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Xiang DH, Ji H, Cheng D, Semenov Y, Theodosakis N. Investigating price trends and cost-saving opportunities for prescription of topical calcineurin inhibitors using the Truven Marketscan Database. J Am Acad Dermatol 2024; 91:356-359. [PMID: 38642858 DOI: 10.1016/j.jaad.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/08/2024] [Accepted: 04/03/2024] [Indexed: 04/22/2024]
Affiliation(s)
- David H Xiang
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Helen Ji
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Debby Cheng
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Yevgeniy Semenov
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nicholas Theodosakis
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
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Kirtschig G, Kinberger M, Kreuter A, Simpson R, Günthert A, van Hees C, Becker K, Ramakers MJ, Corazza M, Müller S, von Seitzberg S, Boffa MJ, Stein R, Barbagli G, Chi CC, Dauendorffer JN, Fischer B, Gaskins M, Hiltunen-Back E, Höfinger A, Köllmann NH, Kühn H, Larsen HK, Lazzeri M, Mendling W, Nikkels AF, Promm M, Rall KK, Regauer S, Sárdy M, Sepp N, Thune T, Tsiogka A, Vassileva S, Voswinkel L, Wölber L, Werner RN. EuroGuiderm guideline on lichen sclerosus-Treatment of lichen sclerosus. J Eur Acad Dermatol Venereol 2024. [PMID: 38822598 DOI: 10.1111/jdv.20083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/22/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness; it may lead to sexual and urinary dysfunction in females and males; however, it may be asymptomatic. First signs of LS are usually a whitening of the genital skin, sometimes preceded by redness and oedema; fissuring, scarring, shrinkage and fusion of structures may follow in its course. LS is associated with an increased risk of genital cancer. LS has a huge impact on the quality of life of affected patients, and it is important to raise more awareness of this not uncommon disease in order to diagnose and treat it early. OBJECTIVES The guideline intends to provide guidance on the diagnostic of LS (part 1), highlight important aspects in the care of LS patients, generate recommendations and treatment algorithms (part 2) on topical, interventional and surgical therapy, based on the latest evidence, provide guidance in the management of LS patients during pregnancy, provide guidance for the follow-up of patients with LS and inform about new developments and potential research aspects. MATERIALS AND METHODS The guideline was developed in accordance with the EuroGuiDerm Methods Manual v1.3 https://www.edf.one/de/home/Guidelines/EDF-EuroGuiDerm.html. The wording of the recommendations was standardized (as suggested by the GRADE Working Group). The guideline development group is comprised of 34 experts from 16 countries, including 5 patient representatives. RESULTS Ultrapotent or potent topical corticosteroids in females and males, adults and children remain gold standard of care for genital LS; co-treatment with emollients is recommended. If standard treatment fails in males, a surgical intervention is recommended, complete circumcision may cure LS in males. UV light treatment is recommended for extragenital LS; however, there is limited scientific evidence. Topical calcineurin inhibitors are second line treatment. Laser treatment, using various wave lengths, is under investigation, and it can currently not be recommended for the treatment of LS. Treatment with biologics is only reported in single cases. CONCLUSIONS LS has to be diagnosed and treated as early as possible in order to minimize sequelae like scarring and cancer development. Topical potent and ultrapotent corticosteroids are the gold standard of care; genital LS is often a lifelong disease and needs to be treated long-term.
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Affiliation(s)
- G Kirtschig
- Medbase Health Centre, Frauenfeld, Switzerland
| | - M Kinberger
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, Oberhausen, Germany
| | - R Simpson
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - A Günthert
- Gynäkologisches Tumorzentrum St. Anna, Lucerne, Switzerland
| | - C van Hees
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - K Becker
- Office for Paediatric Surgery, Bonn, Germany
| | - M J Ramakers
- CenSeRe (Centre for Psychological, Relational, Sexual Health), Voorschoten, The Netherlands
| | - M Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - S Müller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | | | - M J Boffa
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - R Stein
- Center for Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University of Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - G Barbagli
- Centro Chirurgico Toscano, Arezzo, Italy
| | - C C Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - J N Dauendorffer
- Department of Dermatology, Centre for Genital and Sexually Transmitted Diseases, University Hospital Saint Louis, Paris, France
| | - B Fischer
- The Swiss Lichen Sclerosus Association, Switzerland/Verein Lichen Sclerosus e.V., Dottikon, Switzerland
| | - M Gaskins
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - E Hiltunen-Back
- Department of Dermatovenereology, Helsinki University Hospital, Helsinki, Finland
| | - A Höfinger
- The Swiss Lichen Sclerosus Association, Switzerland/Verein Lichen Sclerosus e.V., Dottikon, Switzerland
| | - N H Köllmann
- The Swiss Lichen Sclerosus Association, Switzerland/Verein Lichen Sclerosus e.V., Dottikon, Switzerland
| | - H Kühn
- The German Lichen Sclerosus Association, Hamburg, Germany
| | - H K Larsen
- Department of Dermatology and Venereology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
| | - M Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - W Mendling
- German Center for Infections in Gynecology and Obstetrics, Helios University Hospital Wuppertal-University Witten/Herdecke, Wuppertal, Germany
| | - A F Nikkels
- Department of Dermatology, University Medical Center of Liège, Liège, Belgium
| | - M Promm
- Department of Paediatric Urology and Clinic St. Hedwig, University Medical Centre of Regensburg, Regensburg, Germany
| | - K K Rall
- Department of Women's Health, Women's University Hospital Tuebingen, Tuebingen, Germany
| | - S Regauer
- Diagnostic and Research Institute of Pathology, Medical University Graz, Graz, Austria
| | - M Sárdy
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - N Sepp
- Department of Dermatology and Venereology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - T Thune
- Department of Dermatology, Haukeland University Hospital, Bergen, Norway
| | - A Tsiogka
- 1st Department of Dermatology-Venereology, Faculty of Medicine, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - S Vassileva
- Department of Dermatology and Venereology, University Hospital "Alexandrovska", Medical University - Sofia, Sofia, Bulgaria
