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Ayén-Rodríguez Á, Gil-Villalba A, Ruiz-Villaverde R, Navarro-Triviño FJ. Methotrexate Toxicity in Dermatological Patients. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:741-743. [PMID: 38373610 DOI: 10.1016/j.ad.2023.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 02/27/2023] [Accepted: 10/09/2023] [Indexed: 02/21/2024] Open
Affiliation(s)
- Á Ayén-Rodríguez
- Servicio de Dermatología. Hospital Universitario San Cecilio, Granada, España
| | - A Gil-Villalba
- Servicio de Dermatología. Hospital Universitario San Cecilio, Granada, España
| | - R Ruiz-Villaverde
- Servicio de Dermatología. Hospital Universitario San Cecilio, Granada, España
| | - F J Navarro-Triviño
- Servicio de Dermatología. Dermatología. Hospital Universitario San Cecilio. Unidad de Eczema de Contacto e Inmunoalergia , Granada, España.
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2
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Ayén-Rodríguez Á, Gil-Villalba A, Ruiz-Villaverde R, Navarro-Triviño FJ. [Translated article] Methotrexate Toxicity in Dermatological Patients. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00430-7. [PMID: 38815680 DOI: 10.1016/j.ad.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 02/27/2023] [Accepted: 10/09/2023] [Indexed: 06/01/2024] Open
Affiliation(s)
- Á Ayén-Rodríguez
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain
| | - A Gil-Villalba
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain
| | - R Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain
| | - F J Navarro-Triviño
- Servicio de Dermatología, Dermatología, Hospital Universitario San Cecilio, Unidad de Eczema de Contacto e Inmunoalergia, Granada, Spain.
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3
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Yang Q, Wang Y, Cao G, Li X, Zhao T. Anti-sepsis effect of Xiaochaihu decoction based on the TLR4/MyD88/NF-κB signalling pathway. Heliyon 2024; 10:e26712. [PMID: 38434364 PMCID: PMC10907734 DOI: 10.1016/j.heliyon.2024.e26712] [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: 04/26/2023] [Revised: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
The aims of this study were to explore the protective effect of Xiaochaihu decoction in mice with sepsis induced by intraperitoneal injection; to explore its anti-inflammatory effect on the TLR4-MyD88-NF-κB signalling pathway; and to explore the main material basis of the anti-inflammatory effect of Xiaochaihu decoction, with the aim of supplementing and expanding the associated research and providing a scientific foundation for the clinical use of the decoction. The effects of Xiaochaihu decoction on septic mice were analysed by measurements of white blood cells (WBC) and Platelets (PLT); Nitric Oxide (NO) level in serum; IL-6, IL-1β and TNF-α levels in serum; RT-PCR; Haematoxylin-Eosin (HE) immunohistochemistry; western blotting (WB). The results showed the excellent in vivo anti-inflammatory effects of Xiaochaihu decoction in LPS-induced septic mice, through down regulation of the gene and protein expression of TLR4, MYD88, TRAF6, IKK, IKBα and p65 and the subsequent reduction in the release of inflammatory mediators IL-6, IL-1β, TNF-α and NO. Moreover, significant anti-septic effect was observed from high and medium doses of Xiaochaihu decoction, but not from the low dose.
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Affiliation(s)
- Qingxin Yang
- Department of Pharmacy, MianYang Orthopaedic Hospital, Mianyang, 621000, PR China
| | - Yulong Wang
- Office of Party and Government Affairs, MianYang Orthopaedic Hospital, Mianyang, 621000, PR China
| | - Gefei Cao
- Office of Party and Government Affairs, MianYang Orthopaedic Hospital, Mianyang, 621000, PR China
| | - Xiaoqing Li
- Pharmaceutical Department, MianYang Hospital of Traditional Chinese Medicine, Mianyang, 621000, PR China
| | - Tinghui Zhao
- Burn and Plastic Surgery, MianYang Central Hospital, Mianyang, 621000, PR China
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Cappello A, Mancini M, Madonna S, Rinaldo S, Paone A, Scarponi C, Belardo A, Zolla L, Zuccotti A, Panatta E, Pallotta S, Annicchiarico-Petruzzelli M, Albanesi C, Cutruzzolà F, Wang L, Jia W, Melino G, Candi E. Extracellular serine empowers epidermal proliferation and psoriasis-like symptoms. SCIENCE ADVANCES 2022; 8:eabm7902. [PMID: 36525488 DOI: 10.1126/sciadv.abm7902] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The contribution of nutrient availability to control epidermal cell proliferation, inflammation, and hyperproliferative diseases remains unknown. Here, we studied extracellular serine and serine/glycine metabolism using human keratinocytes, human skin biopsies, and a mouse model of psoriasis-like disease. We focused on a metabolic enzyme, serine hydroxymethyltransferase (SHMT), that converts serine into glycine and tetrahydrofolate-bound one‑carbon units to support cell growth. We found that keratinocytes are both serine and glycine auxotrophs. Metabolomic profiling and hypoxanthine supplementation indicated that SHMT silencing/inhibition reduced cell growth through purine depletion, leading to nucleotide loss. In addition, topical application of an SHMT inhibitor suppressed both keratinocyte proliferation and inflammation in the imiquimod model and resulted in a decrease in psoriasis-associated gene expression. In conclusion, our study highlights SHMT2 activity and serine/glycine availability as an important metabolic hub controlling both keratinocyte proliferation and inflammatory cell expansion in psoriasis and holds promise for additional approaches to treat skin diseases.
