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Mähönen K, Keskitalo S, Salokas K, Tuhkala A, Panelius J, Ranki A, Varjosalo M. Mass spectrometry -based proteomic analysis of the skin of patients with localized scleroderma. J Dermatol Sci 2024; 113:148-150. [PMID: 38350786 DOI: 10.1016/j.jdermsci.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/09/2024] [Accepted: 01/22/2024] [Indexed: 02/15/2024]
Affiliation(s)
- Katariina Mähönen
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Hospital, Finland.
| | | | - Kari Salokas
- Institute of Biotechnology, University of Helsinki, Finland
| | - Antti Tuhkala
- Institute of Biotechnology, University of Helsinki, Finland
| | - Jaana Panelius
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Hospital, Finland
| | - Annamari Ranki
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Hospital, Finland
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2
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Wu S, Li J, Zhang W, Yan Z. Morphea: an unusual case affecting lip and alveolar bone. Int J Dermatol 2023; 62:e623-e625. [PMID: 37694714 DOI: 10.1111/ijd.16840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/19/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Shuangshuang Wu
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Jin Li
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Department of Stomatology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Wenqing Zhang
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Department of Pediatric Dentistry, The Affiliated Stomatology Hospital of Xuzhou Medical University, Xuzhou, PR China
| | - Zhimin Yan
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
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3
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Marathe M, Borkar S. Limited Cutaneous Scleroderma: A Case Report. Cureus 2023; 15:e45336. [PMID: 37849593 PMCID: PMC10577515 DOI: 10.7759/cureus.45336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/16/2023] [Indexed: 10/19/2023] Open
Abstract
Scleroderma is an uncommon disease that affects the connective tissue, causing skin hardening and sometimes organ damage. There are two main forms of scleroderma: localised scleroderma, or morphea, which usually has a mild and limited course and only affects the skin and/or the tissues below it, and systemic sclerosis, which involves skin hardening and internal organ problems. The cause of localised scleroderma is unknown. Recent studies suggest that this form can have different levels of severity and can affect some organs. To avoid complications due to the high morbidity of localised scleroderma, early treatment is recommended. In this article, we present the main aspects and details of the management of patients with localised scleroderma.
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Affiliation(s)
- Manvi Marathe
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shweta Borkar
- Internal Medicine, Datta Meghe Medical College, Nagpur, IND
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4
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Zhu JL, Paniagua RT, Chen HW, Florez-Pollack S, Kunzler E, Teske N, Rainwater YB, Li QZ, Hosler GA, Li W, Ramirez DMO, Monson NL, Jacobe HT. Autoantigen microarrays reveal myelin basic protein autoantibodies in morphea. J Transl Med 2022; 20:41. [PMID: 35073943 PMCID: PMC8785566 DOI: 10.1186/s12967-022-03246-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Morphea is an autoimmune, sclerosing skin disorder. Despite the recent emphasis on immune dysregulation in morphea, the role of autoantibodies in morphea pathogenesis or utility as biomarkers are poorly defined. METHODS Autoantigen microarray was used to profile autoantibodies from the serum of participants from the Morphea in Adults and Children (MAC) cohort. Clinical and demographic features of morphea patients with myelin basic protein (MBP) autoantibodies were compared to those without. MBP immunohistochemistry staining was subsequently performed in morphea skin to assess for perineural inflammation in areas of staining. Immunofluorescence staining on mouse brain tissue was also performed using patient sera and mouse anti-myelin basic protein antibody to confirm the presence of MBP antibodies in patient sera. RESULTS Myelin basic protein autoantibodies were found in greater frequency in morphea (n = 50, 71.4%) compared to systemic sclerosis (n = 2, 6.7%) and healthy controls (n = 7, 20%). Patients with MBP antibodies reported pain at higher frequencies. Morphea skin biopsies, highlighted by immunohistochemistry, demonstrated increased perineural inflammation in areas of MBP expression. Immunofluorescence staining revealed an increased fluorescence signal in myelinated areas of mouse brain tissue (i.e. axons) when incubated with sera from MBP antibody-positive morphea patients compared to sera from MBP antibody-negative morphea patients. Epitope mapping revealed target epitopes for MBP autoantibodies in morphea are distinct from those reported in MS, and included fragments 11-30, 41-60, 51-70, and 91-110. CONCLUSIONS A molecular classification of morphea based on distinct autoantibody biosignatures may be used to differentially classify morphea. We have identified anti-MBP as a potential antibody associated with morphea due to its increased expression in morphea compared to healthy controls and systemic sclerosis patients.
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Affiliation(s)
- Jane L Zhu
- Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9069, USA
| | - Ricardo T Paniagua
- Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9069, USA
| | - Henry W Chen
- Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9069, USA
| | - Stephanie Florez-Pollack
- Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9069, USA
| | - Elaine Kunzler
- Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9069, USA
| | - Noelle Teske
- Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9069, USA
| | - Yevgeniya Byekova Rainwater
- Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9069, USA
- ProPath, Dallas, TX, USA
| | - Quan-Zhen Li
- Department of Immunology and Microarray Core Facility, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gregory A Hosler
- Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9069, USA
- ProPath, Dallas, TX, USA
| | - Wenhao Li
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Denise M O Ramirez
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nancy L Monson
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Heidi T Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9069, USA.