| | - L Voswinkel
- The German Lichen Sclerosus Association, Hamburg, Germany
| | - L Wölber
- Department of Gynaecology, University Medical Centre Hamburg-Eppendorf and Centre for Colposcopy and Vulvovaginal Disease Jersualem Hospital Hamburg, Hamburg, Germany
| | - R N Werner
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Pinter A, Tsianakas A, Eichner A. Efficacy and Safety of Topical Tacrolimus Microemulsion Applied Twice Daily in Patients with Mild to Moderate Scalp Psoriasis. Dermatol Ther (Heidelb) 2024; 14:521-532. [PMID: 38345680 PMCID: PMC10891015 DOI: 10.1007/s13555-024-01102-6] [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: 12/01/2023] [Accepted: 01/15/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Involvement of the scalp is common in psoriasis and severely affects the quality of life of those affected. It is difficult to treat and places special demands on the galenics of a drug formulation. Tacrolimus is a calcineurin inhibitor and is approved as an ointment formulation for the treatment of atopic dermatitis. The efficacy and safety of topically applied tacrolimus have also been studied and proven for psoriasis. However, no proprietary pharmaceutical product is currently approved for this indication. METHODS A multicenter, double-blind, vehicle-controlled phase 3 study was conducted to evaluate the efficacy and safety of 0.1% tacrolimus microemulsion when applied topically twice daily in 128 patients independently of sex with scalp psoriasis. RESULTS The primary efficacy analysis showed a scalp Investigator Global Assessment (s-IGA) of 0 (absence of disease) or 1 (very mild disease) at 8 weeks in 28.6% of subjects in the tacrolimus group, indicating a significantly better response (p = 0.0476, chi-square test) versus 12.7% of subjects in the placebo group (difference of 15.9%-points). The Dermatology Life Quality Index (DLQI) improved over time and was more pronounced in the group treated with tacrolimus-containing microemulsion than in the placebo group, but showed no statistically significant difference after 8 weeks of use (p = 0.193, ANCOVA). The safety analysis revealed no evidence of cutaneous side effects other than those known. Toxicologically relevant serum levels of tacrolimus could be excluded. CONCLUSION The study data show that 0.1% tacrolimus microemulsion has good efficacy and safety in the treatment of scalp psoriasis.
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Affiliation(s)
- Andreas Pinter
- Clinic for Dermatology, Venereology and Allergy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Adina Eichner
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06097, Halle (Saale), Germany.
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Ho JSS, Molin S. A Review of Existing and New Treatments for the Management of Hand Eczema. J Cutan Med Surg 2023; 27:493-503. [PMID: 37496489 PMCID: PMC10617006 DOI: 10.1177/12034754231188325] [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: 12/28/2022] [Revised: 04/15/2023] [Accepted: 05/31/2023] [Indexed: 07/28/2023]
Abstract
Hand eczema is a chronic condition that affects an estimated 14.5% of the general population. It has severe quality of life ramifications in those that struggle with it, including days missed from work or school, productivity loss and impaired work functioning. For years, the standard of care included topical moisturizing creams, topical steroids and more recently systemic agents. As new therapeutic targets emerge and recent advances are being developed, it is now more possible than ever that hand eczema can be managed via the underlying mechanisms. A review of the literature was conducted to identify current treatment options for hand eczema and chronic hand eczema. The terms 'hand eczema', 'hand dermatitis' were used to search PubMed, CENTRAL and Embase. To identify new therapies still undergoing investigation, we used the terms 'hand eczema', 'hand dermatitis', 'atopic dermatitis', and 'vesicular eczema of hands and/or feet' to search Clinicaltrials.gov for all studies until December 2022. There were 56 ongoing clinical trials identified for pharmacological treatments for hand eczema on Clinicaltrials.gov from 2000 - 2022, with 16 that are new or ongoing. These included studies for dupilumab, ruxolitinib, delgocitinib (LEO124249), gusacitinib (ASN002), AFX 5931, and roflumilast (ARQ-252). Two major classes of drugs emerging for the treatment of hand eczema include IL-4/IL-13 inhibitors and JAK inhibitors. With the increase in efficacy seen with these new drugs, we are also noting improved adverse effect profiles, making them attractive options to add to a clinician's management toolbox for patients with hand eczema.
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Affiliation(s)
| | - Sonja Molin
- Division of Dermatology, Department of Medicine, Queen’s University, Kingston, ON, Canada
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Hu W, Lin F, Lei J, Xu AE. Impacts of exposure to topical calcineurin inhibitors on metabolism in vitiligo infants. Pediatr Res 2023; 93:661-665. [PMID: 35681095 DOI: 10.1038/s41390-022-02133-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tacrolimus ointment is a recently developed topical immunomodulator that has been approved for use in patients with vitiligo older than 2 years. Concern regarding potential systemic toxic effects has limited treatment options for children younger than 2 years. We wanted to determine whether topical tacrolimus therapy is safe and effective in patients with vitiligo younger than 2 years. METHODS The present 6-month clinical trial was conducted to evaluate the efficacy and safety of 0.03% tacrolimus in the treatment of vitiligo in children under 2 years of age. Meanwhile, serum and urine samples were collected, and liquid chromatography-mass spectrometry was performed to generate the serum and urine metabolic profile data of patients and healthy controls. RESULTS The overall response rate at the sixth month, which was defined by the degree of re-pigmentation, was 100%. As revealed by blood monitoring and metabolite detection 6 months later, there was no difference between the treatment group and the control group. There is no evidence that long-term topical application of 0.03% tacrolimus ointment will cause metabolite or other physical changes in the body. CONCLUSIONS Tacrolimus ointment appears to be effective and safe in the treatment of vitiligo in children younger than 2 year. TRIAL REGISTRATION http://www.chictr.org.cn identifier: ChiCTR 2100045920. IMPACT We first reported the efficacy and safety of topical application of 0.03% tacrolimus ointment in infants with vitiligo characterized by the metabolites. There is no evidence that long-term topical application of 0.03% tacrolimus ointment will cause metabolite or other physical changes in the body. This study provide evidence for the TCI treatment of infants with vitiligo.
