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Eren Karanis Mİ, Küçükosmanoğlu İ, Oltulu P, Kılınç F, Özer İ. Relationship between histomorphological findings and platelet activation in psoriasis. J Cosmet Dermatol 2022; 21:6129-6133. [PMID: 35696281 DOI: 10.1111/jocd.15155] [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: 04/28/2022] [Revised: 05/27/2022] [Accepted: 06/07/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Elevated platelet count (PC), mean platelet volume (MPV), and Platelet Mass Index (PMI) are reported in patients with psoriasis, while platelet activation is associated with psoriasis severity. Available studies examining the relationship between platelet activation markers and psoriasis have mostly focused on psoriasis area severity index. To the best of our knowledge, there is no study examining the relationship between histopathological features of a single psoriatic plaque and platelet activation. The present study examined the relationship between histomorphological findings obtained by morphometric analysis and psoriasis patients' PC, MPV, and PMI values. MATERIALS AND METHODS Morphometric analysis was performed on hematoxylin and eosin-stained preparations of skin biopsies to measure minimum suprapapillary epidermis thickness (SPETmin ) and maximum epidermal thickness (ETmax ), maximum suprapapillary keratosis thickness (SPKTmax ), and maximum keratosis thickness (KTmax ). The relationship between PC, MPV, PMI, and morphometric skin biopsy outcomes was evaluated. RESULTS While an inverse correlation was found between SPETmin and PC and PMI in cases with psoriasis (p values = 0.015 and 0.005, r values = -0.238 and -0.271, respectively), no significant correlation was found between SPETmin and MPV (p value = 0.600, r value = -. 052). On the contrary, no significant correlation was found between SPKTmax, ETmax, and KTmax values and platelet parameters. CONCLUSION We assume that an increased risk of platelet activation-related diseases is expected in psoriasis patients displaying histopathological findings of suprapapillary thinning due to increased platelet activation; therefore, it may be beneficial to monitor these patients in terms of such risks.
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Affiliation(s)
| | - İlknur Küçükosmanoğlu
- Department of Pathology, Konya City Hospital, University of Health Sciences, Konya, Turkey
| | - Pembe Oltulu
- Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Fahriye Kılınç
- Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - İlkay Özer
- Department of Dermatology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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2
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Chung BY, Um JY, Kang SY, Jung MJ, Kim JC, Kwak IS, Park CW, Kim HO. Oral Alitretinoin for Patients with Refractory Prurigo. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E599. [PMID: 33182351 PMCID: PMC7695266 DOI: 10.3390/medicina56110599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 11/17/2022]
Abstract
Background: prurigo is a chronic skin disorder associated with a history of chronic pruritus. The pathogenesis of prurigo is largely unknown and the treatment of prurigo is unsatisfactory and challenging. Conventional systemic treatments may be beneficial; however, their possible side effects and possible transient efficacy is still a problem. We aimed to present the clinical course and effect of treatment with alitretinoin on patients with prurigo nodularis initially treated with conventional treatments like oral antihistamine, cyclosporine, and phototherapy. Methods: all the patients had prurigo nodularis refractory to conventional treatment. Their medical records included demographic features, past medical history, duration of disease, and treatment modalities; and the clinical courses of the patients were reviewed for this retrospective study. We evaluated patient pruritus and skin lesions for the duration. Results: we present reports involving 10 patients with refractory prurigo. All the patients in our cases were treated with oral alitretinoin after previous treatments and reported the improvement of skin lesions and pruritus within 2 weeks to 3 months. Conclusions: we suggest that oral alitretinoin may be an effective and well tolerated treatment option for patients with intractable prurigo. Further clinical studies are warranted to confirm the long-lasting efficacy and safety of alitretinoin for treating patients with prurigo.