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Arndt S, Unger P, Bosserhoff AK, Berneburg M, Karrer S. The Anti-Fibrotic Effect of Cold Atmospheric Plasma on Localized Scleroderma In Vitro and In Vivo. Biomedicines 2021; 9:biomedicines9111545. [PMID: 34829774 PMCID: PMC8615017 DOI: 10.3390/biomedicines9111545] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/22/2021] [Accepted: 10/24/2021] [Indexed: 02/06/2023] Open
Abstract
Cold Atmospheric Plasma (CAP) has shown promising results in the treatment of various skin diseases. The therapeutic effect of CAP on localized scleroderma (LS), however, has not yet been evaluated. We investigated the effects of CAP on LS by comparing human normal fibroblasts (hNF), human TGF-β-activated fibroblasts (hAF), and human localized scleroderma-derived fibroblasts (hLSF) after direct CAP treatment, co-cultured with plasma-treated human epidermal keratinocytes (hEK) and with an experimental murine model of scleroderma. In hAF and hLSF, 2 min CAP treatment with the MicroPlaSterβ® plasma torch did not affect pro-fibrotic gene expression of alpha smooth muscle actin, fibroblast activating protein, and collagen type I, however, it promoted re-expression of matrix metalloproteinase 1. Functionally, CAP treatment reduced cell migration and stress fiber formation in hAF and hLSF. The relevance of CAP treatment was confirmed in an in vivo model of bleomycin-induced dermal fibrosis. In this model, CAP-treated mice showed significantly reduced dermal thickness and collagen deposition as well as a decrease in both alpha smooth muscle actin-positive myofibroblasts and CD68-positive macrophages in the affected skin in comparison to untreated fibrotic tissue. In conclusion, this study provides the first evidence for the successful use of CAP for treating LS and may be the basis for clinical trials including patients with LS.
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Affiliation(s)
- Stephanie Arndt
- Department of Dermatology, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany; (P.U.); (M.B.); (S.K.)
- Correspondence: ; Tel.: +49-941-944-9650
| | - Petra Unger
- Department of Dermatology, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany; (P.U.); (M.B.); (S.K.)
| | - Anja-Katrin Bosserhoff
- Institute of Biochemistry, University of Erlangen-Nuernberg (FAU), 91054 Erlangen, Germany;
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - Mark Berneburg
- Department of Dermatology, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany; (P.U.); (M.B.); (S.K.)
| | - Sigrid Karrer
- Department of Dermatology, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany; (P.U.); (M.B.); (S.K.)
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6
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Menkü Özdemir FD, Üstün GG, Vargel İ, Özgür FF. "Treatment of En Coup de Sabre Deformity with Fat Grafting and Demineralized Bone Matrix: A Case Series". J Plast Reconstr Aesthet Surg 2021; 74:3353-3360. [PMID: 34417126 DOI: 10.1016/j.bjps.2021.05.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/28/2021] [Accepted: 05/27/2021] [Indexed: 11/30/2022]
Abstract
En coup de sabre deformity (ECDS) is a form of localized scleroderma in the frontoparietal region caused by progressive subcutaneous tissue atrophy and bony defect. Although ECDS involves two layers, skin/subcutaneous tissue and bone, the existing literature mainly focuses only on treating the skin/subcutaneous tissue layer. In this case series, we aimed to propose a novel approach that includes the combined use of fat grafting and demineralized bone matrix (DBM). Four patients with ECDS deformity, operated between February 2016 and October 2018, were retrospectively evaluated. All the patients were treated with the novel approach. Patients were evaluated with localized scleroderma scale and computed tomography (CT) scan in the preoperative period and at the annual follow-up. We observed remarkable improvement in the localized scleroderma scale including appearance, palpation, and size scores in all patients at the annual follow-up. CT scans at the annual follow-up revealed new callus formation at the bony defect area in all patients. Reinforcing fat grafting with DBM could promote healing of the bony and skin/subcutaneous tissue defects associated with ECDS.
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Affiliation(s)
- Fethiye Damla Menkü Özdemir
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Ankara, Turkey
| | - Galip Gencay Üstün
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Ankara, Turkey
| | - İbrahim Vargel
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Ankara, Turkey.
| | - Fatma Figen Özgür
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Ankara, Turkey
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7
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O'Brien JC, Nymeyer H, Green A, Jacobe HT. Changes in Disease Activity and Damage Over Time in Patients With Morphea. JAMA Dermatol 2020; 156:513-520. [PMID: 32236501 PMCID: PMC7113826 DOI: 10.1001/jamadermatol.2020.0034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Importance Prospective studies of the disease course in patients with morphea are lacking, particularly those comparing adults and children. Objective To investigate the disease course in patients with morphea treated with standard-of-care therapy using validated clinical outcome measures. Design, Setting, and Participants Prospective cohort study of 130 adults and children from the Morphea in Adults and Children cohort with at least 2 years of clinical follow-up and Localized Scleroderma Cutaneous Assessment Tool scores recorded at each study visit. Study patients were seen at a tertiary referral center (UT Southwestern Medical Center, Dallas, Texas) from November 1, 2008, through April 1, 2016. The dates of analysis were May 2016 through July 2019. Exposures All patients received standard-of-care therapy. Main Outcomes and Measures Patterns in disease activity and recurrence were examined. The time to recurrence of morphea disease activity from the first visit with inactive disease was assessed using survival analysis with the log-rank test to compare differences between morphea subtypes. Results In total, 130 adults and children (663 study visits) were included in this study. The mean (SD) age of patients was 34.4 (23.8) years, and 101 of 130 (78%) were female. The mean (SD) follow-up was 4.3 (1.7) years. Fifty patients had at least 5 years of follow-up. Most patients were white individuals (96 of 130 [74%]) and had linear subtype (72 of 130 [55%]) or generalized subtype (40 of 130 [31%]). Overall, 13 of 30 (43%) with generalized subtype had recurrence of disease activity compared with 14 of 66 (21%) with linear subtype (hazard ratio, 3.28; 95% CI, 1.38-7.79). The median (interquartile range) time to first recurrence of disease activity after initial resolution of disease activity was 1.1 (0.8-1.9) years for generalized subtype and 2.3 (1.0-3.3) years for linear subtype. Of the 50 patients followed up for at least 5 years, 18 (36%) had recurrence of disease activity. Conclusions and Relevance Disease activity appeared to improve in most patients with morphea over 6 to 12 months using previously published treatment plans, underscoring their effectiveness. Sclerosis improved more slowly (over 2-5 years), often after discontinuation of treatment, but atrophy increased slightly as sclerosis subsided. Standard-of-care therapy appears to improve disease activity, which allows sclerosis to improve, and provides relative stability of other features of disease damage. A substantial number of patients, particularly those with generalized subtype, have a relapsing-remitting course over many years. Patients with morphea should be monitored for recurrent disease activity over extended periods.
