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Sun X, Pan H, Lu H, Song S, Jin C, Pu Y. Diagnostic significance of combined anti-extractable nuclear antigens antibody, anti-cardiolipin antibody and anti-β2-glycoprotein 1 in systemic lupus erythematosus patients. Heliyon 2024; 10:e29230. [PMID: 38617903 PMCID: PMC11015451 DOI: 10.1016/j.heliyon.2024.e29230] [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: 10/16/2023] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/16/2024] Open
Abstract
Objective This study aimed to investigate the diagnostic value of a combination of anti-extractable nuclear antigens (anti-ENA) antibodies, anti-cardiolipin antibodies (ACA), and anti-β2-glycoprotein 1 (anti-β2 GPI) antibodies in patients with systemic lupus erythematosus (SLE). Methods A total of 646 SLE patients diagnosed in our hospital between January 2020 and April 2023 were randomly selected as study subjects, while 2075 non-SLE subjects during the same period were selected as the control group. The levels of anti-extractable nuclear antigen (ENA) antibody, ACA, and anti-β2 GPI antibodies were measured, and their diagnostic value for SLE was analyzed using binary logistic regression and receiver operating characteristic (ROC) analysis. Results The rates of positive anti-RNP, anti-Sm, anti-Sjögren's syndrome (SS-A), and anti-SS-B antibodies in the SLE patient group were significantly higher than those in the control group, with all differences being statistically significant (P < 0.01). The rates of positive ACA, as well as the levels of ACA IgA, ACA IgG, and ACA IgM, were significantly higher in the SLE patients group compared to the control group, with statistically differences (P < 0.05). Similarly, the rates of positive anti-β2 GPI antibodies, anti-β2 GPI antibody IgA, IgG, and IgM, were significantly higher in the SLE patient group compared to the control group, with all differences being statistically significant (P < 0.01). Gender, age, positive anti-JO1 antibodies, positive anti-RNP antibodies, positive anti-SS-A antibodies, positive ACA, high level ACA IgG and ACA IgM, positive anti-β2 GPI antibodies, and high level of anti-β2 GPI antibody IgA were identified as independent risk factors for the development of SLE (P < 0.05). The combined use of age, sex, anti-ENA antibodies, ACA, and anti-β2 GPI antibodies yielded a sensitivity of 82.12% (80.41%-83.71%) and a specificity of 80.03% (76.77%-82.93%) for the diagnosis of SLE. Conclusion The combination of age, sex, anti-ENA antibodies, ACA, and anti-β2 GPI antibodies shows high diagnostic value for SLE and holds potential for clinical application as an auxiliary diagnostic tool for SLE.
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Affiliation(s)
| | | | | | - Shanshan Song
- Department of Clinical Laboratory, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Chengjun Jin
- Department of Clinical Laboratory, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yingye Pu
- Department of Clinical Laboratory, Changhai Hospital, Naval Medical University, Shanghai, China
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2
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McKinley BJ, Allen ME, Michels N. Photodistributed Stevens-Johnson syndrome and toxic epidermal necrolysis: a systematic review and proposal for a new diagnostic classification. Eur J Med Res 2023; 28:188. [PMID: 37303053 DOI: 10.1186/s40001-023-01142-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Ultraviolet radiation (UVR) exposure is commonly reported as a risk factor for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, minimal evaluation of photo-induced SJS/TEN has been conducted. Thus, this review identifies all cases of SJS/TEN that are linked to an acute exposure of UVR and outlines the unifying characteristics of these cases. Furthermore, the theoretical pathogenesis, differential diagnoses, and proposed diagnostic criteria are defined. METHODS PubMed, Google Scholar, and other databases and websites were searched from inception to September 2021 to identify studies that met inclusion criteria. The following keywords were utilized: "Stevens-Johnson syndrome" and "toxic epidermal necrolysis" with "ultraviolet," "photodistributed," "photo-induced," "photosensitivity," and "photo." One reviewer assessed study characteristics, with confirmation by a second. The risk of bias was assessed independently by another. RESULTS Thirteen patient cases were identified, all reporting ultraviolet radiation prior to rash onset and an underlying causal drug. Case classifications included 7/13 SJS and 6/13 TEN. All cases described the rash as photodistributed with UVR exposure prior to rash onset (delay of 1-3 days) and a causal drug. 10 cases provided evidence that the photodistributed rash lacked linear demarcation (as in a sunburn) with satellite target-like lesions. No cases described a flu-like prodrome. DISCUSSION Mucositis, palmar and plantar rash, a positive Nikolsky sign, and a prolonged disease course can help distinguish from photosensitive reactions, while a negative direct immunofluorescence test is important to distinguish from other photo-induced disorders. CONCLUSION Physicians should be aware that UVR may precipitate SJS/TEN in patients taking susceptible drugs. After a 24-h delay from UVR exposure, a non-distinct, photodistributed rash appears with no flu-like prodrome and progresses for at least 48 h to include vesiculobullous eruptions and mucous membrane involvement. Photodistributed SJS/TEN appears to be photo-drug-induced with a unique onset and rash presentation that should be recognized as a distinct diagnosis.
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Affiliation(s)
- Blake Jeffrey McKinley
- Department of Internal Medicine, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.
| | - Mitchell Edger Allen
- Department of Primary Care, Rocky Vista University College of Osteopathic Medicine, Ivins, UT, 84738, USA
| | - Nicole Michels
- Department of Medical Humanities and Biomedical Sciences, Rocky Vista University College of Osteopathic Medicine, 8401 S. Chambers Road, Parker, CO, 80134, USA.
