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Brown M, Williams A, Chilcott RP, Brady B, Lenn J, Evans C, Allen L, McAuley WJ, Beebeejaun M, Haslinger J, Beuttel C, Vieira R, Guidali F, Miranda M. Topically Applied Therapies for the Treatment of Skin Disease: Past, Present, and Future. Pharmacol Rev 2024; 76:689-790. [PMID: 38914467 DOI: 10.1124/pharmrev.123.000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/26/2024] Open
Abstract
The purpose of this review is to summarize essential biological, pharmaceutical, and clinical aspects in the field of topically applied medicines that may help scientists when trying to develop new topical medicines. After a brief history of topical drug delivery, a review of the structure and function of the skin and routes of drug absorption and their limitations is provided. The most prevalent diseases and current topical treatment approaches are then detailed, the organization of which reflects the key disease categories of autoimmune and inflammatory diseases, microbial infections, skin cancers, and genetic skin diseases. The complexity of topical product development through to large-scale manufacturing along with recommended risk mitigation approaches are then highlighted. As such topical treatments are applied externally, patient preferences along with the challenges they invoke are then described, and finally the future of this field of drug delivery is discussed, with an emphasis on areas that are more likely to yield significant improvements over the topical medicines in current use or would expand the range of medicines and diseases treatable by this route of administration. SIGNIFICANCE STATEMENT: This review of the key aspects of the skin and its associated diseases and current treatments along with the intricacies of topical formulation development should be helpful in making judicious decisions about the development of new or improved topical medicines. These aspects include the choices of the active ingredients, formulations, the target patient population's preferences, limitations, and the future with regard to new skin diseases and topical medicine approaches.
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Affiliation(s)
- Marc Brown
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Adrian Williams
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Robert P Chilcott
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Brendan Brady
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Jon Lenn
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Charles Evans
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Lynn Allen
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - William J McAuley
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Mubinah Beebeejaun
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Jasmin Haslinger
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Claire Beuttel
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Raquel Vieira
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Florencia Guidali
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Margarida Miranda
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
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Takahashi H, Morimoto H, Sugimura Y, Honda T. Primary localized cutaneous nodular amyloidosis of the scalp arising from folliculitis decalvans. J Dermatol 2024. [PMID: 39126225 DOI: 10.1111/1346-8138.17418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/10/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024]
Affiliation(s)
- Honoka Takahashi
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroki Morimoto
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuki Sugimura
- Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tetsuya Honda
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Jawade S, Singh S, Quazi S, Dudhe M, Neazee S, Meghe SR, Jawade S. Effective Treatment of Folliculitis Decalvans With a Combination of Oral Isotretinoin and Rifampicin. Cureus 2024; 16:e60633. [PMID: 38903375 PMCID: PMC11187474 DOI: 10.7759/cureus.60633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/19/2024] [Indexed: 06/22/2024] Open
Abstract
Folliculitis decalvans (FD) is a rare type of inflammatory scalp disorder that leads to scarring alopecia. It is classified as primary neutrophilic cicatricial alopecia. FD presents a challenging scenario in clinical dermatology due to its rarity, resistance to treatment, and potential for scarring alopecia. This inflammatory scalp disorder primarily affects middle-aged adults, predominantly males. While its exact pathogenesis remains uncertain, a deficient host immune response to Staphylococcus aureus infection is hypothesized. Therapeutic interventions for FD pose difficulties, with limited treatment options available A 58-year-old female patient presented with a history of follicular papules that gradually progressed to form clusters of pustules, crusting, and hemorrhagic lesions with tufting of hairs on the crown area of the scalp, and was diagnosed with FD. Considering isotretinoin's role in inhibiting abnormal keratinization and inflammation, and rifampicin's ability to eradicate S. aureus, the combination of both provides a comprehensive approach to tackling the underlying factors contributing to FD. Despite previous unsuccessful treatments, combination therapy with isotretinoin and rifampicin yielded a remarkable outcome, prompting further exploration of this approach.
