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Appoo A, Christensen BL, Somayaji R. Examining the Association between Immunosuppressants and Wound Healing: A Narrative Review. Adv Skin Wound Care 2024; 37:261-267. [PMID: 38648239 DOI: 10.1097/asw.0000000000000127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To review how different classes of immunosuppressants affect wound healing. DATA SOURCES A literature search was conducted in PubMed, Google Scholar, and the University of Calgary Health Sciences Library. STUDY SELECTION The researchers initially screened article titles using key words such as "immunosuppressive medication," "wound healing," and "immunosuppression." Articles in which the title and/or abstract contained these key words, that addressed wound healing related to immunosuppressant medications, and were published after 2000 were included in the review. When human data were not available for an immunosuppressant (class), animal studies were included. DATA EXTRACTION The 61 included articles underwent full text review and summarization. DATA SYNTHESIS All included studies were summarized descriptively including immunosuppressive mechanism of action, study participants or subjects, and evidence of effects on wound healing. CONCLUSIONS Corticosteroids and mechanistic target of rapamycin inhibitors most consistently demonstrate detrimental effects on wound healing. For other classes of immunosuppressants, evidence is limited with varying effects on wound healing described. Larger, high-quality studies are required to better understand the effects of immunosuppressants, including those with new mechanisms of action, to identify those with the most impact on wound healing.
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Affiliation(s)
- Aria Appoo
- Aria Appoo is Medical Student, University of Oxford, United Kingdom. At the University of Calgary, Alberta, Canada, Brandon L. Christensen, MD, is Resident Physician, Division of Infectious Diseases, and Ranjani Somayaji, BScPT, MD, MPH, is Assistant Professor, Departments of Medicine, Microbiology, Immunology and Infectious Disease and Community Health Sciences. Acknowledgments: Alberta Innovates High School Youth Research Summer (HYRS) Program provided an educational stipend to the lead author for her work on this and other projects. The authors have disclosed no other financial relationships related to this article. Submitted February 1, 2023; accepted in revised form May 23, 2023
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Na HD, Yan H, Park CH. Misdiagnosis of Pyoderma Gangrenosum Increases Medical Costs and Prolongs Hospital Stay: A Case Report. INT J LOW EXTR WOUND 2021; 22:428-433. [PMID: 33891524 DOI: 10.1177/15347346211011870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare, immunological ulcerative, and necrotic inflammatory skin disease that can be easily misdiagnosed as cellulitis, abscess, diabetic foot ulcer, and other infectious diseases. Misdiagnosing PG leads to unnecessary surgical incision and debridement, which further exacerbates the lesion, ultimately leading to longer treatment periods and higher medical costs. Therefore, early and accurate diagnosis of PG is extremely important for its treatment. In particular, PG should be suspected in patients with inflammatory bowel disease.
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Affiliation(s)
- Ho D Na
- College of Medicine, 65676Yeungnam University, Daegu, Republic of Korea
| | - Hongfei Yan
- College of Medicine, 65676Yeungnam University, Daegu, Republic of Korea
| | - Chul H Park
- College of Medicine, 65676Yeungnam University, Daegu, Republic of Korea
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Tominaga K, Kamimura K, Sato H, Ko M, Kawata Y, Mizusawa T, Yokoyama J, Terai S. Cytapheresis for pyoderma gangrenosum associated with inflammatory bowel disease: A review of current status. World J Clin Cases 2020; 8:2092-2101. [PMID: 32548138 PMCID: PMC7281039 DOI: 10.12998/wjcc.v8.i11.2092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/27/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis clinically characterized by the presence of painful skin ulcerations with erythematous. As it is frequently associated with inflammatory bowel diseases, including ulcerative colitis, gastroenterologists should be familiar with the disease including therapeutic options. Therefore, we have conducted a review focusing on the cytapheresis for PG in cases of inflammatory bowel diseases. A literature search was conducted to extract studies published in the last 20 years, with information on demographics, clinical symptoms, treatment, and the clinical course from a total of 22 cases reported and our recent case. In most patients, cytapheresis was associated with improvement or resolution of PG after failure of conventional therapeutic options such as corticosteroids, antibiotics, immunosuppressive agents and immunoglobulin. Based on the information summarized, cytapheresis is helpful in the majority of patients with PG refractory to medical treatment associated with inflammatory bowel diseases and could be further studied in a multicenter, randomized trial.
