, fungal and bacterial infections, contact dermatitis, seborrheic dermatitis, and lichen planus. Dermoscopy represents a useful tool for an enhanced non-invasive diagnosis. The treatment of inverse psoriasis may be challenging and include topical corticosteroids, topical calcineurin inhibitors, vitamin D analogs, traditional oral systemic therapies such as cyclosporine and methotrexate, and biologic therapies.
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Karadag AS, Elmas ÖF, Altunay İK. Cutaneous manifestations associated with HIV infections: A great imitator. Clin Dermatol 2019; 38:160-175. [PMID: 32513397 DOI: 10.1016/j.clindermatol.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
HIV is associated with an increased incidence of mucocutaneous disorders, with the overwhelming majority of HIV-infected individuals being afflicted with skin diseases during the course of the infection. Skin diseases in HIV patients are rarely fatal, but they have a significant effect on the quality of life. The immunologic stage of the infection and the use of highly active antiretroviral therapy (HAART) are the main elements that determine the spectrum of the mucocutaneous involvement. Many skin diseases may occur simultaneously in HIV patients, and the course of these diseases may or may not be different than it is in HIV-negative individuals. The unusual, severe, and different presentations of the mucocutaneous involvement make HIV one of the great imitators in dermatology.
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Affiliation(s)
- Ayse Serap Karadag
- Department of Dermatology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ömer Faruk Elmas
- Department of Dermatology, Faculty of Medicine, Ahi Evran University, Kırşehir, Turkey.
| | - İlknur Kıvanç Altunay
- Department of Dermatology, Şişli Hamidiye Etfal Research and Training Hospital, Health Science University, Istanbul, Turkey
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Raychaudhuri SK, Abria C, Mitra A, Raychaudhuri SP. Functional significance of MAIT cells in psoriatic arthritis. Cytokine 2019; 125:154855. [PMID: 31541902 DOI: 10.1016/j.cyto.2019.154855] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mucosal-associated invariant T (MAIT) cells are gaining more relevance for autoimmune diseases because of its (i) innate and adaptive immune response (ii) tissue homing properties (iii) production of IL-17A. These cells are predominantly CD8+ cells, because of its strong association with MHC-I. Tc17 CD8+/MAIT cells likely to have a critical role in psoriatic arthritis (PsA). Herein, we have explored pathological significance of MAIT cell in PsA. METHODS Peripheral blood mononuclear cells (PBMC) and synovial fluid mononuclear cells (SFMC) were collected from age/sex matched (n = 10 for each) PsA, rheumatoid arthritis (RA) and osteoarthritis patients (OA). Hi-D FACS studies were performed: (i) activated memory cells (CD3+CD45RO+) T cells were identified (ii) gating strategies were made to identity the MAIT (CD3+Vα7.2TCR+CD161hi) cells, its phenotype pattern; and functional significance in respect to IL-17A production and responsiveness to human rIL-23. Anti CD3/CD28 ab cocktail was used to activate cells along with rIL-23 to culture and enrich the MAIT cells. The percentages of each cell population and the mean fluorescence intensity (MFI) were analyzed using Flow Jo software. RESULTS MAIT cells were enriched in synovial fluid of PsA (4.29 ± 0.82%) compared to PBMC (1.04 ± 0.71). With stimulation, SFMC MAIT cells produced significantly more IL-17A (32.66 ± 4.01%) compared to that of RA (23.93 ± 2.81%, p < 0.05) and OA (5.02 ± 0.16%, p < 0.05). MAIT cells were predominantly CD8+ (>80%). Significant upregulation of IL-23R was noted in synovial fluid MAIT cells of PsA (24.97 ± 2.33%, p < 0.001) and RA (21.93 ± 2.29%, p < 0.001) compared to that of OA (2.13 ± 2.29). This IL-23R was functionally active as evidenced by profound mitotic effect in presence of rIL-23. CONCLUSION MAIT cells are poly functional; produce multiple cytokines (IL-17A, IFN-γ, TNF-α). Here, we demonstrated synovial fluid MAIT cells as a major source of IL-17A and majority of MAIT cells were CD8+. Functionally active IL-23R on these migrated MAIT cells brings a new dimension. They may not need MR1 associated activation rather lesional IL-23 in the synovium can independently regulate these critical Tc17 CD8+ MAIT cells. Thus, these cells likely to be a part of the IL-23/IL-17A cytokine network and play a critical role in the pathogenesis of PsA.