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Affiliation(s)
- Angela Cappello
- Department of Experimental Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
- Istituto Dermopatico dell'Immacolata, IDI-IRCCS, 00167 Rome, Italy
| | - Mara Mancini
- Istituto Dermopatico dell'Immacolata, IDI-IRCCS, 00167 Rome, Italy
| | - Stefania Madonna
- Istituto Dermopatico dell'Immacolata, IDI-IRCCS, 00167 Rome, Italy
| | - Serena Rinaldo
- Department of Biochemical Sciences A.Rossi Fanelli, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessio Paone
- Department of Biochemical Sciences A.Rossi Fanelli, Sapienza University of Rome, 00185 Rome, Italy
| | - Claudia Scarponi
- Istituto Dermopatico dell'Immacolata, IDI-IRCCS, 00167 Rome, Italy
| | - Antonio Belardo
- Agriculture and Forest Sciences (DAFNE), University of Tuscia, 01100 Viterbo, Italy
| | - Lello Zolla
- Agriculture and Forest Sciences (DAFNE), University of Tuscia, 01100 Viterbo, Italy
| | | | - Emanuele Panatta
- Department of Experimental Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
| | | | | | | | - Francesca Cutruzzolà
- Department of Biochemical Sciences A.Rossi Fanelli, Sapienza University of Rome, 00185 Rome, Italy
| | - Lu Wang
- Chinese Medicine and Systems Biology/School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Wei Jia
- Chinese Medicine and Systems Biology/School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Gerry Melino
- Department of Experimental Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Eleonora Candi
- Department of Experimental Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
- Istituto Dermopatico dell'Immacolata, IDI-IRCCS, 00167 Rome, Italy
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5
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Nowicka D, Mertowska P, Mertowski S, Hymos A, Forma A, Michalski A, Morawska I, Hrynkiewicz R, Niedźwiedzka-Rystwej P, Grywalska E. Etiopathogenesis, Diagnosis, and Treatment Strategies for Lymphomatoid Papulosis with Particular Emphasis on the Role of the Immune System. Cells 2022; 11:cells11223697. [PMID: 36429125 PMCID: PMC9688547 DOI: 10.3390/cells11223697] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/04/2022] [Accepted: 11/12/2022] [Indexed: 11/23/2022] Open
Abstract
Lymphomatoid papulosis (LyP) is a very rare disease that belongs to the group of CD30+ lymphoproliferative skin diseases. LyP is localized or generalized and usually presents as isolated or clustered red/brown-red lesions in the form of nodules and/or papules. The course of the disease is in most cases mild; however, depending on concomitant risk factors and history, it may progress to lymphoma, significantly reducing the survival rate and prognosis. Importantly, the clinical picture of the disease remains somewhat ambiguous, leading to a large number of misdiagnoses that result in inappropriate treatment, which is usually insufficient to alleviate symptoms. In addition to clinical manifestations, the histological characteristics vary widely and usually overlap with other conditions, especially those belonging to the group of lymphoproliferative disorders. Although diagnosis remains a challenge, several recommendations and guidelines have been introduced to standardize and facilitate the diagnostic process. This article reviews the available literature on the most important aspects of etiopathogenesis, clinical and histopathological features, diagnostic criteria, and possible treatment strategies for LyP, with particular emphasis on the role of the immune system.
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Affiliation(s)
- Danuta Nowicka
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, 50-368 Wrocław, Poland
| | - Paulina Mertowska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Sebastian Mertowski
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Anna Hymos
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Alicja Forma
- Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Poland
| | - Adam Michalski
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland
| | - Izabela Morawska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland
| | - Rafał Hrynkiewicz
- Institute of Biology, University of Szczecin, 71-412 Szczecin, Poland
| | | | - Ewelina Grywalska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
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6
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Bose S, Madke B. A comprehensive review of immunosuppressive drugs in pediatric dermatoses: Part II – methotrexate and mycophenolate mofetil. INDIAN JOURNAL OF PAEDIATRIC DERMATOLOGY 2022. [DOI: 10.4103/ijpd.ijpd_84_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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7
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An Experimental Study: Benefits of Digoxin on Hepatotoxicity Induced by Methotrexate Treatment. Gastroenterol Res Pract 2021; 2021:6619844. [PMID: 34804155 PMCID: PMC8598353 DOI: 10.1155/2021/6619844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 08/02/2021] [Accepted: 10/19/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose The aim of the study is to examine the possible therapeutic effects of a known cardiac glycoside, digoxin, on a rat model of MTX-induced hepatotoxicity. Methods The study was conducted on twenty-four male rats. While eighteen rats received a single dose of 20 mg/kg MTX to obtain an injured liver model, six rats constituted the control group. Also, the eighteen liver toxicity model created rats were equally divided into two groups, one of which received digoxin 0.1 mg/kg/day digoxin (Group 1) and the other group (Group 2) was given saline (% 0.9NaCl) with a dose of 1 ml/kg/day for ten days. Following the trial, the rats were sacrificed to harvest blood and liver tissue samples to determine blood and tissue MDA, serum ALT, plasma TNF-α, TGF-β, IL-6, IL-1-Beta, and PTX3 levels. Results MTX's structural and functional hepatotoxicity was observable and evidenced by relatively worse histopathological scores and increased biochemical marker levels. Digoxin treatment significantly reduced the liver enzyme ALT, plasma TNF-α, TGF-β, PTX3, and MDA levels and decreased histological changes in the liver tissue with MTX-induced hepatotoxicity in the rat model. Conclusion We suggest that digoxin has an anti-inflammatory and antihepatotoxic effect on the MTX-induced liver injury model.
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8
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Levian B, Chan J, DeLeo VA, Adler BL. Patch Testing and Immunosuppression: a Comprehensive Review. CURRENT DERMATOLOGY REPORTS 2021. [DOI: 10.1007/s13671-021-00346-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Nastro F, Ruggiero A, Spanò G, Cacciapuoti S, Cantelli M, Fabbrocini G, Marasca C. Neoadjuvant use of methotrexate in eosinophilic angiocentric fibrosis of upper lip and hard palate: A case report. Dermatol Ther 2021; 34:e15094. [PMID: 34369069 PMCID: PMC9286048 DOI: 10.1111/dth.15094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Francesca Nastro
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Angelo Ruggiero
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Gustavo Spanò
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Sara Cacciapuoti
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Mariateresa Cantelli
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Claudio Marasca
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
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10
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Burlando M, Herzum A, Cozzani E, Paudice M, Parodi A. Can Methotrexate be a successful treatment for unresponsive generalized annular elastolytic giant cell granuloma? Case report and review of the literature. Dermatol Ther 2020; 34:e14705. [PMID: 33369018 DOI: 10.1111/dth.14705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/06/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022]
Abstract
Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous skin disorder, characterized by erythematous plaques with elevated borders and hypopigmented center, occurring mainly on sun exposed-skin. Histologically it presents with elastophagocytosis and elastolysis. There is no established first line treatment for AEGCG, especially for the generalized form. In a small number of cases, antimalarial drugs and tranilast, associated to topical or oral steroids, have been proposed to treat generalized AEGCG with partial benefits. We herein present the case of a patient with AEGCG aged 74 years, who was unresponsive to classical therapies, and then successfully treated with methotrexate.