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Affiliation(s)
- Kentaro Tominaga
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Kenya Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Hiroki Sato
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Masayoshi Ko
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Yuzo Kawata
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Takeshi Mizusawa
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Junji Yokoyama
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
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Ben Abdallah H, Fogh K, Bech R. Pyoderma gangrenosum and tumour necrosis factor alpha inhibitors: A semi-systematic review. Int Wound J 2019; 16:511-521. [PMID: 30604927 PMCID: PMC7949186 DOI: 10.1111/iwj.13067] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/12/2018] [Accepted: 12/18/2018] [Indexed: 12/13/2022] Open
Abstract
Pyoderma gangrenosum (PG) is a rare ulcerative skin disease that presents a therapeutic challenge. Tumour necrosis factor alpha (TNFα) inhibitors have been reported to successfully control PG. Our aim was to systematically evaluate and compare the clinical effectiveness of TNFα inhibitors in adults with PG. A literature search including databases such as PubMed, Embase, Scopus, and Web of Science was conducted, using search terms related to PG and TNFα inhibitors. Studies and case reports were included if patients were diagnosed with PG, over the age of 18 and administered TNFα inhibitor. A total of 3212 unique citations were identified resulting in 222 articles describing 356 patients being included in our study. The study we report found an 87% (95% CI: 83%-90%) response rate and a 67% (95% CI: 62%-72%) complete response rate to TNFα inhibitors. No statistically significant differences in the response rates (P = 0.6159) or complete response rates (P = 0.0773) to infliximab, adalimumab, and etanercept were found. In our study TNFα inhibitors demonstrated significant effectiveness with response and complete response rates supporting the use of TNFα inhibitors to treat PG in adults. Our study suggests that there is no significant difference in effectiveness among infliximab, adalimumab, and etanercept.
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Affiliation(s)
- Hakim Ben Abdallah
- Institute of Clinical Medicine, Aarhus Faculty of Health SciencesAarhus UniversityAarhusDenmark
| | - Karsten Fogh
- Department of DermatologyAarhus University HospitalAarhusDenmark
| | - Rikke Bech
- Department of DermatologyAarhus University HospitalAarhusDenmark
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Quist SR, Kraas L. Treatment options for pyoderma gangrenosum. J Dtsch Dermatol Ges 2019; 15:34-40. [PMID: 28140549 DOI: 10.1111/ddg.13173] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 08/02/2016] [Indexed: 12/19/2022]
Abstract
Pyoderma gangrenosum (PG) is an orphan disease. While research on such disorders is based on only few randomized multicenter as well as retrospective studies, most of the data comes from case series of small patient groups. Apart from topical and intralesional therapeutic options for early stages and mild disease courses, treatment predominantly involves systemic therapeutic agents. Besides systemic corticosteroids and cyclosporine A (CsA), options also include intravenous immunoglobulins (IVIG) and biologics such as the TNFα inhibitors infliximab, adalimumab, and etanercept; the interleukin (IL) 12/23 antibody ustekinumab; the IL-1 receptor antagonist anakinra; and the IL-1β antibody canakinumab. The best evidence-based study data is available for CsA, prednisolone, and infliximab; the latter especially in patients with concomitant ulcerative colitis or Crohn's disease. A response to IVIG and canakinumab has been reported in smaller case series. First described by Brocq almost 100 years ago, it was soon recognized that PG did in fact require treatment. To this day, however, such treatment remains a clinical challenge. Despite the severe - albeit rare -clinical picture, improvement in therapeutic options may be expected in the future, primarily due to further clinical studies - especially with a greater number of patients, a better understanding of the etiopathogenesis, as well as the use of modern targeted therapies with higher efficacy and a lower rate of side effects than conventional immunosuppressants such as prednisolone and CsA.