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Kopera D, Cerroni L, Trüeb R. [Frontal hypopigmentation with band-like alopecia]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2022; 73:744-746. [PMID: 35347356 PMCID: PMC9427918 DOI: 10.1007/s00105-022-04976-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Daisy Kopera
- Klinik für Dermatologie, Medizinische Universität Graz, Auenbruggerplatz 8, 8036, Graz, Österreich.
| | - Lorenzo Cerroni
- Klinik für Dermatologie, Medizinische Universität Graz, Auenbruggerplatz 8, 8036, Graz, Österreich
| | - Ralph Trüeb
- Haarcenter Wallisellen, Wallisellen, Schweiz
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Domingo S, Solé C, Moliné T, Ferrer B, Cortés-Hernández J. Thalidomide Exerts Anti-Inflammatory Effects in Cutaneous Lupus by Inhibiting the IRF4/NF-ҡB and AMPK1/mTOR Pathways. Biomedicines 2021; 9:biomedicines9121857. [PMID: 34944673 PMCID: PMC8698478 DOI: 10.3390/biomedicines9121857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
Thalidomide is effective in patients with refractory cutaneous lupus erythematosus (CLE). However, the mechanism of action is not completely understood, and its use is limited by its potential, severe side-effects. Immune cell subset analysis in thalidomide’s CLE responder patients showed a reduction of circulating and tissue cytotoxic T-cells with an increase of iNKT cells and a shift towards a Th2 response. We conducted an RNA-sequencing study using CLE skin biopsies performing a Therapeutic Performance Mapping System (TMPS) analysis in order to generate a predictive model of its mechanism of action and to identify new potential therapeutic targets. Integrating RNA-seq data, public databases, and literature, TMPS analysis generated mathematical models which predicted that thalidomide acts via two CRBN-CRL4A- (CRL4CRBN) dependent pathways: IRF4/NF-ҡB and AMPK1/mTOR. Skin biopsies showed a significant reduction of IRF4 and mTOR in post-treatment samples by immunofluorescence. In vitro experiments confirmed the effect of thalidomide downregulating IRF4 in PBMCs and mTOR in keratinocytes, which converged in an NF-ҡB reduction that led to a resolution of the inflammatory lesion. These results emphasize the anti-inflammatory role of thalidomide in CLE treatment, providing novel molecular targets for the development of new therapies that could avoid thalidomide’s side effects while maintaining its efficacy.
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Affiliation(s)
- Sandra Domingo
- Lupus Unit, Rheumatology Departament, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (S.D.); (J.C.-H.)
| | - Cristina Solé
- Lupus Unit, Rheumatology Departament, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (S.D.); (J.C.-H.)
- Correspondence: ; Tel.: +34-93-489-4045
| | - Teresa Moliné
- Department of Pathology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (T.M.); (B.F.)
| | - Berta Ferrer
- Department of Pathology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (T.M.); (B.F.)
| | - Josefina Cortés-Hernández
- Lupus Unit, Rheumatology Departament, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (S.D.); (J.C.-H.)
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5
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Merola JF, Wang W, Wager CG, Hamann S, Zhang X, Thai A, Roberts C, Lam C, Musselli C, Marsh G, Rabah D, Barbey C, Franchimont N, Reynolds TL. RNA tape sampling in cutaneous lupus erythematosus discriminates affected from unaffected and healthy volunteer skin. Lupus Sci Med 2021; 8:8/1/e000428. [PMID: 33658303 PMCID: PMC7931768 DOI: 10.1136/lupus-2020-000428] [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: 07/10/2020] [Revised: 12/20/2020] [Accepted: 01/17/2021] [Indexed: 12/13/2022]
Abstract
Objective Punch biopsy, a standard diagnostic procedure for patients with cutaneous lupus erythematosus (CLE) carries an infection risk, is invasive, uncomfortable and potentially scarring, and impedes patient recruitment in clinical trials. Non-invasive tape sampling is an alternative that could enable serial evaluation of specific lesions. This cross-sectional pilot research study evaluated the use of a non-invasive adhesive tape device to collect messenger RNA (mRNA) from the skin surface of participants with CLE and healthy volunteers (HVs) and investigated its feasibility to detect biologically meaningful differences between samples collected from participants with CLE and samples from HVs. Methods Affected and unaffected skin tape samples and simultaneous punch biopsies were collected from 10 participants with CLE. Unaffected skin tape and punch biopsies were collected from 10 HVs. Paired samples were tested using quantitative PCR for a candidate immune gene panel and semi-quantitative immunohistochemistry for hallmark CLE proteins. Results mRNA collected using the tape device was of sufficient quality for amplification of 94 candidate immune genes. Among these, we found an interferon (IFN)-dominant gene cluster that differentiated CLE-affected from HV (23-fold change; p<0.001) and CLE-unaffected skin (sevenfold change; p=0.002), respectively. We found a CLE-associated gene cluster that differentiated CLE-affected from HV (fourfold change; p=0.005) and CLE-unaffected skin (fourfold change; p=0.012), respectively. Spearman’s correlation between per cent area myxovirus 1 protein immunoreactivity and IFN-dominant mRNA gene cluster expression was highly significant (dermis, rho=0.86, p<0.001). In total, skin tape-derived RNA expression comprising both IFN-dominant and CLE-associated gene clusters correlated with per cent area immunoreactivity of some hallmark CLE-associated proteins in punch biopsies from the same lesions. Conclusions A non-invasive tape RNA collection technique is a potential tool for repeated skin biomarker measures throughout a clinical trial.
