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Kurz B, Arndt S, Unger P, Ivanova I, Berneburg M, Hellerbrand C, Karrer S. Association of polymorphous light eruption with NOD-2 and TLR-5 gene polymorphisms. J Eur Acad Dermatol Venereol 2022; 36:2172-2180. [PMID: 35748133 DOI: 10.1111/jdv.18364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Polymorphous light eruption (PLE) is a common, immunologically mediated, photosensitive skin disease. After ultraviolet-B (UV-B) irradiation, patients with PLE show reduced Langerhans cell (LC) depletion in the epidermis, which results in a non-suppressive microenvironment in the skin. Interestingly, severe acute graft-versus-host-disease (aGvHD) occurred in stem cell transplanted patients that showed no or incomplete depletion of LCs after UVB-irradiation. Genetic variation in nucleotide-binding oligomerization domain 2 (NOD-2) and toll-like receptor 5 (TLR-5) genes also confers susceptibility to aGvHD. OBJECTIVES We hypothesized that PLE is associated with genetic variation in the NOD-2 and TLR-5 genes. METHODS We investigated single nucleotid polymorphisms (SNPs) of NOD-2 (R702W, G908R, 3020Cins) and TLR-5 (A592S, P616L, N392STOP) in skin biopsies of PLE-patients (n=143) and in healthy controls (n=104) using restriction fragment-length polymorphism analysis. RESULTS The frequency of NOD-2 alleles with the SNP R702W was significantly higher in PLE than in controls (31.8% vs 6.3%; p<0.0001), and homozygous carriers of this mutation were more common in PLE (27.9% vs 0%; p<0.0001). For SNP 3020Cins, the allele frequency (7.3% vs 0.7%; p=0.0025) and the number of heterozygotes (14.7% vs 1.3%; p=0.0019) were higher in PLE. The frequency of alleles with the N392STOP SNP of the TLR5 gene, which is associated with a truncated, non-functional receptor, was significantly higher in PLE (21% vs 5%; 7% vs 1% homozygotes, 28% vs 8% heterozygotes; p<0.0001). The other SNPs did not differ significantly. CONCLUSIONS This study yielded a high frequency of functional SNPs in the NOD-2 and TLR-5 genes in PLE. The same SNPs are associated with aGvHD and there are similarities in the reaction of LCs after UVB-irradiation between aGvHD and PLE. This leads to the hypothesis that PLE-patients may be more susceptible to developing GvHD after stem-cell transplantation, an assumption that needs to be investigated further.
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Affiliation(s)
- B Kurz
- Department of Dermatology, University Hospital Regensburg, D-93042, Regensburg, Germany
| | - S Arndt
- Department of Dermatology, University Hospital Regensburg, D-93042, Regensburg, Germany
| | - P Unger
- Department of Dermatology, University Hospital Regensburg, D-93042, Regensburg, Germany
| | - I Ivanova
- Department of Dermatology, University Hospital Regensburg, D-93042, Regensburg, Germany
| | - M Berneburg
- Department of Dermatology, University Hospital Regensburg, D-93042, Regensburg, Germany
| | - C Hellerbrand
- Institute of Biochemistry, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054, Erlangen, Germany
| | - S Karrer
- Department of Dermatology, University Hospital Regensburg, D-93042, Regensburg, Germany
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Lee CN, Chen TY, Wong TW. The Immunogenetics of Photodermatoses. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1367:369-381. [DOI: 10.1007/978-3-030-92616-8_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kadurina M, Kazandjieva J, Bocheva G. Immunopathogenesis and management of polymorphic light eruption. Dermatol Ther 2021; 34:e15167. [PMID: 34676645 DOI: 10.1111/dth.15167] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022]
Abstract
Polymorphic light eruption (PLE) is the most common immunologically mediated photodermatosis, demonstrating many abnormalities caused by critical failure of ultraviolet (UV)-induced immunosuppression. The unique expression of antimicrobial peptides in PLE, which is most likely determined by alteration of microbiome components upon UV exposure, implicates their possible triggering role and pathogenic significance in the eruption. The review aims to clarify current knowledge regarding the immunological disturbances correlated with PLE that serve a base for better understanding of molecular pathogenesis of the disease and the development of new therapeutic strategies. Preventive treatment with broad-spectrum suncreens and sunscreens containing DNA repair enzymes, as well as natural photohardening with graduate exposure to sunlight in early spring could be sufficient in milder cases. Antioxidants and topical calcipotriol are promising approach for adjuvant prevention. Phototherapy, mainly with narrow band UVB rays, is more appropriate method in severe cases of the disease. The established treatment options for PLE include local and systemic glucocorticoids, systemic nonsedative antihistamines for itch relief, and rarely, immunosuppressive drugs in the refractory cases. Like medical photohardening, afamelanotide has the potential of photoprotection by inducing a melanization of the skin. Afamelanotide is believed to be a possible new treatment option for very severe and refractory cases of PLE. Targeting the main pruritogenic cytokine, IL-31, opens a new road for the development of novel therapeutic approaches to combat moderate and severe itching in cases of PLE with intense pruritus.