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Affiliation(s)
- Jack C O'Brien
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas
| | - Hugh Nymeyer
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas
| | - Allison Green
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas
| | - Heidi T Jacobe
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas
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8
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Mostmans Y, Richert B, Badot V, Nagant C, Smith V, Michel O. The importance of skin manifestations, serology and nailfold (video)capillaroscopy in morphea and systemic sclerosis: current understanding and new insights. J Eur Acad Dermatol Venereol 2020; 35:597-606. [PMID: 32656859 DOI: 10.1111/jdv.16813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/24/2020] [Indexed: 11/29/2022]
Abstract
Since the field around morphea and systemic sclerosis (SSc) is evolving rapidly, this review approaches conventional as well as more recent clinical developments from a dermatological point of view. Skin manifestations are critical in sub-classifying these diseases ensuring a correct prognosis for these patients. They can be discretely present, and therefore, diagnosis can be challenging sometimes, implicating a thorough dermatological examination is mandatory. Furthermore, a growing amount of dermatologists perform nailfold videocapillaroscopy (NVC), a more recent reliable non-invasive imaging technique used for in vivo assessment of the microcirculation at the nailfold. After all, specific NVC-changes are present in a majority of patients with SSc. This way, dermatologists not only take part in the diagnosis process through clinical investigation but also through the use of a modern state of the art imaging technique that is becoming the golden standard in SSc multidisciplinary workup. In this review, current understandings for NVC in morphea and SSc are revised. So far, the role of NVC in the diagnosis/prognosis/classification of morphea patients has not been thoroughly investigated to make proper conclusions. As for SSc, it is well known that NVC contributes to the diagnosis and can make a fundamental difference especially when obvious clinical SSc signs are absent. This review emphasizes the (somewhat underestimated) role of dermatologists in the process of diagnosis and follow-up, and thus, the difference we can make for our patients and fellow colleagues in the multidisciplinary workup of SSc and morphea.
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Affiliation(s)
- Y Mostmans
- Department of Immunology-Allergology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Department of Dermatology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - B Richert
- Department of Dermatology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - V Badot
- Department of Immunology-Allergology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Department of Rheumatology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - C Nagant
- Department of Immunology IRIS Laboratory, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - V Smith
- Department of Rheumatology, Ghent University Hospital, University Hospital (UZ) Ghent, Ghent, Belgium
| | - O Michel
- Department of Immunology-Allergology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
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9
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Khatri AM, McLemore M, Malhotra P. Morphea (Localized Scleroderma) Presenting With Recurrent Skin and Soft Tissue Infections: A Diagnostic Dilemma. Cureus 2020; 12:e8067. [PMID: 32542124 PMCID: PMC7290118 DOI: 10.7759/cureus.8067] [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: 04/23/2020] [Accepted: 05/12/2020] [Indexed: 11/08/2022] Open
Abstract
Morphea or localized scleroderma is reported to be triggered through diverse stimuli. We present a case of morphea that presented as a non-healing wound with superimposed methicillin-sensitive Staphylococcus aureus (MSSA) infection. In our case, morphea was thought to have been potentially triggered by a post-surgical infection. We discuss the potential infectious triggers and common infections that may confound the diagnosis.
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Affiliation(s)
| | - Michael McLemore
- Dermatology, Pathology and Laboratory Medicine, Northwell Health, Manhasset, USA
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10
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Zigler CK, Ardalan K, Lane S, Schollaert KL, Torok KS. A novel patient-reported outcome for paediatric localized scleroderma: a qualitative assessment of content validity. Br J Dermatol 2020; 182:625-635. [PMID: 31498874 PMCID: PMC7050359 DOI: 10.1111/bjd.18512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND According to current standards, no existing patient-reported outcome (PRO) measures have high-quality validity evidence for use with individuals diagnosed with paediatric localized scleroderma (LS). This severely hinders patient-centred LS-focused research, including much needed clinical trials. OBJECTIVES To develop a valid health-related quality of life measure for individuals with paediatric LS and to qualitatively evaluate its content validity using a patient-centred approach. METHODS Previously collected qualitative data from youth with LS and their caregivers was used to develop items. The resulting item set was administered in a clinical setting to participants aged 8-18 years old. Cognitive interviews were used to evaluate time to survey completion, readability/understanding of the items, appropriateness of the recall period and construct representation. RESULTS Seventeen children and adolescents with LS participated in the study. Interviews supported readability, understanding of the items and appropriateness of the recall period in individuals > 10 years old. Revisions were made to simplify the instructions and to be more inclusive of different subtypes of LS. Three items were added to improve content representation. CONCLUSIONS Content validity was supported by the patient-centred development process of the outcome measure and via direct feedback from individuals with LS and their families. Although an important first step, the resulting PRO, termed the Localized Scleroderma Quality of Life Instrument, should be further evaluated in a larger sample before being implemented. What's already known about this topic? No current health-related quality of life (HRQoL) measures have been created using direct input from children and adolescents with localized scleroderma (LS). When compared with qualitative reports of HRQoL impact in youth with all LS subtypes, no existing patient-reported outcome (PRO) measures have appropriate content validity for individuals with paediatric LS. What does this study add? This study proposes a novel LS-specific PRO and is the first qualitative assessment of content validity for any PRO measure in this population. Results from cognitive interviews with children and adolescents support the content validity of the newly developed item set and its ability to capture HRQoL impact in a clinical context. What are the clinical implications of this work? Incorporating a content-valid PRO of HRQoL impact into clinical practice would allow for the valid, ongoing capture of patient experience in LS. Although content validity is an important and necessary step in the process of evaluating validity, items within this novel measure will undergo additional psychometric evaluation before implementation in research and clinical settings.