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Affiliation(s)
- Joseph F Merola
- Department of Dermatology and Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Alice Thai
- Biogen Inc, Cambridge, Massachusetts, USA
| | | | - Christina Lam
- Dermatology, Boston University, Boston, Massachusetts, USA
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Schempp CM, Schauer F, Huhn CK, Venhoff N, Finzel S. Skin inflammation associated with arthritis, synovitis and enthesitis. Part 2: rheumatoid arthritis, reactive arthritis, Reiter's syndrome, Lyme borreliosis, dermatomyositis and lupus erythematosus. J Dtsch Dermatol Ges 2020; 17:167-181. [PMID: 30762968 DOI: 10.1111/ddg.13761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/16/2019] [Indexed: 11/30/2022]
Abstract
Syndromes associated with concurrent skin and joint inflammation frequently pose a therapeutic challenge for both dermatologists and rheumatologists. In part 1 of this review, we discussed psoriatic arthritis as well as the autoinflammatory disorders SAPHO syndrome, Still's disease and Behçet's disease. Part 2 will address rheumatoid arthritis, reactive arthritis, Reiter's syndrome and Lyme borreliosis. In addition, we will discuss dermatomyositis and lupus erythematosus, two common autoimmune disorders that frequently present with both cutaneous and joint involvement. For each of the aforementioned disorders, we will highlight aspects of epidemiology, pathogenesis, clinical presentation, diagnosis and treatment.
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Affiliation(s)
- Christoph M Schempp
- Department of Dermatology and Venereology, Freiburg University Medical Center, Medical Faculty, Albert Ludwigs University, Freiburg, Germany
| | - Franziska Schauer
- Department of Dermatology and Venereology, Freiburg University Medical Center, Medical Faculty, Albert Ludwigs University, Freiburg, Germany
| | - Christian K Huhn
- Department of Dermatology and Venereology, Freiburg University Medical Center, Medical Faculty, Albert Ludwigs University, Freiburg, Germany
| | - Nils Venhoff
- Department of Rheumatology and clinical Immunology, Freiburg University Medical Center, Medical Faculty, Albert Ludwigs University, Freiburg, Germany
| | - Stephanie Finzel
- Department of Rheumatology and clinical Immunology, Freiburg University Medical Center, Medical Faculty, Albert Ludwigs University, Freiburg, Germany
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7
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Schempp CM, Schauer F, Huhn CK, Venhoff N, Finzel S. Hautentzündungen mit Arthritis, Synovitis und Enthesitis. Teil 2: Rheumatoide Arthritis, reaktive Arthritis, Morbus Reiter, Lyme-Borreliose, Dermatomyositis und Lupus erythematodes. J Dtsch Dermatol Ges 2019; 17:167-182. [DOI: 10.1111/ddg.13761_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/16/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Christoph M. Schempp
- Klinik für Dermatologie und Venerologie; Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Franziska Schauer
- Klinik für Dermatologie und Venerologie; Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Christian K. Huhn
- Klinik für Dermatologie und Venerologie; Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Nils Venhoff
- Klinik für Rheumatologie und klinische Immunologie; Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Stephanie Finzel
- Klinik für Rheumatologie und klinische Immunologie; Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
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8
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Verdelli A, Coi A, Marzano AV, Antiga E, Cozzani E, Quaglino P, La Placa M, Benucci M, De Simone C, Papini M, Parodi A, Bianchi F, Caproni M. Autoantibody profile and clinical patterns in 619 Italian patients with cutaneous lupus erythematosus. J Eur Acad Dermatol Venereol 2018; 33:742-752. [PMID: 29924416 DOI: 10.1111/jdv.15147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/30/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Anti-nuclear antibodies (ANA), anti-extractable nuclear antigens (ENA) and anti-dsDNA antibodies are often associated with cutaneous lupus erythematosus (CLE), with variable frequency depending on skin subtype. However, specific data based on large case-series on the pathogenetic, diagnostic and prognostic meaning of such autoantibodies are still lacking. OBJECTIVE To characterize the correlations between CLE subtypes as well as LE-non-specific skin lesions and their autoantibody pattern. METHODS Epidemiological, clinical and immunopathological data of 619 Italian patients with CLE and LE-non-specific skin lesions were analysed. Differences in age, sex, clinical features and autoantibody profile were evaluated in each LE subgroup. RESULTS Anti-nuclear antibodies (P < 0.0001), anti-dsDNA (P < 0.0001), ENA (P = 0.001), anti-Sm (P = 0.001), anti-RNP (P = 0.004) and anti-histone (P = 0.005) antibodies were associated with SLE. A strong association between ANA (P < 0.0001) and anti-dsDNA (P < 0.0001) and female gender was also found: positive ANA and positive anti-dsDNA had a higher prevalence among females. Chronic CLE resulted to be negatively associated with ENA (OR = 0.51, P < 0.0001), anti-Ro/SSA (OR = 0.49, P < 0.0001) and anti-dsDNA (OR = 0.37, P < 0.0001). Intermittent CLE resulted to be negatively associated with ENA (OR = 0.50, P = 0.007) and ANA (OR = 0.61, P = 0.025). Subacute CLE resulted to be associated with ENA (OR = 5.19, P < 0.0001), anti-Ro/SSA (OR = 3.83, P < 0.0001), anti-Smith (OR = 2.95, P = 0.004) and anti-RNP (OR = 3.18, P = 0.007). Acute CLE resulted to be strongly associated with anti-dsDNA (OR = 6.0, P < 0.0001) and ANA (OR = 18.1, P < 0.0001). LE-non-specific skin lesions resulted to be significantly associated with systemic involvement. Livedo reticularis was significantly associated with ENA (P = 0.007) and anti-Ro/SSA (P = 0.036). Palpable purpura and periungual telangiectasia were significantly associated with ANA. CONCLUSION According to our findings, some well-known associations between CLE subtypes and autoantibody profile were confirmed; moreover, specific association between autoantibodies and LE-non-specific skin lesions was highlighted. A strict association between anti-ENA and anti-Ro/SSA antibodies and livedo reticularis, ANA and palpable purpura, and ANA and periungual telangiectasia was evidenced.