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Affiliation(s)
- Miroslava Kadurina
- Department of Dermatology, University Acibadem City Clinic, Sofia, Bulgaria
| | - Jana Kazandjieva
- Department of Dermatology, Medical University of Sofia, Sofia, Bulgaria
| | - Georgeta Bocheva
- Department of Pharmacology and Toxicology, Medical University of Sofia, Sofia, Bulgaria
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Satish N, Dakshinamoorthy A, S S. A study of the pattern of dermatoses in adolescent patients in South India. Int J Dermatol 2021; 61:299-305. [PMID: 34231880 DOI: 10.1111/ijd.15602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 01/01/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adolescence describes the age group between 10 and 19 years. This is the transitional stage of physical and physiological human development generally occurring between puberty and adulthood. Hormonal changes occurring during puberty result in various physical and psychological changes, affecting their social relationship. At this stage, external appearance is of immense concern to them. As such, any dermatological condition can extremely affect their psychological status. This study was conducted to give an insight on the various dermatological conditions of the adolescent age groups and their incidence. METHODS Study design: Descriptive study - Cross-sectional study. Three hundred patients between the ages of 10 and 19 years, attending the tertiary care center in South India, were included in the study. A detailed history, clinical examination, and appropriate laboratory investigations were carried out. RESULTS Out of 300 patients, females (52.7%) more commonly presented with dermatoses than males (47.3%). Most of the 300 patients belonged to the age group of 17-19 years (50.33%). Infections/infestations (39%) were the most predominant dermatoses followed by acne (17.67%), eczema (9.67%), insect bite reactions (IBRs) (7%), keratinization disorders (6.67%), polymorphic light eruptions (PLEs) (4.33%), urticaria (4.33%), and pigmentary disorders (4.33%). CONCLUSION This study gives an insight of various dermatological conditions among the adolescent age groups. Females more commonly presented with dermatoses. The most common dermatoses were infections. Since very few studies regarding dermatoses in adolescents are available in the literature, this study is distinctive in this regard.
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Affiliation(s)
- Nithya Satish
- Dermatology and Cosmetology Unit, Thaj Laser Skin Care Centre, Balakrishnan Hospital, Coimbatore, India
| | - Abirami Dakshinamoorthy
- Department of Dermatology, Venereology & Leprology, Mahatma Gandhi Medical College Hospital & Research Institute, Pillaiyarkuppam, Pondicherry, India
| | - Srikanth S
- Department of Dermatology, Venereology & Leprology, Mahatma Gandhi Medical College Hospital & Research Institute, Pillaiyarkuppam, Pondicherry, India
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Nahhas AF, Oberlin DM, Braunberger TL, Lim HW. Recent Developments in the Diagnosis and Management of Photosensitive Disorders. Am J Clin Dermatol 2018; 19:707-731. [PMID: 29959757 DOI: 10.1007/s40257-018-0365-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Photodermatoses occur in males and females of all races and ages. Onset can be variable in timing and influenced by genetic and environmental factors. Photodermatoses are broadly classified as immunologically mediated, chemical- and drug-induced, photoaggravated, and genetic (defective DNA repair or chromosomal instability) diseases. Advances in the field have led to improved recognition and treatment of many photodermatoses. The purpose of this focused review is to provide an update on the diagnosis and management of a variety of photodermatoses, both common and less common, with review of recent updates in the literature pertaining to their diagnosis and management.
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Affiliation(s)
- Amanda F Nahhas
- Department of Dermatology, Henry Ford Hospital, 3031 West Grand Blvd, Suite 800, Detroit, MI, 48202, USA
| | - David M Oberlin
- Department of Dermatology, Henry Ford Hospital, 3031 West Grand Blvd, Suite 800, Detroit, MI, 48202, USA
| | - Taylor L Braunberger
- Department of Dermatology, Henry Ford Hospital, 3031 West Grand Blvd, Suite 800, Detroit, MI, 48202, USA
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, 3031 West Grand Blvd, Suite 800, Detroit, MI, 48202, USA.
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Lembo S, Raimondo A. Polymorphic Light Eruption: What's New in Pathogenesis and Management. Front Med (Lausanne) 2018; 5:252. [PMID: 30250845 PMCID: PMC6139322 DOI: 10.3389/fmed.2018.00252] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/22/2018] [Indexed: 01/25/2023] Open
Abstract
Polymorphic light eruption is the commonest photosensitive disorder, characterized by an intermittent eruption of non-scarring erythematous papules, vesicles or plaques that develop within hours of ultraviolet radiation exposure of patient skin. Together with the lesions, a terrible itch starts and increases with the spreading of the disease, sometimes aggravated by a sort of burning sensation. Clinical picture and symptoms can improve during the rest of the summer with further solar exposures. In the last years many advances have been performed in the knowledge of its pathogenesis and some news have been proposed as preventive, as well as therapeutic options. All this has been discussed in the current mini review.
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Affiliation(s)
- Serena Lembo
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Annunziata Raimondo
- Department of Clinical Medicine and Surgery, University of Naples, Federico II, Naples, Italy
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Lembo S, Caiazzo G, Balato N, Monfrecola G, Patra V, Wolf P, Balato A. Polymorphic light eruption and IL-1 family members: any difference with allergic contact dermatitis? Photochem Photobiol Sci 2018; 16:1471-1479. [PMID: 28812775 DOI: 10.1039/c7pp00142h] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Polymorphic light eruption (PLE) is described as a delayed-type hypersensitivity reaction (DTHR) toward a de novo light-induced antigen, yet to be identified. In effect, the inflammatory pathways of PLE and allergic contact dermatitis (ACD) share common patterns in terms of the mediators involved from the innate and adaptive immune system participating in the DTHR. As we have previously highlighted the role of interleukin (IL)-1 family members in ACD, we hypothesised that the same mediators could have similar functions in PLE. Our research aimed to assess the expression of certain IL-1family members in PLE patients vs. controls, and to compare it with ACD. The study population comprised 17 patients with PLE, 5 affected by ACD and 10 healthy controls in the same age range. Lesional and healthy skin samples were collected respectively from patients and donors. IL-36α, IL-36β, IL-36γ, IL-36 receptor antagonist (Ra), IL-1β, IL-33 gene and protein expressions were evaluated through RT-PCR and immunohistochemistry. Circulating proteins in the PLE patients were analysed by using western blot. The IL-36γ gene expression was significantly increased in PLE lesions compared to that in healthy controls and ACD lesions (***p < 0.001; ##p < 0.01 respectively), whereas the other analyzed ILs were more expressed in ACD. Immunohistochemical analysis revealed that IL-36α and IL-36γ protein levels were increased in PLE lesions compared to those of the healthy samples (***p < 0.001). Furthermore the IL-36γ plasma level was increased in PLE patients vs. controls (*p < 0.05). Our findings indicate that the IL-1 family pro-inflammatory members are increased in PLE with distinct differences from those in ACD, in particular with regard to IL-36γ mRNA regulation. Their role as activators of the local, and perhaps systemic, immune response, or as inhibitors of the immune tolerance machinery, needs further investigation.