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Affiliation(s)
- C K Zigler
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, U.S.A
| | - K Ardalan
- Division of Rheumatology, Departments of Paediatrics and Medical Social Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, U.S.A
- Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A
| | - S Lane
- School of Education and 5School of Medicine, University of Pittsburgh, Pittsburgh, PA, U.S.A
| | | | - K S Torok
- Division of Rheumatology, Department of Paediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, U.S.A
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11
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Sethu C, Wong KY, Slade-Sharman D. Morphea masquerading as cellulitis. BMJ Case Rep 2019; 12:12/8/e230816. [PMID: 31420439 DOI: 10.1136/bcr-2019-230816] [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: 11/04/2022] Open
Abstract
A case of morphea postbreast reconstruction is presented. It is a rare condition that can be easily mistaken for other inflammatory conditions or infection.
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Affiliation(s)
- Claire Sethu
- Plastic & Reconstructive Surgery, John Radcliffe Hospital, Oxford, UK
| | - Kai Yuen Wong
- Plastic & Reconstructive Surgery, Health Sciences Centre, Winnipeg, Canada
| | - Diana Slade-Sharman
- Plastic & Reconstructive Surgery, Salisbury District Hospital, Salisbury, UK
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12
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Torok KS, Li SC, Jacobe HM, Taber SF, Stevens AM, Zulian F, Lu TT. Immunopathogenesis of Pediatric Localized Scleroderma. Front Immunol 2019; 10:908. [PMID: 31114575 PMCID: PMC6503092 DOI: 10.3389/fimmu.2019.00908] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/09/2019] [Indexed: 01/03/2023] Open
Abstract
Localized scleroderma (LS) is a complex disease characterized by a mixture of inflammation and fibrosis of the skin that, especially in the pediatric population, also affects extracutaneous tissues ranging from muscle to the central nervous system. Although developmental origins have been hypothesized, evidence points to LS as a systemic autoimmune disorder, as there is a strong correlation to family history of autoimmune disease, the presence of shared HLA types with rheumatoid arthritis, high frequency of auto-antibodies, and elevated circulating chemokines and cytokines associated with T-helper cell, IFNγ, and other inflammatory pathways. This inflammatory phenotype of the peripheral blood is reflected in the skin via microarray, RNA Sequencing and tissue staining. Research is underway to identify the key players in the pathogenesis of LS, but close approximation of inflammatory lymphocytic and macrophage infiltrate with collagen and fibroblasts deposition supports the notion that LS is a disease of inflammatory driven fibrosis. The immune system is dynamic and undergoes changes during childhood, and we speculate on how the unique features of the immune system in childhood could potentially contribute to some of the differences in LS between children and adults. Interestingly, the immune phenotype in pediatric LS resembles to some extent the healthy adult cellular phenotype, possibly supporting accelerated maturation of the immune system in LS. We discuss future directions in better understanding the pathophysiology of and how to better treat pediatric LS.
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Affiliation(s)
- Kathryn S. Torok
- Division of Pediatric Rheumatology, Department of Pediatrics, Childrens's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, United States
| | - Suzanne C. Li
- Division of Pediatric Rheumatology, Department of Pediatrics, Hackensack University Medical Center, Hackensack, NJ, United States
- Hackensack Meridian School of Medicine at Seton Hall University, Clifton, NJ, United States
| | - Heidi M. Jacobe
- Department of Dermatology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Sarah F. Taber
- Division of Pediatric Rheumatology, Department of Rheumatology, Hospital for Special Surgery, New York, NY, United States
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States
| | - Anne M. Stevens
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Washington, Seattle, WA, United States
- Seattle Children's Research Institute, University of Washington, Seattle, WA, United States
| | - Francesco Zulian
- Pediatric Rheumatology Unit, Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | - Theresa T. Lu
- Division of Pediatric Rheumatology, Department of Rheumatology, Hospital for Special Surgery, New York, NY, United States
- HSS Research Institute, Hospital for Special Surgery, New York, NY, United States
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY, United States
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Wang Y, Shan JL, Chen HY, Wu ZF. Comparison of 2-D shear wave elastography with clinical score in localized scleroderma: A new method to increase the diagnostic accuracy. J Dermatol 2018; 46:131-138. [PMID: 30506714 DOI: 10.1111/1346-8138.14713] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/22/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Ying Wang
- Department of Ultrasonography; Huashan Hospital; School of Medicine; Fudan University; Shanghai China
| | - Jie-ling Shan
- Department of Ultrasonography; Huashan Hospital; School of Medicine; Fudan University; Shanghai China
| | - Hu-yan Chen
- Department of Dermatology; Huashan Hospital; School of Medicine; Shanghai China
| | - Zhi-feng Wu
- Fudan University; Department of Radiation Oncology; Zhongshan Hospital; School of Medicine; Fudan University; Shanghai China
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14
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Moinzadeh P, Kreuter A, Krieg T, Hunzelmann N. Morphea/lokalisierte Sklerodermie und extragenitaler Lichen sclerosus. Hautarzt 2018; 69:892-900. [DOI: 10.1007/s00105-018-4266-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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15
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Donaldson SL, Hunt KM, Theos A. Red-brown macules in a linear distribution on the arm. Pediatr Dermatol 2018; 35:685-687. [PMID: 30211465 DOI: 10.1111/pde.13567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Katherine M Hunt
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Amy Theos
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