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Affiliation(s)
- A Verdelli
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
| | - A Coi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - A V Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, UOC Dermatologia, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - E Antiga
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
| | - E Cozzani
- IRCCS-AOU San Martino-IST, Dissal, Section of Dermatology, University of Genoa, Genoa, Italy
| | - P Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - M La Placa
- Dermology Division, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - M Benucci
- Rheumatology Unit, S. Giovanni di Dio Hospital, Florence, Italy
| | - C De Simone
- Dermatology Department, Policlinico Universitario 'A. Gemelli', Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Papini
- Department of Surgical and Biomedical Sciences, Dermatologic Clinic of Terni, University of Perugia, Perugia, Italy
| | - A Parodi
- IRCCS-AOU San Martino-IST, Dissal, Section of Dermatology, University of Genoa, Genoa, Italy
| | - F Bianchi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - M Caproni
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
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Petersen MP, Möller S, Bygum A, Voss A, Bliddal M. Epidemiology of cutaneous lupus erythematosus and the associated risk of systemic lupus erythematosus: a nationwide cohort study in Denmark. Lupus 2018; 27:1424-1430. [PMID: 29788808 DOI: 10.1177/0961203318777103] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives The objectives of this paper are to describe the epidemiology of cutaneous lupus erythematosus (CLE) and its subtypes in Denmark, and to investigate the probability of receiving a subsequent diagnosis of systemic lupus erythematosus (SLE) and the related time course. Methods A nationwide registry-based cohort study was conducted in Denmark based on data from the Danish National Patient Registry from 1998 to 2013 using International Classification of Diseases, Revision 10. Results We identified 2380 patients with CLE. The annual incidence rate (IR) of CLE was 2.74/100,000 with a female:male ratio of 4:1. During 12,047 person-years of follow-up, 8% were diagnosed with SLE. The probability of receiving a subsequent diagnosis of SLE was 12.9% after 10 years taking death as a competing risk into consideration, and the probability was highest among women and patients diagnosed with subacute CLE. The median time until a diagnosis of SLE was 2.05 years. Conclusions This is the first nationwide study on CLE in Denmark. Although we found the annual IR of CLE and the risk of receiving an additional diagnosis of SLE to be lower than previously described, continued monitoring and thorough information for patients with CLE is important due to the inherent risk of SLE.
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Affiliation(s)
- M Prütz Petersen
- 1 Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - S Möller
- 2 OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Denmark.,3 Odense University Hospital, Odense, Denmark
| | - A Bygum
- 1 Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - A Voss
- 4 Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - M Bliddal
- 2 OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Denmark.,3 Odense University Hospital, Odense, Denmark
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Alniemi DT, Gutierrez A, Drage LA, Wetter DA. Subacute Cutaneous Lupus Erythematosus: Clinical Characteristics, Disease Associations, Treatments, and Outcomes in a Series of 90 Patients at Mayo Clinic, 1996-2011. Mayo Clin Proc 2017; 92:406-414. [PMID: 28185656 DOI: 10.1016/j.mayocp.2016.10.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/10/2016] [Accepted: 10/25/2016] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To characterize the clinical presentation, laboratory studies, disease associations, and treatments of subacute cutaneous lupus erythematosus (SCLE). PATIENTS AND METHODS A retrospective review of 90 patients with SCLE at Mayo Clinic from January 1, 1996, through October 28, 2011, was performed. RESULTS The mean patient age at diagnosis was 61 years; 64 patients (71%) were women, and 11 cases (12%) were drug induced (1996-2000, no drug-induced cases; 2001-2005, 2 cases; 2006-2011, 9 cases). Seventeen of 59 patients (29%) with available data were smokers at the time of diagnosis. The SCLE lesions were photodistributed in 75 patients (83%), and 52 (58%) had papulosquamous morphologic findings. Anti-Ro/SS-A positivity was present in 84 of 85 patients tested (99%), whereas 32 of the 85 patients (38%) tested positive for anti-La/SS-B. Associated autoimmune connective tissue diseases included Sjögren syndrome (n=13, 14%) and systemic lupus erythematosus (SLE) (n=8, 9%). Eighteen patients (20%) had at least 4 American College of Rheumatology criteria for SLE; 1 had lupus nephritis, and none had neurologic or notable hematologic sequelae. The most common therapy was hydroxychloroquine, with a complete response noted in 34 of 46 patients (74%) with available follow-up data. CONCLUSION Twenty-eight percent of patients with SCLE (n=25) had an associated autoimmune connective tissue disease, although the severe sequelae of SLE, such as nephritis, were rare. The frequency of drug-induced SCLE increased during the study. Most patients responded to treatment with hydroxychloroquine.