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Affiliation(s)
- S Lembo
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana" University of Salerno, Italy.
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Lembo S, Hawk JLM, Murphy GM, Kaneko K, Young AR, McGregor JM, Walker SL, Palmer RA. Aberrant gene expression with deficient apoptotic keratinocyte clearance may predispose to polymorphic light eruption. Br J Dermatol 2017; 177:1450-1453. [PMID: 27873316 DOI: 10.1111/bjd.15200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Lembo
- Department of Clinical Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Salerno, Italy
| | - J L M Hawk
- St John's Institute of Dermatology, King's College London, London, SE1 9RT, U.K
| | - G M Murphy
- Department of Dermatology, Beaumont Hospital, Dublin 9, Ireland
| | - K Kaneko
- Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and The University of Nottingham, Nottingham, NG7 2NR, U.K
| | - A R Young
- St John's Institute of Dermatology, King's College London, London, SE1 9RT, U.K
| | - J M McGregor
- Department of Cell Biology and Cutaneous Research, Blizzard Institute, Barts and The London School of Medicine and Dentistry, London, E1 2AT, U.K
| | - S L Walker
- St John's Institute of Dermatology, King's College London, London, SE1 9RT, U.K
| | - R A Palmer
- Princess Margaret Hospital, Osborne Road, Windsor, SL4 3SJ, U.K
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Abstract
Polymorphous light eruption (PLE) is the commonest immuno-mediated photodermatosis. It occurs after solar or artificial UV-light exposure and affects only the sun-exposed areas with preference of the V-area of the chest, of arms and forearms, legs, upper part of the back, and rarely the face. The lesions are itching or burning, and vary morphologically from erythema to papules, vesico-papules and occasionally blisters, plaques, sometimes erythema multiforme-like, insect bite-like wheals and purpura. The clinical manifestations befall within a few hours to days from light exposure, last a few days, and subside in about a week without sequelae. Its diagnosis is based on history, morphology and phototests. PLE is considered as a delayed hypersensitivity response to newly UV induced, but still unidentified, antigen(s). Usually, MED is normal, but the provocative phototests with UVA or UVB reproduce the spontaneous lesions in about 50% of the patients. Broad spectrum sunscreens and antioxidants, photohardening with PUVA or narrow band UVB may be beneficial to prevent the disease. Therapy is based mainly on topical or systemic corticosteroids.
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Schweintzger NA, Gruber-Wackernagel A, Shirsath N, Quehenberger F, Obermayer-Pietsch B, Wolf P. Influence of the season on vitamin D levels and regulatory T cells in patients with polymorphic light eruption. Photochem Photobiol Sci 2016; 15:440-6. [PMID: 26911519 PMCID: PMC4841162 DOI: 10.1039/c5pp00398a] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 02/09/2016] [Indexed: 01/16/2023]
Abstract
The exact mechanisms of photohardening in polymorphic light eruption (PLE) are still unknown, but medical photohardening was shown to increase regulatory T cell (Treg) numbers in the blood of PLE patients, similar to natural hardening. Furthermore, oral vitamin D supplementation increased peripheral Tregs in healthy individuals. We herein report on a post hoc analysis of 26 screened PLE patients of a clinical trial (ClinicalTrials.gov No. NCT01595893), in which the influence of the progressing season was investigated on baseline CD4+CD25+FoxP3+CD127- Treg numbers by flow cytometry and Treg suppressive function by co-culture assays with T effector cells as a secondary endpoint, together with 25-hydroxy vitamin D (25(OH)D) serum levels at the study's screening visit, taking place in the period from January to June. The mean 25(OH)D serum level of all patients was 33.2 ng ml(-1). Ten of those patients (38.5%) were identified with low 25(OH)D levels (<30 ng ml(-1)). Significantly higher baseline 25(OH)D serum levels (plus 34.4%; P = 0.0182) as well as higher relative Treg percentages in CD4+ population (plus 62.8%; P = 0.0157) and in total lymphocyte population (plus 59.6%; P = 0.0372) and higher absolute Treg numbers (plus 100.2%; P = 0.0042) were observed in the late spring/early summer period (April to June) compared to the winter period (January to February). No significant relationship was observed when Treg numbers and function were correlated with 25(OH)D levels. These data indicate that in PLE patients Treg numbers and their suppressive function are independent of vitamin D serum levels and suggest that UV light and/or other seasonal factors may affect these cells via the non-vitamin D related pathway(s).