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Affiliation(s)
- Sugat Jawade
- Dermatology, Venereology, and Leprosy, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Sudhir Singh
- Dermatology, Venereology, and Leprosy, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Sabiha Quazi
- Dermatology, Venereology, and Leprosy, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Mayur Dudhe
- Dermatology, Venereology, and Leprosy, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Sabha Neazee
- Dermatology, Venereology, and Leprosy, Datta Meghe Medical College, Datta Meghe Institute of higher education and research, Nagpur, IND
| | - Soham R Meghe
- Dermatology, Venereology, and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapna Jawade
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Lyakhovitsky A, Segal O, Galili E, Thompson CT, Tzanani I, Scope A, Baum S, Barzilai A. Diagnoseverzögerung, komorbide Hidradenitis suppurativa und die prognostische Bedeutung bakterieller Kulturen bei Folliculitis decalvans: eine Kohortenstudie. J Dtsch Dermatol Ges 2023; 21:1469-1478. [PMID: 38082530 DOI: 10.1111/ddg.15202_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/09/2023] [Indexed: 12/18/2023]
Abstract
ZusammenfassungHintergrundFolliculitis decalvans (FD) ist eine primäre neutrophile vernarbende Alopezie, die häufig zu irreversiblem Haarverlust führt. Daten zu Epidemiologie, klinischen Merkmalen, Folgen und prognostischen Faktoren sind nur eingeschränkt verfügbar.ZielDie Beurteilung einer Patientenkohorte mit FD sowie die Charakterisierung schwerer Krankheitsverläufe und prognostischer Faktoren, die eine Remission verhindern.Patienten und MethodenDiese retrospektive Kohortenstudie umfasste 192 Patienten, bei denen zwischen 2010 und 2020 an einem tertiären Zentrum eine FD diagnostiziert und die mindestens sechs Monate nachverfolgt wurden.ErgebnisseDie Diagnose wurde im Mittel um 22,2 (± 29,7) Monate verzögert gestellt. Komorbide Erkrankungen mit Okklusion der Haarfollikel waren häufig. In 45,6% der Fälle waren Bakterienkulturen positiv, am häufigsten mit Staphylococcus (S.) aureus. Schwere Krankheitsverläufe waren mit komorbider Hidradenitis suppurativa und positiver Bakterienkultur, insbesondere S. aureus, assoziiert. Bei 50,7% der Patienten kam es zu vollständiger Remission: Bei 32% innerhalb der ersten sechs Monate der Behandlung und bei 18,7% während der Nachkontrolle. Rezidive waren häufig. Negative Prognosefaktoren bezüglich der Remission waren jüngeres Alter und positive Bakterienkultur.SchlussfolgerungenEs besteht Bedarf hinsichtlich der Ausbildung von Dermatologen, um die Diagnoseverzögerung zu reduzieren. Das Screening von FD‐Patienten auf komorbide Hidradenitis suppurativa und Bakterienkulturen sind wichtig für die Behandlungsplanung.
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Affiliation(s)
- Anna Lyakhovitsky
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Oz Segal
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Eran Galili
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Curtis T Thompson
- CTA Pathology, Portland, USA
- Departments of Dermatology and Pathology, Oregon Health Sciences University, Portland, USA
| | - Ido Tzanani
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Alon Scope
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Kittner Skin Cancer Screening and Research Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Sharon Baum
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Institute of Pathology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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Lyakhovitsky A, Segal O, Galili E, Thompson CT, Tzanani I, Scope A, Baum S, Barzilai A. Diagnostic delay, comorbid hidradenitis suppurativa and the prognostic value of bacterial culture in folliculitis decalvans: A cohort study. J Dtsch Dermatol Ges 2023; 21:1469-1477. [PMID: 37875786 DOI: 10.1111/ddg.15202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/09/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Folliculitis decalvans (FD) is a type of primary neutrophilic cicatricial alopecia often leading to irreversible hair loss. Data on its epidemiology, clinical features, outcomes, and prognostic factors are limited. OBJECTIVE To evaluate a cohort of patients with FD and identify characteristics of severe disease and prognostic factors which impede remission. PATIENTS AND METHODS This retrospective cohort study included 192 patients diagnosed with FD and followed for at least six months at a tertiary center between 2010 and 2020. RESULTS There was a diagnostic delay averaging 22.2 (± 29.7) months. Comorbid follicular occlusion disorders were common. Bacterial cultures were positive in 45.6% of the cases, with Staphylococcus (S.) aureus being the most common pathogen. Severe disease was associated with comorbid hidradenitis suppurativa and a positive bacterial culture, particularly S. aureus. 50.7% of patients experienced complete remission: 32% within the first six months of treatment and 18.7% later during follow-up. Relapses were frequent. Negative prognostic factors for achieving remission included younger age and a positive bacterial culture. CONCLUSIONS There is a need for the education of dermatologists to reduce the diagnostic delay. Screening FD patients for comorbid hidradenitis suppurativa and obtaining bacterial cultures is important for treatment planning.
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Affiliation(s)
- Anna Lyakhovitsky
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Oz Segal
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Eran Galili
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Curtis T Thompson
- CTA Pathology, Portland, USA
- Departments of Dermatology and Pathology, Oregon Health Sciences University, Portland, USA
| | - Ido Tzanani
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Alon Scope
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Kittner Skin Cancer Screening and Research Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Sharon Baum
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Institute of Pathology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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Sood S, Sriranganathan A, Heung M, Georgakopoulos JR, Mufti A, Yeung J. Biologic and Small Molecule Treatments for Primary Neutrophilic Cicatricial Alopecias: An Evidence-Based Review. J Cutan Med Surg 2023; 27:411-412. [PMID: 37489902 DOI: 10.1177/12034754231188326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Affiliation(s)
- Siddhartha Sood
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Martin Heung
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | | | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- Department of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- Department of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Dermatology, Women's College Hospital, Toronto, Canada
- Probity Medical Research, Waterloo, Canada
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Dupont A, Eyraud A, Milpied B, De Bataille S, Cassassa E, Darrigade AS, Barnetche T, Doutre MS, Matard B, Beylot-Barry M, Seneschal J. Efficacy and Safety of Tumour Necrosis Factor-α Antagonists for Folliculitis Decalvans: A Retrospective Case-series Pilot Study. Acta Derm Venereol 2023; 103:adv3713. [PMID: 36987539 PMCID: PMC10074284 DOI: 10.2340/actadv.v103.3713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/16/2022] [Indexed: 03/30/2023] Open
Abstract
Folliculitis decalvans is a chronic inflammatory skin disease leading to scarring alopecia. Management of this disabling disease is difficult and no treatment is currently approved. Current knowledge regarding the pathogenesis of folliculitis decalvans suggests the benefit of using anti-tumour necrosis factor-α. This pilot study aimed to evaluate the clinical efficacy of anti-tumour necrosis factor-α for management of folliculitis decalvans. A single-centre retrospective pilot study included patients with refractory folliculitis decalvans treated by tumour necrosis factor-α inhibitors. An Investigator's Global Assessment (IGA) score was designed and validated to assess the efficacy of the therapy. Response to treatment was considered good to excellent when an IGA ≤ 2 was obtained at month 12. Eleven patients were included, with a mean time from diagnosis of folliculitis decalvans to the introduction of infliximab (n = 9) or adalimumab (n = 2) of 8.55 ± 1.26 years. Nine patients had failed on at least 2 lines of systemic therapies before starting anti-tumour necrosis factor-α. The median IGA score at baseline was 3. At the end of follow-up, 5 patients were considered responders. Overall, the safety profile of anti-tumour necrosis factor-α was good. The results suggest that the clinical benefit of anti-tumour necrosis factor-α is obtained after at least 6 months of treatment. However, further prospective studies are needed to confirm these results.