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Affiliation(s)
- Dema T Alniemi
- Mayo Clinic School of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | | | - Lisa A Drage
- Department of Dermatology, Mayo Clinic, Rochester, MN
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Abstract
Treatment of skin manifestations in systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and dermatomyositis (DM) is based on the results of only few randomized controlled trials. The first-line treatment for disfiguring and widespread cutaneous involvement in SLE is antimalarials, but some patients are therapy resistant. Recently, the monoclonal antibody belimumab was approved for SLE as an adjunct therapy for patients with autoantibody-positive disease who despite standard therapy show high disease activity, intolerance of other treatments, or an unacceptably high need for corticosteroids. However, a validated skin score has not been used to confirm the efficacy of belimumab on mucocutaneous manifestations. In SSc, another multi-systemic progressive disease, involvement of the lung, kidney, and the heart is frequently treated with corticosteroids and immunosuppressives, but therapeutic modalities for cutaneous lesions, such as skin sclerosis and digital ulcers, are limited. In the past years, treatment with the endothelin-receptor antagonist bosentan has been proven to reduce the occurrence of new digital ulcers in SSc patients but has no or limited effect on healing of digital ulcers. DM is an idiopathic autoimmune disease characterized by inflammation of the muscles and skin, which is treated with immunosuppressives. Corticosteroids are the first-line treatment for muscle involvement in DM, but skin lesions often flare by reduction or discontinuation. In summary, there is a high unmet need for new therapeutic strategies focusing on skin involvement in systemic autoimmune diseases. Therefore, innovative designs of randomized controlled trials with validated skin scores are warranted to develop new therapeutic strategies for patients with cutaneous manifestations.
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Trofimov PN, Antonova OV, Shvyrev DN, Khairutdinov VR, Belousova IE, Samtsov AV. Cutaneous lupus erythematosus: pathogenesis, clinical pattern, diagnostics, therapy. VESTNIK DERMATOLOGII I VENEROLOGII 2015. [DOI: 10.25208/0042-4609-2015-91-5-24-33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
This article contains the latest information about the mechanisms of development of lupus erythematosus based on the literature review. The modern classification of specific and non-specific skin lesions in lupus erythematosus is shown.The authors described the clinical pattern of cutaneous forms of lupus erythematosus very detailed. the data about pathological and immunological criteria for the disease diagnostics, modern methods of pharmacotherapy lupus erythematosus was classified.
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Gambichler T, Pätzholz J, Schmitz L, Lahner N, Kreuter A. FOXP3+ and CD39+ regulatory T cells in subtypes of cutaneous lupus erythematosus. J Eur Acad Dermatol Venereol 2015; 29:1972-7. [DOI: 10.1111/jdv.13123] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/02/2015] [Indexed: 11/28/2022]
Affiliation(s)
- T. Gambichler
- Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - J. Pätzholz
- Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - L. Schmitz
- Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - N. Lahner
- Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - A. Kreuter
- Department of Dermatology; Venereology; and Allergology; HELIOS St. Elisabeth Hospital; Oberhausen Germany
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14
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Chiewchengchol D, Murphy R, Edwards SW, Beresford MW. Mucocutaneous manifestations in juvenile-onset systemic lupus erythematosus: a review of literature. Pediatr Rheumatol Online J 2015; 13:1. [PMID: 25587243 PMCID: PMC4292833 DOI: 10.1186/1546-0096-13-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/21/2014] [Indexed: 02/04/2023] Open
Abstract
Patients diagnosed with juvenile-onset systemic lupus erythematosus (JSLE) often have skin and oral lesions as part of their presentation. These mucocutaneous lesions, as defined by the American College of Rheumatology (ACR) in 1997, include malar rash, discoid rash, photosensitivity and oral ulcers. It is therefore essential to recognize mucocutaneous lesions to accurately diagnose JSLE. The mucocutaneous lesions can be divided into those with classical histological features (LE specific) and those strongly associated with and forming part of the diagnostic spectrum, but without the classical histological changes of lupus (LE nonspecific). A malar rash is the most commonly associated LE specific dermatological presentation. This skin manifestation is an acute form and also correlates with disease activity. Subacute (polycyclic or papulosquamous lesions) and chronic (discoid lesions) forms, whilst showing classical histological changes supportive of lupus, are less commonly associated with systemic lupus and do not correlate with disease activity. The most commonly associated skin lesions without classical lupus changes are cutaneous vasculitis, oral ulcers and diffuse non-scarring alopecia. These signs frequently relate to disease activity. An understanding of cutaneous signs and symptoms of lupus in children is important to avoid delay in diagnosis. They will often improve as lupus is adequately controlled and their reappearance is often the first indicator of a disease flare.