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Affiliation(s)
- Bo Young Chung
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| | - Ji Young Um
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| | - Seok Young Kang
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| | - Min Je Jung
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| | - Jin Cheol Kim
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| | - In-Suk Kwak
- Department of Anesthesiology and Pain Medicine, Burn Center, Hangang Sacred Heart Hospital, Hallym University College of Medicine, 94-200 Yeoungdeungpo-dong, Yeoungdeungpo-gu, Seoul 07247, Korea;
| | - Chun Wook Park
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| | - Hye One Kim
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
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3
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Ring NG, Craiglow BG, Panse G, Antaya RJ, Ashack K, Ashack R, Faith EF, Paller AS, McNiff JM, Choate KA, Ko CJ. Histopathologic findings characteristic of CARD14-associated papulosquamous eruption. J Cutan Pathol 2019; 47:425-430. [PMID: 31849081 DOI: 10.1111/cup.13633] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 10/24/2019] [Accepted: 12/05/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pathogenic mutations in caspase recruitment domain-containing protein 14 (CARD14) lead to CARD14-associated papulosquamous eruption, which shares clinicopathologic findings with psoriasis and pityriasis rubra pilaris. We aimed to describe distinguishing histopathologic features of CARD14-associated papulosquamous eruption. METHODS This retrospective study examined the histopathologic features of specimens from patients with confirmed CARD14-associated papulosquamous eruption and adult patients with plaque psoriasis and pityriasis rubra pilaris. RESULTS Lesional skin biopsies from patients with CARD14-associated papulosquamous eruption consistently showed alternating checkerboard parakeratosis and orthokeratosis, acanthosis without acantholysis, and dilated vessels in the dermal papillae, with some cases also showing follicular plugging. CONCLUSION CARD14-associated papulosquamous eruption has a range of findings, with a predominance of features typically associated with pityriasis rubra pilaris.
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Affiliation(s)
- Nan G Ring
- Department of Dermatology, Yale University, New Haven, Connecticut
| | | | - Gauri Panse
- Department of Dermatology, Yale University, New Haven, Connecticut.,Department of Pathology, Yale University, New Haven, Connecticut
| | - Richard J Antaya
- Department of Dermatology, Yale University, New Haven, Connecticut
| | - Kurt Ashack
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois
| | - Richard Ashack
- Dermatology Associates of West Michigan, Grand Rapids, Michigan
| | - Esteban F Faith
- Department of Pediatrics and Dermatology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Amy S Paller
- Department of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jennifer M McNiff
- Department of Dermatology, Yale University, New Haven, Connecticut.,Department of Pathology, Yale University, New Haven, Connecticut
| | - Keith A Choate
- Department of Dermatology, Yale University, New Haven, Connecticut
| | - Christine J Ko
- Department of Dermatology, Yale University, New Haven, Connecticut.,Department of Pathology, Yale University, New Haven, Connecticut
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4
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Sasaki-Iwaoka H, Taguchi K, Okada Y, Imamura E, Kubo S, Furukawa S, Morokata T. AS2762900-00, a potent anti-human IL-23 receptor monoclonal antibody, prevents epidermal hyperplasia in a psoriatic human skin xenograft model. Eur J Pharmacol 2019; 843:190-198. [PMID: 30472202 DOI: 10.1016/j.ejphar.2018.11.030] [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: 09/12/2018] [Revised: 11/17/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
Abstract
Interleukin (IL)-23 is thought to be critical in the pathogenesis of psoriasis, and anti-IL-23 monoclonal antibodies (mAbs) have been approved for the treatment of psoriasis. We speculated that an anti-IL-23 receptor mAb might have greater efficacy than an anti-IL-23 mAb in the treatment of local inflamed lesions with high IL-23 levels. We previously generated an anti-human IL-23 receptor mAb, AS2762900-00, which potently blocked IL-23-induced cell proliferation, regardless of the concentration of IL-23. Here, we evaluated the therapeutic potential of AS2762900-00 in the treatment of psoriasis. Compared with untreated control, AS2762900-00 significantly reduced the epidermal thickness of lesions in a clinically relevant psoriatic human skin xenograft model. The expression of inflammatory genes including genes downstream of IL-23 signaling in the lesion tended to be lower in the AS2762900-00 group than the untreated group, suggesting that the inhibitory effects of AS2762900-00 in the psoriatic human skin xenograft model might occur via blockade of IL-23 signaling pathways. Further, AS2762900-00 showed an inhibitory effect on signal transducer and activator of transcription 3 (STAT3) phosphorylation as a downstream signal of IL-23 receptor activation in whole blood from patients with psoriasis. We also confirmed that AS2762900-00 inhibited IL-23-induced STAT3 phosphorylation in a concentration-dependent manner using whole blood from healthy donors. These data suggest that AS2762900-00 is a promising drug candidate for the treatment of psoriasis. In addition, STAT3 phosphorylation in whole blood may be a useful biomarker for the evaluation of the pharmacodynamic effects of AS2762900-00 in healthy volunteers in clinical development.