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Affiliation(s)
- Sven R Quist
- Department of Dermatology and Venereology, Otto von Guericke University, Magdeburg, Germany
| | - Luise Kraas
- Department of Dermatology and Venereology, Otto von Guericke University, Magdeburg, Germany
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McKenzie F, Cash D, Gupta A, Cummings LW, Ortega-Loayza AG. Biologic and small-molecule medications in the management of pyoderma gangrenosum. J DERMATOL TREAT 2018; 30:264-276. [PMID: 30051737 DOI: 10.1080/09546634.2018.1506083] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pyoderma gangrenosum (PG) is an uncommon inflammatory skin disorder characterized by neutrophil dysfunction. There are currently no FDA-approved drugs for the treatment of this disease, and treatment has typically relied on traditional immunosuppressive medications such as prednisone or cyclosporine. The efficacy of biologics in the treatment of other pro-inflammatory conditions such as psoriasis, rheumatoid arthritis, and inflammatory bowel disease is well-documented in the literature. Therefore, the use of biologic medications for the treatment of rarer inflammatory skin conditions, such as PG, is a compelling topic for investigation. Biologic and small-molecule therapies allow physicians to target specific pro-inflammatory mediators that underlie PG pathogenesis. This review provides an update on the use of biologic and small-molecule medications for the treatment of PG and summarizes the latest data on the clinical efficacy and pharmacology of these treatments.
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Affiliation(s)
- Fatima McKenzie
- a Department of Dermatology , Oregon Health & Science University , Portland , OR , USA
| | - Devin Cash
- b School of Medicine , Virginia Commonwealth University , Richmond , VA , USA
| | - Angela Gupta
- b School of Medicine , Virginia Commonwealth University , Richmond , VA , USA
| | - Laurel W Cummings
- b School of Medicine , Virginia Commonwealth University , Richmond , VA , USA
| | - Alex G Ortega-Loayza
- a Department of Dermatology , Oregon Health & Science University , Portland , OR , USA
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Quist SR, Kraas L. Therapieoptionen beim Pyoderma gangraenosum. J Dtsch Dermatol Ges 2017; 15:34-41. [DOI: 10.1111/ddg.13173_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 08/02/2016] [Indexed: 01/02/2023]
Affiliation(s)
- Sven R. Quist
- Klinik für Dermatologie und Venerologie; Otto-von-Guericke Universität; Magdeburg
| | - Luise Kraas
- Klinik für Dermatologie und Venerologie; Otto-von-Guericke Universität; Magdeburg
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Pyoderma gangrenosum with monoclonal IgA gammopathy and pulmonary tuberculosis. Illustrative case and review. Postepy Dermatol Alergol 2015; 32:137-41. [PMID: 26015785 PMCID: PMC4436233 DOI: 10.5114/pdia.2014.40974] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 01/06/2014] [Accepted: 01/13/2014] [Indexed: 02/07/2023] Open
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Agarwal A, Andrews JM. Systematic review: IBD-associated pyoderma gangrenosum in the biologic era, the response to therapy. Aliment Pharmacol Ther 2013; 38:563-72. [PMID: 23914999 DOI: 10.1111/apt.12431] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 02/05/2013] [Accepted: 07/07/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) in inflammatory bowel disease (IBD) is uncommon and therapeutically challenging. Its treatment remains poorly characterised due to limited individual centre or practitioner experience. No large series are reported since 2003, yet IBD treatment has changed substantially. AIM To provide an up-to-date review of the published treatment efficacy of currently available therapies for IBD-related PG in the biologic era. METHODS Systematic review of cases published post-2003 since the broad availability of anti-tumour necrosis factor-alpha (TNFα) therapy. Cases which did not have coexistent IBD, were non-English language, of paediatric age or without data on response to therapy were excluded. RESULTS Sixty cases were identified; 55% female, 50% UC, 45% CD, 5% IBD-U. At PG diagnosis, 58% had active and only 15% inactive IBD, with 27% with IBD activity unspecified. Predominant sites were lower limb (48%) and peristomally (25%); 42% had multiple lesions. In 12%, trauma preceded PG. In 42%, new PG appeared whilst on IBD-specific therapy, whilst 28% were on no therapy and in 30%, IBD therapy was unspecified. Of patients on no therapy at PG onset (n = 17), 16 healed; seven with first- and eight with second-line therapy. In total, 34/60 patients received infliximab, four received adalimumab, two had both; with 33 (92%) responding to one or the other. There was no correlation of PG duration or size with healing times. CONCLUSIONS Pyoderma gangrenosum appears predominantly during active IBD and is seen equally in CD and UC. New PG may be a manifestation of recrudescent IBD or it follow trauma. Anti-TNFα therapy as a first-line agent for PG should be considered, as it appears to be highly effective.