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Affiliation(s)
- Martina Burlando
- DISSAL Department of Dermatology, University of Genova Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Astrid Herzum
- DISSAL Department of Dermatology, University of Genova Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Emanuele Cozzani
- DISSAL Department of Dermatology, University of Genova Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Michele Paudice
- Department of Surgical and Diagnostic Sciences, University of Genova, Anatomic Pathology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Aurora Parodi
- DISSAL Department of Dermatology, University of Genova Ospedale Policlinico San Martino IRCCS, Genoa, Italy
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11
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Chen C, Liu YH, Cheng SB, Wu SL, Zhai XJ. The hepatoprotective effects of XCHD and MgIG against methotrexate-induced liver injury and inflammation in rats through suppressing the activation of AIM2 inflammasomes. Pathol Res Pract 2020; 216:152875. [PMID: 32113793 DOI: 10.1016/j.prp.2020.152875] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/17/2020] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent studies have shown that drug-induced liver injury may be related to the immune response activated by drugs. A cytosolic dsDNA inflammasome called absent in melanoma 2 (AIM2) was found to be associated with aseptic inflammation. The present study aimed to explore the effects of on the liver injury and inflammation in methotrexate (Mtx)-induced rats. METHODS Sprague Dawley (SD) rats were selected and classified into 4 groups randomly, includes control group, Mtx group, Mtx-Xiaochaihu decoction (XCHD) group and Mtx-magnesium isoglycyrrhizinate (MgIG) group. Light microscopy was used to examine histological specimens after hematoxylin-eosin (HE) staining. The AST levels in liver tissue and blood serum ALT in the rats were assessed with enzyme linked immunosorbent assay (ELISA). Then AIM2 expression and inflammatory factors, including caspase-1, IL-18, and IL-1β, in the liver biopsy specimens of rats were detected by immunohistochemistry. Furthermore, the correlation between inflammatory and AIM2 expression factors was comprehensively analyzed. RESULTS Functional and structural hepatotoxicity can be caused by the exposure to Mtx, which was supported by the improved biochemical marker levels and the worse histopathological changes in liver tissue. Compared with the Mtx group, the levels of liver enzymes ALT and AST, histological deterioration in the liver tissues were effectively decreased by XCHD and MgIG treatment, respectively. In addition, the expression of AIM2, caspase-1 and IL-1β was observably higher in the Mtx group, which was apparently inhibited in the Mtx-XCHD and Mtx-MgIG groups. There was no obvious change in IL-18 expression among four groups. AIM2 expression were positively associated with the severity of liver inflammation and had a higher relevance with caspase-1 expression. CONCLUSIONS AIM2 inflammasome in hepatocytes has a significant effect on the development of Mtx-induced liver injury, which can be ameliorated by both XCHD and MgIG treatment. The latent mechanism and potential signal pathway require further study.
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Affiliation(s)
- Chen Chen
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yi-Hui Liu
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shu-Biao Cheng
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - San-Lan Wu
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xue-Jia Zhai
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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12
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Mousa HM, Starr CE, Soifer M, Savarain C, Perez VL. Ocular Cicatricial Pemphigoid. CURRENT OPHTHALMOLOGY REPORTS 2020. [DOI: 10.1007/s40135-020-00226-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Use of methotrexate in an exuberant case of confluent and reticulated papillomatosis of Gougerot and Carteaud in a teenager. An Bras Dermatol 2019; 94:717-720. [PMID: 31789249 PMCID: PMC6939189 DOI: 10.1016/j.abd.2018.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/10/2018] [Indexed: 11/21/2022] Open
Abstract
Confluent and reticulated papillomatosis of Gougerot and Carteaud is a rare dermatosis with onset during puberty, more prevalent in females than in males. The pathogenesis is unknown, but some theories suggest either a keratinization or endocrine disorder. The lesions are verrucous, brownish, hyperkeratotic papules or spots that coalesce in a confluent and/or reticulated pattern. This report presents a case with extensive cutaneous involvement associated with acanthosis nigricans and good response to treatment with methotrexate.