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Magnetic Resonance Imaging Evaluation in Patients with Linear Morphea Treated with Methotrexate and High-Dose Corticosteroid. Dermatol Res Pract 2018; 2018:8391218. [PMID: 30057597 PMCID: PMC6051098 DOI: 10.1155/2018/8391218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 05/04/2018] [Accepted: 05/30/2018] [Indexed: 11/25/2022] Open
Abstract
Background Morphea is an inflammatory disease of the connective tissue that may lead to thickening and hardening of the skin due to fibrosis. The aim of this study was to document magnetic resonance imaging (MRI) changes in patients with linear morphea who were treated with methotrexate (MTX) and high-dose corticosteroid. Methods This study was conducted on 33 patients from the outpatient's dermatology clinic of our institute, who fulfilled the inclusion criteria. Patients received 15 mg/week of MTX and monthly pulses of methylprednisolone for three days in six months. The effectiveness of the treatment was evaluated by MRI, modified LS skin severity index (mLoSSI), and localized scleroderma damage index (LoSDI). Results All parameters of mLoSSI and LoSDI including erythema, skin thickness, new lesion/lesion extension, dermal atrophy, subcutaneous atrophy, and dyspigmentation were also noticeably improved after treatment. Subcutaneous fat enhancement was the most common finding in MRI. MRI scores were significantly associated with clinical markers both before and after the treatment with the exception of skin thickness and new lesion/lesion extension which were not associated with MRI scores before and after the treatment, respectively. Limitations The lack of correlative laboratory disease activity markers, control group, and clearly defined criteria to judge the MRI changes. Conclusion MRI could be a promising tool for the assessment of musculoskeletal and dermal involvement and also monitoring treatment response in patients with morphea.
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Waki Y, Kamiya K, Maekawa T, Komine M, Murata S, Ohtsuki M. Localized scleroderma occurring after treatment of chronic hepatitis C with sofosbuvir and ribavirin. J Dermatol 2018; 46:e34-e35. [PMID: 29863777 DOI: 10.1111/1346-8138.14495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yuma Waki
- Department of Dermatology, Jichi Medical University, Shimotsuke City, Japan
| | - Koji Kamiya
- Department of Dermatology, Jichi Medical University, Shimotsuke City, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University, Shimotsuke City, Japan
| | - Mayumi Komine
- Department of Dermatology, Jichi Medical University, Shimotsuke City, Japan
| | - Satoru Murata
- Department of Dermatology, Jichi Medical University, Shimotsuke City, Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke City, Japan
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18
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Quantitative Assessment of Skin Stiffness in Localized Scleroderma Using Ultrasound Shear-Wave Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1339-1347. [PMID: 28457631 DOI: 10.1016/j.ultrasmedbio.2017.02.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 02/04/2017] [Accepted: 02/13/2017] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to evaluate the usefulness of ultrasound shear-wave elastography (US-SWE) in characterization of localized scleroderma (LS), as well as in the disease staging. A total of 21 patients with 37 LS lesions were enrolled in this study. The pathologic stage (edema, sclerosis or atrophy) of the lesions was characterized by pathologic examination. The skin elastic modulus (E-values including Emean, Emin, Emax and Esd) and thickness (h) was evaluated both in LS lesions and site-matched unaffected skin (normal controls) using US-SWE. The relative difference of E-values (ERD) was calculated between each pair of lesions and its normal control for comparison among different pathologic stages. Of the 37 LS lesions, 2 were in edema, 22 were in sclerosis and 13 were in atrophy. US-SWE results showed a significant increase of skin elastic modulus and thickness in all lesions (p < 0.001 in sclerosis and p < 0.05 in atrophy) compared with the normal controls. The measured skin elastic modulus and thickness were greater in sclerosis than in atrophy. However, once normalized by skin thickness, the atrophic lesions, which were on average thinner, appeared significantly stiffer than those of the sclerosis (normalized ERD: an increase of 316.3% in atrophy vs. 50.6% in sclerosis compared with the controls, p = 0.007). These findings suggest that US-SWE allows for quantitative evaluation of the skin stiffness of LS lesions in different stages; however, the E-values directly provided by the US-SWE system alone do not distinguish between the stages, and the normalization by skin thickness is necessary. This non-invasive, real-time imaging technique is an ideal tool for assessing and monitoring LS disease severity and progression.
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Transcriptional and Cytokine Profiles Identify CXCL9 as a Biomarker of Disease Activity in Morphea. J Invest Dermatol 2017; 137:1663-1670. [PMID: 28450066 DOI: 10.1016/j.jid.2017.04.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 03/27/2017] [Accepted: 04/12/2017] [Indexed: 01/13/2023]
Abstract
IFN-related pathways have not been studied in morphea, and biomarkers are needed. We sought to characterize morphea serum cytokine imbalance and IFN-related gene expression in blood and skin to address this gap by performing a case-control study of 87 participants with morphea and 26 healthy control subjects. We used multiplexed immunoassays to determine serum cytokine concentrations, performed transcriptional profiling of whole blood and lesional morphea skin, and used double-staining immunohistochemistry to determine the cutaneous cellular source of CXCL9. We found that CXCL9 was present at increased concentrations in morphea serum (P < 0.0001), as were other T helper type 1 cytokines. CXCL9 serum concentration correlated with the modified Localized Scleroderma Skin Severity Index (r = 0.44, P = 0.0001), a validated measure of disease activity. CXCL9 gene expression was also increased in inflammatory lesional morphea skin (fold change = 30.6, P = 0.006), and preliminary transcriptional profiling showed little evidence for IFN signature in whole blood. Double-staining immunohistochemistry showed CXCL9 co-localized with CD68+ dermal macrophages. In summary, inflammatory morphea is characterized by T helper type 1 cytokine imbalance in serum, particularly CXCL9, which is associated with disease activity. CXCL9 expression in lesional macrophages implicates the skin as the source of circulating cytokines. CXCL9 is a promising biomarker of disease activity in morphea.