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Affiliation(s)
- Aurore Dupont
- Department of Dermatology, National Reference Center for Rare Skin Diseases, University Hospital of Bordeaux, Bordeaux, France
| | - Alexia Eyraud
- Department of Dermatology, Centre hospitalier de Périgueux, Périgueux, France
| | - Brigitte Milpied
- Department of Dermatology, National Reference Center for Rare Skin Diseases, University Hospital of Bordeaux, Bordeaux, France
| | | | - Eline Cassassa
- Department of Dermatology, Hôpital Larrey, Toulouse, France
| | - Anne-Sophie Darrigade
- Department of Dermatology, National Reference Center for Rare Skin Diseases, University Hospital of Bordeaux, Bordeaux, France
| | - Thomas Barnetche
- Department of Rheumatology, National Reference Center for Severe Systemic Autoimmune Diseases, FHU ACRONIM, University Hospital of Bordeaux, Bordeaux, France
| | - Marie-Sylvie Doutre
- Department of Dermatology, National Reference Center for Rare Skin Diseases, University Hospital of Bordeaux, Bordeaux, France
| | - Bruno Matard
- Centre Sabouraud, Hôpital Saint-Louis, Paris, France
| | - Marie Beylot-Barry
- Department of Dermatology, National Reference Center for Rare Skin Diseases, University Hospital of Bordeaux, Bordeaux, France; INSERM U1053, BaRITOn, Oncogenesis of cutaneous lymphomas Team, University of Bordeaux, Bordeaux, France
| | - Julien Seneschal
- Department of Dermatology, National Reference Center for Rare Skin Diseases, University Hospital of Bordeaux, Bordeaux, France; CNRS, UMR-5164, ImmunoConCept, F-33000, Bordeaux, France .
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8
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Linz MS, Mattappallil A, Finkel D, Parker D. Clinical Impact of Staphylococcus aureus Skin and Soft Tissue Infections. Antibiotics (Basel) 2023; 12:antibiotics12030557. [PMID: 36978425 PMCID: PMC10044708 DOI: 10.3390/antibiotics12030557] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
The pathogenic bacterium Staphylococcus aureus is the most common pathogen isolated in skin-and-soft-tissue infections (SSTIs) in the United States. Most S. aureus SSTIs are caused by the epidemic clone USA300 in the USA. These infections can be serious; in 2019, SSTIs with S. aureus were associated with an all-cause, age-standardized mortality rate of 0.5 globally. Clinical presentations of S. aureus SSTIs vary from superficial infections with local symptoms to monomicrobial necrotizing fasciitis, which can cause systemic manifestations and may lead to serious complications or death. In order to cause skin infections, S. aureus employs a host of virulence factors including cytolytic proteins, superantigenic factors, cell wall-anchored proteins, and molecules used for immune evasion. The immune response to S. aureus SSTIs involves initial responders such as keratinocytes and neutrophils, which are supported by dendritic cells and T-lymphocytes later during infection. Treatment for S. aureus SSTIs is usually oral therapy, with parenteral therapy reserved for severe presentations; it ranges from cephalosporins and penicillin agents such as oxacillin, which is generally used for methicillin-sensitive S. aureus (MSSA), to vancomycin for methicillin-resistant S. aureus (MRSA). Treatment challenges include adverse effects, risk for Clostridioides difficile infection, and potential for antibiotic resistance.
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Affiliation(s)
- Matthew S. Linz
- Department of Pathology, Immunology and Laboratory Medicine, Center for Immunity and Inflammation, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Arun Mattappallil
- Department of Pharmaceutical Services, University Hospital, Newark, NJ 07103, USA
| | - Diana Finkel
- Division of Infectious Diseases, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Dane Parker
- Department of Pathology, Immunology and Laboratory Medicine, Center for Immunity and Inflammation, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
- Correspondence: ; Fax: +1-973-972-3047
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9
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Case for diagnosis. Cicatricial alopecia on the vertex - Folliculitis decalvans and lichen planopilaris phenotypic spectrum. An Bras Dermatol 2023:S0365-0596(23)00047-8. [PMID: 36894349 DOI: 10.1016/j.abd.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 03/09/2023] Open
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10
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Matard B, Bourrat E, Cavalié M, Chiaverini C, Reygagne P. Folliculitis decalvans and dystrophic epidermolysis bullosa: a significant association. Br J Dermatol 2022; 187:1026-1028. [PMID: 35904062 DOI: 10.1111/bjd.21796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 12/24/2022]
Abstract
This work reports 30 cases of folliculitis decalvans (FD) in patients with dystrophic epidermolysis bullosa (DEB) among a cohort of 125 DEB patients seen between 2010 and 2021 in 2 French expert centers for the management of inherited epidermolysis bullosa. Such an association between two rare diseases cannot be fortuitous and implies a physiopathological link that we discuss in this paper. This association is a new significant fact to add to the reflexion on FD causes, suggesting that skin abnormality of DEB could act as a factor of a specific skin barrier alteration which could favor FD. Scarring alopecia with tufted folliculitis and pustules on inflamed skin at the vertex of a woman with dominant dystrophic epidermolysis bullosa.