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14
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Wollina U, Tirant M, Vojvodic A, Lotti T. Treatment of Psoriasis: Novel Approaches to Topical Delivery. Open Access Maced J Med Sci 2019; 7:3018-3025. [PMID: 31850114 PMCID: PMC6910788 DOI: 10.3889/oamjms.2019.414] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 07/04/2019] [Accepted: 07/15/2019] [Indexed: 12/16/2022] Open
Abstract
Topical treatment is the cornerstone for the management of mild to moderate psoriasis. Despite efforts in drug development, patient's satisfaction with the available topical treatments is limited. A strategy to improve safety, efficacy and comfort of topical treatment provides the development of new drug delivery and drug carrier systems. This review provides an overview of recent advances in this field with a focus on psoriasis. Laser-assisted drug delivery, foam formulations, nanoparticles, ethosomes, and niomes are considered. Hopefully, these new developments will improve topical drug therapy and patient satisfaction.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
| | - Michael Tirant
- Department of Dermatology, University of Rome “G. Marconi”, Rome, Italy
| | | | - Torello Lotti
- Department of Dermatology, University of Rome “G. Marconi”, Rome, Italy
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15
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Nedelcu RI, Balaban M, Turcu G, Brinzea A, Ion DA, Antohe M, Hodorogea A, Calinescu A, Badarau AI, Popp CG, Cioplea M, Nichita L, Popescu S, Diaconu C, Bleotu C, Pirici D, Popescu R, Popescu CM, Zurac SA. Efficacy of methotrexate as anti-inflammatory and anti-proliferative drug in dermatology: Three case reports. Exp Ther Med 2019; 18:905-910. [PMID: 31384322 DOI: 10.3892/etm.2019.7511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/17/2018] [Indexed: 12/27/2022] Open
Abstract
Methotrexate (MTX) is a folic acid analog with anti-proliferative (anti-neoplastic, cytotoxic), immunosuppressive and anti-inflammatory properties, which has been used in the treatment of various cutaneous disorders, such as psoriasis, keratoacanthoma, pityriasis rubra pilaris, atopic dermatitis, mycosis fungoides, bullous skin diseases, systemic sclerosis, morphea, lupus erythematosus, dermatomyositis and crusted scabies. Inhibition of cell proliferation is explained through its role in blocking DNA/RNA synthesis, by inhibiting dihydrofolate reductase, necessary for the production of pyrimidine and purine nucleotides. An anticancer effect can be related to α-oxoaldehyde metabolism (MTX increases methylglyoxal levels). Its anti-inflammatory property is based on the inhibition of 5-aminoimidazole-4-carboxamide ribonucleotide transformylase, thus increasing intracellular and extracellular adenosine, a purine nucleoside with anti-inflammatory effect. This drug can limit inflammation by scavenging free radicals and decreasing malondialdehyde-acetaldehyde protein-adduct production. Moreover, the anti-proliferative and anti-inflammatory effects can also be related to inhibition of the DNA methylation pathway, thus inhibiting methionine formation. The aim of the present study was to report various dermatological cases from our daily practice that demonstrate the efficacy of MTX in the treatment of cutaneous diseases, highlighting different mechanisms of action: its anti-inflammatory effect in psoriasis and its anti-proliferative, and anti-neoplastic effect in well-differentiated squamous cell carcinoma or in keratoacanthoma. Moreover, different administration pathways and doses are addressed. Assessment of the treatment plan, clinical improvement of cutaneous lesions, biologic evaluation, final aesthetic result, quality of life, as well as potential adverse effects and drug tolerance related to each case mentioned.
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Affiliation(s)
- Roxana-Ioana Nedelcu
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Dermatology, Derma 360° Clinic, 011273 Bucharest, Romania
| | - Mihaela Balaban
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Dermatology, Derma 360° Clinic, 011273 Bucharest, Romania
| | - Gabriela Turcu
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Dermatology, Derma 360° Clinic, 011273 Bucharest, Romania.,Department of Ambulatory, National Institute for Infectious Diseases 'Prof. Dr. Matei Balș', 020105 Bucharest, Romania
| | - Alice Brinzea
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Ambulatory, National Institute for Infectious Diseases 'Prof. Dr. Matei Balș', 020105 Bucharest, Romania.,Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Daniela Adriana Ion
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mihaela Antohe
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Dermatology, Derma 360° Clinic, 011273 Bucharest, Romania
| | - Anastasia Hodorogea
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Andreea Calinescu
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Anca Ioana Badarau
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | | | - Mirela Cioplea
- Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Luciana Nichita
- Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Silvia Popescu
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Carmen Diaconu
- Department of Cellular and Molecular Pathology, 'Stefan S. Nicolau' Institute of Virology, 030304 Bucharest, Romania
| | - Coralia Bleotu
- Department of Cellular and Molecular Pathology, 'Stefan S. Nicolau' Institute of Virology, 030304 Bucharest, Romania
| | - Daniel Pirici
- Department of Pathology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Raluca Popescu
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Catalin Mihai Popescu
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Sabina Andrada Zurac
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
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16
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Airborne Allergic Contact Dermatitis: Management and Responsible Allergens on the American Contact Dermatitis Society Core Series. Dermatitis 2019; 30:106-115. [DOI: 10.1097/der.0000000000000439] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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17
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Rostang A, Mosca M, Jeannin M, Luissiez C, Berny P, Fourel I, Pin D, Prouillac C. Pharmacokinetics of low-dose methotrexate in healthy beagle dogs. J Vet Pharmacol Ther 2018; 41:659-669. [DOI: 10.1111/jvp.12673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/23/2018] [Accepted: 05/08/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Antoine Rostang
- Interaction Cellule Environnement; Unité Pharmacologie et Toxicologie; VetAgro Sup-Campus Vétérinaire de Lyon; Marcy l’Etoile France
| | - Marion Mosca
- Interaction Cellule Environnement; Unité Dermatologique; VetAgro Sup-Campus Vétérinaire de Lyon; Marcy l’Etoile France
| | - Morgan Jeannin
- Interaction Cellule Environnement; Unité Pharmacologie et Toxicologie; VetAgro Sup-Campus Vétérinaire de Lyon; Marcy l’Etoile France
| | - Coralie Luissiez
- Interaction Cellule Environnement; Unité Pharmacologie et Toxicologie; VetAgro Sup-Campus Vétérinaire de Lyon; Marcy l’Etoile France
| | - Philippe Berny
- Interaction Cellule Environnement; Unité Pharmacologie et Toxicologie; VetAgro Sup-Campus Vétérinaire de Lyon; Marcy l’Etoile France
| | - Isabelle Fourel
- USC 1233 RS2GP; INRA; VetAgro Sup; Université Lyon; Marcy l’Etoile France
| | - Didier Pin
- Interaction Cellule Environnement; Unité Dermatologique; VetAgro Sup-Campus Vétérinaire de Lyon; Marcy l’Etoile France
| | - Caroline Prouillac
- Interaction Cellule Environnement; Unité Pharmacologie et Toxicologie; VetAgro Sup-Campus Vétérinaire de Lyon; Marcy l’Etoile France
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18
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Naka F, Strober BE. Methotrexate treatment of generalized granuloma annulare: a retrospective case series. J DERMATOL TREAT 2018; 29:720-724. [DOI: 10.1080/09546634.2018.1447075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Fludiona Naka
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Bruce E. Strober
- UConn Health Department of Dermatology, Farmington, CT, USA
- Probity Medical Research, Waterloo, Canada
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Abstract
Neurotoxicity and cognitive effects of low-dose methotrexate for rheumatologic disease have often been described, but the neuropsychiatric effects of low-dose methotrexate for cutaneous disease have been underreported in the dermatology literature. We describe two children who experienced mood changes with methotrexate treatment for lichen sclerosus with morphea overlap and psoriasis, with rapid resolution of these symptoms after methotrexate cessation. We also detail possible mechanisms underlying psychiatric changes with methotrexate therapy.