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Affiliation(s)
- N. A. Schweintzger
- Research Unit for Photodermatology , Department of Dermatology , Medical University of Graz , Graz , Austria . ; Fax: +43 316 385-12466 ; Tel: +43 316 385-12371
- Center for Medical Research , Medical University of Graz , Graz , Austria
| | - A. Gruber-Wackernagel
- Research Unit for Photodermatology , Department of Dermatology , Medical University of Graz , Graz , Austria . ; Fax: +43 316 385-12466 ; Tel: +43 316 385-12371
| | - N. Shirsath
- Research Unit for Photodermatology , Department of Dermatology , Medical University of Graz , Graz , Austria . ; Fax: +43 316 385-12466 ; Tel: +43 316 385-12371
- Center for Medical Research , Medical University of Graz , Graz , Austria
| | - F. Quehenberger
- Institute for Medical Informatics , Statistics and Documentation , Medical University of Graz , Graz , Austria
| | - B. Obermayer-Pietsch
- Division of Endocrinology and Metabolism , Department of Internal Medicine , Medical University of Graz , Graz , Austria
| | - P. Wolf
- Research Unit for Photodermatology , Department of Dermatology , Medical University of Graz , Graz , Austria . ; Fax: +43 316 385-12466 ; Tel: +43 316 385-12371
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Martínez-Luna E, Bologna-Molina R, Mosqueda-Taylor A, Cuevas-González JC, Rodríguez-Lobato E, Martínez-Velasco MA, Vega-Memíje ME. Inmunohistochemical detection of mastocytes in tissue from patients with actinic prurigo. J Clin Exp Dent 2015; 7:e656-9. [PMID: 26644844 PMCID: PMC4663070 DOI: 10.4317/jced.52823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 10/28/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Actinic prurigo (AP) is a type of photodermatosis, the pathophysiology of which has not been determined. AP has been suggested to be a hypersensitivity reaction to the presence of eosinophils and the local production of IgE. MATERIAL AND METHODS Descriptive study, using paraffin blocks of tissue that have been diagnosed with AP from the Dermopathology department, Hospital General Dr. Manuel Gea González. In 66 blocks from 63 patients, eosinophils were identified by hematoxylin and eosin staining, and mastocytes were labeled by immunohistochemistry. Three random microphotographs (40x) were used, and cell counts were calculated as the mean count in the 3 microphotographs. RESULTS Forty cases (63.5%) were female, and 23 (36.5%) were male. The mean age was 26.49 ±14.09 years; regarding the evolution time of the disease, the average was 11.93 years ±11.39. In 38 of 63 cases (60%), the lip, skin, and conjunctiva were affected clinically. In 22 of 63 cases (34%), AP cheilitis was the sole manifestation, and in 4 of 63 cases (6%), there were lesions in the skin and conjunctiva. The mean eosinophil count was 9 per case, the average number of mastocytes/field was 28.48 (range 0 to 66) Kruskal-Wallis p=0.001. CONCLUSIONS There are elements in AP that mediate the reaction of hypersensitivity type IV b, necessitating the identification of triggering factors. KEY WORDS Actinic prurigo, eosinophil, hypersensitivity IV b, IgE, mastocytes.
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Schweintzger N, Gruber-Wackernagel A, Reginato E, Bambach I, Quehenberger F, Byrne SN, Wolf P. Levels and function of regulatory T cells in patients with polymorphic light eruption: relation to photohardening. Br J Dermatol 2015; 173:519-26. [PMID: 26032202 PMCID: PMC4564948 DOI: 10.1111/bjd.13930] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2015] [Indexed: 12/23/2022]
Abstract
Background We hypothesized that regulatory T cells (Tregs) are involved in the immunological abnormalities seen in patients with polymorphic light eruption (PLE). Objectives To investigate the number and suppressive function of peripheral Tregs in patients with PLE compared with healthy controls. Methods Blood sampling was done in 30 patients with PLE [seeking or not seeking 311‐nm ultraviolet (UV)B photohardening] as well as 19 healthy controls at two time points: TP1, March to June (before phototherapy); and TP2, May to August (after phototherapy). We compared the number of CD4+CD25highCD127−FoxP3+ Tregs by flow cytometry and their function by assessing FoxP3 mRNA levels and effector T cell/Treg suppression assays. Results Tregs isolated from healthy controls significantly suppressed the proliferation of effector T cells at TP1 by 68% (P = 0·0156). In contrast, Tregs from patients with PLE entirely lacked the capacity to suppress effector T‐cell proliferation at that time point. The medical photohardening seen in 23 patients with PLE resulted in a significant increase in the median percentage of circulating Tregs [both as a proportion of all lymphocytes; 65 6% increase (P = 0·0049), and as a proportion of CD4+ T cells; 32.5% increase (P = 0·0049)]. This was accompanied by an increase in the expression of FoxP3 mRNA (P = 0·0083) and relative immunosuppressive function of Tregs (P = 0·083) comparing the two time points in representative subsets of patients with healthy controls tested. Seven patients with PLE not receiving 311‐nm UVB also exhibited an increase in the number of Tregs but this was not statistically significant. No significant differences in Treg numbers were observed in healthy subjects between the two time points. Conclusions An impaired Treg function is likely to play a role in PLE pathogenesis. A UV‐induced increase in the number of Tregs (either naturally or therapeutically) may be a compensatory mechanism by which the immune system counteracts the susceptibility to PLE. What's already known about this topic? Patients with polymorphic light eruption (PLE) display immunological abnormalities. Previous studies have shown that they are resistant to the immune suppressive effects of sunlight.
What does this study add? We found that the number and suppressive function of regulatory T cells (Tregs) are crucial in the pathogenesis of PLE. An increase in Treg levels (after photohardening) might be a compensatory mechanism by which the immune system intends to counteract the susceptibility to PLE formation.
