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He Z, Dong Q, Xi Y, Zheng R. Epidermolysis Bullosa Pruriginosa treated with baricitinib: A case report. Medicine (Baltimore) 2024; 103:e38854. [PMID: 38968458 PMCID: PMC11224809 DOI: 10.1097/md.0000000000038854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/17/2024] [Indexed: 07/07/2024] Open
Abstract
INTRODUCTION Epidermolysis Bullosa Pruriginosa (EBP) is a persistent, recurring disease that seriously affects quality of life. Fewer than 100 cases of EBP have been reported to date. Numerous inflammatory dermatoses are driven by soluble inflammatory mediators, which rely on Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling, and inhibition of this pathway using Janus kinase (JAK) inhibitors might be a useful therapeutic strategy for these diseases. PATIENT CONCERNS A male patient, 28 years of age, was admitted to our hospital because of recurrent papules, nodules, and intense itching on the trunk and extremities for 12 years. Repeated large and intense itching has seriously affected the patient normal life. DIAGNOSIS The patient was diagnosed with EBP based on examination results. INTERVENTIONS Oral baricitinib tablets (2 mg, once a day) + Oral desloratadine citrate disodium tablets (8.8 mg, once a day) combined with topical compound flumethasone ointment and Fucidin cream. OUTCOMES The patient skin rashes had subsided and flattened remarkable, and his itching was markedly relieved. The visual analogue scale (VAS) itching score of the patient gradually declined from 8 to 9 points to 2 to 3 points. CONCLUSION This study confirms that baricitinib is effective and feasible in treating EBP, especially in remarkable relieving itching, which rendered new ideas for therapeutic approaches for EBP in the future.
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Affiliation(s)
- Zhe He
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - Qian Dong
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yue Xi
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - Rui Zheng
- Department of Dermatology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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Roque Quintana B, Piqué Durán E, Pérez Cejudo JA. [Translated article] Successful Control of Recalcitrant Pruritus in Epidermolysis Bullosa Pruriginosa With Dupilumab. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T184-T186. [PMID: 38048956 DOI: 10.1016/j.ad.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/29/2022] [Indexed: 12/06/2023] Open
Affiliation(s)
- B Roque Quintana
- Servicio de Dermatología, Hospital Dr. José Molina Orosa, Lanzarote, Las Palmas, Spain.
| | - E Piqué Durán
- Servicio de Dermatología, Hospital Dr. José Molina Orosa, Lanzarote, Las Palmas, Spain
| | - J A Pérez Cejudo
- Servicio de Dermatología, Hospital Dr. José Molina Orosa, Lanzarote, Las Palmas, Spain
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Roque Quintana B, Piqué Durán E, Pérez Cejudo JA. Successful Control of Recalcitrant Pruritus in Epidermolysis Bullosa Pruriginosa With Dupilumab. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:184-186. [PMID: 36871818 DOI: 10.1016/j.ad.2022.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/29/2022] [Indexed: 03/06/2023] Open
Affiliation(s)
- B Roque Quintana
- Servicio de Dermatología, Hospital Dr. José Molina Orosa, Arrecife, Las Palmas, España.
| | - E Piqué Durán
- Servicio de Dermatología, Hospital Dr. José Molina Orosa, Arrecife, Las Palmas, España
| | - J A Pérez Cejudo
- Servicio de Dermatología, Hospital Dr. José Molina Orosa, Arrecife, Las Palmas, España
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LaMonica LC, Lang-Houser M, Bresler SC, Mervak JE. Low-dose naltrexone as treatment for epidermolysis bullosa pruriginosa-associated refractory pruritus. JAAD Case Rep 2023; 38:82-85. [PMID: 37456515 PMCID: PMC10339115 DOI: 10.1016/j.jdcr.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Affiliation(s)
| | | | - Scott C. Bresler
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Julie E. Mervak
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
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Romanelli M, Manzo Margiotta F, Michelucci A, Granieri G, Janowska A, Dini V. Compression Therapy in Dermatology. CURRENT DERMATOLOGY REPORTS 2023. [DOI: 10.1007/s13671-023-00388-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Abstract
Purpose of Review
The compression therapy provides valuable support during management of vascular and inflammatory lower leg skin disorders. The review outlines the mechanism of action and the treatment options available with indications for use in wound management and general dermatology.