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Affiliation(s)
- Wenting Hu
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Fuquan Lin
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jiehao Lei
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ai-E Xu
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital of Zhejiang University School of Medicine, Hangzhou, China.
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Pazyar N, Hatami M, Yaghoobi R, Parvar SY, Radmanesh M, Hadibarhaghtalab M. The efficacy of adding topical 5-fluorouracil to micro-needling in the treatment of vitiligo: A randomized controlled trial. J Cosmet Dermatol 2023; 22:1513-1520. [PMID: 36718813 DOI: 10.1111/jocd.15616] [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: 10/03/2022] [Revised: 12/03/2022] [Accepted: 12/21/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIM Vitiligo is an autoimmune skin disorder characterized by circumscribed depigmented macules and patches caused by the loss of functional melanocytes. Although there is no definitive treatment for vitiligo, several treatment options have been associated with relative satisfactory outcomes. The purpose of this study was to compare the efficacy of micro-needling in conjunction with topical 5-fluorouracil (5-FU) versus topical tacrolimus ointment in treating vitiligo patches. PATIENTS AND METHODS This study included nineteen participants, each of whom received both treatments on two randomly selected vitiligo patches of approximately the same size and location. On one patch, a combination of weekly micro-needling and topical application of 5-FU solution was used every other day, while on the other, 0.1% tacrolimus topical ointment was applied twice daily. The G-score was used to compare treatment outcomes after 3 months. RESULTS The median duration of the disease in our population was 7 years. Six patients (32%) in the micro-needling plus topical 5-FU treated group showed a moderate to excellent response, indicating a significant improvement between both treatments (p-value = 0.019). In contrast, all other patches treated with topical tacrolimus showed poor improvement. Lower extremity and trunk responded more to treatment with micro-needling plus topical 5-FU than upper extremity and acral areas. Moreover, none of those who have had the disease for more than ten years have responded to treatment. Mild erythema, pinpoint bleeding, and irritation were detected only in the micro-needling treated group. CONCLUSION The current study showed that using micro-needling in conjunction with 5-FU could treat vitiligo patients more efficiently than tacrolimus monotherapy. Despite showing moderate to excellent improvement in patches treated with micro-needling and 5-FU, this well-tolerated office-based modality still requires additional research.
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Affiliation(s)
- Nader Pazyar
- Department of Dermatology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Hatami
- Department of Dermatology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Yaghoobi
- Department of Dermatology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyedeh Yasamin Parvar
- Molecular Dermatology Research Center, Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of medical sciences, Shiraz, Iran
| | - Mohammad Radmanesh
- Department of Dermatology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Hadibarhaghtalab
- Molecular Dermatology Research Center, Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Skoner DP, Golant AK, Norton AE, Stukus DR. Is This Medication Safe for My Child? How to Discuss Safety of Commonly Used Medications With Parents. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3064-3072. [PMID: 35963511 DOI: 10.1016/j.jaip.2022.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/25/2022] [Accepted: 07/30/2022] [Indexed: 12/14/2022]
Abstract
All drugs have potential side effects, but thoughtful use can maximize benefits while minimizing risks. Children should not be considered just small adults regarding drug safety because their growth and development are discordant with their ability to sense and self-report drug side effects. Detecting side effects requires vigilance and education from prescribers to parents, who are tasked with monitoring their child over time. A drug's safety profile is published in the package label after pivotal trials are conducted in relatively small and sometimes narrow segments of the population during the U.S. Food and Drug Administration approval process. Drug safety profiles can change as data from postmarketing reports and long-term monitoring during phase IV trials emerge. As such, prescribers are obligated to maintain current understanding of any changes to drug labels. Discussing potential side effects, monitoring, and when to report concerns can be a time-consuming process during patient encounters. This review offers current information regarding potential side effects of some of the most commonly used medications for allergic conditions, asthma, and atopic dermatitis. This information and discussion will hopefully assist clinicians in their conversations with parents, including advice surrounding prescribing medication to minimize adverse effects, parental monitoring, and documentation.
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Affiliation(s)
- David P Skoner
- Section of Allergy and Immunology, West Virginia University Children's Hospital, Morgantown, WVa
| | - Alexandra K Golant
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Allison E Norton
- Division of Allergy, Immunology and Pulmonology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn
| | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital, Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio.
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Chen A, Luo Y, Xu J, Guan X, He H, Xuan X, Wu J. Latest on biomaterial-based therapies for topical treatment of psoriasis. J Mater Chem B 2022; 10:7397-7417. [PMID: 35770701 DOI: 10.1039/d2tb00614f] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Psoriasis is an autoimmune inflammatory disease which is fundamentally different from dermatitis. Its treatments include topical medications and systemic drugs depending on different stages of the disease. However, these commonly used therapies are falling far short of clinical needs due to various drawbacks. More precise therapeutic strategies with minimized side effects and improved compliance are highly demanded. Recently, the rapid development of biomaterial-based therapies has made it possible and promising to attain topical psoriasis treatment. In this review, we briefly describe the significance and challenges of the topical treatment of psoriasis and emphatically overview the latest progress in novel biomaterial-based topical therapies for psoriasis including microneedles, nanoparticles, nanofibers, and hydrogels. Current clinical trials related to each biomaterial are also summarized and discussed.
