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Gao H, Zhang Z, Ma L, Xu Y, Hu Y, Luo X. Photosensitivity is an important cause of refractory facial erythema in atopic dermatitis: A retrospective study of 82 Chinese patients. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2022. [PMID: 36099079 DOI: 10.1111/phpp.12836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/09/2022] [Accepted: 09/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Ultraviolet radiation can aggravate facial erythema in atopic dermatitis (AD) patients. OBJECTIVE To investigate the photobiological testing results of Chinese AD patients with refractory facial erythema. METHODS We conducted a retrospective analysis of 82 AD patients with refractory facial erythema who visited our department during 2004-2021. All of them completed phototesting and photopatch testing. RESULTS 82 patients were enrolled in the study, and 53 (64.6%) were between 18 and 30 years old. 51.2% (42/82) had positive phototesting results and were considered photosensitive AD (PhAD) patients. One-third of them were both allergic to ultraviolet A and ultraviolet B. 65.9% (54/82) suffered from photoallergic contact dermatitis. Chlorpromazine (50.7%), potassium dichromate (13.2%), and thimerosal (11.8%) were the top three common photoallergens. Overall, 86.3% of AD patients with refractory facial erythema had direct photoallergy or photocontact allergy. PhAD patients had fewer allergic comorbidities than the other group (p = .007). More non-PhAD patients (55.0%) suffered from AD at 2-14 years old (p = .015). CONCLUSIONS Photosensitivity contributes a lot to the facial lesions of AD patients, especially in their 20s. 86.3% of these patients had direct photoallergy or photocontact allergy. Therefore, AD patients with facial erythema should undergo phototesting and photopatch testing routinely.
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Affiliation(s)
- Haiqing Gao
- Department of Allergy and Immunology, Huashan Hospital affiliated to Fudan University, Shanghai, China
- Department of Dermatology, Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - Zhen Zhang
- Department of Allergy and Immunology, Huashan Hospital affiliated to Fudan University, Shanghai, China
- Department of Dermatology, Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - Li Ma
- Department of Allergy and Immunology, Huashan Hospital affiliated to Fudan University, Shanghai, China
- Department of Dermatology, Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - Yu Xu
- Department of Allergy and Immunology, Huashan Hospital affiliated to Fudan University, Shanghai, China
- Department of Dermatology, Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - Yue Hu
- Department of Allergy and Immunology, Huashan Hospital affiliated to Fudan University, Shanghai, China
- Department of Dermatology, Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - Xiaoqun Luo
- Department of Allergy and Immunology, Huashan Hospital affiliated to Fudan University, Shanghai, China
- Department of Dermatology, Huashan Hospital affiliated to Fudan University, Shanghai, China
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Ali K, Wu L, Lou H, Zhong J, Qiu Y, Da J, Shan J, Lu K. Clearance of Chronic Actinic Dermatitis With Dupilumab Therapy in Chinese Patients: A Case Series. Front Med (Lausanne) 2022; 9:803692. [PMID: 35280879 PMCID: PMC8907828 DOI: 10.3389/fmed.2022.803692] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/14/2022] [Indexed: 12/01/2022] Open
Abstract
Chronic actinic dermatitis (CAD) is a rare chronic immunological photo-dermatosis resulting in pruritic eczematous eruption on sun-exposed skin to ultraviolet (UV) light. The disease mechanism may include a delay-type hypersensitivity reaction to an endogenous photo-induced antigen, postulated to be UVR-altered DNA, but the exact pathophysiology is unknown. Minimum erythema dosing and patch testing are diagnostic tools of CAD. There are limited safe and effective treatment options for CAD. Herein, a case series of three patients with severe recalcitrant CAD is presented after being treated with dupilumab off-label. The patients in this study had persistent severe disease and taken the first-line management plan, which consists of topical calcineurin inhibitors (TCI), topical corticosteroids (TCS), and strict photoprotection. However, the above treatment options were not able to control the symptoms. The patients were treated with dupilumab 600 mg first dose, 300 mg biweekly subcutaneously (SC), and hydroxychloroquine. Dupilumab showed excellent clinical benefits, including safe and well-tolerated in chronic actinic dermatitis. Further studies are required to be carried out before being applied in clinical practice.