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Affiliation(s)
- Trisha Bhat
- School of Medicine, Washington University, St. Louis, MO, USA
| | - Carrie C Coughlin
- Departments of Medicine and Pediatrics, Division of Dermatology, School of Medicine, Washington University, St. Louis, MO, USA
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20
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Leis-Dosil V, Prats-Caelles I. Practical Management of Immunosuppressants in Dermatology. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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21
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Leis-Dosil VM, Prats-Caelles I. Practical Management of Immunosuppressants in Dermatology. ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:24-34. [PMID: 28964393 DOI: 10.1016/j.ad.2017.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/24/2017] [Accepted: 05/14/2017] [Indexed: 12/17/2022] Open
Abstract
The treatment of inflammatory and autoimmune diseases is challenging because of their frequency and complexity. Treatment of these diseases is based on the suppression of the patient's immune system using corticosteroids, corticosteroid-sparing immunosuppressive agents, and biologic drugs, making an understanding of the management of immunosuppressive therapy essential. Before an immunosuppressive agent is prescribed, a study must be carried out to identify contraindications, detect latent infections, and determine the most appropriate dose. During treatment, regular monitoring is required to detect adverse effects. The clinician must be familiar with the time lag between start of treatment and onset of the immunosuppressive effect as well as the maximum recommended duration of treatment and cumulative dose for each drug. As dermatologists we are accustomed to using these immunosuppressive agents, but we should have a good knowledge of the guidelines for their use and the monitoring required in each case if we are to reduce variability and avoid potentially serious adverse effects.
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Affiliation(s)
- V M Leis-Dosil
- Sección de Dermatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España.
| | - I Prats-Caelles
- Sección de Dermatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
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22
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Haber R, Baroudjian B, Battistella M, Bagot M, Petit A. [Apparent worsening of psoriasis lesions revealing methotrexate overdosage]. Ann Dermatol Venereol 2017; 145:104-108. [PMID: 28917574 DOI: 10.1016/j.annder.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/04/2017] [Accepted: 07/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Methotrexate (MTX) is an antimetabolite drug used in the treatment of cancers and autoimmune diseases and frequently in dermatology for cutaneous and/or arthritic psoriasis. Toxicities due to MTX overdosage are mainly cutaneous, hepatic and hematologic. Herein, we report a case of MTX overdosage presenting as an erosive and an inflammatory flare of preexisting psoriatic plaques and with new palmar lesions. PATIENTS AND METHODS A 51-year-old male with a 6-year history of plaque psoriasis resistant to topical corticosteroids was started for the first time on MTX 20mg weekly. One week later, he presented with fever, general weakness and mucocutaneous ulcerations. Physical examination revealed inflammatory, erythematous and partially erosive annular plaques strictly confined to preexisting psoriatic lesions, along with keratotic psoriatic palmar plaques. Further questioning indicated that the patient was taking MTX 20mg daily. Investigations revealed neutropenia (1040/mm3) and skin histology showed prominent dystrophic keratinocytes and confirmed the diagnosis of methotrexate toxicity. Clinical and biological improvements were observed after cessation of MTX and treatment with folinic acid, IV hydration and urine alkalization. DISCUSSION Skin lesions due to acute MTX toxicity are rare, but they herald later-onset pancytopenia. Identification of these cutaneous lesions might enable earlier treatment initiation. The predilection of MTX toxicity for preexisting lesions or the de novo appearance of palmoplantar pustules should not lead to the erroneous diagnosis of psoriasis flare.
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Affiliation(s)
- R Haber
- Service de dermatologie, St George Hospital University Medical Center, Beirut, Liban.
| | - B Baroudjian
- Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - M Battistella
- Service de pathologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - M Bagot
- Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - A Petit
- Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
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Evaluation of ototoxicity of intratympanic administration of Methotrexate in rats. Int J Pediatr Otorhinolaryngol 2017; 100:132-136. [PMID: 28802357 DOI: 10.1016/j.ijporl.2017.06.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/25/2017] [Accepted: 06/30/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Methotrexate is a dihydrofolate reductase enzyme inhibitor with very high selectivity, and it is an antiproliferative folic acid antagonist used for the treatment of autoimmune diseases. In this study, our objective was to evaluate the effect of intratympanic Methotrexate application in the inner ear. METHODS This study was planned as an animal study. This study performed in a tertiary referral center. 24 healthy female rats were used in our study. They were separated into three groups. 0.2 cc intratympanic saline was applied to both ears of Group 1. Paracentesis was applied to the tympanic membrane in both ears of Group 2. 0.2 cc intratympanic Methotrexate was applied to both ears of Group 3. At the beginning of the study, Distortion-product otoacoustic emissions (DPOAE) and Auditory brainstem response (ABR) of all rats were measured and then again on the 5th, 10th and 15th day. Histologic examinations of all groups were compared. RESULTS There was not any significant difference between basal DPOAE and ABR measurement values of the groups and the results were measured again on the 5th, 10th and 15th day (p > 0.05). There was no difference between the groups in terms of histology. CONCLUSION The intratympanic Methotrexate injection does not have any ototoxic effect on inner ear. We assume that intratympanic Methotrexate could be used safely on inner ear diseases in which steroid treatment is contraindicated or not effective.
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Antifibrotic Effect of Lactulose on a Methotrexate-Induced Liver Injury Model. Gastroenterol Res Pract 2017; 2017:7942531. [PMID: 28912805 PMCID: PMC5585605 DOI: 10.1155/2017/7942531] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 07/25/2017] [Indexed: 12/13/2022] Open
Abstract
The most severe side effect of prolonged MTX treatment is hepatotoxicity. The aim of this study is to investigate the effect of lactulose treatment on MTX-induced hepatotoxicity in a rat model. Twenty-four male rats were included in the study. Sixteen rats were given a single dose of 20 mg/kg MTX to induce liver injury. Eight rats were given no drugs. 16 MTX-given rats were divided into two equal groups. Group 1 subjects were given lactulose 5 g/kg/day, and group 2 subjects were given saline 1 ml/kg/day for 10 days. The rats were then sacrificed to harvest blood and liver tissue samples in order to determine blood and tissue MDA, serum ALT, plasma TNF-α, TGF-β, and PTX3 levels. Histological specimens were examined via light microscopy. Exposure to MTX caused structural and functional hepatotoxicity, as evidenced by relatively worse histopathological scores and increased biochemical marker levels. Lactulose treatment significantly reduced the liver enzyme ALT, plasma TNF-α, TGF-β, PTX3, and MDA levels and also decreased histological changes in the liver tissue with MTX-induced hepatotoxicity in the rat model. We suggest that lactulose has anti-inflammatory and antifibrotic effects on an MTX-induced liver injury model. These effects can be due to the impact of intestinal microbiome.