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20
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Morphea - selected local treatment methods and their effectiveness. Reumatologia 2017; 55:305-313. [PMID: 29491539 PMCID: PMC5825969 DOI: 10.5114/reum.2017.72628] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 11/30/2017] [Indexed: 01/15/2023] Open
Abstract
Localised scleroderma is an uncommon connective tissue disease of multifactorial aetiology occurring in the paediatric and adult population. It is relatively difficult to conduct any research on the subject of this disease entity treatment due to the low number of patients suffering from morphea, a tendency of the disease to remit spontaneously, and not yet well recognised aetiology. Hence, there has been developed no causal treatment of well-proven effectiveness, and schedules of symptomatic therapy are not yet clearly determined. The paper depicts most widely used topical treatment methods in morphea therapy, which due to minor risk of systemic adverse effects seem to be a beneficial therapeutic alternative. The main aim of this article was to analyse different topical treatment options used in localised scleroderma therapy and to indicate the most appropriate, safe, and effective one.
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21
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Affiliation(s)
- Erika Yue Lee
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario
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22
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Brady SM, Shapiro L, Mousa SA. Current and future direction in the management of scleroderma. Arch Dermatol Res 2016; 308:461-71. [PMID: 27139430 DOI: 10.1007/s00403-016-1647-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/23/2016] [Accepted: 04/08/2016] [Indexed: 12/19/2022]
Abstract
Scleroderma is a heterogeneous disease with a complex etiology. As more information is gained about the underlying mechanisms and the improved classifications of scleroderma subtypes, treatments can be better personalized. Improving scleroderma patients' early diagnosis before end organ manifestations occur should improve clinical trial design and outcomes. Two recently FDA-approved antifibrotics for idiopathic pulmonary fibrosis may be effective treatments in patients with pulmonary fibrosis secondary to scleroderma after further investigation. The potential impact of Nanobiotechnology in improving the efficacy and safety of existing antifibrotics and immunomodulators might present an exciting new approach in the management of scleroderma.
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Affiliation(s)
- Sean M Brady
- The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, 1 Discovery Drive (Room 238), Rensselaer, NY, 12144, USA
| | - Lee Shapiro
- Division of Rheumatology, Steffens Scleroderma Center, Albany Medical College, Albany, NY, USA
| | - Shaker A Mousa
- The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, 1 Discovery Drive (Room 238), Rensselaer, NY, 12144, USA.
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23
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Evaluation of serum concentrations of the selected cytokines in patients with localized scleroderma. Postepy Dermatol Alergol 2016; 33:47-51. [PMID: 26985179 PMCID: PMC4793054 DOI: 10.5114/pdia.2015.48044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 07/17/2014] [Indexed: 11/28/2022] Open
Abstract
Introduction Localized scleroderma is an autoimmune disease primarily affecting the skin. The cause of disease remains unexplained although environmental factors are implicated, which are likely to be responsible for activation of the endothelium and subsequent inflammation leading to excessive synthesis of collagen and extracellular matrix components. Aim To determine concentrations of interleukin (IL)-27, transforming growth factor (TGF)-β1, TGF-β2, IL-6, and sIL-6R in patients with localized scleroderma compared to controls and to assess the relations between their levels and laboratory markers. Material and methods The study encompassed 17 females with localized scleroderma (aged 25–67). The control group consisted of 30 age-matched healthy women. The blood was sampled from the basilic vein. Serum levels of cytokines were determined using ELISA. Results The TGF-β2 levels were found to be significantly lower in patients with localized scleroderma compared to controls. Concentrations of TGF-β1 were decreased in scleroderma patients when compared to controls but without statistical significance. There were no significant differences in serum IL-6, sIL-6R and IL-27 levels between patients and the control group; however, we found a significant positive correlation between the level of sIL-6 and ESR among subjects with localized scleroderma. Conclusions The findings of decreased serum levels of TGF-β1 and TGF-β2 in patients with localized scleroderma demonstrate a possible association of these cytokines with pathogenesis of the disease. The results suggest also that sIL-6R is likely to be involved in inflammation in patients with localized scleroderma.
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24
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Abstract
Cutaneous fibrosing disorders encompass a diverse array of diseases united by the presence of varying degrees of dermal sclerosis. The quality and distribution of skin involvement, presence or absence of systemic complications and unique associated laboratory abnormalities often help to distinguish between these diseases. It is imperative that an effort is made to accurately differentiate between scleroderma and its mimics, in order to guide long-term management and facilitate implementation of the appropriate treatment modality where indicated.