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Affiliation(s)
- Haruna Sasaki-Iwaoka
- Drug Discovery Research, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba-shi, Ibaraki 305-8585, Japan.
| | - Katsunari Taguchi
- Drug Discovery Research, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba-shi, Ibaraki 305-8585, Japan
| | - Yohei Okada
- Drug Discovery Research, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba-shi, Ibaraki 305-8585, Japan
| | - Emiko Imamura
- Drug Discovery Research, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba-shi, Ibaraki 305-8585, Japan
| | - Satoshi Kubo
- Drug Discovery Research, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba-shi, Ibaraki 305-8585, Japan
| | - Shigetada Furukawa
- Drug Discovery Research, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba-shi, Ibaraki 305-8585, Japan
| | - Tatsuaki Morokata
- Drug Discovery Research, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba-shi, Ibaraki 305-8585, Japan
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5
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Abu Hashim II, Abo El-Magd NF, El-Sheakh AR, Hamed MF, Abd El-Gawad AEGH. Pivotal role of Acitretin nanovesicular gel for effective treatment of psoriasis: ex vivo-in vivo evaluation study. Int J Nanomedicine 2018; 13:1059-1079. [PMID: 29503541 PMCID: PMC5824759 DOI: 10.2147/ijn.s156412] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The goal of the current study was to explore the potential benefits of Acitretin (Act) nanovesicular gel as a prospective antipsoriatic topical delivery system counteracting the drug challenges in terms of its extremely low aqueous solubility, instability, skin irritation, and serious systemic adverse effects. Act-loaded niosomes were successfully developed, entirely characterized, and optimized. Further evaluation of the optimized formula was conducted regarding its stability and ex vivo cytotoxicity on different cell lines. The optimized niosomal vesicles were then incorporated in gel base matrix and investigated by sequential ex vivo (skin permeation and deposition) and in vivo (skin irritation and antipsoriatic activity using mouse tail model) experiments. The optimized Act-loaded niosomes (span 60:cholesterol molar ratio 1:1) were spherical in shape and exhibited the highest entrapment efficiency (90.32±3.80%) with appropriate nanosize and zeta potential of 369.73±45.45 nm and -36.33±1.80 mV, respectively. Encapsulation of the drug in the nanovesicles was further emphasized by differential scanning calorimetric and powder X-ray diffraction studies. After 3 months storage at 4±1°C, the optimized formula preserved its stability. Act nano niosomal gel produced a remarkable enhanced ex vivo permeation profile up to 30 h and significant drug deposition in the viable epidermal-dermal layers compared with those of Act gel. The pronounced antipsoriatic activity of the medicated nano niosomes was proved ex vivo in HaCaT cells (a keratinocyte cell line). Topical application of Act nano niosomal gel to mouse tail model further established its distinct in vivo antipsoriatic superiority in terms of significantly higher orthokeratosis, drug activity, and reduction in epidermal thickness compared with the control and other gel formulations. Also, negligible skin irritation and better skin tolerability of Act nanovesicular gel were revealed by primary irritation index and histopathologic examination.