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Affiliation(s)
- Kamran Ali
- Department of Dermatology, International Education College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Liming Wu
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - HaiYue Lou
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianbo Zhong
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - YunMi Qiu
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - JiaYang Da
- Department of Oncological Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - JingPeng Shan
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - KaiNing Lu
- Department of Oncological Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Vieyra-Garcia PA, Wolf P. A deep dive into UV-based phototherapy: Mechanisms of action and emerging molecular targets in inflammation and cancer. Pharmacol Ther 2020; 222:107784. [PMID: 33316286 DOI: 10.1016/j.pharmthera.2020.107784] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023]
Abstract
UV-based phototherapy (including psoralen plus UVA (PUVA), UVB and UVA1) has a long, successful history in the management of numerous cutaneous disorders. Photoresponsive diseases are etiologically diverse, but most involve disturbances in local (and occasionally systemic) inflammatory cells and/or abnormalities in keratinocytes that trigger inflammation. UV-based phototherapy works by regulating the inflammatory component and inducing apoptosis of pathogenic cells. This results in a fascinating and complex network of simultaneous events-immediate transcriptional changes in keratinocytes, immune cells, and pigment cells; the emergence of apoptotic bodies; and the trafficking of antigen-presenting cells in skin-that quickly transform the microenvironment of UV-exposed skin. Molecular elements in this system of UV recognition and response include chromophores, metabolic byproducts, innate immune receptors, neurotransmitters and mediators such as chemokines and cytokines, antimicrobial peptides, and platelet activating factor (PAF) and PAF-like molecules that simultaneously shape the immunomodulatory effects of UV and their interplay with the microbiota of the skin and beyond. Phototherapy's key effects-proapoptotic, immunomodulatory, antipruritic, antifibrotic, propigmentary, and pro-prebiotic-promote clinical improvement in various skin diseases such as psoriasis, atopic dermatitis (AD), graft-versus-host disease (GvHD), vitiligo, scleroderma, and cutaneous T-cell lymphoma (CTCL) as well as prevention of polymorphic light eruption (PLE). As understanding of phototherapy improves, new therapies (UV- and non-UV-based) are being developed that will modify regulatory T-cells (Treg), interact with (resident) memory T-cells and /or utilize agonists and antagonists as well as antibodies targeting soluble molecules such as cytokines and chemokines, transcription factors, and a variety of membrane-associated receptors.
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Affiliation(s)
- Pablo A Vieyra-Garcia
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, Graz A-8036, Austria.
| | - Peter Wolf
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, Graz A-8036, Austria.
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Wang T, Gong Y, Rong W, Li L, Zhang J, Li HZ. Ultraviolet A rush hardening for chronic actinic dermatitis: Pilot treatment outcomes. J Dermatol 2020; 48:385-388. [PMID: 33264455 DOI: 10.1111/1346-8138.15667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/17/2020] [Accepted: 09/28/2020] [Indexed: 11/29/2022]
Abstract
Chronic actinic dermatitis (CAD) is a common debilitating photodermatosis. Patients often have to completely avoid outdoor activities, which severely impacts their quality of life. Phototherapy is effective for CAD and seems to increase patients' tolerance towards sunlight and consequently decrease the extent of disease. Unfortunately, the slower onset and time-consuming nature of phototherapy limits the clinical application. Considering the effectiveness and time-saving nature of ultraviolet (UV)-A rush hardening in solar urticaria, we performed a pilot study to determine whether UV-A rush hardening is effective in CAD. Six patients with CAD were exposed to multiple sessions of UV-A for 4-5 days at 1-h intervals/day. Subsequently, maintenance UV-A exposure was performed at 1-2-week intervals. Phototesting at baseline showed that three patients were sensitive to both UV-A and -B, and the other three patients only showed UV-A sensitivity. All of the patients responded well to UV-A rush hardening and four (67%) maintained a good remission status after 1 year. The results of this pilot study suggest that UV-A rush hardening phototherapy is effective and well tolerated in the treatment of CAD, while future larger prospective studies using objective scores of disease activity and quality of life are needed.