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Abstract
Therapy of severe atopic dermatitis, which is refractory to consistent treatment with topical steroids and topical calcineurin inhibitors is still a problem in many cases. The use of cyclosporine, which is the only approved systemic drug for the therapy of severe atopic dermatitis, is often limited by contraindications or adverse reactions. In this context, results from controlled and open-label studies with novel therapeutic approaches such as methotrexate, omalizumab or rituximab, which are in part very promising, are of great interest. In this work we would like to provide an overview of established and new therapeutic options for the treatment of severe atopic dermatitis.
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Adenosine A2A and A2B Receptors Differentially Modulate Keratinocyte Proliferation: Possible Deregulation in Psoriatic Epidermis. J Invest Dermatol 2017; 137:123-131. [DOI: 10.1016/j.jid.2016.07.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/04/2016] [Accepted: 07/11/2016] [Indexed: 12/13/2022]
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27
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Can pretreatment serum calcium level predict the efficacy of methotrexate in the treatment of severe plaque psoriasis? J Am Acad Dermatol 2015; 73:991-7.e3. [PMID: 26416303 DOI: 10.1016/j.jaad.2015.08.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 08/10/2015] [Accepted: 08/15/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND The efficacy of methotrexate (MTX) varies in the treatment of psoriasis. OBJECTIVE We sought to identify an indicator from routine pretreatment tests to predict MTX efficacy in the treatment of psoriasis. METHODS In a retrospective analysis of 77 psoriatic patients, the correlation between MTX efficacy and pretreatment routine test results was analyzed with Spearman correlation. The potential risks were further evaluated with a linear regression model. Receiver operating characteristic analysis was performed to examine the effectiveness of serum total calcium (tCa) to predict the effect of MTX on psoriasis. The highest Youden index was used to determine the cutoff point, with which the positive and negative predictive values were calculated. Synergistic effects of MTX and calcium on keratinocyte growth and psoriasis-like mouse model were also investigated. RESULTS The pretreatment tCa level exhibited the closest association with MTX efficacy. The relative psoriasis improvement with tCa was 61.07% (95% confidence interval, 42.85-79.29; P < .001) and better improvements were observed in patients with higher tCa (r = 0.588; P < .002). MTX inhibited keratinocyte growth, which was enhanced synergistically by calcium. In a psoriasis-like mouse model, MTX strongly inhibited epidermis proliferation in the high-calcium group. LIMITATIONS One limitation of our study is the relatively small sample size. CONCLUSION Pretreatment tCa level has the highest correlation with MTX efficacy, which might be useful in predicting beneficial treatment results in psoriasis. Larger studies are required to confirm our findings.
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28
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Yélamos O, Català A, Vilarrasa E, Roé E, Puig L. Acute Severe Methotrexate Toxicity in Patients with Psoriasis: A Case Series and Discussion. Dermatology 2014; 229:306-9. [DOI: 10.1159/000366501] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 08/04/2014] [Indexed: 11/19/2022] Open
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30
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Spring P, Gschwind I, Gilliet M. Prurigo nodularis: retrospective study of 13 cases managed with methotrexate. Clin Exp Dermatol 2014; 39:468-73. [DOI: 10.1111/ced.12365] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 11/28/2022]
Affiliation(s)
- P. Spring
- Dermatology Clinic; Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
| | - I. Gschwind
- Dermatology Clinic; Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
| | - M. Gilliet
- Dermatology Clinic; Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
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31
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Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, Sheikh J, Weldon D, Zuraw B, Bernstein DI, Blessing-Moore J, Cox L, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CR, Schuller DE, Spector SL, Tilles SA, Wallace D. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol 2014; 133:1270-7. [DOI: 10.1016/j.jaci.2014.02.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 02/10/2014] [Accepted: 02/12/2014] [Indexed: 12/13/2022]
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32
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Sako EY, Famenini S, Wu JJ. Bullous drug eruption in a patient with psoriasis after a test dose of methotrexate. J Am Acad Dermatol 2013; 69:e264-e265. [DOI: 10.1016/j.jaad.2013.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 07/09/2013] [Accepted: 07/10/2013] [Indexed: 11/28/2022]
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Marques C, Teixeira D, Cunha A, Meireles M, Pestana D, Keating E, Calhau C, Monteiro R, Faria A. Methotrexate enhances 3T3-L1 adipocytes hypertrophy. Cell Biol Toxicol 2013; 29:293-302. [PMID: 23955089 DOI: 10.1007/s10565-013-9255-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/05/2013] [Indexed: 11/26/2022]
Abstract
Methotrexate (MTX) is broadly used in the treatment of chronic inflammatory diseases such as rheumatoid arthritis (RA). The prevalence of metabolic syndrome (MeS) in patients with this condition is relatively high. Given the importance of adipose tissue in the development of obesity metabolic complications, this study aimed to investigate the effect of methotrexate on preadipocyte proliferation, adipogenesis, and glucose uptake by adipocytes. 3T3-L1 preadipocytes proliferation was evaluated by sulforhodamine B staining and (3)H-thymidine incorporation, after 24 or 48 h of treatment with MTX (0.1 and 10 μM). Preadipocytes were induced to differentiate with an appropriate adipogenic cocktail in the presence or absence of MTX. Adipogenesis was determined by measuring lipid accumulation after staining with oil red O. (3)H-Deoxyglucose ((3)H-DG) uptake was determined by liquid scintillation counting. MTX treatment reduced culture protein content in a concentration-dependent manner and (3)H-thymidine incorporation (P < 0.05). MTX (0.1 μM) treatment increased lipid accumulation and basal (3)H-DG uptake by adipocytes (P < 0.05). In 0.1 μM MTX-treated adipocytes, insulin stimulation did not result in an increase of (3)H-DG uptake, contrarily to what was observed in control cells. These results demonstrate that methotrexate interferes with adipocyte proliferation and promotes the hypertrophic growth of adipocytes. These molecular effects may have implications on metabolic profile of RA patients treated with MTX.