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Affiliation(s)
- N Schweintzger
- Research Unit for Photodermatology, Department of Dermatology, Medical University of Graz, Auenbrugger Platz 8, A-8036, Graz, Austria.,Center for Medical Research, Medical University of Graz, Auenbrugger Platz 8, A-8036, Graz, Austria
| | - A Gruber-Wackernagel
- Research Unit for Photodermatology, Department of Dermatology, Medical University of Graz, Auenbrugger Platz 8, A-8036, Graz, Austria
| | - E Reginato
- Research Unit for Photodermatology, Department of Dermatology, Medical University of Graz, Auenbrugger Platz 8, A-8036, Graz, Austria.,Center for Medical Research, Medical University of Graz, Auenbrugger Platz 8, A-8036, Graz, Austria
| | - I Bambach
- Center for Medical Research, Medical University of Graz, Auenbrugger Platz 8, A-8036, Graz, Austria
| | - F Quehenberger
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbrugger Platz 8, A-8036, Graz, Austria
| | - S N Byrne
- Cellular Photoimmunology Group, Infectious Diseases and Immunology, Sydney Medical School, The Charles Perkins Centre Hub at The University of Sydney, Australia
| | - P Wolf
- Research Unit for Photodermatology, Department of Dermatology, Medical University of Graz, Auenbrugger Platz 8, A-8036, Graz, Austria
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Gruber-Wackernagel A, Byrne SN, Wolf P. Polymorphous light eruption: clinic aspects and pathogenesis. Dermatol Clin 2015; 32:315-34, viii. [PMID: 24891054 DOI: 10.1016/j.det.2014.03.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Polymorphous light eruption is an immunologically mediated photodermatosis with high prevalence, particularly among young women in temperate climates, characterized by pruritic skin lesions of variable morphology, occurring in spring or early summer on sun-exposed body sites. A resistance to ultraviolet radiation (UVR)-induced immunosuppression and a subsequent delayed-type hypersensitivity response to a photoantigen have been suggested as key factors in the disease. Molecular and immunologic disturbances associated with disease pathogenesis include a failure of skin infiltration by neutrophils and other regulatory immune cells on UVR exposure linked to a disturbed cytokine microenvironment. Standard management is based on prevention.
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Affiliation(s)
- Alexandra Gruber-Wackernagel
- Research Unit for Photodermatology, Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, Graz A-8036, Austria
| | - Scott N Byrne
- Cellular Photoimmunology Group, Infectious Diseases and Immunology, Department of Dermatology, Sydney Medical School, Royal Prince Alfred Hospital, The University of Sydney, 676, Blackburn Building D06, Darlington, New South Wales 2006, Australia
| | - Peter Wolf
- Research Unit for Photodermatology, Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, Graz A-8036, Austria.
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Abstract
The systematic evaluation of photosensitive patients involves a comprehensive history, physical examination, phototesting, and, if necessary, photopatch testing and laboratory evaluation. Polymorphous light eruption, chronic actinic dermatitis, solar urticaria, and photosensitivity secondary to systemic medications are the most commonly encountered photodermatoses in dermatology clinics worldwide.
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Chantorn R, Lim HW, Shwayder TA. Photosensitivity disorders in children: part I. J Am Acad Dermatol 2012; 67:1093.e1-18; quiz 1111-2. [PMID: 23158621 DOI: 10.1016/j.jaad.2012.07.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 07/25/2012] [Accepted: 07/29/2012] [Indexed: 11/18/2022]
Abstract
Photosensitivity disorders in children encompass a diverse group of diseases. Compared to adult patients, underlying systemic disorders, including genetic or metabolic defects, are common causes in pediatric photosensitivity disorders. Photosensitivity in a child should be suspected if the child develops a sunburn reaction in sun-exposed sites after limited sun exposure. Diagnosis of a photodermatosis is made based on careful history taking and a physical examination. Early recognition and prompt diagnosis are essential to minimize long-term complications associated with inadequate photoprotection. In part I of this continuing medical education article, immunologically mediated photodermatoses, photodermatoses caused by exogenous photosensitizers, and the cutaneous porphyrias will be covered.
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Affiliation(s)
- Rattanavalai Chantorn
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Zirbs M, Pürner C, Buters JTM, Effner R, Weidinger S, Ring J, Eberlein B. GSTM1, GSTT1 and GSTP1 gene polymorphism in polymorphous light eruption. J Eur Acad Dermatol Venereol 2012; 27:157-62. [PMID: 22225519 DOI: 10.1111/j.1468-3083.2011.04431.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Polymorphous light eruption (PLE) is the most common chronic and idiopathic photodermatosis. PLE is assumed to represent an immunological hypersensitivity reaction to a radiation-induced cutaneous antigen involving reactive oxygen species (ROS) on the basis of a genetic predisposition. Among others, cellular protection against ROS is provided by glutathione S-transferases (GSTs). Different variants of the GST enzymes may influence the activity and efficiency of detoxification and biotransformation of unknown UV-induced skin-antigens and other factors that may play an important role in the pathogenesis of PLE. METHODS In this study the relationship between isoenzymes of the GST genes GSTM1, GSTT1 and GSTP1 and possible protective or predisposing effects on PLE was examined in 29 patients and 144 controls. Diagnosis of PLE was based on the presence of characteristic clinical features. RESULTS No association between the functional polymorphisms of the GST gene family and PLE was found. Prevalence of certain GST isoenzymes or polymorphisms in patients with PLE did not differ from healthy controls. CONCLUSION Our data do not support prevalence of GST isoenzymes or polymorphisms as a protective effect against PLE. Especially a higher carrier frequency of GSTP1 Val(105) as a protective factor against PLE which has been published before could not be proved. The GST genotypes GSTM1, GSTT1 and GSTP1 (including SNPs) seem to have no relevant association with PLE.