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Affiliation(s)
| | | | | | - Siba P Raychaudhuri
- VA Medical Center Sacramento, CA, USA; Division of Rheumatology, Allergy & Clinical Immunology, University of California Davis, School of Medicine Sacramento, CA, USA.
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42
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Tan J, Pina A, Borges-Costa J. Skin Diseases in the Era of Highly Active Antiretroviral Therapy: A Retrospective Study of 534 Patients. J Int Assoc Provid AIDS Care 2019; 17:2325957417752255. [PMID: 29380667 DOI: 10.1177/2325957417752255] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND With the increasing number of HIV-infected patients receiving highly active antiretroviral therapy (HAART), the shift in their dermatologic profile becomes less characteristic of AIDS-defining illnesses. METHODS Retrospective review of mucocutaneous pathology among patients seen at HIV-Dermatology Clinic from January 2009 to December 2013. RESULTS Among 534 patients, there were 68.4% males and 31.6% females, with 8.7-year average duration of infection; 82.8% were receiving HAART. Kaposi sarcoma was the only relatively frequent AIDS-defining disease. Fungal and viral infections were common, with human papilloma virus (HPV) as the most frequent overall. Benign and premalignant tumors were associated with HAART and CD4 >200/mm3 ( P < .05). Psoriasis was prevalent among patients without HAART ( P < .05). Prurigo was associated with lower CD4 count ( P < .001). CONCLUSION Patients receiving HAART are faced with chronic skin problems such as benign and premalignant tumors, and HPV infection adds to their neoplastic predisposition. Further research is recommended to develop protocols for treating psoriasis and screening for HPV-associated neoplasia among patients.
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Affiliation(s)
| | - Ana Pina
- 2 Clínica Universitária de Dermatologia de Lisboa, Hospital de Santa Maria, Lisboa, Portugal
| | - João Borges-Costa
- 2 Clínica Universitária de Dermatologia de Lisboa, Hospital de Santa Maria, Lisboa, Portugal.,3 Faculdade de Medicina da Universidade de Lisboa, Unidade de Investigação em Dermatologia, Lisboa, Portugal.,4 Instituto de Higiene e Medicina Tropical, Lisboa, Portugal
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43
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Sbidian E, Madrange M, Viguier M, Salmona M, Duchatelet S, Hovnanian A, Smahi A, Le Goff J, Bachelez H. Respiratory virus infection triggers acute psoriasis flares across different clinical subtypes and genetic backgrounds. Br J Dermatol 2019; 181:1304-1306. [PMID: 31150103 PMCID: PMC7161746 DOI: 10.1111/bjd.18203] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E Sbidian
- AP-HP, Hôpitaux Universitaires Henri Mondor, Département de Dermatologie, UPEC, Créteil, F-94010, France.,Inserm, Centre d'Investigation Clinique 1430, Créteil, F-94010, France.,EA 7379 EpidermE, Université Paris-Est Créteil, UPEC, Créteil, F-94010, France
| | - M Madrange
- Laboratoire de Génétique des Maladies Autoinflammatoires, INSERM UMR 1163, Institut Imagine, Hôpital Necker, Paris, France
| | - M Viguier
- Université Reims-Champagne Ardenne, Service de Dermatologie-Vénéréologie, Hôpital Robert Debré, Reims, France
| | - M Salmona
- Sorbonne Paris Cité Université Paris Diderot, Paris, France.,Department of Virology, AP-HP, Hôpital Saint-Louis, Paris, F-75010, France.,Inserm INSIGHT U976, AP-HP, Hôpital Saint-Louis, Paris, F-75010, France
| | - S Duchatelet
- Laboratoire de Génétique des Maladies Cutanées, INSERM UMR 1163, Institut Imagine, Hôpital Necker, Paris, France
| | - A Hovnanian
- Laboratoire de Génétique des Maladies Cutanées, INSERM UMR 1163, Institut Imagine, Hôpital Necker, Paris, France
