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Hwang AS, Kechter JA, Li X, Hughes A, Severson KJ, Boudreaux B, Bhullar P, Nassir S, Yousif M, Zhang N, Butterfield RJ, Nelson S, Xing X, Tsoi LC, Zunich S, Sekulic A, Pittelkow M, Gudjonsson JE, Mangold A. Topical Ruxolitinib in the Treatment of Necrobiosis Lipoidica: A Prospective, Open-Label Study. J Invest Dermatol 2024; 144:1994-2001.e4. [PMID: 38417541 DOI: 10.1016/j.jid.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 03/01/2024]
Abstract
Necrobiosis lipoidica (NL) is a rare granulomatous disease. There are few effective treatments for NL. We sought to investigate the efficacy and safety of the Jak1/2 inhibitor, ruxolitnib, in the treatment of NL and identify the biomarkers associated with the disease and treatment response. We conducted an open-label, phase 2 study of ruxolitinib in 12 patients with NL. We performed transcriptomic analysis of tissue samples before and after treatment. At week 12, the mean NL lesion score decreased by 58.2% (SD = 28.7%, P = .003). Transcriptomic analysis demonstrated enrichment of type I and type II IFN pathways in baseline disease. Weighted gene coexpression network analysis demonstrated post-treatment changes in IFN pathways with key hub genes IFNG and signal transducer and activator of transcription 1 gene STAT1. Limitations include small sample size and a study group limited to patients with <10% body surface area. In conclusion, ruxolitinib is an effective treatment for NL and targets the key pathogenic mediators of the disease.
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Affiliation(s)
- Angelina S Hwang
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jacob A Kechter
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Xing Li
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Alysia Hughes
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Kevin J Severson
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Blake Boudreaux
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Puneet Bhullar
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Shams Nassir
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Miranda Yousif
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Nan Zhang
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Steven Nelson
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Xianying Xing
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lam C Tsoi
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Samantha Zunich
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Mark Pittelkow
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Aaron Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA.
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Arnet L, Erfurt-Berge C. Effect of abrocitinib in a patient with extensive necrobiosis lipoidica. J Eur Acad Dermatol Venereol 2023; 37:e1208-e1210. [PMID: 37170953 DOI: 10.1111/jdv.19189] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Affiliation(s)
- L Arnet
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - C Erfurt-Berge
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Hwang E, Abdelghaffar M, Shields BE, Damsky W. Molecularly Targeted Therapies for Inflammatory Cutaneous Granulomatous Disorders: A Review of the Evidence and Implications for Understanding Disease Pathogenesis. JID INNOVATIONS 2023; 3:100220. [PMID: 37719661 PMCID: PMC10500476 DOI: 10.1016/j.xjidi.2023.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 09/19/2023] Open
Abstract
Inflammatory cutaneous granulomatous diseases, including granuloma annulare, cutaneous sarcoidosis, and necrobiosis lipoidica, are distinct diseases unified by the hallmark of macrophage accumulation and activation in the skin. There are currently no Food and Drug Administration-approved therapies for these conditions except prednisone and repository corticotropin injection for pulmonary sarcoidosis. Treatment of these diseases has generally been guided by low-quality evidence and may involve broadly immunomodulatory medications. Development of new treatments has in part been limited by an incomplete understanding of disease pathogenesis. Recently, there has been substantial progress in better understanding the molecular pathogenesis of these disorders, opening the door for therapeutic innovation. Likewise, reported outcomes of treatment with immunologically targeted therapies may offer insights into disease pathogenesis. In this systematic review, we summarize progress in deciphering the pathomechanisms of these disorders and discuss this in the context of emerging evidence on the use of molecularly targeted therapies in treatment of these diseases.
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Affiliation(s)
- Erica Hwang
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mariam Abdelghaffar
- School of Medicine, Royal College of Surgeons in Ireland, Busaiteen, Bahrain
| | - Bridget E. Shields
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
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Cheboxarov DI, Molodykh KJ, Monakhov KN, Sokolovskiy EV. A new atypical form of lipoid necrobiosis not associated with diabetes mellitus. VESTNIK DERMATOLOGII I VENEROLOGII 2023. [DOI: 10.25208/vdv1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
A 55-year-old woman has lipoid necrobiosis of both legs, complicated by ulceration. The first manifestations of the disease appeared after an injury in the region of the left shin, an abrasion appeared, which later transformed into a glossy spot that slowly increased in size. She first sought medical help in 2017 and was clinically diagnosed with necrobiosis lipoidica. The prescribed treatment did not lead to an improvement in the patients condition. In 2021, after vaccination against COVID-19, the patient notes a sharp deterioration in the process. No convincing data for diabetes mellitus received. She has a history of multinodular non-toxic goiter, for which in 1995 a complete resection of the left lobe of the thyroid gland was performed and in 2003 a partial resection of the right lobe of the thyroid gland. The patient has been receiving L-thyroxine replacement therapy since 2003. A biopsy of the affected skin was taken. The final diagnosis was established according to the pathological and anatomical study of the biopsy. As a result of the treatment, the patient was discharged from the clinic with improvement.
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Vetsiou E, Mpouras V, Nikolaidou C, Klonizakis P, Mandala E, Vamvakis K, Psarras K, Vlachaki E. Necrobiosis Lipoidica in a Patient with β-Thalassemia Major: A Case Report and Review of the Literature. Hemoglobin 2020; 44:221-223. [PMID: 32605400 DOI: 10.1080/03630269.2020.1783287] [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] [Indexed: 10/23/2022]
Abstract
Necrobiosis lipoidica (NL) is a rare granulomatous disease that predominantly affects middle-aged women and is often associated with diabetes mellitus (DM), rheumatoid arthritis (RA) and other metabolic disorders. Thalassemias are the most common hereditary hemoglobin (Hb) disorders worldwide. A few studies investigated dermatologic problems that coexist with β-thalassemia major (β-TM). The most common skin disorders in patients with β-TM are xerosis, urticaria, pseudoxanthoma, hyperpigmentation, leg ulcers and small-vessel vasculitis. Necrobiosis lipoidica has only been occasionally reported in patients with β-TM. Herein, we present a female with β-TM and NL. Furthermore, a brief review of the literature was performed.
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Affiliation(s)
- Evangelia Vetsiou
- Diabetes and Endocrine Department, South Warwickshire National Health Service Foundation Trust, Warwick, Warwickshire, UK
| | - Vasileios Mpouras
- Second Propedeutical Department of Surgery, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Philippos Klonizakis
- Adult Thalassemia Unit, Second Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evdokia Mandala
- Fourth Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Kyriakos Psarras
- Second Propedeutical Department of Surgery, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efthymia Vlachaki
- Adult Thalassemia Unit, Second Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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