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Affiliation(s)
- Direkrit Chiewchengchol
- />Institute of Translational Medicine, Alder Hey Children’s NHS Foundation Trust, University of Liverpool, Liverpool, UK
- />Institute of Integrative Biology, University of Liverpool, Liverpool, UK
- />Immunology Unit & Center of Excellence in Immunology and Immune-mediated Disease, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ruth Murphy
- />Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, UK
| | - Steven W Edwards
- />Institute of Integrative Biology, University of Liverpool, Liverpool, UK
| | - Michael W Beresford
- />Institute of Translational Medicine, Alder Hey Children’s NHS Foundation Trust, University of Liverpool, Liverpool, UK
- />Department of Women’s and Children’s Health, Institute of Translational Medicine, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP UK
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15
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Kuhn A, Landmann A. The classification and diagnosis of cutaneous lupus erythematosus. J Autoimmun 2014; 48-49:14-9. [PMID: 24486120 DOI: 10.1016/j.jaut.2014.01.021] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/13/2013] [Indexed: 02/08/2023]
Abstract
Lupus erythematosus (LE) is an inflammatory connective tissue disease of generalized autoimmunity characterized by pathogenic autoantibodies and immune complexes, attributed to loss of immune tolerance. Cutaneous involvement, which appears in the majority of patients with the disease, can present as LE-specific or LE-nonspecific manifestations. The LE-nonspecific manifestations include e.g. vascular skin changes and may be associated with systemic organ manifestations or other autoimmune diseases. In contrast, the LE-specific manifestations encompass the various subtypes of cutaneous lupus erythematosus (CLE), which are classified as separate entities without or with less severe systemic organ involvement. In the "Duesseldorf Classification", CLE is subdivided into four different categories: acute CLE (ACLE), subacute CLE (SCLE), chronic CLE (CCLE), and intermittent CLE (ICLE). Differentiation between these subtypes is based on clinical features and average duration of the cutaneous lesions, but can also consider histological changes of skin biopsy specimens and laboratory abnormalities. In addition, direct immunofluorescence and photoprovocation may be applied to confirm the diagnosis in specific cases. Further investigations should be considered dependent on the clinical symptoms of the CLE patient and the results of the laboratory tests. A revised scoring system, the Cutaneous Lupus Erythematosus Disease Area and Severity Index (RCLASI) has recently been validated to assess disease activity and damage in CLE. In this review, we focus on the classification of CLE and the diagnostic procedures to identify and confirm the different subtypes of the disease.
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Affiliation(s)
- Annegret Kuhn
- Department of Dermatology, University of Muenster, Germany; Division of Immunogenetics, Tumor Immunology Program, German Cancer Research Center, Heidelberg, Germany.
| | - Aysche Landmann
- Division of Immunogenetics, Tumor Immunology Program, German Cancer Research Center, Heidelberg, Germany
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16
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Moura Filho JP, Peixoto RL, Martins LG, de Melo SD, de Carvalho LL, Pereira AKFDTC, Freire EAM. Lupus erythematosus: considerations about clinical, cutaneous and therapeutic aspects. An Bras Dermatol 2014; 89:118-25. [PMID: 24626656 PMCID: PMC3938362 DOI: 10.1590/abd1806-4841.20142146] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 01/18/2013] [Indexed: 12/31/2022] Open
Abstract
Systemic Lupus Erythematosus is a chronic inflammatory disease with multifactorial etiology. Although clinical manifestations are varied, the skin is an important target-organ, which contributes to the inclusion of skin lesions in 4 out of the 17 new criteria for the diagnosis of the disease, according to the Systemic Lupus International Collaborating Clinics. The cutaneous manifestations of lupus are pleomorphic. Depending on their clinical characteristics, they can be classified into Acute Cutaneous Lupus Erythematosus, Subacute Cutaneous Lupus Erythematosus, Chronic Cutaneous Lupus Erythematosus and Intermittent Cutaneous Lupus Erythematosus. Treatment is based on preventive measures, reversal of inflammation, prevention of damage to target organs and relief of adverse events due to pharmacological therapy. The most commonly used treatment options are topical, systemic and surgical treatment, as well as phototherapy. The correct handling of the cases depends on a careful evaluation of the morphology of the lesions and the patient's general status, always taking into consideration not only the benefits but also the side effects of each therapeutic proposal.
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Affiliation(s)
| | - Raiza Luna Peixoto
- Medical Students Paraiba Federal University (UFPB) - João Pessoa (PB),
Brazil
| | - Lívia Gomes Martins
- Medical Students Paraiba Federal University (UFPB) - João Pessoa (PB),
Brazil
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17
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Abstract
Systemic lupus erythematosus (SLE) is a multiorgan autoimmune disease of unknown etiology with many clinical manifestations. The skin is one of the target organs most variably affected by the disease. The American College of Rheumatology (ACR) established 11 criteria as a classificatory instrument to operationalise the definition of SLE in clinical trials. They were not intended to be used to diagnose individuals and do not do well in that capacity. Cutaneous lesions account for four of these 11 revised criteria of SLE. Skin lesions in patients with lupus may be specific or nonspecific. This paper covers the SLE-specific cutaneous changes: malar rash, discoid rash, photosensitivity, and oral mucosal lesions as well as SLE nonspecific skin manifestations, their pathophysiology, and management. A deeper thorough understanding of the cutaneous manifestations of SLE is essential for diagnosis, prognosis, and efficient management. Thus, dermatologists should cooperate with other specialties to provide optimal care of SLE patient.