| | - A Smahi
- Laboratoire de Génétique des Maladies Autoinflammatoires, INSERM UMR 1163, Institut Imagine, Hôpital Necker, Paris, France
| | - J Le Goff
- Sorbonne Paris Cité Université Paris Diderot, Paris, France.,Department of Virology, AP-HP, Hôpital Saint-Louis, Paris, F-75010, France.,Inserm INSIGHT U976, AP-HP, Hôpital Saint-Louis, Paris, F-75010, France
| | - H Bachelez
- Laboratoire de Génétique des Maladies Autoinflammatoires, INSERM UMR 1163, Institut Imagine, Hôpital Necker, Paris, France.,Laboratoire de Génétique des Maladies Cutanées, INSERM UMR 1163, Institut Imagine, Hôpital Necker, Paris, France.,Department of Dermatology, AP-HP, Hôpital Saint-Louis, 1, avenue Claude Vellefaux., 75475, Paris cedex 10, France
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44
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Shah BJ, Mistry D, Chaudhary N. Apremilast in People Living with HIV with Psoriasis Vulgaris: A Case Report. Indian J Dermatol 2019; 64:242-244. [PMID: 31148866 PMCID: PMC6537689 DOI: 10.4103/ijd.ijd_633_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Psoriasis is a chronic papulosquamous skin disease that involves immune-mediated cutaneous inflammation and keratinocyte hyperproliferation. The associated immunosuppression in people living with HIV (PLHIV) with psoriasis poses a challenge to the clinician as therapeutic options are limited. Until now, there have been no documented case of apremilast therapy for HIV-associated psoriasis in India. Here, we report a case of HIV-associated psoriasis who achieved Psoriasis Area and Severity Index (PASI) 100 with apremilast therapy.
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Affiliation(s)
- Bela J Shah
- Department of Dermatology, B J Medical College, Civil Hospital, Ahmedabad, Gujarat, India
| | - Deval Mistry
- Department of Dermatology, B J Medical College, Civil Hospital, Ahmedabad, Gujarat, India
| | - Navin Chaudhary
- Department of Dermatology, B J Medical College, Civil Hospital, Ahmedabad, Gujarat, India
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45
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Chelidze K, Thomas C, Chang AY, Freeman EE. HIV-Related Skin Disease in the Era of Antiretroviral Therapy: Recognition and Management. Am J Clin Dermatol 2019; 20:423-442. [PMID: 30806959 PMCID: PMC6581453 DOI: 10.1007/s40257-019-00422-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Antiretroviral therapy (ART) has revolutionized the treatment and prognosis of people living with HIV (PLHIV). With increased survival and improved overall health, PLHIV are experiencing dermatologic issues both specific to HIV and common to the general population. In this new era of ART, it is crucial for dermatologists to have a strong understanding of the broad range of cutaneous disease and treatment options in this unique population. In this review, we outline the most common skin diseases in PLHIV, including HIV-associated malignancies, inflammatory conditions, and infections, and focus on the role of ART in altering epidemiology, clinical features, diagnosis, and treatment of cutaneous conditions.
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Affiliation(s)
- Khatiya Chelidze
- Weill Cornell Medical College, Massachusetts General Hospital, 1300 York Avenue, New York, NY, 10021, USA
| | - Cristina Thomas
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, Boston, MA, 02114, USA
| | - Aileen Yenting Chang
- Department of Dermatology, University of California, San Francisco, 505 Paranassus Avenue, San Francisco, CA, 94143, USA
| | - Esther Ellen Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, Boston, MA, 02114, USA.
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA.