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Affiliation(s)
- M Zirbs
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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Smith E, Kiss F, Porter RM, Anstey AV. A review of UVA-mediated photosensitivity disorders. Photochem Photobiol Sci 2011; 11:199-206. [PMID: 22127510 DOI: 10.1039/c1pp05191a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A number of skin conditions are characterised by photosensitivity to UVA. Some of these are exclusively UVA-mediated conditions, while others include UVA in the action spectrum which also include UVB and/or visible light. This review aims to describe this diverse range of conditions for non-dermatologist scientists with an interest in this topic. As such, clinical details, including treatments, are brief and succinct. Recent advances in understanding the pathogenesis of these conditions is highlighted.
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Affiliation(s)
- E Smith
- Cardiff and Vale University Health Board, Heath Park, Cardiff, United Kingdom CF14 4XN
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Horkay I, Emri G, Varga V, Simics E, Remenyik E. Environmental dermatology in childhood: photosensitivity. ACTA ACUST UNITED AC 2008. [DOI: 10.2217/17455111.2.6.749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Recently, sunlight-induced damage of healthy human skin, including skin malignancies and a large scale of photodermatoses representing a diverse group of diseases, have increased in childhood as a result of unfavorable environmental changes. This article yields an overview of the diagnosis, the clinical features and the treatment of these conditions and disorders and also reveals perspectives. Some diseases are more frequent in the pediatric population than in adulthood, whereas others heal spontaneously during adolescence and vice versa. The majority of cases are idiopathic photodermatoses, mainly polymorphic light eruption. Photosensitivity may be an early symptom of genetic disorders, such as porphyria, or very rare genophotodermatoses. Photosensitivity, secondary to topical or systemic external agents as well as photoexacerbated dermatoses, is not so frequent in childhood. Effective photoprotection is crucial.
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Affiliation(s)
- Irene Horkay
- Department of Dermatology, University of Debrecen, Nagyerdei krt. 98, H-4032 Debrecen, Hungary
| | - Gabriella Emri
- Department of Dermatology, University of Debrecen, Hungary
| | - Viktoria Varga
- Department of Dermatology, University of Debrecen, Hungary
| | - Eniko Simics
- Department of Dermatology, University of Debrecen, Hungary
| | - Eva Remenyik
- Department of Dermatology, University of Debrecen, Hungary
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Lembo S, Fallon J, O’Kelly P, Murphy G. Polymorphic light eruption and skin cancer prevalence: is one protective against the other? Br J Dermatol 2008; 159:1342-7. [DOI: 10.1111/j.1365-2133.2008.08734.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Polymorphous light eruption is the most common photodermatosis, with a prevalence of as high as 10-20% in Western Europe and in the USA. It starts during the second and third decades of life. Although not life-threatening it can severely impair the quality of life, in particular during leisure activities and in outdoors workers. Polymorphous light eruption belongs to the group of so-called idiopathic photodermatoses. This term denotes dermatoses that occur in otherwise healthy individuals from exposure to sunlight or artificial light without the intervention of an exogenous photosensitizing agent. These diseases have two factors in common: they are precipitated by ultraviolet or visible radiation; and their exact pathomechanism remains obscure but is presumably immunologic in nature.
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Affiliation(s)
- Herbert Hönigsmann
- Department of Dermatology, Medical University of Vienna, Vienna, Austria.
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Horkay I, Emri G, Varga V, Simics E, Remenyik E. Photosensitivity skin disorders in childhood. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2008; 24:56-60. [DOI: 10.1111/j.1600-0781.2008.00341.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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A protective effect of glutathione-S-transferase GSTP1*Val(105) against polymorphic light eruption. J Invest Dermatol 2008; 128:1901-5. [PMID: 18288203 DOI: 10.1038/jid.2008.14] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Polymorphic light eruption (PLE) is a common skin disease, susceptibility to which is genetically determined. The prevalence of PLE is significantly increased in patients with lupus erythematosus (LE) including subacute cutaneous lupus erythematosus (SCLE) and discoid lupus erythematosus (DLE), which may reflect a common genetic background. Experimental evidence supports a role for reactive oxygen species (ROS) in the pathogenesis of PLE, and the family of glutathione-S-transferase (GST) enzymes exerts a critical physiological role in cellular protection against this oxidative damage. Our aim was to look for association between the functional GST gene polymorphisms and PLE, SCLE, and DLE in a case-control study. The carrier frequency of GSTP1 Val(105) in subjects with PLE was 40%, significantly lower than the carrier frequency in controls (54%, P=0.019), although significance was lost on correction for multiple testing. However, the carrier frequency of the GSTP1 Val(105) allele in combined cutaneous LE (SCLE and DLE) patients with PLE was 42%, significantly lower than in those without PLE (72%), which did survive correction (corrected P=0.043). We have identified evidence supporting a protective GSTP1 allele, the first genetic association to be reported for PLE. This supports a role for ROS in the pathogenesis of PLE and may provide a therapeutic target for future treatment of this common, often disabling, condition.
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Perrett CM, Harwood CA, Khorshid M, Cerio R, McGregor JM. Primary cutaneous B-cell lymphoma associated with actinic prurigo. Br J Dermatol 2005; 153:186-9. [PMID: 16029348 DOI: 10.1111/j.1365-2133.2005.06611.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We describe two patients with a diagnosis of actinic prurigo who subsequently developed cutaneous B-cell lymphoma. This is the first report, to our knowledge, of this association. We propose that chronic antigenic stimulation by ultraviolet radiation, in the context of actinic prurigo, may have been causal in the development of these unusual lymphomas.