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18
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Cutaneous manifestations of systemic lupus erythematosus. Autoimmune Dis 2012; 2012:834291. [PMID: 22888407 PMCID: PMC3410306 DOI: 10.1155/2012/834291] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 06/04/2012] [Indexed: 11/28/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a multiorgan autoimmune disease of unknown etiology with many clinical manifestations. The skin is one of the target organs most variably affected by the disease. The American College of Rheumatology (ACR) established 11 criteria as a classificatory instrument to operationalise the definition of SLE in clinical trials. They were not intended to be used to diagnose individuals and do not do well in that capacity. Cutaneous lesions account for four of these 11 revised criteria of SLE. Skin lesions in patients with lupus may be specific or nonspecific. This paper covers the SLE-specific cutaneous changes: malar rash, discoid rash, photosensitivity, and oral mucosal lesions as well as SLE nonspecific skin manifestations, their pathophysiology, and management. A deeper thorough understanding of the cutaneous manifestations of SLE is essential for diagnosis, prognosis, and efficient management. Thus, dermatologists should cooperate with other specialties to provide optimal care of SLE patient.
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19
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Kuhn A, Gensch K, Haust M, Schneider SW, Bonsmann G, Gaebelein-Wissing N, Lehmann P, Wons A, Reitmeir P, Ruland V, Luger TA, Ruzicka T. Efficacy of tacrolimus 0.1% ointment in cutaneous lupus erythematosus: a multicenter, randomized, double-blind, vehicle-controlled trial. J Am Acad Dermatol 2011; 65:54-64, 64.e1-2. [PMID: 21501887 DOI: 10.1016/j.jaad.2010.03.037] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 02/26/2010] [Accepted: 03/28/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Topical calcineurin inhibitors are licensed for the treatment of atopic dermatitis; however, the efficacy of tacrolimus in cutaneous lupus erythematosus (CLE) has only been shown in single case reports. OBJECTIVE In a multicenter, randomized, double-blind, vehicle-controlled trial, we sought to evaluate the efficacy of tacrolimus 0.1% ointment for skin lesions in CLE. METHODS Thirty patients (18 female, 12 male) with different subtypes of CLE were included, and two selected skin lesions in each patient were treated either with tacrolimus 0.1% ointment or vehicle twice daily for 12 weeks. The evaluation included scoring of clinical features, such as erythema, hypertrophy/desquamation, edema, and dysesthesia. RESULTS Significant improvement (P < .05) was seen in skin lesions of CLE patients treated with tacrolimus 0.1% ointment after 28 and 56 days, but not after 84 days, compared with skin lesions treated with vehicle. Edema responded most rapidly to tacrolimus 0.1% ointment and the effect was significant (P < .001) in comparison to treatment with vehicle after 28 days. Clinical score changes in erythema also showed remarkable improvement (P < .05) after 28 days, but not after 56 and 84 days. Moreover, patients with lupus erythematosus tumidus revealed the highest degree of improvement. None of the patients with CLE demonstrated any major side effects. LIMITATIONS The study was limited by the small sample size. CONCLUSION Explorative subgroup analyses revealed that topical application of tacrolimus 0.1% ointment may provide at least temporary benefit, especially in acute, edematous, non-hyperkeratotic lesions of CLE patients, suggesting that calcineurin inhibitors may represent an alternative treatment for the various disease subtypes.
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Affiliation(s)
- Annegret Kuhn
- Department of Dermatology, University of Muenster, Muenster, Germany.
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20
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Sticherling M. Update on the use of topical calcineurin inhibitors in cutaneous lupus erythematosus. Biologics 2011; 5:21-31. [PMID: 21383913 PMCID: PMC3044791 DOI: 10.2147/btt.s9806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Indexed: 11/23/2022]
Abstract
Cutaneous manifestations of lupus erythematosus (CLE) are manifold, presenting with unspecific skin manifestations or well-defined clinical dermatological entities. Their relation to each other as well as to systemic lupus erythematosus is variable, yet diagnostically and therapeutically challenging. Therapeutic decisions have to be based on the activity and distribution as well as the type of skin lesions and the extent of systemic disease. Limited skin manifestations may be amply tackled by topical therapy, so far, mainly relying on corticosteroids. In many cases, however, internal treatment has to be combined by using antimalarials, in addition to strict UV-protection. The advent of topical calcineurin inhibitors has contributed substantially to the armamentarium of external treatment options. By specifically interfering with intracytoplasmic signal transduction to activate the nuclear factor of activated T-cells (NF-AT), they are able to modulate various inflammatory mechanisms. The two available compounds, pimecrolimus and tacrolimus, do not induce the skin atrophy characteristic of corticosteroids. They have been studied in a number of case reports, but only in a few randomized, comparative studies. Both are well-tolerated, but differentially effective in the various subsets of CLE. Further studies are needed to directly compare the two compounds to each other, as well as to topical corticosteroids, before final recommendations can be made.