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Affiliation(s)
- Anqi Chen
- Department of Dermatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China. .,School of Pharmaceutical Sciences, Key Laboratory of Biotechnology and Pharmaceutical Engineering, Wenzhou Medical University, Wenzhou, 325035, China
| | - Yuting Luo
- School of Pharmaceutical Sciences, Key Laboratory of Biotechnology and Pharmaceutical Engineering, Wenzhou Medical University, Wenzhou, 325035, China
| | - Jie Xu
- School of Pharmaceutical Sciences, Key Laboratory of Biotechnology and Pharmaceutical Engineering, Wenzhou Medical University, Wenzhou, 325035, China
| | - Xueran Guan
- School of Pharmaceutical Sciences, Key Laboratory of Biotechnology and Pharmaceutical Engineering, Wenzhou Medical University, Wenzhou, 325035, China
| | - Huacheng He
- College of Chemistry and Materials Engineering, Wenzhou University, Wenzhou, 325035, China.
| | - Xuan Xuan
- Department of Dermatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| | - Jiang Wu
- Department of Dermatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China. .,School of Pharmaceutical Sciences, Key Laboratory of Biotechnology and Pharmaceutical Engineering, Wenzhou Medical University, Wenzhou, 325035, China
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Rostagno E, Campanati A, Mordini N, Cannici C, Cioce M, De Cecco V, Samarani E, Foà R, Olivieri A, Botti S. Phototherapy and topical treatments for cutaneous graft versus host disease in hematopoietic stem cell transplantation patients: A scoping review. J Eur Acad Dermatol Venereol 2022; 36:1003-1015. [DOI: 10.1111/jdv.18074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
Affiliation(s)
- E. Rostagno
- Pediatric Oncology and Hematology Unit IRCCS Azienza Ospedaliero Universitaria di Bologna Via Massarenti 11 ‐ 40138 Bologna Italy
| | - A. Campanati
- Dermatology Unit Department of Clinical and Molecular Sciences United Hospitals of Ancona and Polytechnic Marche University Via Conca 70 ‐ 60200 Ancona Italy
| | - N. Mordini
- Hematology Division Azienda Ospedaliera S. Croce e Carle Via Coppino 26 ‐ 12100 Cuneo Italy
| | - C. Cannici
- Hematology Unit AO SS Antonio e Biagio e Cesare Arrigo di Alessandira Via Venezia 16 ‐ 15121 Alessandria Italy
| | - M. Cioce
- UOC SITRA Fondazione Policlinico Universitario A. Gemelli – IRCCS Largo Agostino Gemelli 00168 Roma Italy
| | - V. De Cecco
- Trapianto Emopoietico e Terapia Cellulare Ospedale Pediatrico Bambino Gesù Piazza di Sant'Onofrio 4 ‐ 00165 Roma Italy
| | - E. Samarani
- Unit of Blood Diseases and Stem Cell Transplantation Department of Clinical Oncology ASST Spedali Civili di Brescia Piazzale Spedali Civili 1 ‐ 25123 Brescia Italy
| | - R. Foà
- Department of Translational and Precision Medicine Sapienza University of Rome Via Benevento 6 ‐ 00165 Italy
| | - A. Olivieri
- Clinic of Hematology United Hospitals of Ancona and Polytechnic Marche University Via Conca 71 ‐ 60126 Ancona Italy
| | - S. Botti
- Hematology Unit Azienda USL‐IRCCS Reggio Emilia Viale Risorgimento 80 42123 Reggio Emilia Italy
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Nofal A, Eldeeb F, Shalaby M, Al-Balat W. Microneedling combined with pimecrolimus, 5-fluorouracil and trichloroacetic acid in the treatment of vitiligo: A comparative study. Dermatol Ther 2021; 35:e15294. [PMID: 34964230 DOI: 10.1111/dth.15294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Treatment of vitiligo represents a highly therapeutic challenge in spite of the continuous development of new modalities. Combination therapies of vitiligo can help improve treatment response, and reduce recurrence potential. OBJECTIVE To compare the efficacy and adverse effects of microneedling combined with 5-fluorouracil, pimecrolimus, and TCA in the treatment of localized, stable vitiligo. METHODS The study included 75 patients with non-segmental, stable vitiligo who were randomly assigned to three equal groups: group 1 received a combination of microneedling and 5-FU, group 2 received microneedling and pimecrolimus, and group 3 received microneedling and TCA. The procedure was done every 2 weeks for a maximum of 6 sessions. RESULTS Combined microneedling and TCA was associated with the highest degree of repigmentation followed by combined microneedling + 5-fluorouracil, and lastly combined microneedling + pimecrolimus. The difference between the three groups was statistically significant in favor of the combined microneedling and TCA. Pain, erythema, post-inflammatory hyperpigmentation, infection, and scarring were variably reported adverse effects in the 3 groups. CONCLUSION Combination therapy seems to be a promising modality for the treatment of vitiligo. Combined microneedling and TCA is superior to combined microneedling with either 5-fluorouracil or pimecrolimus.
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Affiliation(s)
- Ahmad Nofal
- Dermatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Fatma Eldeeb
- Dermatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mona Shalaby
- Dermatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Waleed Al-Balat
- Dermatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Clinical Efficacy of Tacrolimus Ointment + 3% Boric Acid Lotion Joint Chinese Angelica Decoction in Chronic Perianal Eczema. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:1016108. [PMID: 34721653 PMCID: PMC8553483 DOI: 10.1155/2021/1016108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022]
Abstract
Objective To unearth the clinical efficacy of tacrolimus ointment + 3% boric acid lotion joint Chinese angelica decoction in chronic perianal eczema. Methods Patients with chronic perianal eczema admitted to hospital from June 2018 and June 2019 were retrospectively analyzed. Patients in the control group (n = 38) underwent basic therapy with tacrolimus ointment + 3% boric acid lotion, whereas those in the observation group (n = 38) were given oral Chinese angelica decoction on the basis of the above therapy. Patient's baseline information before therapy and clinical symptoms after therapy were observed and compared, including pruritus ani score, anus drainage and damp score, skin lesion score, skin lesion area score, life quality index score, and IL-2, IL-4, and IgE levels in serum. Overall efficacy in the two groups was also evaluated. Results No significant differences were found in the baseline information between the observation group and control group before therapy. After therapy, pruritus ani score (P = 0.023), anus drainage and damp score (P = 0.041), skin lesion score (P = 0.025), and skin lesion area score (P = 0.035) of patients in the observation group were remarkably lower than those in the control group. Significantly higher release levels of clinical symptoms of patients in the observation group were indicated. With respect to the control group, the life quality score (P = 0.020) and IgE level in serum (P = 0.003) of patients in the observation group were significantly lower, while IL-4 level in serum was significantly higher (P = 0.129). The therapy in the observation group achieved better clinical efficacy. Overall efficacy in the observation group was markedly favorable with respect to the control group. Conclusion With respect to tacrolimus ointment + 3% boric acid lotion, patients with chronic perianal eczema displayed better clinical efficacy after jointly being treated by Chinese angelica decoction.