Recent Findings
Atypical wounds such as pyoderma gangrenosum, cutaneous vasculitis and other inflammatory skin diseases may benefit from the use of compression therapy. Adherence to treatment is always a challenging aspects for patients and caregiver, but modern technologies and specific materials have improved the compliance during treatment.
Summary
Compression therapy is a main option in vascular ulcer management. The technology provided by different devices together with new methods of bandaging application have increased the outcomes and acceptability from patients. Physicians should be aware of the advantages provided by compression therapy in skin diseases.
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Leonova MA, Murashkin NN. Pruriginosa Pattern of Dystrophic Epidermolisys Bullosa: Clinical Case. PEDIATRIC PHARMACOLOGY 2023. [DOI: 10.15690/pf.v19i6.2476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background. Epidermolisys bullosa pruriginosa is a rare pattern of dystrophic epidermolisys bullosa and characterized by severe itching that accompanies the formation of papules, plaques and nodes primarily on the lower limbs skin and imitating prurigo nodularis. Nowadays, less than 100 cases of this disease are reported in the world, thus, the presentation of this clinical case is relevant. Clinical case description. The authors describe the clinical case of pruriginous pattern of dominant dystrophic bullous epidermolysis in 14-year-old female patient. Conclusion. Diagnosis of this disease pattern is extremely difficult and currently all treatment is limited to the symptomatic therapy in order to stop itching and prevent scarring.
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Affiliation(s)
- Maria A. Leonova
- National Medical Research Center of Children’s Health; Pirogov Russian National Research Medical University
| | - Nikolay N. Murashkin
- National Medical Research Center of Children’s Health; Sechenov First Moscow State Medical University; Central State Medical Academy of Department of Presidential Affairs
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Darbord D, Hickman G, Pironon N, Barbieux C, Bonnet-des-Claustres M, Titeux M, Miskinyte S, Cordoliani F, Vignon-Pennamen MD, Amode R, Hovnanian A, Bourrat E. Dystrophic epidermolysis bullosa pruriginosa: a new case series of a rare phenotype unveils skewed Th2 immunity. J Eur Acad Dermatol Venereol 2021; 36:133-143. [PMID: 34543471 DOI: 10.1111/jdv.17671] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/03/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Dystrophic epidermolysis bullosa pruriginosa (DEB-Pr) is a rare subtype of hereditary epidermolysis bullosa, with a poorly understood pathogenesis and no satisfactory treatment. OBJECTIVES To assess the clinical and biological features, genetic basis and therapeutic management, to better characterize this rare genodermatosis. METHODS We have conducted a retrospective study, reviewing the clinical presentation, genetic diagnosis, immunohistopathological findings and biological characteristics and management of patients with dystrophic epidermolysis bullosa pruriginosa. This study was conducted in the Department of Dermatology at Saint-Louis Hospital and the Department of Genetics at Necker Hospital (Paris, France). All patients with a diagnosis of DEB-Pr seen between 2010 and 2020 were included. RESULTS Seven patients were included, the average age of 50.1 years [range 36-76]. Pruriginous-lichenified papules, plaques or nodules appeared at 27.6 years on average [range 7-66] on pretibial areas and forearms, associated with milia and toenails dystrophy. All patients received multiple treatments, but none could sustainably reduce pruritus. Immunohistopathological analysis of lesion skin revealed subepidermal blister with fibrosis, milia and mast cell infiltration. Serum TNFα, IL1β and IL6 levels were elevated in 2/6 patients. Total serum IgE levels were increased in 7/7 patients, with no history of atopy. Immunophenotyping of circulating T-cells revealed an increased Th2 subset in 4/4 patients, with reduced Th1 and Th17 subpopulations. Genetic analysis of COL7A1 identified 7 distinct causative mutations, six of which were new. Intra-familial clinical variability was documented in 5/7 patients and was associated with the co-inheritance of a recessive COL7A1 mutation or an FLG2 mutation in 2 families. CONCLUSION Our study confirms the stereotyped presentation of DEB-Pr with large intra-familial variability in disease expression. Mast cell infiltration, elevated IgE and increased Th2 subset without atopy strongly support a role of Th2-mediated immunity in DEB-Pr, and further argue for new targeted therapeutic options such as dupilumab.