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Affiliation(s)
- C M Perrett
- Centre for Cutaneous Research and Department of Dermatology, Barts and The London School of Medicine and Dentistry, 2 Newark Street, London E1 2AT, UK.
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Ling TC, Gibbs NK, Rhodes LE. Treatment of polymorphic light eruption. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2003; 19:217-27. [PMID: 14535892 DOI: 10.1034/j.1600-0781.2003.00048.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Polymorphic light eruption (PLE) is a highly prevalent photosensitivity disorder, estimated to affect 11-21% people in temperate countries. Typically, PLE appears as a recurrent pruritic eruption comprising papules and/or vesicles and/or plaques, which occurs on photo-exposed skin sites following sun exposure, and which heals without scarring. Commoner in females, the aetiology is uncertain, although there is evidence of an immune basis. We perform a review of the prophylaxis and treatment of this condition. While sun protection, corticosteroids and desensitization phototherapy are the mainstays of management, a range of anti-inflammatory and immunomodulatory agents are reported.
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Affiliation(s)
- Tsui C Ling
- Photobiology Unit, Dermatology Centre, University of Manchester, Hope Hospital, Manchester, UK
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Crouch RB, Foley PA, Baker CS. Analysis of patients with suspected photosensitivity referred for investigation to an Australian photodermatology clinic. J Am Acad Dermatol 2003; 48:714-20. [PMID: 12734500 DOI: 10.1067/mjd.2003.219] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Australia's first dedicated photodermatology clinic was established at St Vincent's Hospital Melbourne in 1993. OBJECTIVE We sought to review clinical diagnoses and results of investigations performed on patients seen at this institution. METHODS A database was created to enable a retrospective and prospective analysis of all patients attending for evaluation of suspected photosensitivity from April 1993 to October 2000. RESULTS A total of 513 patients were seen, 289 (56.3%) female and 224 (43.7%) male, with a mean age of 45.2 years (range: 2.6-85.9). A photosensitive disorder was diagnosed in 397 patients (77.4%), with the acquired idiopathic photodermatoses accounting for diagnoses in 215 (41.9%) of all patients seen. The most common diagnosis was polymorphous light eruption. Reduced minimal erythema doses were seen in 25.3% of all patients light tested. In those photopatch tested, 23.3% had at least 1 photocontact reaction. Allergic contact dermatitis in a photosensitive distribution was diagnosed in 7.4% of the clinic population. CONCLUSION A large proportion of referrals to a photodermatology clinic comprise people with acquired idiopathic photodermatoses, with other common diagnoses that may mimic photosensitivity including allergic contact dermatitis, atopic dermatitis, and rosacea.
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Affiliation(s)
- Rohan B Crouch
- University of Melbourne, Department of Medicine (Dermatology), Australia
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Affiliation(s)
- Allison L Naleway
- Epidemiology Research Center, Marshfield Medical Research and Education Foundation, 1000 North Oak Avenue, Marshfield, WI 54449, USA.
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Abstract
Polymorphous light eruption (PLE) is a common idiopathic photosensitivity disorder with an estimated prevalence of 10-20%. It is characterized by an intermittent skin reaction to ultraviolet (UV) radiation exposure, consisting of non-scarring pruritic erythematous papules, vesicles or plaques that develop on light-exposed skin. Despite the different morphology in different individuals, the eruption tends to have a monomorphous presentation in any single subject. The histopathological features of PLE are distinct and comprise a perivascular lymphocytic infiltrate in the dermis, subepidermal oedema and variable epidermal changes. The pathogenesis of PLE is not well known, but findings suggest that it is a delayed-type hypersensitivity reaction to one or more UV-modified cutaneous antigens. The principal action of PLE is mainly in the UVA region, although some subjects exhibit sensitivity to UVB alone or to both UVA and UVB radiation at the same time. Preventive measures in PLE include the regular use of photoprotective methods combined with graduated exposures to natural sunlight. The induction of immune tolerance by phototherapy and photochemotherapy are useful prophylactic methods in moderate to severe cases. The role of systemic agents in the management of PLE is under investigation. This article reviews the epidemiological, pathogenetic and clinical aspects of PLE and discusses recent advances in the diagnostic approach and management of this condition.
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Affiliation(s)
- A J Stratigos
- Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital for Skin and Venereal Diseases, 5 Dragoumi Street, Kesariani 161 21, Athens, Greece
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Millard TP, Kondeatis E, Vaughan RW, Lewis CM, Khamashta MA, Hughes GR, Hawk JL, McGregor JM. Polymorphic light eruption and the HLA DRB1*0301 extended haplotype are independent risk factors for cutaneous lupus erythematosus. Lupus 2002; 10:473-9. [PMID: 11480844 DOI: 10.1191/096120301678416024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Recent evidence suggests that polymorphic light eruption (PLE) is an inherited photosensitivity disorder which may predispose to cutaneous lupus erythematosus (LE). In this study we examine the relative risk (RR) attributable to the presence of PLE, together with the effect of the major histocompatibility complex (MHC) in the development of cutaneous LE. Eighty-five Caucasian patients with annular subacute cutaneous LE (SCLE) and discoid LE (DLE) were recruited, together with 102 first degree relatives and 200 healthy local Caucasian controls. Symptoms suggestive of PLE were elicited in patients and relatives, and human leukocyte antigen (HLA) typing determined by PCR-SSP. Standard association analysis and family transmission disequilibrium testing (TDT) were then used to compare the HLA frequencies between groups. We found a significant (P < 0.05) association of the HL4 A*01, B*08, DRB1*0301 extended haplotype with both SCLE and DLE and also significant association of DLE with the HLA A*03, B*07, DRB1*15 haplotype, with a possible protective effect in SCLE for HLA B*44 and DRB1*04 (P=0.002 and 0.001 respectively). Association was observed between PLE and cutaneous LE (P < 0.001), but not between PLE and any HLA allele. From these figures we estimate, for the general population, that the RR of developing SCLE given the presence of (a) PLE, (b) DRB1*0301 and (c) both PLE and DRB1*0301 is 3.37, 5.45 and 12.03, respectively. For DLE, equivalent RRs are 3.11, 2.15 and 6.94. In conclusion, these data imply the involvement of both PLE and HLA DRB1*0301 in the development of SCLE and DLE. They form a basis for examining the genetic architecture of photosensitivity, some aspects of which may be common to both cutaneous LE and PLE.