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46
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Guignant M, Mahé E, Duval-Modeste AB, Vermersch-Langlin A. [Psoriasis and HIV infection, what do French dermatologists do?]. Ann Dermatol Venereol 2019; 146:265-272. [PMID: 30833038 DOI: 10.1016/j.annder.2019.01.008] [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: 06/13/2018] [Revised: 11/14/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The prevalence of psoriasis among patients presenting human immunodeficiency virus (HIV)infection is the same as in the general population, but the disease is more severe and refractory, and management is more complex. The aim of this survey was to assess the practices of French dermatologists concerning both screening for HIV in psoriasis patients and therapeutic management and follow-up of psoriasis patients with HIV. PATIENTS AND METHODS An anonymous national survey of practices was conducted by means of a questionnaire emailed to dermatologists in hospital in private practice in France between March and June 2017. RESULTS The questionnaire was completed by 262 dermatologists. They indicated that they carried out screening for HIV in psoriasis patients presenting risk factors (79.4%), prior to biotherapy (63.4%) or different systemic treatments other than retinoids (53.1%), if the psoriasis was severe (45.8%), or in the event of worsening (37.8%). 28.7% of practitioners surveyed were in fact treating patients with psoriasis and HIV, with a mean 3.1 patients being followed up. All practitioners prescribe systemic treatment, other than cyclosporine, but they frequently consult an infectious disease specialist before prescribing these therapies. The most widely used biotherapy was etanercept (65.5% of practitioners). More intensive laboratory follow-up was conducted for these patients in 72.1% of cases. CONCLUSION French dermatologists do not perform routine screening for HIV in psoriasis patients. However, where infection has been identified, their practices are modified accordingly. Therapeutic choices are consistent with the French recommendations. Nevertheless, recommendations appear necessary concerning HIV screening in this population.
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Affiliation(s)
- M Guignant
- Service de dermatologie, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France.
| | - E Mahé
- Service de dermatologie, hôpital Victor-Dupouy, 69, rue du Lieutenant-ColonelPrud'hon, 95100 Argenteuil, France
| | - A-B Duval-Modeste
- Service de dermatologie, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - A Vermersch-Langlin
- Service de dermatologie/IST, hôpital-Jean Bernard, avenue Desandrouin, 59322 Valenciennes cedex, France
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- Service de dermatologie, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France; Service de dermatologie, hôpital Victor-Dupouy, 69, rue du Lieutenant-ColonelPrud'hon, 95100 Argenteuil, France; Service de dermatologie/IST, hôpital-Jean Bernard, avenue Desandrouin, 59322 Valenciennes cedex, France
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Abstract
Psoriasis is a prevalent systemic immune-mediated disease with cutaneous manifestations. In HIV-infected patients, psoriasis may have a higher incidence, present atypical and more exuberant clinical features, and is frequently recalcitrant to treatment. Despite this aggravated severity, treatment options for psoriasis in HIV-infected individuals remain limited due to the risk of fatal immunosuppression associated with both classical immunosuppressants and new biological drugs. Notwithstanding, drug therapy in psoriasis has been undergoing major advances for the last few years, with novel drugs approved, which could significantly add to the management of HIV-infected patients. It is therefore our aim to present a review of the available literature to highlight the updated evidence on psoriasis in HIV-infected individuals, particularly in regards to its epidemiology, proposed pathophysiology, clinical presentation, currently available therapeutic options, and future perspectives.
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Affiliation(s)
- Miguel Alpalhão
- 1 Dermatology and Venereology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.,2 Dermatology Investigation Unit, Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal
| | - J Borges-Costa
- 1 Dermatology and Venereology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.,2 Dermatology Investigation Unit, Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal.,3 Clínica Universitária de Dermatologia, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Paulo Filipe
- 1 Dermatology and Venereology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.,2 Dermatology Investigation Unit, Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal.,3 Clínica Universitária de Dermatologia, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
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48
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Li YY, Dong RJ, Cao LJ, Upadhyay P, Kuang YQ. Case of coincident severe acne and psoriasis in AIDS patient successfully treated with antiretroviral therapy. J Dermatol 2019; 46:431-435. [PMID: 30811070 DOI: 10.1111/1346-8138.14823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 01/17/2019] [Indexed: 11/28/2022]
Abstract
Cutaneous disorders remain a major problem in HIV-infected patients, even under antiretroviral therapy (ART). Patients at any stage of HIV/AIDS may suffer from skin lesions. Acnes and psoriasis are both common chronic and inflammatory skin diseases, and the treatment becomes more challenging and complex when combined with HIV infection. Whether the incidence and severity of acne and psoriasis are related to HIV infection is still controversial. Here, we report a rare case of an AIDS patient who developed severe acne along with psoriasis. The patient had initially received multiple systemic and topical antipsoriatic and anti-acne treatments which failed. Ultimately, he achieved dramatic clinical improvement after initiation of ART for main treatment. An 8-year follow up demonstrated that the patient has been free of symptoms of both psoriasis and acne till now.