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Affiliation(s)
- Bruno Matard
- Sabouraud Centre for Hair Diseases, Hôpital Saint-Louis, Paris, France
| | - Emmanuelle Bourrat
- Department of Dermatology, Expert Centre for Epidermolysis Bullosa (MAGEC), Hôpital Saint-Louis, Paris, France
| | - Marine Cavalié
- CRMRP-Sud Nice, Department of Dermatology, Hôpital L'Archet, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Christine Chiaverini
- CRMRP-Sud Nice, Department of Dermatology, Hôpital L'Archet, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Pascal Reygagne
- Sabouraud Centre for Hair Diseases, Hôpital Saint-Louis, Paris, France
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11
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Zhang X, Zhu M, Zhou J, Wu S, Liu J, Qin Q. Folliculitis Decalvans and Lichen Planopilaris Phenotypic Spectrum: A Case Report. Clin Cosmet Investig Dermatol 2022; 15:993-996. [PMID: 35677221 PMCID: PMC9167836 DOI: 10.2147/ccid.s365566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/26/2022] [Indexed: 11/23/2022]
Abstract
The folliculitis decalvans (FD) and lichen planopilaris (LPP) phenotypic spectrum combines biphasic features of FD and LPP. It is characterized by successive or concomitant occurrence of pustules, crusts, follicular tufts, perifollicular erythema, perifollicular scales, and cicatricial alopecia and includes mixed histologic features of both FD and LPP. Here, we report the case of a 33-year-old female patient with a 30-year history of FD-LPP phenotypic spectrum lesions.
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Affiliation(s)
- Xi Zhang
- Department of Dermatology, The Second Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, People's Republic of China
| | - Mingfang Zhu
- Department of Dermatology, The Second Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, People's Republic of China
| | - Jia Zhou
- Department of Dermatology, The Second Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, People's Republic of China
| | - Shuhui Wu
- Department of Dermatology, The Second Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, People's Republic of China
| | - Juan Liu
- Department of Dermatology, The Second Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, People's Republic of China
| | - Qiuyan Qin
- Department of Dermatology, The Second Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, People's Republic of China
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12
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Moussa A, Asfour L, Eisman S, Bhoyrul B, Sinclair R. Successful treatment of folliculitis decalvans with baricitinib: A case series. Australas J Dermatol 2022; 63:279-281. [DOI: 10.1111/ajd.13786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Leila Asfour
- Sinclair Dermatology East Melbourne Victoria Australia
| | | | - Bevin Bhoyrul
- Sinclair Dermatology East Melbourne Victoria Australia
| | - Rodney Sinclair
- Sinclair Dermatology East Melbourne Victoria Australia
- University of Melbourne Melbourne Victoria Australia
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13
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Cummins DM, Chaudhry IH, Harries M. Scarring Alopecias: Pathology and an Update on Digital Developments. Biomedicines 2021; 9:biomedicines9121755. [PMID: 34944572 PMCID: PMC8698437 DOI: 10.3390/biomedicines9121755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/15/2021] [Accepted: 11/20/2021] [Indexed: 01/06/2023] Open
Abstract
Primary cicatricial alopecias (PCA) represent a challenging group of disorders that result in irreversible hair loss from the destruction and fibrosis of hair follicles. Scalp skin biopsies are considered essential in investigating these conditions. Unfortunately, the recognised complexity of histopathologic interpretation is compounded by inadequate sampling and inappropriate laboratory processing. By sharing our successes in developing the communication pathway between the clinician, laboratory and histopathologist, we hope to mitigate some of the difficulties that can arise in managing these conditions. We provide insight from clinical and pathology practice into how diagnoses are derived and the key histological features observed across the most common PCAs seen in practice. Additionally, we highlight the opportunities that have emerged with advances in digital pathology and how these technologies may be used to develop clinicopathological relationships, improve working practices, enhance remote learning, reduce inefficiencies, optimise diagnostic yield, and harness the potential of artificial intelligence (AI).