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Mohd Nordin UU, Ahmad N, Salim N, Mohd Yusof NS. Lipid-based nanoparticles for psoriasis treatment: a review on conventional treatments, recent works, and future prospects. RSC Adv 2021; 11:29080-29101. [PMID: 35478537 PMCID: PMC9038133 DOI: 10.1039/d1ra06087b] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/19/2021] [Indexed: 12/19/2022] Open
Abstract
Psoriasis is a lingering inflammatory skin disease that attacks the immune system. The abnormal interactions between T cells, immune cells, and inflammatory cytokines causing the epidermal thickening. International guidelines have recommended topical treatments for mild to moderate psoriasis whilst systemic and phototherapy treatments for moderate to severe psoriasis. However, current therapeutic approaches have a wider extent to treat moderate to severe type of psoriasis especially since the emergence of diverse biologic agents. In the meantime, topical delivery of conventional treatments has prompted many unsatisfactory effects to penetrate through the skin (stratum corneum). By understanding the physiology of stratum corneum barrier functions, scientists have developed different types of lipid-based nanoparticles like solid lipid nanoparticles, nanostructured lipid carriers, nanovesicles, and nanoemulsions. These novel drug delivery systems help the poorly solubilised active pharmaceutical ingredient reaches the targeted site seamlessly because of the bioavailability feature of the nanosized molecules. Lipid-based nanoparticles for psoriasis treatments create a paradigm for topical drug delivery due to their lipids' amphiphilic feature to efficiently encapsulate both lipophilic and hydrophilic drugs. This review highlights different types of lipid-based nanoparticles and their recent works of nano formulated psoriasis treatments. The encapsulation of psoriasis drugs through lipid nanocarriers unfold numerous research opportunities in pharmaceutical applications but also draw challenges for the future development of nano drugs.
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Affiliation(s)
- Ummu Umaimah Mohd Nordin
- Department of Chemistry, Faculty of Science, University of Malaya 50603 Kuala Lumpur Malaysia +603-79674193 +603-79674008
| | - Noraini Ahmad
- Department of Chemistry, Faculty of Science, University of Malaya 50603 Kuala Lumpur Malaysia +603-79674193 +603-79674008
| | - Norazlinaliza Salim
- Integrated Chemical Biophysics Research, Faculty of Science, Universiti Putra Malaysia 43400 UPM Serdang Selangor Malaysia
| | - Nor Saadah Mohd Yusof
- Department of Chemistry, Faculty of Science, University of Malaya 50603 Kuala Lumpur Malaysia +603-79674193 +603-79674008
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Zhang H, Yang L, Wang Y, Zhang D, Tang K, Fang R, Sun Q. Topical calcineurin inhibitors as a double-edged sword in rosacea: A systematic review. J Cosmet Dermatol 2021; 21:1695-1704. [PMID: 34192412 DOI: 10.1111/jocd.14315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/03/2021] [Accepted: 06/28/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Rosacea is a chronic inflammatory disease mainly with skin or ocular manifestations. Topical calcineurin inhibitors, pimecrolimus and tacrolimus, can be used to treat rosacea. However, they can also induce rosacea-like eruptions. AIMS This study systematically reviewed the double-edged sword effects of pimecrolimus and tacrolimus on rosacea. METHODS Four databases were retrieved to search for articles on the effects of pimecrolimus and tacrolimus on rosacea, including Cochrane Library, Embase, PubMed, and Web of Science. Only English articles were included in the systematic review. Relevant data were collected, and the levels of evidence were evaluated. RESULTS 28 articles published between 2001 and 2016 were included. 11 articles were about pimecrolimus as the treatment of rosacea, 4 articles were about the pimecrolimus-induced rosacea, 9 articles were about tacrolimus as the treatment of rosacea, and 4 articles were about tacrolimus-induced rosacea. Participants for each study ranged from 1 to 200. Several types of outcome measurements were used for these publications. CONCLUSIONS Both pimecrolimus and tacrolimus might have double-edged sword effects on rosacea. Pimecrolimus and tacrolimus could be effective for rosacea. However, both of them could also induce rosacea. Larger, randomized, controlled studies on pimecrolimus and tacrolimus as the treatment of rosacea and studies on the mechanisms of pimecrolimus and tacrolimus in treating or inducing rosacea are needed. This systematic review emphasized the double-edged sword role of topical calcineurin inhibitors in rosacea, which may pave the way for future research.