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Affiliation(s)
| | | | - Ahmed Ramadan El-Sheakh
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - Mohammed Fawzy Hamed
- Department of Pathology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt
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6
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Methotrexate treatment provokes apoptosis of proliferating keratinocyte in psoriasis patients. Clin Exp Med 2016; 17:371-381. [PMID: 27435483 DOI: 10.1007/s10238-016-0431-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 07/07/2016] [Indexed: 12/23/2022]
Abstract
Psoriasis is a chronic inflammatory skin disease characterized by hyper proliferation of keratinocytes. Recent data show that the epidermis thickening in psoriasis may be related to imbalance of homeostasis caused by abnormal apoptotic process. Maintenance of keratinocyte apoptotic process is very important in psoriasis. Methotrexate (MTX) has been used for many years to restore the normal skin in psoriasis condition. However, the exact mechanism of MTX in psoriasis condition is poorly understood. The aim of this study was to examine the role of MTX on keratinocyte apoptosis pathway in psoriasis patients. A total of 58 psoriasis vulgaris patients were recruited for this study. Nonlesional skin biopsies served as control. Skin biopsies of psoriatic patients were collected and analyzed for cytosolic, mitochondria and total cytochrome c by ELISA. Expression of caspase-9, NFκBp65, pAkt1 by western blot, real-time PCR and immunohistochemical analysis of c-FLIP protein was analyzed in nonlesional and lesional skin biopsies before (day 0) and after (at the end of 6 and 12 weeks) MTX treatment. After MTX treatment, a significant increase in cytochrome c was observed when compared with before MTX treatment in psoriasis patients (p < 0.001). Protein and gene expression of cleaved caspase-9 were significantly increased after MTX treatment, whereas the expression of Bcl-xL, c-FLIP, NFκBp65, pAkt1 significantly downregulated after MTX treatment. In conclusion, these results showed that intrinsic apoptotic pathway induced by MTX eventually adds the beneficial therapeutic role of MTX in psoriasis by controlling the acanthosis.
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7
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Abstract
Alitretinoin is a pan retinoic acid agonist. It was initially used as 0.1% gel in the management of localized Kaposi's sarcoma. At present, the use of systemic alitretinoin has proved extremely efficacious in the management of recalcitrant chronic hand eczema. Furthermore, there have been other retinoid responsive dermatosis that have demonstrated remission post usage of systemic alitretinoin. With a better toxicity profile, compared to the other systemic retinoids, alitretinoin could be considered a valuable treatment option in the near future for the treatment of these dermatologic disorders.
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Affiliation(s)
- Aditya Kumar Bubna
- Department of Dermatology, Sri Ramachandra University, Chennai, Tamil Nadu, India
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8
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Sezer E, Böer-Auer A, Cetin E, Tokat F, Durmaz E, Sahin S, Ince U. Diagnostic utility of Ki-67 and Cyclin D1 immunostaining in differentiation of psoriasis vs. other psoriasiform dermatitis. Dermatol Pract Concept 2015; 5:7-13. [PMID: 26336616 PMCID: PMC4536874 DOI: 10.5826/dpc.0503a02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 05/03/2015] [Indexed: 11/13/2022] Open
Abstract