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Affiliation(s)
- Donna M. Cummins
- The Dermatology Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester M6 8HD, UK;
| | - Iskander H. Chaudhry
- Department of Pathology, Royal Liverpool University Hospital, Liverpool L7 8XP, UK;
| | - Matthew Harries
- The Dermatology Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester M6 8HD, UK;
- Centre for Dermatology Research, University of Manchester, MAHSC and NIHR Manchester, Biomedical Research Centre, Manchester M13 9WU, UK
- Correspondence:
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14
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Massiot P, Clavaud C, Thomas M, Ott A, Guéniche A, Panhard S, Muller B, Michelin C, Kerob D, Bouloc A, Reygagne P. Continuous clinical improvement of mild-to-moderate seborrheic dermatitis and rebalancing of the scalp microbiome using a selenium disulfide-based shampoo after an initial treatment with ketoconazole. J Cosmet Dermatol 2021; 21:2215-2225. [PMID: 34416081 DOI: 10.1111/jocd.14362] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/24/2021] [Accepted: 07/22/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Scalp seborrheic dermatitis (SD) is a chronic, relapsing, and inflammatory scalp disease. Studies indicate a global bacterial and fungal microbiota shift of scalp SD, as compared to healthy scalp. Ketoconazole and selenium disulfide (SeS2 ) improve clinical signs and symptoms in both scalp dandruff and SD. AIM The main objective of this study was to investigate the changes in the scalp microbiota diversity and counts in subjects with scalp SD during a two-phase treatment period. MATERIAL AND METHODS The scalp microbiota and clinical efficacy were investigated in 68 subjects with mild-to-moderate scalp SD after an initial one-month treatment with 2% ketoconazole, and after a 2-month maintenance phase, either with a 1% SeS2 -based shampoo or its vehicle. RESULTS Thirty one subjects in the active and 37 subjects in the vehicle group participated. Ketoconazole provided an improvement of clinical symptoms (adherent (-1.75 p < 0.05), non-adherent (-1.5, p < 0.05)) flakes and erythema (scores 1.67-0.93, p < 0.001), in an increased fungal diversity and in a significant (p < 0.005) decrease of Malassezia spp. SeS2 provided an additional clinical improvement (-0.8; p = 0.0002 and -0.7; p = 0.0081 for adherent and non-adherent flakes, respectively, at Day 84) compared to the vehicle associated with a low Malassezia spp. count and an additional significant (p < 0.001) decrease of the Staphylococcus spp. level. CONCLUSION Selenium disulfide provides an additional benefit on the scalp microbiota and in clinical symptoms of SD and dandruff after treatment with ketoconazole. The results confirm the role of Staphylococcus spp. in scalp SD and open possible perspectives for preventing relapses.
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Affiliation(s)
| | | | - Marie Thomas
- L'Oréal Research & Innovation, Aulnay-sous-Bois, France
| | - Alban Ott
- L'Oréal Research & Innovation, Aulnay-sous-Bois, France
| | | | | | | | | | | | - Anne Bouloc
- Vichy Laboratoires, Levallois-Perret, France
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15
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Alopecia and the Microbiome: A Future Therapeutic Target? ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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16
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Barquero-Orias D, Muñoz Moreno-Arrones O, Vañó-Galván S. Alopecia y microbioma: ¿futura diana terapéutica? ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.ad.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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17
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Ramos PM, Melo DF, Lemes LR, Alcantara G, Miot HA, Lyra MR, Vargas TJDS. Folliculitis decalvans and lichen planopilaris phenotypic spectrum: case report of two paediatric cases. J Eur Acad Dermatol Venereol 2021; 35:e674-e676. [PMID: 34014598 DOI: 10.1111/jdv.17379] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/26/2021] [Accepted: 04/28/2021] [Indexed: 01/05/2023]
Affiliation(s)
- P M Ramos
- Department of Dermatology and Radiotherapy, São Paulo State University (UNESP), Botucatu, Brazil
| | - D F Melo
- Department of Dermatology, University of State of Rio de Janeiro - UERJ, Brazil
| | - L R Lemes
- Department of Dermatology, University of State of Rio de Janeiro - UERJ, Brazil
| | - G Alcantara
- Department of Dermatology and Radiotherapy, São Paulo State University (UNESP), Botucatu, Brazil
| | - H A Miot
- Department of Dermatology and Radiotherapy, São Paulo State University (UNESP), Botucatu, Brazil
| | - M R Lyra
- Oswaldo Cruz Foundation - Infectious Disease in Dermatology, Rio de Janeiro, Brazil
| | - T J de S Vargas
- Department of Dermatology, Federal Hospital of Bonsucesso, Rio de Janeiro, Brazil
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18
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Lousada MB, Lachnit T, Edelkamp J, Rouillé T, Ajdic D, Uchida Y, Di Nardo A, Bosch TCG, Paus R. Exploring the human hair follicle microbiome. Br J Dermatol 2021; 184:802-815. [PMID: 32762039 DOI: 10.1111/bjd.19461] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 12/31/2022]
Abstract
Human hair follicles (HFs) carry complex microbial communities that differ from the skin surface microbiota. This likely reflects that the HF epithelium differs from the epidermal barrier in that it provides a moist, less acidic, and relatively ultraviolet light-protected environment, part of which is immune-privileged, thus facilitating microbial survival. Here we review the current understanding of the human HF microbiome and its potential physiological and pathological functions, including in folliculitis, acne vulgaris, hidradenitis suppurativa, alopecia areata and cicatricial alopecias. While reviewing the main human HF bacteria (such as Propionibacteria, Corynebacteria, Staphylococci and Streptococci), viruses, fungi and parasites as human HF microbiome constituents, we advocate a broad view of the HF as an integral part of the human holobiont. Specifically, we explore how the human HF may manage its microbiome via the regulated production of antimicrobial peptides (such as cathelicidin, psoriasin, RNAse7 and dermcidin) by HF keratinocytes, how the microbiome may impact on cytokine and chemokine release from the HF, and examine hair growth-modulatory effects of antibiotics, and ask whether the microbiome affects hair growth in turn. We highlight major open questions and potential novel approaches to the management of hair diseases by targeting the HF microbiome.