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Affiliation(s)
- Hanlin Zhang
- Department of Dermatology, Peking Union Medical College Hospital, No.1, Shuaifuyuan, Beijing, China
| | - Leyan Yang
- Department of Dermatology, Peking Union Medical College Hospital, No.1, Shuaifuyuan, Beijing, China
| | - Yuchen Wang
- Department of Dermatology, Peking Union Medical College Hospital, No.1, Shuaifuyuan, Beijing, China
| | - Dingyue Zhang
- Department of Dermatology, Peking Union Medical College Hospital, No.1, Shuaifuyuan, Beijing, China
| | - Keyun Tang
- Department of Dermatology, Peking Union Medical College Hospital, No.1, Shuaifuyuan, Beijing, China
| | - Rouyu Fang
- Department of Dermatology, Peking Union Medical College Hospital, No.1, Shuaifuyuan, Beijing, China
| | - Qiuning Sun
- Department of Dermatology, Peking Union Medical College Hospital, No.1, Shuaifuyuan, Beijing, China
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Hand Dermatitis in the Time of COVID-19: A Review of Occupational Irritant Contact Dermatitis. Dermatitis 2021; 32:86-93. [PMID: 33606414 DOI: 10.1097/der.0000000000000721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Occupational contact dermatitis accounts for 95% of all cases of occupational skin disease with irritant contact dermatitis (ICD) constituting 80% to 90% of these cases. Health care workers, hairdressers, and food service workers are typically most affected by occupational ICD of the hands as these occupations require frequent hand hygiene and/or prolonged exposure to water, also known as "wet work." In the context of the current COVID-19 pandemic, frequent hand hygiene has become a global recommendation for all individuals, and new workplace guidelines for hand sanitization and surface sterilization are affecting occupations not previously considered at risk of excessive wet work including grocery or retail workers, postal workers, sanitization workers, and others. In this review, we discuss the etiology and pathogenesis of occupational ICD with additional focus on treatment and interventions that can be made at an institutional and even national level for education and prevention of ICD resulting from frequent hand hygiene.
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Mycosis Fungoides and Sézary Syndrome: An Integrative Review of the Pathophysiology, Molecular Drivers, and Targeted Therapy. Cancers (Basel) 2021; 13:cancers13081931. [PMID: 33923722 PMCID: PMC8074086 DOI: 10.3390/cancers13081931] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/29/2022] Open
Abstract
Simple Summary In the last few years, the field of cutaneous T-cell lymphomas has experienced major advances. In the context of an active translational and clinical research field, next-generation sequencing data have boosted our understanding of the main molecular mechanisms that govern the biology of these entities, thus enabling the development of novel tools for diagnosis and specific therapy. Here, we focus on mycosis fungoides and Sézary syndrome; we review essential aspects of their pathophysiology, provide a rational mechanistic interpretation of the genomic data, and discuss the current and upcoming therapies, including the potential crosstalk between genomic alterations and the microenvironment, offering opportunities for targeted therapies. Abstract Primary cutaneous T-cell lymphomas (CTCLs) constitute a heterogeneous group of diseases that affect the skin. Mycosis fungoides (MF) and Sézary syndrome (SS) account for the majority of these lesions and have recently been the focus of extensive translational research. This review describes and discusses the main pathobiological manifestations of MF/SS, the molecular and clinical features currently used for diagnosis and staging, and the different therapies already approved or under development. Furthermore, we highlight and discuss the main findings illuminating key molecular mechanisms that can act as drivers for the development and progression of MF/SS. These seem to make up an orchestrated constellation of genomic and environmental alterations generated around deregulated T-cell receptor (TCR)/phospholipase C, gamma 1, (PLCG1) and Janus kinase/ signal transducer and activator of transcription (JAK/STAT) activities that do indeed provide us with novel opportunities for diagnosis and therapy.
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Ju HJ, Han JH, Kim MS, Lee SH, Shin JW, Choi M, Jeong KH, Han TY, Choi CW, Lee HJ, Oh SH, Lee SH, Kim DH, Shin J, Lee JH, Kim SS, Kang HY, Chang SE, Kim JS, Lee DY, Choi GS, Suh DH, Chan Kim Y, Park CJ, Kim KH, Lee AY, Chan Park K, Lee MH, Bae JM. The long-term risk of lymphoma and skin cancer did not increase after topical calcineurin inhibitor use and phototherapy in a cohort of 25,694 patients with vitiligo. J Am Acad Dermatol 2021; 84:1619-1627. [PMID: 33508387 DOI: 10.1016/j.jaad.2021.01.067] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Topical calcineurin inhibitors have been used to treat vitiligo, either alone or in combination with phototherapy; however, the long-term safety of these agents remains controversial. OBJECTIVE To investigate the risk of lymphoma and skin cancer in vitiligo patients who received topical calcineurin inhibitors or phototherapy. METHODS A multicenter retrospective cohort study of 25,694 vitiligo patients who received topical calcineurin inhibitors or phototherapy for 6 weeks or more between 2001 and 2019 was performed. Cumulative doses of topical calcineurin inhibitors and total phototherapy sessions were determined. Outcomes were the development of lymphoma or skin cancer after enrollment, confirmed through chart review and pathology reports. RESULTS During 95,203 person-years, 13 cases of lymphoma, 22 of actinic keratosis, 15 of nonmelanoma skin cancer, and 5 of melanoma were observed. The risk of lymphoma and skin cancer was not significantly increased by topical calcineurin inhibitor dose or phototherapy sessions. The interaction between the topical calcineurin inhibitors and phototherapy was not associated with an increased risk of skin cancer. LIMITATIONS Retrospective study, individual follow-up duration less than 4 years, and no adjustment for comorbidities and medication history. Not generalizable to other races. CONCLUSION The long-term risk of skin cancer or lymphoma was not associated with the use of topical calcineurin inhibitors, phototherapy, and both treatments in combination in patients with vitiligo.