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Affiliation(s)
- Tianjing Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Yangyang Gong
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Wei Rong
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Li Li
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Jialin Zhang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Hui-Zhong Li
- Dermatology Hospital, Southern Medical University, Guangzhou, China
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Patel N, Konda S, Lim HW. Dupilumab for the treatment of chronic actinic dermatitis. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 36:398-400. [PMID: 32320500 DOI: 10.1111/phpp.12566] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/08/2020] [Accepted: 04/19/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Nayha Patel
- School of Medicine, Tulane University, New Orleans, Louisiana, USA.,Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Sasank Konda
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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Abstract
Ultraviolet light (UV) and visible light are important components in the diagnosis of photodermatoses, and UV has the unique ability to also be used to manage photodermatoses. Phototesting, provocative light testing, and photopatch testing can provide important information in diagnosing patients with photodermatoses; phototesting can be used to determine the starting dose for phototherapy in these patients. Once photosensitivity is established, narrowband UVB and UVA1 therapy have helped to improve the quality of life of photosensitive patients, such as those with polymorphous light eruption, chronic actinic dermatitis, and solar urticaria.
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Affiliation(s)
- Angela J Jiang
- Department of Dermatology, Henry Ford Health System, 3031 West Grand Boulevard, Suite 800, Detroit, MI 48202, USA
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health System, 3031 West Grand Boulevard, Suite 800, Detroit, MI 48202, USA.
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Liu L, Huang J, Wang Y, Li Y. Risk factors of striae gravidarum in Chinese primiparous women. PLoS One 2018; 13:e0198720. [PMID: 29927959 PMCID: PMC6013206 DOI: 10.1371/journal.pone.0198720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 05/06/2018] [Indexed: 11/19/2022] Open
Abstract
Background Striae gravidarum is a common skin problem of considerable cosmetic concern for many pregnant women. Various risk factors associated with the development of striae have been reported, with conflicting results. Objectives To analyze the risk factors of striae gravidarum in Chinese primiparous women and to provide evidence relevant to the prevention of this condition. Methods Singleton primiparous pregnant women who were hospitalized for delivery were included, and relevant data were collected. Independent risk factors associated with striae gravidarum in women with and those without striae gravidarum were identified using logistic regression. Results Among 213 singleton primiparous pregnant women, 125 had striae gravidarum, yielding a prevalence of up to 58.9%. There was a significant variation (P < 0.05, odds ratio >1) between the striae gravidarum and non-striae gravidarum groups in terms of several factors, including younger maternal age, weight gain during pregnancy, body mass index gain, uterine height, abdominal girth, and positive family history. Factors such as maternal height, birth weight, systemic disease, skin type, and neonatal gender did not significantly differ between the 2 groups. Conclusion This study showed that the independent risk factors for striae gravidarum in primiparous women were younger maternal age, weight gain during pregnancy, body mass index gain, uterine height, abdominal girth, and a positive family history. The severity of striae gravidarum was associated with weight gain during pregnancy, body mass index gain, abdominal girth, and timing of the onset of striae gravidarum.
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Affiliation(s)
- Liping Liu
- Department of Dermatology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
- Regeneration Medicine Research Center, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Jianling Huang
- Department of Dermatology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
- Regeneration Medicine Research Center, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
- The Central Hospital of Xiaogan, Xiaogan, Hubei, China
| | - Ying Wang
- Department of Dermatology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
- Regeneration Medicine Research Center, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yumei Li
- Department of Dermatology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
- Regeneration Medicine Research Center, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
- * E-mail:
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