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Affiliation(s)
- M B Lousada
- Monasterium Laboratory, Münster, Germany
- Zoological Institute, Christian-Albrechts University Kiel, Kiel, Germany
| | - T Lachnit
- Zoological Institute, Christian-Albrechts University Kiel, Kiel, Germany
| | - J Edelkamp
- Monasterium Laboratory, Münster, Germany
| | - T Rouillé
- Monasterium Laboratory, Münster, Germany
| | - D Ajdic
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Y Uchida
- Monasterium Laboratory, Münster, Germany
| | - A Di Nardo
- Department of Dermatology, University of California, San Diego, CA, USA
| | - T C G Bosch
- Zoological Institute, Christian-Albrechts University Kiel, Kiel, Germany
| | - R Paus
- Monasterium Laboratory, Münster, Germany
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Centre for Dermatology Research, School of Biological Sciences, University of Manchester & NIHR Biomedical Research Centre, Manchester, UK
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19
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The role of lactobacilli in inhibiting skin pathogens. Biochem Soc Trans 2021; 49:617-627. [PMID: 33704415 DOI: 10.1042/bst20200329] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 12/25/2022]
Abstract
The human skin microbiota forms a key barrier against skin pathogens and is important in modulating immune responses. Recent studies identify lactobacilli as endogenous inhabitants of healthy skin, while inflammatory skin conditions are often associated with a disturbed skin microbiome. Consequently, lactobacilli-based probiotics are explored as a novel treatment of inflammatory skin conditions through their topical skin application. This review focuses on the potential beneficial role of lactobacilli (family Lactobacillaceae) in the skin habitat, where they can exert multifactorial local mechanisms of action against pathogens and inflammation. On one hand, lactobacilli have been shown to directly compete with skin pathogens through adhesion inhibition, production of antimicrobial metabolites, and by influencing pathogen metabolism. The competitive anti-pathogenic action of lactobacilli has already been described mechanistically for common different skin pathogens, such as Staphylococcus aureus, Cutibacterium acnes, and Candida albicans. On the other hand, lactobacilli also have an immunomodulatory capacity associated with a reduction in excessive skin inflammation. Their influence on the immune system is mediated by bacterial metabolites and cell wall-associated or excreted microbe-associated molecular patterns (MAMPs). In addition, lactobacilli can also enhance the skin barrier function, which is often disrupted as a result of infection or in inflammatory skin diseases. Some clinical trials have already translated these mechanistic insights into beneficial clinical outcomes, showing that topically applied lactobacilli can temporarily colonize the skin and promote skin health, but more and larger clinical trials are required to generate in vivo mechanistic insights and in-depth skin microbiome analysis.
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20
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Matard B, Cavelier Balloy B, Assouly P, Reygagne P. It has the Erythema of a Lichen Planopilaris, it has the Hyperkeratosis of a Lichen Planopilaris, but it is Not a Lichen Planopilaris: About the "Lichen Planopilaris-Like" Form of Folliculitis Decalvans. Am J Dermatopathol 2021; 43:235-236. [PMID: 32769552 DOI: 10.1097/dad.0000000000001758] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Bruno Matard
- Centre Sabouraud, Hôpital Saint-Louis, Paris, France ; and
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21
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Constantinou A, Kanti V, Polak-Witka K, Blume-Peytavi U, Spyrou GM, Vogt A. The Potential Relevance of the Microbiome to Hair Physiology and Regeneration: The Emerging Role of Metagenomics. Biomedicines 2021; 9:biomedicines9030236. [PMID: 33652789 PMCID: PMC7996884 DOI: 10.3390/biomedicines9030236] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/18/2022] Open
Abstract
Human skin and hair follicles are recognized sites of microbial colonization. These microbiota help regulate host immune mechanisms via an interplay between microbes and immune cells, influencing homeostasis and inflammation. Bacteria affect immune responses by controlling the local inflammatory milieu, the breakdown of which can result in chronic inflammatory disorders. Follicular microbiome shifts described in some inflammatory cutaneous diseases suggest a link between their development or perpetuation and dysbiosis. Though the hair follicle infundibulum is an area of intense immunological interactions, bulb and bulge regions represent immune-privileged niches. Immune privilege maintenance seems essential for hair growth and regeneration, as collapse and inflammation characterize inflammatory hair disorders like alopecia areata and primary cicatricial alopecia. Current research largely focuses on immunological aberrations. However, studies suggest that external stimuli and interactions across the follicular epithelium can have profound effects on the local immune system, homeostasis, and cycling. Herein, we review hair follicle bacterial colonization, its possible effects on the underlying tissue, and links to the pathogenesis of alopecia, beyond the pure investigation of specific species abundance. As skin microbiology enters the metagenomics era, multi-dimensional approaches will enable a new level of investigations on the effects of microorganisms and metabolism on host tissue.