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Affiliation(s)
- Cláudia Marques
- Departamento de Bioquímica (U38-FCT), Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Oporto, Portugal.
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Thornsberry LA, English JC. Etiology, diagnosis, and therapeutic management of granuloma annulare: an update. Am J Clin Dermatol 2013; 14:279-90. [PMID: 23696233 DOI: 10.1007/s40257-013-0029-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Granuloma annulare (GA) is a common cutaneous disorder classically presenting as annular groups of skin-colored to erythematous papules without epidermal change localized to the dorsal hands and/or feet. In addition to the localized form, there are variants including generalized (including generalized annular GA, disseminated papular GA, and atypical generalized GA), subcutaneous, and perforating GA, providing for a wide spectrum of clinical lesions. The etiology of GA remains unknown and several systemic associations have been proposed but not proven, including diabetes mellitus, malignancy, thyroid disease, and dyslipidemia. The diagnosis of GA relies on clinicopathological correlation, with a skin biopsy confirming the histological features of the disease, including palisading granulomas, collagen degeneration, mucin, and a lymphohistiocytic infiltrate. Localized GA is often asymptomatic and self-limited within 2 years; however, the patient may desire treatment for cosmetic reasons, with topical and intralesional corticosteroids as the mainstays of therapy. When GA is generalized, disseminated, or atypical, a more thorough medical workup for underlying diseases may be considered depending on the physical examination, a thorough review of systems, comorbidities, and clinical suspicion. Treatment is often challenging for generalized GA, especially because of its recalcitrant nature and a lack of evidence-based therapy. Over 30 different treatments have been described for GA with variable results; however, the majority of these have been single case reports, small case series, or retrospective studies. Reported treatments for GA include topical, intralesional, intramuscular, and oral medications (steroidal vs. non-steroidal); biologic agents; surgical interventions; phototherapy; and laser treatments. When selecting a systemic therapy for a patient with GA, multiple variables must be considered, such as baseline blood evaluations, comorbidities, drug interactions, compliance, adverse effect profiles, prior treatments, and reproductive status. This evidence-based review will focus on the advances made in the twenty-first century regarding the etiology, diagnosis, and therapeutic management of GA.
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Affiliation(s)
- Laura A Thornsberry
- Department of Dermatology, University of Pittsburgh, 200 Lothrop St., Presby South Tower Suite 3880, Pittsburgh, PA 15213, USA
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35
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Cutaneous dermatomyositis: an updated review of treatment options and internal associations. Am J Clin Dermatol 2013; 14:291-313. [PMID: 23754636 DOI: 10.1007/s40257-013-0028-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Dermatomyositis is a specific type of inflammatory myopathy with characteristic cutaneous findings. Patients may have skin disease without clinically apparent muscle disease, but this disorder is best thought of as a systemic process. Therefore, all patients with dermatomyositis skin lesions need appropriate evaluation for muscle disease, esophageal dysfunction, cardiopulmonary disease, and potential internal malignancy. There are many therapies that have been used for patients with dermatomyositis, but most are based upon case series or expert opinion rather than meta-analyses or randomized, placebo-controlled trials. Even those therapies that have been subjected to randomized, blinded, placebo-controlled trials include a mixture of patients with idiopathic inflammatory myopathy and do not utilize a validated assessment tool for measuring cutaneous disease responses. In this review, we discuss the therapies available as well as the internal associations with dermatomyositis.
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36
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Venning V, Taghipour K, Mohd Mustapa M, Highet A, Kirtschig G, Hughes J, McLelland J, McDonagh A, Punjabi S, Buckley D, Nasr I, Swale V, Duarte Williams C, McHenry P, Wagle S, Amin S, Davis R, Haveron S. British Association of Dermatologists’ guidelines for the management of bullous pemphigoid 2012. Br J Dermatol 2012; 167:1200-14. [DOI: 10.1111/bjd.12072] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- V.A. Venning
- Department of Dermatology, Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ, U.K
| | - K. Taghipour
- Department of Dermatology, Whittington Hospital, Magdala Avenue, London N19 5NF, U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London W1T 5HQ, U.K
| | - A.S. Highet
- York Hospital, Wigginton Road, York YO31 8HE, U.K
| | - G. Kirtschig
- Vrije Universtiteit, PO Box 7057, Amsterdam NL‐1007 MB, the Netherlands
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Abstract
Cutaneous lupus erythematosus is a heterogeneous autoimmune condition that can significantly impact quality of life. Treatment is focused on reducing clinical inflammation and preventing scarring. The choice of treatment should be guided based on the severity of disease. Mild or localized disease can be treated with sun protection and topical agents. Antimalarials are the initial treatment of choice if systemic therapy is required. Patients with severe or unresponsive disease can also be treated with a number of other immunomodulating or immunosuppressive agents. Clinicians should be aware of their potential adverse effects and appropriate dosing.
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Affiliation(s)
- Christopher B Hansen
- Department of Dermatology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
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38
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Abstract
Atopic eczema, also known as atopic dermatitis, is a frequent, highly pruritic, chronic skin disease, which is typically running in flares. The traditional treatment mainly consists of the reactive application of topical anti-inflammatory agents such as topical corticosteroids and topical calcineurin inhibitors. The short term benefit of this approach is well known, but long term remission between flares is difficult to achieve. Therefore, innovative long-term treatment strategies targeting flare prevention and skin barrier stabilization are needed. We and others have shown that normal looking, non-lesional skin of atopic dermatitis patients is immunobiologially not normal but characterized by an invisible inflammation and barrier defect. This has led to the novel concept of proactive therapy, which is defined as long-term, low-dose intermittent application of anti-inflammatory therapy to the previously affected skin, together with an ongoing emollient treatment of unaffected skin. This review article describes the most important long-term treatment options for atopic dermatitis, which includes emollient therapy, the novel concept of proactive treatment, the different ultraviolet light modalities and a selection of systemic immunosuppressive drugs and biologics. Current trial data, licensed indications, off-label use and relevant side effects of the different treatment modalities are summarized.