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Affiliation(s)
- Michael Sticherling
- Hautklinik, Universitätsklinikum, Erlangen (Clinic of Dermatology, University Hospitals of Erlangen), Erlangen, Germany
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21
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Fonseca E, Fernández-Torres RM. Managing Acute and Complex Dermatological Situations. Autoimmune Dis 2011. [DOI: 10.1007/978-0-85729-358-9_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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22
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Obermoser G, Sontheimer RD, Zelger B. Overview of common, rare and atypical manifestations of cutaneous lupus erythematosus and histopathological correlates. Lupus 2010; 19:1050-70. [PMID: 20693199 DOI: 10.1177/0961203310370048] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The skin is the second most frequently affected organ system in lupus erythematosus. Although only very rarely life threatening--an example is lupus erythematosus-associated toxic epidermal necrolysis--skin disease contributes disproportionally to disease burden in terms of personal and psychosocial wellbeing, vocational disability, and hence in medical and social costs. Since several manifestations are closely associated with the presence and activity of systemic lupus erythematosus, prompt and accurate diagnosis of cutaneous lupus erythematosus is essential. This review aims to cover common, rare, and atypical manifestations of lupus erythematosus-associated skin disease with a detailed discussion of histopathological correlates. Cutaneous lupus erythematosus covers a wide morphological spectrum well beyond acute, subacute and chronic cutaneous lupus erythematosus, which are commonly classified as lupus-specific skin disease. Other uncommon or less well-known manifestations include lupus erythematosus tumidus, lupus profundus, chilblain lupus, mucosal lupus erythematosus, and bullous lupus erythematosus. Vascular manifestations include leukocytoclastic and urticarial vasculitis, livedoid vasculopathy and livedo reticularis/ racemosa. Finally, we discuss rare presentations such as lupus erythematosus-related erythema exsudativum multiforme (Rowell syndrome), Kikuchi-Fujimoto disease, extravascular necrotizing palisaded granulomatous dermatitis (Winkelmann granuloma), and neutrophilic urticarial dermatosis.
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Affiliation(s)
- G Obermoser
- Baylor Institute for Immunology Research, Dallas, TX, USA.
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23
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Kretz CC, Norpo M, Abeler-Dörner L, Linke B, Haust M, Edler L, Krammer PH, Kuhn A. Anti-annexin 1 antibodies: A new diagnostic marker in the serum of patients with discoid lupus erythematosus. Exp Dermatol 2010; 19:919-21. [DOI: 10.1111/j.1600-0625.2010.01145.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Sticherling M. [Involvement of mucous membranes in papulosquamous diseases]. Hautarzt 2009; 60:891-7. [PMID: 19876609 DOI: 10.1007/s00105-009-1805-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Many skin diseases may affect the oral and genital mucous membranes but involvement is generally uncommon. Mucous membranes are most often affected by lichen planus and less frequently by psoriasis or lupus erythematosus. Macroscopic changes may vary from increased vulnerability, erythema and erosions to leukoplakia. Subjective symptoms of burning sensations or localized pain must be distinguished from underlying psychiatric disorders. Furthermore, neoplasia may complicate chronic lichen planus. Therefore, depending on the location and extent of mucous membrane symptoms, both local and systemic therapy may be necessary. Short- and long-term dermatologic care are required.
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Affiliation(s)
- M Sticherling
- Hautklinik, Universitätsklinikum Erlangen, 91052 Erlangen.
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25
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Jemec GBE, Ullman S, Goodfield M, Bygum A, Olesen AB, Berth-Jones J, Nyberg F, Cramers M, Faergemann J, Andersen P, Kuhn A, Ruzicka T. A randomized controlled trial of R-salbutamol for topical treatment of discoid lupus erythematosus. Br J Dermatol 2009; 161:1365-70. [PMID: 19681862 DOI: 10.1111/j.1365-2133.2009.09330.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In a recent open pilot trial, R-salbutamol sulphate, a well-known molecule with anti-inflammatory effects, was tested successfully on patients with therapy-resistant discoid lupus erythematosus (DLE). OBJECTIVES To compare the efficacy and safety of R-salbutamol cream 0.5% vs. placebo on DLE lesions in a multicentre, double-blinded, randomized, placebo-controlled phase II trial. METHODS Thirty-seven patients with at least one newly developed DLE lesion were randomized - 19 to the R-salbutamol cream 0.5% and 18 to placebo - and treated twice daily for 8 weeks. Efficacy was evaluated through scores of erythema, scaling/hypertrophy and induration as well as pain and itching; general improvement scored by the investigator and global improvement scored by patients' assessment were also evaluated. RESULTS The mean area under the curve of improvement for scaling/hypertrophy, pain, itching and global patient assessment was significantly better for the actively treated patients as compared with placebo (scaling/hypertrophy, P = 0.0262; pain, P = 0.0238; itching, P = 0.0135; global patient assessment, P = 0.045). Moreover, the percentage of patients without induration was significantly higher in the active group compared with the placebo group (P = 0.013), and a statistically significantly greater decrease in the size of the lesional area was also seen in the overall analysis of the R-salbutamol-treated patients (P = 0.0197). No serious adverse events were reported. CONCLUSIONS Application of R-salbutamol cream 0.5% was safe and well tolerated. Statistically significant effects were seen on scaling/hypertrophy, induration, pain and itching as well as patient global assessment, suggesting that R-salbutamol could be a promising new topical therapy alternative for DLE.
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Affiliation(s)
- G B E Jemec
- Department of Dermatology, Health Sciences Faculty, University of Copenhagen, Roskilde Hospital, Roskilde, Denmark.
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26
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Sárdy M, Ruzicka T, Kuhn A. Topical calcineurin inhibitors in cutaneous lupus erythematosus. Arch Dermatol Res 2008; 301:93-8. [DOI: 10.1007/s00403-008-0894-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2008] [Accepted: 08/22/2008] [Indexed: 12/19/2022]
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