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25
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Lee HY, Kim SY, Cho MK, Choi JY, Hong M, Lee JH, Lee I, Hong JW, Han CW, Kwon JN. A case report of generalized morphea treated with herbal medication and moxibustion. ACTA ACUST UNITED AC 2015. [DOI: 10.13048/jkm.15037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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26
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Foldvari M, Chen DW, Nafissi N, Calderon D, Narsineni L, Rafiee A. Non-viral gene therapy: Gains and challenges of non-invasive administration methods. J Control Release 2015; 240:165-190. [PMID: 26686079 DOI: 10.1016/j.jconrel.2015.12.012] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/26/2015] [Accepted: 12/09/2015] [Indexed: 12/20/2022]
Abstract
Gene therapy is becoming an influential part of the rapidly increasing armamentarium of biopharmaceuticals for improving health and combating diseases. Currently, three gene therapy treatments are approved by regulatory agencies. While these treatments utilize viral vectors, non-viral alternative technologies are also being developed to improve the safety profile and manufacturability of gene carrier formulations. We present an overview of gene-based therapies focusing on non-viral gene delivery systems and the genetic therapeutic tools that will further revolutionize medical treatment with primary focus on the range and development of non-invasive delivery systems for dermal, transdermal, ocular and pulmonary administrations and perspectives on other administration methods such as intranasal, oral, buccal, vaginal, rectal and otic delivery.
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Affiliation(s)
- Marianna Foldvari
- School of Pharmacy, Waterloo Institute of Nanotechnology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada; Center for Bioengineering and Biotechnology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - Ding Wen Chen
- School of Pharmacy, Waterloo Institute of Nanotechnology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada; Center for Bioengineering and Biotechnology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Nafiseh Nafissi
- School of Pharmacy, Waterloo Institute of Nanotechnology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada; Center for Bioengineering and Biotechnology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Daniella Calderon
- School of Pharmacy, Waterloo Institute of Nanotechnology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada; Center for Bioengineering and Biotechnology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Lokesh Narsineni
- School of Pharmacy, Waterloo Institute of Nanotechnology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada; Center for Bioengineering and Biotechnology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Amirreza Rafiee
- School of Pharmacy, Waterloo Institute of Nanotechnology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada; Center for Bioengineering and Biotechnology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
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27
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Abstract
Eosinophil infiltration can be observed in skin disorders, such as allergic/immunologic, autoimmune, infectious, and neoplastic diseases. Clinical presentations are variable and include eczematous, papular, urticarial, bullous, nodular, and fibrotic lesions; pruritus is a common symptom in all. In this review, we present representative eosinophilic skin diseases according to their clinical pattern, together with histologic findings and diagnostic procedures. We also discuss the potential roles of eosinophils in the pathogenesis of dermatologic disorder. Current pathogenesis-based diagnostic and therapeutic approaches are outlined.
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Affiliation(s)
- Elisabeth de Graauw
- Department of Dermatology, Inselspital, Freiburgstrasse, Bern CH-3010, Switzerland; Institute of Pharmacology, University of Bern, Inselspital, Bern CH-3010, Switzerland
| | - Helmut Beltraminelli
- Department of Dermatology, Inselspital, Freiburgstrasse, Bern CH-3010, Switzerland
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Inselspital, Bern CH-3010, Switzerland
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Freiburgstrasse, Bern CH-3010, Switzerland.
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28
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Mertens J, Seyger M, Kievit W, Hoppenreijs E, Jansen T, van de Kerkhof P, Radstake T, de Jong E. Disease recurrence in localized scleroderma: a retrospective analysis of 344 patients with paediatric- or adult-onset disease. Br J Dermatol 2015; 172:722-8. [DOI: 10.1111/bjd.13514] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 01/25/2023]
Affiliation(s)
- J.S. Mertens
- Department of Dermatology; Radboud University Medical Center; Nijmegen The Netherlands
| | - M.M.B. Seyger
- Department of Dermatology; Radboud University Medical Center; Nijmegen The Netherlands
| | - W. Kievit
- Department of Epidemiology, Biostatistics and Health Technology Assessment; Radboud University Medical Center; Nijmegen The Netherlands
| | - E.P.A.H. Hoppenreijs
- Department of Pediatric Rheumatology; Radboud University Medical Center; Nijmegen The Netherlands
| | - T.L.Th.A. Jansen
- Department of Rheumatology; Radboud University Medical Center; Nijmegen The Netherlands
| | - P.C.M. van de Kerkhof
- Department of Dermatology; Radboud University Medical Center; Nijmegen The Netherlands
| | - T.R.D. Radstake
- Department of Rheumatology and Clinical Immunology and Laboratory of Translational Immunology; University Medical Center Utrecht; Utrecht The Netherlands
| | - E.M.G.J. de Jong
- Department of Dermatology; Radboud University Medical Center; Nijmegen The Netherlands
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29
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Larcher L, Eisendle K, Schwaiger K, Kaplan R, Riml S, Mattiassich G, Ensat F, Wechselberger G. Lipomatosis of the mons pubis secondary to localized scleroderma (Morphea): first report of surgical management. J Eur Acad Dermatol Venereol 2014; 30:377-8. [PMID: 25370577 DOI: 10.1111/jdv.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L Larcher
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God (Barmherzige Brüder) Salzburg (A), University Teaching Hospital - Paracelsus Medical University Salzburg, Salzburg, Austria
| | - K Eisendle
- Department of Dermatology and Venerology, Central Teaching Hospital of Bozen, Bozen, Italy
| | - K Schwaiger
- Paracelsus Medical University Salzburg, Salzburg, Austria
| | - R Kaplan
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God (Barmherzige Brüder) Salzburg (A), University Teaching Hospital - Paracelsus Medical University Salzburg, Salzburg, Austria
| | - S Riml
- Department of Plastic, Reconstructive and Hand Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - G Mattiassich
- Trauma Center Unfallkrankenhaus Linz, University Teaching Hospital - Paracelsus Medical University Salzburg, Salzburg, Austria
| | - F Ensat
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God (Barmherzige Brüder) Salzburg (A), University Teaching Hospital - Paracelsus Medical University Salzburg, Salzburg, Austria
| | - G Wechselberger
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God (Barmherzige Brüder) Salzburg (A), University Teaching Hospital - Paracelsus Medical University Salzburg, Salzburg, Austria
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30
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Abstract
Morphea (localized scleroderma) is a rare fibrosing disorder of the skin and underlying tissues characterized by skin thickening and hardening due to increased collagen deposition. The significance of the disease depends on the extent of the lesions, potential for functional disability or cosmetic disfigurement, and presence or absence of extracutaneous manifestations. Treatment is tailored; circumscribed forms may require only topical treatment, while forms causing functional impairment or severe cosmetic change may require systemic treatment. Although localized scleroderma has a good prognosis, some clinical subtypes can be deforming and irreversibly disabling, especially when affecting the extremities or the face.