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Affiliation(s)
- A Agarwal
- IBD Services & Education, Department of Gastroenterology and Hepatology, School of Medicine, University of Adelaide at Royal Adelaide Hospital, Adelaide, SA, Australia
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Gilpin S, Maibach H. Allergic contact dermatitis caused by farnesol: clinical relevance. Cutan Ocul Toxicol 2010; 29:278-87. [PMID: 20858058 DOI: 10.3109/15569527.2010.511369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT The fragrance material farnesol is cited as an infrequent but important cause of allergic contact dermatitis (ACD). It is included in the fragrance mix II patch series and requires labeling in the European Union if it is used in a consumer product. OBJECTIVE To review the existing literature to determine the causative role of farnesol in clinical contact allergy. MATERIALS AND METHODS Survey of the literature on farnesol studies; predictive and clinical elicitation tests in case reports, reviews, and abstracts. RESULTS Predictive animal studies demonstrated in most cases that farnesol was a nonsensitizer. However, 2 local lymph node assays (LLNAs) indicated strong sensitization potential. Predictive human test data indicated a low potential, if any, for sensitization in human tests with farnesol at 10% or 12%. A few clinical reports indicated low-level allergy or questionable reactions to farnesol, with 5% being the most commonly used. There were also reports in which no reactions were seen. DISCUSSION Predictive testing on farnesol in animals shows conflicting results depending on the study methodology used. Human predictive patch-test data also had gaps that prevented it from being definitive in pointing to a causative relationship between farnesol and contact dermatitis. The real sensitizing potential of a material can best be determined by evaluating the clinical and epidemiological data so as to help resolve the conflicting animal and human predictive test data. CONCLUSIONS This literature and scoring exercise showed that predictive and clinical elicitation data do not document a clear causative determination that farnesol is a frequent contact allergen. Detailed clinical relevance and patient studies should clarify the clinical problem farnesol represents.
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Affiliation(s)
- Sarah Gilpin
- Research & Development, Aveda Corporation, Blaine, Minnesota 55449, USA.
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Pérez-De Pedro I, Gómez-Moyano E, López-Carmona D, Muñoz-Roca NL, De Ramón-Garrido E, Camps-García MT. [Utility of infliximab in gangrenous pyoderma not associated with inflammatory bowel disease]. Rev Clin Esp 2010; 210:367-9. [PMID: 20466360 DOI: 10.1016/j.rce.2009.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 11/02/2009] [Accepted: 11/22/2009] [Indexed: 11/19/2022]
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Miller J, Yentzer BA, Clark A, Jorizzo JL, Feldman SR. Pyoderma gangrenosum: a review and update on new therapies. J Am Acad Dermatol 2010; 62:646-54. [PMID: 20227580 DOI: 10.1016/j.jaad.2009.05.030] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 05/13/2009] [Accepted: 05/15/2009] [Indexed: 01/06/2023]
Abstract
Pyoderma gangrenosum is a rare and often painful skin disease that can be unpredictable in its response to treatment. There is currently no gold standard of treatment or published algorithm for choice of therapy. The majority of data comes from case studies that lack a standard protocol not only for treatment administration but also for the objective assessment of lesion response to a specific therapy. This review provides an update to the treatment of pyoderma gangrenosum with a particular focus on new systemic therapies.