Background: Differentiation of psoriasis from non-psoriasis psoriasiform dermatitis (NPPD) may be difficult for dermatopathologists, as lack of distinctive histopathological features in a subset of cases may cause confusion in diagnosis. Objective: As the prototype of psoriasiform dermatitis, psoriasis is a hyperproliferative skin disorder with increased epidermal turnover compared with NPPD, we investigated the role of proliferation markers, Ki-67 and Cyclin D1 as diagnostic tools to differentiate psoriasis from other psoriasiform dermatitis. Methods: Histopathological specimens of psoriasis (n = 35) and NPPD (n = 36, 14 pityriasis rubra pilaris, 12 pityriasis rosea and 10 lichen simplex) cases were reviewed and immunohistochemically stained for Ki-67 and Cyclin D1. Ki-67 and Cyclin D1 positive cells were counted for suprabasal, and total epidermal immunostaining per mm2. Results: Suprabasal and total epidermal cell counts for Ki-67 were found to be significantly higher in the psoriasis group compared with the NPPD group (p < 0.05). An important and interesting feature was the presence of a cut-off value for the suprabasal/total epidermal cell count ratio of 75% for Ki-67 immunostaining, which was higher in all patients having psoriasis (range, 77.1% – 92.4%) and lower in all NPPD cases (range, 21.0% – 73.3%). However, suprabasal Cyclin D1 cell counts were higher in the psoriasis group compared with the NPPD group (p < 0.05), total epidermal Cyclin D1 cell counts were not statistically significant in either group (p = 0.167), and a cut-off value for suprabasal/total epidermal cell count ratio to distinguish these two entities was not detected using this immunostain. Conclusions: We suggest that Ki-67 is a more sensitive marker than Cyclin D1 in terms of having a cutoff value of 75% for the suprabasal/total epidermal immunoreactive cell count ratio, which we believe could be useful for dermatopathologists in differentiating psoriasis from other psoriasiform dermatitis.
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Affiliation(s)
- Engin Sezer
- Department of Dermatology, Acibadem University School of Medicine, Istanbul, Turkey
| | | | - Emel Cetin
- Department of Pathology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Fatma Tokat
- Department of Pathology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Emel Durmaz
- Department of Dermatology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Sedef Sahin
- Department of Dermatology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Umit Ince
- Department of Pathology, Acibadem University School of Medicine, Istanbul, Turkey
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9
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Tan J, Maari C, Nigen S, Bolduc C, Bissonnette R. Open-label exploratory study of acitretin for the treatment of severe chronic hand dermatitis. J DERMATOL TREAT 2014; 26:373-5. [DOI: 10.3109/09546634.2014.952608] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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Akçali C, Guven EH, Kirtak N, Inaloz HS, Ozgoztasi O, Guvenc U. Serum concentrations of interleukin-2 and tumour necrosis factor-α under cyclosporine versus acitretin treatment in plaque-type psoriasis. J Int Med Res 2014; 42:1118-22. [DOI: 10.1177/0300060514539280] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective A prospective, randomized clinical study to compare the short-term effects of cyclosporin and acitretin on psoriasis severity, and serum interleukin (IL)-2 and tumour necrosis factor (TNF)-α concentrations. Methods Patients with moderate-to-severe plaque-type psoriasis were randomly assigned to receive either 3 mg/kg per day cyclosporine or 0.3–0.5 mg/kg per day acitretin for 8 weeks. Disease severity (psoriasis area severity index [PASI] score) and serum IL-2 and TNF-α concentrations were determined before and after treatment. Results PASI scores and serum IL-2 and TNF-α concentrations were significantly decreased after treatment with either cyclosporine ( n = 21) or acitretin ( n = 25). There were no statistically significant between-group differences in any parameter. Conclusions Acitretin and cyclosporine are equally effective in the treatment of moderate-to-severe plaque-type psoriasis.