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Affiliation(s)
- Andria Constantinou
- Charité-Universitatsmedizin Berlin, Corporate Member of Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology, Venereology and Allergy, Charitéplatz 1, 10117 Berlin, Germany; (A.C.); (V.K.); (K.P.-W.); (U.B.-P.)
| | - Varvara Kanti
- Charité-Universitatsmedizin Berlin, Corporate Member of Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology, Venereology and Allergy, Charitéplatz 1, 10117 Berlin, Germany; (A.C.); (V.K.); (K.P.-W.); (U.B.-P.)
| | - Katarzyna Polak-Witka
- Charité-Universitatsmedizin Berlin, Corporate Member of Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology, Venereology and Allergy, Charitéplatz 1, 10117 Berlin, Germany; (A.C.); (V.K.); (K.P.-W.); (U.B.-P.)
| | - Ulrike Blume-Peytavi
- Charité-Universitatsmedizin Berlin, Corporate Member of Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology, Venereology and Allergy, Charitéplatz 1, 10117 Berlin, Germany; (A.C.); (V.K.); (K.P.-W.); (U.B.-P.)
| | - George M. Spyrou
- Bioinformatics ERA Chair, The Cyprus Institute of Neurology and Genetics, 6 Iroon Avenue, 2371 Ayios Dometios, Nicosia, Cyprus;
| | - Annika Vogt
- Charité-Universitatsmedizin Berlin, Corporate Member of Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, Clinical Research Center for Hair and Skin Science, Department of Dermatology, Venereology and Allergy, Charitéplatz 1, 10117 Berlin, Germany; (A.C.); (V.K.); (K.P.-W.); (U.B.-P.)
- Correspondence:
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22
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Dervout C, Chiappa AM, Fleuret C, Plantin P, Acquitter M. Alopécie cicatricielle à type de folliculite décalvante induite par l’erlotinib. Ann Dermatol Venereol 2020; 147:848-852. [DOI: 10.1016/j.annder.2020.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/12/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
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23
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Moreno-Arrones OM, Campo RD, Saceda-Corralo D, Jimenez-Cauhe J, Ponce-Alonso M, Serrano-Villar S, Jaén P, Paoli J, Vañó-Galván S. Folliculitis decalvans microbiological signature is specific for disease clinical phenotype. J Am Acad Dermatol 2020; 85:1355-1357. [PMID: 33144151 DOI: 10.1016/j.jaad.2020.10.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/20/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022]
Affiliation(s)
- O M Moreno-Arrones
- Dermatology Department, Trichology Unit, Ramon y Cajal University Hospital, University of Alcala, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Trichology and Hair Transplantation Unit, Grupo Pedro Jaen Clinic, Madrid, Spain.
| | - R Del Campo
- Microbiology Department, Ramon y Cajal University Hospital, University of Alcala, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain. Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain
| | - D Saceda-Corralo
- Dermatology Department, Trichology Unit, Ramon y Cajal University Hospital, University of Alcala, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Trichology and Hair Transplantation Unit, Grupo Pedro Jaen Clinic, Madrid, Spain
| | - J Jimenez-Cauhe
- Dermatology Department, Trichology Unit, Ramon y Cajal University Hospital, University of Alcala, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - M Ponce-Alonso
- Microbiology Department, Ramon y Cajal University Hospital, University of Alcala, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain. Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain
| | - S Serrano-Villar
- Department of Infectious Diseases Ramon y Cajal University Hospital, University of Alcala, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - P Jaén
- Dermatology Department, Trichology Unit, Ramon y Cajal University Hospital, University of Alcala, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Trichology and Hair Transplantation Unit, Grupo Pedro Jaen Clinic, Madrid, Spain
| | - John Paoli
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden
| | - S Vañó-Galván
- Dermatology Department, Trichology Unit, Ramon y Cajal University Hospital, University of Alcala, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Trichology and Hair Transplantation Unit, Grupo Pedro Jaen Clinic, Madrid, Spain
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Acne in the first three decades of life: An update of a disorder with profound implications for all decades of life. Dis Mon 2020; 67:101103. [PMID: 33041056 DOI: 10.1016/j.disamonth.2020.101103] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acne vulgaris is a chronic, inflammatory, skin condition that involves the pilosebaceous follicles and is influenced by a variety of factors including genetics, androgen-stimulation of sebaceous glands with abnormal keratinization, colonization with Cutibacterium acnes (previously called Propionibacterium acnes), and pathological immune response to inflammation. Acne can occur at all ages and this discussion focuses on the first three decades of life. Conditions that are part of the differential diagnosis and/or are co-morbid with acne vulgaris are also considered. Acne in the first year of life includes neonatal acne (acne neonatorum) that presents in the first four weeks of life and infantile acne that usually presents between 3 and 6 months of the first year of life with a range of 3 to 16 months after birth. Acne rosacea is a chronic, inflammatory, skin condition that is distinct from acne vulgaris, typically presents in adults, and has four main types: erythemato-telangiectatic, papulopustular, phymatous and ocular. Treatment options for acne vulgaris include topical retinoids, topical benzoyl peroxide, antibiotics (topical, oral), oral contraceptive pills, isotretinoin, and others. Management must consider the increasing impact of antibiotic resistance in the 21st century. Psychological impact of acne can be quite severe and treatment of acne includes awareness of the potential emotional toll this disease may bring to the person with acne as well as assiduous attention to known side effects of various anti-acne medications (topical and systemic). Efforts should be directed at preventing acne-caused scars and depigmentation on the skin as well as emotional scars within the person suffering from acne.