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Affiliation(s)
- Hyun Jeong Ju
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ju Hee Han
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Min-Soo Kim
- Department of Dermatology, Veterans Health Service Medical Center, Seoul, South Korea
| | - Si-Hyung Lee
- Department of Dermatology, Seoul National University College of Medicine, South Korea
| | - Jung-Won Shin
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Mira Choi
- Department of Dermatology, Inje University Ilsan Paik Hospital, Seoul, South Korea
| | - Ki-Heon Jeong
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Tae Young Han
- Department of Dermatology, Eulji General Hospital, Eulji University, Seoul, South Korea
| | - Chong Won Choi
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hee Jung Lee
- Department of Dermatology, Cha University Bundang Cha Medical Center School of Medicine, Bundang, South Korea
| | - Sang Ho Oh
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Hoon Lee
- Department of Dermatology, Soon Chun Hyang University Hospital, Bucheon, South Korea
| | - Dong Hyun Kim
- Department of Dermatology, Cha University Bundang Cha Medical Center School of Medicine, Bundang, South Korea
| | - Jeonghyun Shin
- Department of Dermatology, Inha University School of Medicine, Incheon, South Korea
| | - Jong Hee Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang Seok Kim
- Department of Dermatology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hee Young Kang
- Department of Dermatology, Ajou University School of Medicine, Suwon, South Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jeong-Soo Kim
- Department of Dermatology, Hanyang University College of Medicine, Seoul, South Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gwang Seong Choi
- Department of Dermatology, Inha University School of Medicine, Incheon, South Korea
| | - Dae Hun Suh
- Department of Dermatology, Seoul National University College of Medicine, South Korea
| | - You Chan Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, South Korea
| | - Chul Jong Park
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ki-Ho Kim
- Department of Dermatology, Dong-A University School of Medicine, Busan, South Korea
| | - Ai-Young Lee
- Department of Dermatology, Dongkuk University Ilsan Hospital, Dongguk University Graduate School of Medicine, Goyang, South Korea
| | - Kyoung Chan Park
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Mu-Hyoung Lee
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Jung Min Bae
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Skin-Associated B Cells in the Pathogenesis of Cutaneous Autoimmune Diseases-Implications for Therapeutic Approaches. Cells 2020; 9:cells9122627. [PMID: 33297481 PMCID: PMC7762338 DOI: 10.3390/cells9122627] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 12/11/2022] Open
Abstract
B lymphocytes are crucial mediators of systemic immune responses and are known to be substantial in the pathogenesis of autoimmune diseases with cutaneous manifestations. Amongst them are lupus erythematosus, dermatomyositis, systemic sclerosis and psoriasis, and particularly those driven by autoantibodies such as pemphigus and pemphigoid. However, the concept of autoreactive skin-associated B cells, which may reside in the skin and locally contribute to chronic inflammation, is gradually evolving. These cells are believed to differ from B cells of primary and secondary lymphoid organs and may provide additional features besides autoantibody production, including cytokine expression and crosstalk to autoreactive T cells in an antigen-presenting manner. In chronically inflamed skin, B cells may appear in tertiary lymphoid structures. Those abnormal lymph node-like structures comprise a network of immune and stromal cells possibly enriched by vascular structures and thus constitute an ideal niche for local autoimmune responses. In this review, we describe current considerations of different B cell subsets and their assumed role in skin autoimmunity. Moreover, we discuss traditional and B cell-associated approaches for the treatment of autoimmune skin diseases, including drugs targeting B cells (e.g., CD19- and CD20-antibodies), plasma cells (e.g., proteasome inhibitors, CXCR4 antagonists), activated pathways (such as BTK- and PI3K-inhibitors) and associated activator molecules (BLyS, APRIL).
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18
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Singh R, Heron CE, Ghamrawi RI, Strowd LC, Feldman SR. Emerging Role of Janus Kinase Inhibitors for the Treatment of Atopic Dermatitis. Immunotargets Ther 2020; 9:255-272. [PMID: 33204661 PMCID: PMC7667501 DOI: 10.2147/itt.s229667] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/20/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a common chronic, inflammatory skin condition. The pathogenesis of AD involves many cytokines that utilize the Janus kinase/signal transducer and activator of transcription (JAK-STAT) signaling cascade; therefore, JAK inhibitors may be used in the treatment of AD. This review aims to evaluate the pathophysiology, efficacy, and safety of JAK inhibitors and their emerging role as a therapeutic option for patients with AD. METHODS A PubMed search of Phase I, II, and III clinical trials was conducted for relevant literature published between January 2015 and June 2020 utilizing the key terms: JAK inhibitors, atopic dermatitis, efficacy, safety, and treatment. The search was subsequently expanded to include additional terms. RESULTS In multiple Phase II and III clinical trials, JAK inhibitors were more efficacious than placebo or vehicle controls and slightly more efficacious in direct comparisons to corticosteroids. Overall, JAK inhibitors have a moderate safety profile for use in AD. Some of the more severe theoretical adverse events included thrombosis and reactivation of viral infections. While data remain limited for the long-term efficacy and safety of JAK inhibitor use in patients with AD, many ongoing clinical trials have promising preliminary results. DISCUSSION Short-term data suggest that both topical and oral JAK inhibitors are efficacious and safe for use in patients with AD, although cases of thrombosis and viral disease have been reported. While the current standard treatments for AD are likely preferred, failed therapy with these agents or corticosteroid phobia may be indications for the use of JAK inhibitors in patients with AD.
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Affiliation(s)
- Rhea Singh
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Courtney E Heron
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rima I Ghamrawi
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lindsay C Strowd
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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Ugwu N, Cheraghlou S, Cohen JM. Utilization and cost of topical calcineurin inhibitors in the Medicare population: 2013 to 2017. J Am Acad Dermatol 2020; 85:1345-1346. [PMID: 33137441 DOI: 10.1016/j.jaad.2020.10.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Nelson Ugwu
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Shayan Cheraghlou
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.
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Patsinakidis N, Meyer NH, Raap U. [Psoriasis]. MMW Fortschr Med 2020; 162:43-50. [PMID: 33164190 DOI: 10.1007/s15006-020-1458-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Nikolaos Patsinakidis
- Universitätsklinik für Dermatologie und Allergologie, Klinikum Oldenurg AöR, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany.