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Affiliation(s)
- Cenk Akçali
- Department of Dermatology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Ebru Homurlu Guven
- Department of Dermatology, Avukat Cengiz Gokcek State Hospital, Gaziantep, Turkey
| | - Necmettin Kirtak
- Department of Dermatology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - H Serhat Inaloz
- Department of Dermatology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Orhan Ozgoztasi
- Department of Dermatology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Ulas Guvenc
- Dermatology Clinic, Medical Park Hospital, Tarsus, Turkey
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Abstract
Acitretin, a synthetic retinoid, is the pharmacologically active metabolite of etretinate. It is currently approved by the US Food and Drug Administration for the treatment of severe psoriasis in adults and has been established as a second-line therapy for the treatment of psoriasis resistant to the use of topical therapy. It is also an option for generalized pustular psoriasis, palmoplantar pustulosis, exfoliative erythrodermic psoriasis, and severe psoriasis in the setting of acitretin. It also has been shown to have chemo-preventative characteristics. Acitretin is limited by its teratogenicity and therefore considered inappropriate in most female patients of childbearing age. Common side effects include mucocutaneous dryness and elevated triglycerides.
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Affiliation(s)
- Noelani E Gonzalez Ortiz
- Department of Dermatology, St. Luke's-Roosevelt Hospital Center, New York, New York; Beth Israel Medical Center, New York, New York
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12
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Carretero G, Ribera M, Belinchón I, Carrascosa J, Puig L, Ferrandiz C, Dehesa L, Vidal D, Peral F, Jorquera E, Gonzalez-Quesada A, Muñoz C, Notario J, Vanaclocha F, Moreno J. Acitretina: guía de uso en psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.ad.2013.01.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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13
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Carretero G, Ribera M, Belinchón I, Carrascosa JM, Puig L, Ferrandiz C, Dehesa L, Vidal D, Peral F, Jorquera E, González-Quesada A, Muñoz C, Notario J, Vanaclocha F, Moreno JC. Guidelines for the use of acitretin in psoriasis. Psoriasis Group of the Spanish Academy of Dermatology and Venereology. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:598-616. [PMID: 23891453 DOI: 10.1016/j.adengl.2013.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 01/20/2013] [Indexed: 02/01/2023] Open
Abstract
Phototherapy, classic systemic treatments (methotrexate, acitretin, and ciclosporin), and biologic agents (etanercept, infliximab, adalimumab, and ustekinumab) constitute a broad therapeutic arsenal that increases the likelihood of achieving control of severe and extensive disease in patients with psoriasis. Acitretin continues to be a very valuable tool in both monotherapy, in which it is combined with other systemic treatments (classic or biologic), and in sequential therapy. Thanks to its lack of a direct immunosuppressive effect and its ability to achieve a long-term response, acitretin has an important role in the treatment of psoriasis, although this has not always been acknowledged in relevant treatment guidelines. We present consensus guidelines for the use of acitretin in psoriasis drawn up by the Psoriasis Group of the Spanish Academy of Dermatology and Venereology. These guidelines provide a detailed account of acitretin, including pharmacological properties, indications and contraindications, adverse effects, and factors that should be taken into account to enhance the safe use of this drug. They also propose treatment strategies for use in routine clinical practice. The overall aim of these guidelines is to define the criteria for the use and management of acetretin in psoriasis.
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Affiliation(s)
- G Carretero
- Grupo de Psoriasis de la Academia Española de Dermatología y Venereología, Spain.