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Affiliation(s)
- Jeremiah Miller
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1071, USA
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Sadowski DC, Bernstein CN, Bitton A, Croitoru K, Fedorak RN, Griffiths A. Canadian Association of Gastroenterology Clinical Practice Guidelines: The use of tumour necrosis factor-alpha antagonist therapy in Crohn's disease. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 23:185-202. [PMID: 19319383 PMCID: PMC2694654 DOI: 10.1155/2009/201430] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Accepted: 01/08/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND Guidelines regarding the use of infliximab in Crohn's disease were previously published by the Canadian Association of Gastroenterology in 2004. However, recent clinical findings and drug developments warrant a review and update of these guidelines. OBJECTIVE To review and update Canadian guidelines regarding the use of tumour necrosis factor-alpha antibody therapy in both luminal and fistulizing Crohn's disease. METHODS A consensus group of 25 voting participants developed a series of recommendation statements that addressed pertinent clinical questions and gaps in existing knowledge. An iterative voting and feedback process was used in advance of the consensus meeting in conjunction with a systematic literature review to refine the voting statements. These statements were brought to a formal consensus meeting held in Montreal, Quebec (March 2008), wherein each statement underwent discussion, reformulation, voting and subsequent revision until group consensus was obtained (at least 80% agreement). OUTCOME The 47 voting statements addressed three themes: induction therapy, maintenance therapy and safety issues. As a result of the iterative process, 23 statements achieved consensus and were submitted for publication. CONCLUSION In the past five years, tumour necrosis factor-alpha antagonist therapy has become a cornerstone in the management of moderate-to-severe Crohn's disease refractory to conventional treatment algorithms. The evidentiary base supporting the use of these drugs in Crohn's disease is substantial and strengthened by results from longterm clinical and molecular studies. However, significant gaps in knowledge exist, particularly with regard to treatment failure. Confidence in the safety of these drugs is increasing, provided that therapy is administered in a clinical setting in which potential complications can be readily recognized and treated.
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Takayasu disease presenting as malignant pyoderma gangrenosum in a child with relapsing polychondritis. J Am Acad Dermatol 2008; 59:S84-7. [DOI: 10.1016/j.jaad.2008.05.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 05/08/2008] [Accepted: 05/09/2008] [Indexed: 11/18/2022]
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Sánchez Cano D, Callejas Rubio JL, Ortego Centeno N. Uso de los fármacos antagonistas del factor de necrosis tumoral en las enfermedades autoinmunes: situación actual. Med Clin (Barc) 2008; 131:471-7. [DOI: 10.1157/13126958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Eksteen B, Liaskou E, Adams DH. Lymphocyte homing and its role in the pathogenesis of IBD. Inflamm Bowel Dis 2008; 14:1298-312. [PMID: 18393377 DOI: 10.1002/ibd.20453] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Inflammatory bowel disease (IBD) is an idiopathic disorder of chronic inflammation of the gastrointestinal tract. Experimental models of IBD and results from human genomewide linkage studies suggest that the primary defect that leads to IBD is an inappropriate mucosal immune response to normal intestinal microbes. Genetic alterations not only confer increased susceptibility to IBD but also appear to determine the nature and location of the intestinal inflammation, as is evident in patients with genetic alterations of NOD2 and their susceptibility for ileal Crohn's disease. IBD has traditionally been classified into 2 subtypes, namely, ulcerative colitis (UC) and Crohn's disease (CD), based on histological appearance and anatomical distribution. However, an increasing body of data supports the concept that IBD is an umbrella diagnosis encompassing a variety of disorders with distinct genetic, microbial, and environmental determinants that cluster either into a UC or CD phenotype. The shared common pathway is uncontrolled intestinal inflammation. A key element in the pathogenesis of intestinal inflammation in both UC and CD is increased leukocyte recruitment from the circulation, and this provides a potential target for pharmaceutical inhibition. In this article we review the current understanding of the molecules that determine leukocyte trafficking to the gut and highlight opportunities where their inhibition could be exploited to treat IBD.(Inflamm Bowel Dis 2008).
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Affiliation(s)
- Bertus Eksteen
- Liver Research Laboratories, MRC Centre for Immune Regulation, Institute for Biomedical Research, Medical School, University of Birmingham, Birmingham, United Kingdom
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Abstract
Pyoderma gangrenosum (PG) can be differentiated into classic and atypical forms. The classic form is characterized by ulcers and the atypical form by deep erosions with bullous blue-gray margins. Pathergy, the development of cutaneous lesions at sites of trauma, is a common feature of both forms of PG. Approximately 50% of patients who have PG have underlying systemic diseases, most commonly inflammatory bowel disease, myeloproliferative disorders, and various forms of inflammatory arthritis. The diagnosis of PG is one of exclusion. The management of this disorder begins with treatment of any underlying disease and local or systemic glucocorticoids or immunomodulating therapies.
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Affiliation(s)
- Jeffrey P Callen
- Division of Dermatology, University of Louisville, 310 East Broadway, Louisville, KY 40202, USA.
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