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Vogt A, Constantinou A, Rancan F, Ghoreschi K, Blume-Peytavi U, Combadiere B. A niche in the spotlight: Could external factors critically disturb hair follicle homeostasis and contribute to inflammatory hair follicle diseases? Exp Dermatol 2020; 29:1080-1087. [PMID: 33090548 DOI: 10.1111/exd.14212] [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: 06/16/2020] [Accepted: 10/01/2020] [Indexed: 12/22/2022]
Abstract
The anatomy of the hair follicle and the dynamics of its barrier provide a special space for interactions between macromolecules and the underlying tissue. Translocation across the hair follicle epithelium and immune recognition have been confirmed for proteins, nucleic acids, engineered particles, virus particles and others. Tissue responses can be modulated by pro-inflammatory stimuli as demonstrated in penetration and transcutaneous immunization studies. Even under physiological conditions, hair follicle openings are filled with exogenous material ranging from macromolecules, engineered particles to natural particles including diverse communities of microbes. The exposed position of the infundibulum suggests that local inflammatory insults could disturb the finely tuned balance and may trigger downstream responses that initiate or facilitate local outbreaks of inflammatory hair diseases typically occurring in close spatial association with the infundibulum as observed in cicatricial alopecia. The question as to how microbial colonization or deposition of contaminants on the surface of the hair follicle epithelium interact with the barrier status under the influence of individual predisposition, may help us understand local flare-ups of inflammatory hair diseases. Specifically, learning more about skin barrier alterations in the different types of inflammatory hair diseases and cross-talk with exogenous compounds could give new insights in this less explored aspect of hair follicle homeostasis. Such knowledge may not only be used to develop supportive measures to maintain a healthy scalp. It may have wider implications for our understanding on how external factors influence inflammation and immunological responses in the skin.
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Affiliation(s)
- Annika Vogt
- Department of Dermatology, Venerology and Allergy, Charité-Universitatsmedizin Berlin, Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, Berlin Institute of Health, Berlin, Germany
- Sorbonne Université, Inserm Immunologie et des Maladies Infectieuses (Cimi-Paris), Centre, Paris, France
| | - Andria Constantinou
- Department of Dermatology, Venerology and Allergy, Charité-Universitatsmedizin Berlin, Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Fiorenza Rancan
- Department of Dermatology, Venerology and Allergy, Charité-Universitatsmedizin Berlin, Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venerology and Allergy, Charité-Universitatsmedizin Berlin, Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology, Venerology and Allergy, Charité-Universitatsmedizin Berlin, Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Behazine Combadiere
- Sorbonne Université, Inserm Immunologie et des Maladies Infectieuses (Cimi-Paris), Centre, Paris, France
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Asfour L, Trautt E, Harries MJ. Folliculitis Decalvans in the Era of Antibiotic Resistance: Microbiology and Antibiotic Sensitivities in a Tertiary Hair Clinic. Int J Trichology 2020; 12:193-194. [PMID: 33376291 PMCID: PMC7759064 DOI: 10.4103/ijt.ijt_98_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/20/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Leila Asfour
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Elizabeth Trautt
- Department of Microbiology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Matthew John Harries
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Salford, UK.,Centre for Dermatology Research, University of Manchester, MAHSC and NIHR Manchester Biomedical Research Centre, Manchester, UK
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27
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Lin X, Zhou S, Wang X, Zhu X. Aminolevulinic acid photodynamic therapy for folliculitis decalvans: A case report. Dermatol Ther 2020; 33:e13358. [DOI: 10.1111/dth.13358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Xiangfei Lin
- Department of Dermatology, Clinical Medical College Yangzhou University Yangzhou China
| | - Siyu Zhou
- Department of Dermatology The Second Xiangya Hospital of Central South University Changsha China
| | - Xiaokang Wang
- Department of Dermatology, Clinical Medical College Yangzhou University Yangzhou China
| | - Xiaofang Zhu
- Department of Dermatology, Clinical Medical College Yangzhou University Yangzhou China
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28
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Affiliation(s)
- Kevin J. McElwee
- Centre for Skin Sciences University of Bradford Bradford UK
- Department of Dermatology and Skin Science University of British Columbia Vancouver BC Canada
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami Leonard M. Miller School of Medicine Miami FL USA
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29
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Mazzilli S, Vollono L, Tassone F, Cappilli S, Peris K, Bianchi L. Reflectance Confocal Microscopy Applied to Folliculitis Decalvans: Preliminary Results of a Multicenter Study. Skin Appendage Disord 2020; 6:202-206. [DOI: 10.1159/000507655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/01/2020] [Indexed: 11/19/2022] Open
Abstract
Although trichoscopic criteria indicative of disease severity and inflammatory activity have been recently proposed, the potential use of reflectance confocal microscopy (RCM) in the evaluation of the inflammatory stage of FD has never been published to date. Our study investigated RCM features of 14 patients with a histopathological diagnosis of FD, evaluating clinical and trichoscopic findings. RCM findings were divided into 2 main patterns: “follicular” and “interfollicular.” Our results suggest a potential role for RCM as a noninvasive, fast technique for a complementary investigation in the diagnostic process, as well as in the therapeutic management decision.
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30
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Yip L, Barrett TH, Harries MJ. Folliculitis decalvans and lichen planopilaris phenotypic spectrum: a case series of biphasic clinical presentation and theories on pathogenesis. Clin Exp Dermatol 2019; 45:63-72. [DOI: 10.1111/ced.13989] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2019] [Indexed: 12/19/2022]
Affiliation(s)
- L. Yip
- Barton Specialist Centre Barton ACT Australia
| | - T. H. Barrett
- The Skin Hospital 7 Ashley Lane Westmead NSW Australia
| | - M. J. Harries
- The Dermatology Centre University of Manchester Salford Royal NHS Foundation Trust Salford Manchester UK
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