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14
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Johnson J, Ma C, Kanada K, Armstrong A. Diet and nutrition in psoriasis: analysis of the National Health and Nutrition Examination Survey (NHANES) in the United States. J Eur Acad Dermatol Venereol 2013; 28:327-32. [DOI: 10.1111/jdv.12105] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 01/10/2013] [Indexed: 12/30/2022]
Affiliation(s)
- J.A. Johnson
- Department of Dermatology; University of California Davis Health System; Sacramento CA
| | - C. Ma
- Department of Dermatology; University of California Davis Health System; Sacramento CA
| | - K.N. Kanada
- Department of Dermatology; University of California San Francisco; San Francisco CA USA
| | - A.W. Armstrong
- Department of Dermatology; University of California Davis Health System; Sacramento CA
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15
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Irla N, Navarini A, Yawalkar N. Alitretinoin abrogates innate inflammation in palmoplantar pustular psoriasis. Br J Dermatol 2012; 167:1170-4. [DOI: 10.1111/j.1365-2133.2012.11063.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Tang M, Spanou Z, Tang H, Schibler F, Pelivani N, Yawalkar N. Rapid Downregulation of Innate Immune Cells, Interleukin-12 and Interleukin-23 in Generalized Pustular Psoriasis with Infliximab in Combination with Acitretin. Dermatology 2012; 225:338-43. [DOI: 10.1159/000346243] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022] Open
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Busse K, Koo J. Introducing the delayed retinoid burn: A case report and discussion of this potential risk of retinoid-phototherapy combination management. J Am Acad Dermatol 2011; 64:1011-2. [DOI: 10.1016/j.jaad.2010.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 02/22/2010] [Accepted: 02/28/2010] [Indexed: 10/18/2022]
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Knol AC, Quéreux G, Brocard A, Ballanger F, Khammari A, Nguyen JM, Dréno B. About the cutaneous targets of bexarotene in CTCL patients. Exp Dermatol 2011; 19:e299-301. [PMID: 19845753 DOI: 10.1111/j.1600-0625.2009.00995.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
There are several approved therapies for cutaneous T-cell lymphoma (CTCL). The retinoids are one of the major biologic response modifiers used in CTCL, producing good response rates but few complete responses. Bexarotene has been demonstrated to act on malignant T-cells by inducing their apoptosis, but nothing is known about its role on keratinocytes and Langerhans cells. Immunohistochemical analysis using CD1a, HLA-DR, ICAM-1 (activation markers), CD95 and CD40 (apoptosis markers) was conducted on frozen sections of bexarotene-exposed cutaneous explants and skin biopsy specimens from patients treated with bexarotene. None of the studied markers was significantly modulated both on cutaneous explants and on skin biopsy specimens after treatment with bexarotene, compared to controls. Langerhans cells and keratinocytes do not appear to play a central role in the therapeutic control of CTCL by bexarotene therapy. The main bexarotene's target thus remains T-cells by inducing their apoptosis, a mechanism that is different from the other retinoids used in CTCL.
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Shaw FL, Cumberbatch M, Kleyn CE, Begum R, Dearman RJ, Kimber I, Griffiths CEM. Langerhans cell mobilization distinguishes between early-onset and late-onset psoriasis. J Invest Dermatol 2010; 130:1940-2. [PMID: 20237494 DOI: 10.1038/jid.2010.57] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Hadjipavlou-Litina D, Magoulas GE, Krokidis M, Papaioannou D. Syntheses and evaluation of the antioxidant activity of acitretin analogs with amide bond(s) in the polyene spacer. Eur J Med Chem 2010; 45:298-310. [PMID: 19939514 DOI: 10.1016/j.ejmech.2009.10.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 10/06/2009] [Accepted: 10/07/2009] [Indexed: 11/15/2022]
Abstract
Ester analogs of the antipsoriatic drug acitretin were synthesized by coupling either anilines with N-protected indole-3-carboxylic acid, followed by deprotection and coupling with O-monoprotected dicarboxylic acids or Wittig reaction of indole-3-carboxaldehyde, 3-acetyl-1-tosylpyrrole and 4-amino-9-fluorenone with Ph3P=CHCO2tBu, followed by N-deprotection, where necessary, and finally coupling with cinnamoyl fluorides. Corresponding free acids were obtained through TFA-mediated carboxyl group deprotection. Although these analogs and acitretin showed very low reducing abilities, analogs 5, 6, 8 and 12 strongly inhibited LOX with IC50 values ranging from 35-65 microM. Acitretin and its analogs 5-7, 10, 11 and 15 inhibited lipid peroxidation more strongly than trolox whereas acitretin and analog 4 were in vivo more potent anti-inflammatory agents on rat paw oedema induced by Carrageenan than indomethacin.
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Affiliation(s)
- Dimitra Hadjipavlou-Litina
- Department of Pharmaceutical Chemistry, School of Pharmacy, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
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