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Affiliation(s)
- T P Millard
- Department of Photobiology, St John's Institute of Dermatology, London, UK.
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Millard TP, Kondeatis E, Cox A, Wilson AG, Grabczynska SA, Carey BS, Lewis CM, Khamashta MA, Duff GW, Hughes GR, Hawk JL, Vaughan RW, McGregor JM. A candidate gene analysis of three related photosensitivity disorders: cutaneous lupus erythematosus, polymorphic light eruption and actinic prurigo. Br J Dermatol 2001; 145:229-36. [PMID: 11531784 DOI: 10.1046/j.1365-2133.2001.04339.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Polymorphic light eruption (PLE) is a common inherited photosensitivity disorder, which may predispose to several related but distinct conditions, including subacute cutaneous lupus erythematosus (SCLE), discoid lupus erythematosus (DLE) and actinic prurigo (AP). OBJECTIVES To examine specific candidate genes for shared susceptibility alleles between these related phenotypes. METHODS Eighty-five caucasian patients with annular SCLE or DLE were recruited, in addition to 102 first-degree relatives. The prevalence of PLE in both the patient and relative groups was determined by detailed interview and clinical examination. Eighty-five patients with pure PLE and 59 patients with AP were also recruited. Candidate genes were analysed by typing of single nucleotide polymorphisms of IL10 (-1082 G/A and -819 C/T), FCGR2A (131 R/H), SELE (128 S/R), ICAM1 (241 G/R and 469 E/K), IL1A (+ 4845 G/T), IL1B (-511 C/T and + 3954 C/T), IL1RN (+ 2018 T/C) and TNF (-308 G/A) using polymerase chain reaction (PCR) with sequence-specific primers and 5'-nuclease PCR. RESULTS A significant association was found between SCLE and the rare TNF -308 A allele when compared with patients with DLE (P = 0.043), PLE (P = 0.001), AP (P < 0.001) and healthy controls (P < 0.001). However, there was strong linkage disequilibrium between TNF -308 A and the HLA A*01, B*08, DRB1*0301 haplotype. A negative association was also found between SCLE and the IL1B + 3954 T allele (P = 0.039), but the significance was lost on correction for multiple testing. CONCLUSIONS We have demonstrated the association of SCLE with the rare TNF -308 A allele, which may be pathogenic or, alternatively, a marker allele for the extended HLA A*01, B*08, DRB1*0301 haplotype that is associated with a number of autoimmune conditions. Although many of the other loci that we chose failed to demonstrate an association, a candidate gene approach remains the most logical one, and the most likely to yield positive results in the future.
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Affiliation(s)
- T P Millard
- Department of Photobiology, St. John's Institute of Dermatology, St Thomas' Hospital, London SE1 7EH, UK.
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Millard TP, Lewis CM, Khamashta MA, Hughes GR, Hawk JL, McGregor JM. Familial clustering of polymorphic light eruption in relatives of patients with lupus erythematosus: evidence of a shared pathogenesis. Br J Dermatol 2001; 144:334-8. [PMID: 11251568 DOI: 10.1046/j.1365-2133.2001.03897.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Abnormal photosensitivity is a common feature of many forms of lupus erythematosus (LE). OBJECTIVES To examine the role of polymorphic light eruption (PLE) as a possible predisposing factor for cutaneous forms of LE. METHODS Eighty-five patients with well-characterized subacute cutaneous LE (SCLE) and discoid LE (DLE) were recruited from outpatient clinics, and the prevalence of PLE determined by detailed interview and clinical examination. RESULTS Symptoms consistent with PLE were reported in 61% and 55% of SCLE and DLE patients, respectively; this was significantly higher than the overall population prevalence of 13.6% (P < 0.001), giving a relative risk (RR) for PLE in SCLE patients of 3.37 (95% confidence interval, CI 2.46--4.28) and DLE patients of 3.11 (95% CI 2.31--3.91). PLE developed before the onset of LE in 61% of cases (median interval 12 years, range 1--40), concomitantly in 24%, and subsequently in a further 15% (median interval 3.5 years, range 1--25). To delineate the relationship between PLE and LE further, the prevalence of PLE was determined in 103 otherwise unaffected first-degree relatives of SCLE and DLE probands; we had previously demonstrated clustering of PLE in families, reflecting a strong genetic component. We found a significantly higher PLE prevalence in relatives of the LE probands than in the general population (P < 0.001), giving an RR for PLE of 2.29 (95% CI 1.55--3.03) and 2.61 (95% CI 1.32--3.89) for female and male relatives, respectively. CONCLUSIONS The high prevalence of PLE in LE patients, together with clustering of PLE among first-degree relatives of SCLE and DLE probands, suggests that there may be a shared pathogenetic basis for PLE and cutaneous LE. We propose that predisposition to PLE may contribute to the LE phenotype in otherwise susceptible individuals.
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Affiliation(s)
- T P Millard
- Department of Photobiology, St John's Institute of Dermatology, London SE1 7EH, UK.
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