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Stoopler ET, Kulkarni R, Alawi F, Sollecito TP. Novel combination therapy of hydroxychloroquine and topical tacrolimus for chronic ulcerative stomatitis. Int J Dermatol 2020; 60:e162-e163. [PMID: 32970835 DOI: 10.1111/ijd.15190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Eric T Stoopler
- Department of Oral Medicine, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA, USA
| | - Roopali Kulkarni
- Department of Oral Medicine, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA, USA
| | - Faizan Alawi
- Department of Basic and Translational Sciences, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA, USA
| | - Thomas P Sollecito
- Department of Oral Medicine, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA, USA
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Topical tacrolimus and malignancy risk: Should the theory be put to rest? J Am Acad Dermatol 2020; 83:367-368. [DOI: 10.1016/j.jaad.2020.05.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 11/20/2022]
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Manjhi M, Yadav P, Mohan S, Sonthalia S, Ramesh V, Kashyap V. A comparative study of topical tacrolimus and topical triamcinolone acetonide in nodular scabies. Dermatol Ther 2020; 33:e13954. [PMID: 32621663 DOI: 10.1111/dth.13954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/01/2022]
Abstract
The aim of this study was to compare the efficacy and safety of 0.1% triamcinolone acetonide and 0.03% tacrolimus ointment for the treatment of nodular lesions of scabies. In this double-blind randomized controlled trial, 50 Indian men with postscabeitic persistent nodular lesions (labelled to have nodular scabies (NS)/postscabies prurigo (PSP)) over the external genitalia, were enrolled. They were randomized into two groups to receive either a mid-potency topical corticosteroid (TCS); triamcinolone acetonide 0.1% ointment twice daily, or topical calcineurin inhibitor (CNI); tacrolimus ointment 0.03% twice daily over the nodular lesions for 2 weeks. All patients were followed up on three visits: 1, 2, and 6 weeks, for assessment. Efficacy was evaluated by 5-point range investigator-assessed VAS, and a 4-point severity of pruritus scale (SPS) score. The mean VAS score was higher in triamcinolone group compared to tacrolimus group at both follow-ups, although statistically significant only at 2nd week visit. The fall in mean SPS at both follow-ups was also higher in the steroid group, but the difference was not statistically significant. While, the overall tolerance to either ointment was excellent, mild hypopigmentation, and epidermal atrophy were detected on dermoscopic evaluation of the treated areas at the 2nd week visit in a small subset of patients in the triamcinolone group. The frequency of relapse of lesions and/or pruritus after four weeks of the 2-week therapy was high in both the groups (higher in tarolimus group). Conclusively, although both treatment options provided safe and satisfactory short term improvement, the results from this study suggest an overall higher efficacy of a mid-potency TCS like triamcinolone 0.1% over topical CNI like tacrolimus 0.03%, in the short-term treatment of nodular lesions of NS/PSP. Topical CNIs may be considered for maintenance of effect, if prolonged therapy is warranted.
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Affiliation(s)
- Mukesh Manjhi
- Department of Dermatology, Hamdard Institute of Medical Sciences and Research and HAH Centenary Hospital, New Delhi, India
| | - Pravesh Yadav
- Department of Dermatology, Lady Hardinge Medical College and Associated Hospital, New Delhi, India
| | - Sneha Mohan
- Department of Microbiology, School of Medical Sciences and Research and Sharda Hospital, Greater Noida, Uttar Pradesh, India
| | - Sidharth Sonthalia
- Department of Dermatology and Dermatosurgery, Skinnocence: The Skin Clinic and Research Center, Gurugram, Haryana, India
| | - V Ramesh
- Department of Dermatology, Hamdard Institute of Medical Sciences and Research and HAH Centenary Hospital, New Delhi, India
| | - Varun Kashyap
- Department of Community Medicine, Hamdard Institute of Medical Sciences and Research and HAH Centenary Hospital, New Delhi, India
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Bianchi L, Sensini C, Hansel K, Tramontana M, Romita P, Giuffrida R, Stingeni L. Cutaneous necrosis in patient with antiphospholipid syndrome successfully treated with topical pimecrolimus and warfarin. Dermatol Ther 2020; 33:e13655. [DOI: 10.1111/dth.13655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Leonardo Bianchi
- Dermatology Section, Department of Medicine University of Perugia Perugia Italy
| | - Chiara Sensini
- Dermatology Section, Department of Medicine University of Perugia Perugia Italy
| | - Katharina Hansel
- Dermatology Section, Department of Medicine University of Perugia Perugia Italy
| | - Marta Tramontana
- Dermatology Section, Department of Medicine University of Perugia Perugia Italy
| | - Paolo Romita
- Department of Biomedical Science and Human Oncology, Dermatological Clinic University of Bari Bari Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology University of Messina Messina Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine University of Perugia Perugia Italy
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Fiorillo L, Marcoux D, Ramien M. Contemporary Role of Topical Calcineurin Inhibitors: A Pediatric Dermatology Perspective. J Cutan Med Surg 2020; 23:11S-18S. [PMID: 31476940 DOI: 10.1177/1203475419857975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atopic dermatitis (AD) is the most common pediatric chronic inflammatory skin disease in North America, often involving complex treatment regimens and impairing the quality of life of affected children and their families. Two topical calcineurin inhibitors (TCIs) have been available for the treatment of AD in pediatric patients for more than 15 years, and they continue to represent an important steroid-sparing option for the management of AD. Despite the large body of evidence and extensive clinical experience with these agents, there remain concerns among parents and clinicians regarding the long-term safety of this class of therapy, particularly with respect to the boxed warning about the potential risk of lymphoma and malignancy associated with TCIs. Concerns about burning or stinging with initial applications are also common. This review examines the literature on the clinical effectiveness of TCIs, with a focus on the pivotal research that supports the efficacy of these agents, and the reassuring body of evidence supporting their long-term safety in pediatric patients. Practical recommendations for maximizing the utility of TCIs in pediatric patients, including discussion points to address with parents, are offered.
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Affiliation(s)
- Loretta Fiorillo
- 1 Department of Medicine, University of Alberta, Edmonton, Canada
| | - Danielle Marcoux
- 2 Department of Pediatrics, Division of Dermatology, University of Montreal and Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Michele Ramien
- 3 Department of Pediatrics, University of Calgary, AB, Canada
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