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Affiliation(s)
- Elena Pope
- Section of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - Ronald M Laxer
- Departments of Paediatrics and Medicine, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
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31
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Rosario C, Garelick D, Greenberg G, Chapman J, Shoenfeld Y, Langevitz P. Plaque morphea with neurological involvement—an extraordinary uncommon presentation. Clin Rheumatol 2013; 34:597-601. [DOI: 10.1007/s10067-013-2458-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 12/03/2013] [Indexed: 11/30/2022]
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Salem B, Rim BHA, Sihem BK, Maher B. [Oral manifestations of systemic sclerosis]. Pan Afr Med J 2013; 16:114. [PMID: 24778751 PMCID: PMC3998902 DOI: 10.11604/pamj.2013.16.114.3065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 07/08/2013] [Indexed: 12/16/2022] Open
Abstract
Nous rapportons l'observation d'une jeune femme de 26 ans ayant une sclérodermie systémique diffuse présentant une atteinte bucco-dentaire complexe: microstomie, hyperplasie gingivale, parodontite, dépôts tartriques, caries multiples et chevauchement dentaire antéro-inférieur. Nous discuterons à travers cette observation les manifestations bucco-dentaires de cette connectivite qui sont loin d’être rares mais souvent négligées par les cliniciens malgré leur retentissement fonctionnel majeur. Il convient de surveiller régulièrement l’état bucco-dentaire chez tout patient sclérodermique afin de diagnostiquer précocement ces atteintes. Diagnostiquées à un stade tardif les complications bucco-dentaires de la sclérodermie seront très difficiles à traiter.
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Affiliation(s)
- Bouomrani Salem
- Service de Médecine Interne, hôpital Militaire de Gabes 6000, Tunisie
| | - Bel Hadj Ali Rim
- Service de Chirurgie Dentaire, hôpital Militaire de Gabes 6000, Tunisie
| | - Ben Khoud Sihem
- Service de Chirurgie Dentaire, hôpital Militaire de Gabes 6000, Tunisie
| | - Béji Maher
- Service de Médecine Interne, hôpital Militaire de Gabes 6000, Tunisie
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33
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Thareja SK, Sadhwani D, Alan Fenske N. En coup de sabre morphea treated with hyaluronic acid filler. Report of a case and review of the literature. Int J Dermatol 2013; 54:823-6. [DOI: 10.1111/ijd.12108] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 11/21/2012] [Accepted: 12/03/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Sumeet K. Thareja
- Department of Dermatology; University of South Florida; Tampa FL USA
| | - Divya Sadhwani
- Department of Dermatology; University of South Florida; Tampa FL USA
| | - Neil Alan Fenske
- University of Central Florida College of Medicine; Orlando FL USA
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34
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Mohan SV, Nittur V, Stevens KJ. Late-onset en coup de sabre of the skull. Skeletal Radiol 2013; 42:1447-50. [PMID: 23615776 DOI: 10.1007/s00256-013-1617-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/29/2013] [Accepted: 04/02/2013] [Indexed: 02/02/2023]
Abstract
En coup de sabre is a rare subtype of linear scleroderma that characteristically affects the skin, underlying muscle, and bone of the frontoparietal region of the face and scalp. It typically presents in the first two decades of life, and may be associated with focal neurological deficits. We present a case of late-onset en coup de sabre of the frontal bone where the diagnosis was further complicated by a history of breast cancer, prior trauma to the region, and use of topical medication.
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Affiliation(s)
- Shaun V Mohan
- Department of Radiology, Stanford University School of Medicine, Room S-062A Grant Building, 300 Pasteur Drive, Stanford, CA 94305-5105, USA.
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35
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Pavlotsky F, Sakka N, Lozinski A, Barzilai A. Bath psoralen-UVA photochemotherapy for localized scleroderma: experience from a single institute. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2013; 29:247-52. [DOI: 10.1111/phpp.12063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/13/2013] [Indexed: 11/29/2022]
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Butareva MM, Znamenskaya LF, Muradyan NL, Brezgina OV, Afromeyeva DM. Diagnostics and treatment of erythema chronicum migrans Aftselius Lipschutz in a female patient with localized scleroderma under the condition of daytime hospital. VESTNIK DERMATOLOGII I VENEROLOGII 2013. [DOI: 10.25208/vdv621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The authors describe a case study of the primary stage of the Lyme disease erythema chronicum migrans in a female patient suffering from localized scleroderma. They review principal pathogenetic mechanisms of the onset and potential ethiological relationship between the Lyme disease (borreliosis) and localized scleroderma.
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Abstract
This article acquaints the reader with disorders of the skin that might mimic systemic sclerosis but whose pathology is localized to the skin and/or has extracutaneous manifestations that are different than systemic sclerosis. These disorders include localized scleroderma (morphea), eosinophilic fasciitis, scleredema, scleromyxedema, nephrogenic systemic fibrosis, and chronic graft-versus-host disease. Particular emphasis is placed on clinical and histopathologic features that help the clinician differentiate between these disorders. Treatment options are briefly reviewed.
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