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Affiliation(s)
- Yu-Ye Li
- Department of Dermatology and Venereology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Rong-Jing Dong
- Department of Dermatology and Venereology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Li-Juan Cao
- Department of Dermatology and Venereology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Pratishtha Upadhyay
- Department of Dermatology and Venereology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yi-Qun Kuang
- Center for Translational Medicine, Huaihe Clinical College, Huaihe Hospital of Henan University, Kaifeng, China.,Institute of Infection and Immunity, Henan University, Kaifeng, China
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Mechanisms of microbial pathogenesis and the role of the skin microbiome in psoriasis: A review. Clin Dermatol 2019; 37:160-166. [PMID: 30981296 DOI: 10.1016/j.clindermatol.2019.01.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The pathogenesis of psoriasis may involve a breakdown of immune tolerance to cutaneous microorganisms. Psoriasis is associated with a higher incidence of Crohn disease and periodontitis, two diseases involving impaired tolerance and abnormal immune activation in response to intestinal and oral microbiota, respectively. In addition, guttate and chronic plaque psoriasis are associated with Streptococcus pyogenes colonization. The aim of this review is to characterize the microorganisms implicated in psoriasis by examining results of major association studies and possible mechanisms of pathogenesis. Although studies show relative increases in Streptococcus and Staphylococcus and decreases in Malassezia and Cutibacterium, they differ in methods of sampling and methods of microbial analysis. As such, no definitive associations between microbes and psoriasis have been found to date. It also remains unclear if changes in the microbiomal composition have a causal association with psoriasis or are simply a consequence of the inflammatory microenvironment. Techniques enabling strain-level analysis rather than species-level analysis of the skin microbiome are likely necessary to determine microbiomal signatures of psoriasis. Future investigations may lead to new diagnostic tests and novel treatments, such as probiotics or bacterial transplantation.
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50
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Ceccarelli M, Venanzi Rullo E, Vaccaro M, Facciolà A, d'Aleo F, Paolucci IA, Cannavò SP, Cacopardo B, Pinzone MR, Pellicanò GF, Condorelli F, Nunnari G, Guarneri C. HIV-associated psoriasis: Epidemiology, pathogenesis, and management. Dermatol Ther 2019; 32:e12806. [PMID: 30588732 DOI: 10.1111/dth.12806] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/15/2018] [Accepted: 12/25/2018] [Indexed: 01/14/2023]
Abstract
People living with HIV (PLWH) are affected by a higher incidence skin disorders, which are often associated with high morbidity and mortality. In particular, psoriasis affects PLWH severely and for a longer time than the general population. Human immunodeficiency virus (HIV) infection is characterized by a progressive decrease in CD4+ T-cell count, and it could seem paradoxical that psoriasis exacerbations are more frequent in this subset of patients than the general population, even though it is commonly observed at any stage of infection. For a long time, there have been limited therapeutic choices for PLWH affected by psoriasis. The introduction of the combined antiretroviral therapy dramatically changed the natural course of both HIV and psoriasis in PLWH, leading to an improvement of quality and duration of life. However, the clinical severity of psoriasis in PLWH often requires the use of immunosuppressant drugs. Knowledge about their safety and efficacy are limited to case-reports, small case-series and studies, therefore their use has not yet entered the routine. Further studies are needed to determine if immunosuppressive drugs can be safely and effectively used in PLWH affected by psoriasis and other autoimmune disorders.
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Affiliation(s)
- Manuela Ceccarelli
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Emmanuele Venanzi Rullo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Department of Pathology and Laboratory Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mario Vaccaro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alessio Facciolà
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco d'Aleo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | | | - Bruno Cacopardo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Marilia Rita Pinzone
- Department of Pathology and Laboratory Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giovanni Francesco Pellicanò
- Department of Human Pathology of the Adult and the Developmental Age "G. Barresi", University of Messina, Messina, Italy
| | - Fabrizio Condorelli
- Department of Pharmacological Sciences, Università del Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Giuseppe Nunnari
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morpho Functional Imaging, University of Messina, Messina, Italy
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