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Affiliation(s)
- Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany
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39
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Affiliation(s)
- Christina Lam
- Department of Dermatology; Brigham and Women's Hospital; Boston; Massachusetts
| | - Ruth Ann Vleugels
- Department of Dermatology; Brigham and Women's Hospital; Boston; Massachusetts
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40
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Kim HJ, Kim SY, Yi SM, Kim JH, Kim IH. Acute Vesico-Bullous Eruption from Methotrexate Overdose in a Psoriasis Patient. Ann Dermatol 2012; 24:107-8. [PMID: 22363170 PMCID: PMC3283841 DOI: 10.5021/ad.2012.24.1.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 05/11/2011] [Accepted: 05/16/2011] [Indexed: 11/25/2022] Open
Affiliation(s)
- Hee Joo Kim
- Department of Dermatology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, Korea
| | - Sun Yae Kim
- Department of Dermatology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, Korea
| | - Sang Min Yi
- Department of Dermatology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, Korea
| | - Jae Hwan Kim
- Department of Dermatology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, Korea
| | - Il-Hwan Kim
- Department of Dermatology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, Korea
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Shen S, O’Brien T, Yap LM, Prince HM, McCormack CJ. The use of methotrexate in dermatology: a review. Australas J Dermatol 2011; 53:1-18. [DOI: 10.1111/j.1440-0960.2011.00839.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Kuhn A, Ruland V, Bonsmann G. Cutaneous lupus erythematosus: Update of therapeutic options. J Am Acad Dermatol 2011; 65:e195-213. [DOI: 10.1016/j.jaad.2010.06.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 05/28/2010] [Accepted: 06/04/2010] [Indexed: 12/23/2022]
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Plotner A, Mutasim D. Successful treatment of disseminated granuloma annulare with methotrexate. Br J Dermatol 2010; 163:1123-4. [DOI: 10.1111/j.1365-2133.2010.09923.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wee JS, White JML, McFadden JP, White IR. Patch testing in patients treated with systemic immunosuppression and cytokine inhibitors. Contact Dermatitis 2010; 62:165-9. [DOI: 10.1111/j.1600-0536.2009.01695.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gürcan H, Razzaque Ahmed A. Analysis of current data on the use of methotrexate in the treatment of pemphigus and pemphigoid. Br J Dermatol 2009; 161:723-31. [DOI: 10.1111/j.1365-2133.2009.09246.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Strober B, Berger E, Cather J, Cohen D, Crowley JJ, Gordon KB, Gottlieb A, Horn EJ, Kavanaugh AF, Korman NJ, Krueger GG, Leonardi CL, Menter A, Schwartzman S, Sobell JM, Young M. A series of critically challenging case scenarios in moderate to severe psoriasis: A Delphi consensus approach. J Am Acad Dermatol 2009; 61:S1-S46. [DOI: 10.1016/j.jaad.2009.03.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 03/10/2009] [Accepted: 03/16/2009] [Indexed: 12/27/2022]
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47
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Kalb RE, Strober B, Weinstein G, Lebwohl M. Methotrexate and psoriasis: 2009 National Psoriasis Foundation Consensus Conference. J Am Acad Dermatol 2009; 60:824-37. [PMID: 19389524 DOI: 10.1016/j.jaad.2008.11.906] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 11/17/2008] [Accepted: 11/19/2008] [Indexed: 12/14/2022]
Abstract
BACKGROUND Methotrexate remains a valuable option for the treatment of psoriasis. This report will summarize studies regarding the use of methotrexate since the last guidelines were published in 1998. OBJECTIVE A task force of the National Psoriasis Foundation Medical Board was convened to evaluate treatment options. Our aim was to achieve a consensus on new updated guidelines for the use of methotrexate in the treatment of psoriasis. METHODS Reports in the literature were reviewed regarding methotrexate therapy. RESULTS A consensus was achieved on use of methotrexate in psoriasis including specific recommendations on dosing and monitoring. The consensus received unanimous approval from members of the Medical Board of the National Psoriasis Foundation. LIMITATIONS There are few evidence-based studies on the treatment of psoriasis with methotrexate. Many of the reviewed reports are for the treatment of rheumatoid arthritis. CONCLUSIONS Methotrexate is a safe and effective drug for the treatment of psoriasis. Appropriate patient selection and monitoring will significantly decrease the risks of side effects. In patients without risk factors for hepatic fibrosis, liver biopsies may not be indicated or the frequency of liver biopsies may be markedly reduced.
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Affiliation(s)
- Robert E Kalb
- Department of Dermatology: State University of New York at Buffalo, School of Medicine and Biomedical Science, Buffalo, New York, USA
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Bilaç C, Türel Ermertcan A, Öztürkcan S, Şahin MT, Öztürk F, Bayraktar Bilaç D, İşisaǧ A. Psoriatic plaque erosion: a rare side effect of methotrexate. J Eur Acad Dermatol Venereol 2009; 23:335-6. [DOI: 10.1111/j.1468-3083.2008.02855.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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50
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BuBmann C, Bieber T, Novak N. Systemic therapeutic options for severe atopic dermatitis. J Dtsch Dermatol Ges 2008; 7:205-19. [PMID: 18759739 DOI: 10.1111/j.1610-0387.2008.06834.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Systemic therapy of severe atopic dermatitis (AD) is difficult in some cases, because the use of immunosuppressive agents such as cyclosporine A, mofetil mycophenolate, tacrolimus, and azathioprine is limited by adverse reactions or contraindications. Recent reports suggest a helpful role for biologics, methotrexate, anti-IgE antibodies, and immunotherapy. We review the modes of action, as well as advantages and disadvantages of current and new systemic therapeutic options for severe AD.
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Affiliation(s)
- Caroline BuBmann
- Clinic and Polyclinic for Dermatology and Allergology, University of Bonn, Germany
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