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Affiliation(s)
- D Darbord
- Department of Dermatology, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - G Hickman
- Department of Dermatology, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.,Centre de référence maladies rares MAGEC Nord Site Saint Louis, Hôpital Saint Louis, Paris, France
| | - N Pironon
- INSERM UMR 1163, Laboratory of genetic skin diseases, Institut Imagine, Paris Université, Paris, France
| | - C Barbieux
- INSERM UMR 1163, Laboratory of genetic skin diseases, Institut Imagine, Paris Université, Paris, France
| | - M Bonnet-des-Claustres
- INSERM UMR 1163, Laboratory of genetic skin diseases, Institut Imagine, Paris Université, Paris, France
| | - M Titeux
- INSERM UMR 1163, Laboratory of genetic skin diseases, Institut Imagine, Paris Université, Paris, France
| | - S Miskinyte
- INSERM UMR 1163, Laboratory of genetic skin diseases, Institut Imagine, Paris Université, Paris, France
| | - F Cordoliani
- Department of Dermatology, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | | | - R Amode
- Department of Dermatology, Hôpital Bichat, AP-HP, Paris, France
| | - A Hovnanian
- INSERM UMR 1163, Laboratory of genetic skin diseases, Institut Imagine, Paris Université, Paris, France.,Department of Genetics, Hôpital Necker-enfants malades, AP-HP, Paris, France
| | - E Bourrat
- Department of Dermatology, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.,Centre de référence maladies rares MAGEC Nord Site Saint Louis, Hôpital Saint Louis, Paris, France
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Ertop P, Vural S, Gökpınar Ili E, Durmaz CD, Heper AO, McGrath JA, Ilgın RH, Boyvat A. Promising effect of intravenous immunoglobulin therapy for epidermolysis bullosa pruriginosa. Int J Dermatol 2020; 59:851-855. [PMID: 32506551 DOI: 10.1111/ijd.14951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/10/2020] [Accepted: 04/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Epidermolysis bullosa pruriginosa (EBP) is rare a clinical variant of dystrophic epidermolysis bullosa characterized by trauma-induced bullae formation, milia and nail dystrophy accompanied by severe pruritus. Treatment pruritus of EBP focuses on immunosuppressive treatment with limited efficacy. Treatment strategies are not well-established. AIM To provide the genetic characterization of a multi-generational EBP family and discuss the efficacy of intravenous immunoglobulin treatment in EBP. MATERIALS & METHODS The clinical characteristics of patients diagnosed with EBP in three consecutive generations were determined. The mutation is analyzed in the index patient's genomic DNA by Sanger sequencing, and this mutation was confirmed in other affected members of the family. Index case with severe phenotype was treated with intravenous immunoglobulin (IVIG). RESULTS A heterozygous single nucleotide transition, c.6127G>A, in exon 73 of COL7A1 was identified in all affected members. Physical examination of patients revealed lichenoid papules on extensor surfaces of extremities, excoriations, milia formation and nail dystrophy. Majority of patients had elevated serum IgE levels (%86 (6/7)) without a medical history for atopy. Female patients had generalized involvement and severe phenotype. The skin lesions of the index case were refractory to high dose systemic steroids and cyclosporine treatment. Lesions improved significantly with intravenous immunoglobulin therapy. CONCLUSION In severe cases, unresponsive to other therapies, IVIG may be a preferable therapeutic approach to modulate the inflammatory response in patients with EBP.
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Affiliation(s)
- Pelin Ertop
- Department of Dermatology, Ankara University, Ankara, Turkey
| | - Secil Vural
- Department of Dermatology, Koç University, İstanbul, Turkey
| | | | - Ceren D Durmaz
- Department of Medical Genetics, Ankara University, Ankara, Turkey
| | - Aylin O Heper
- Department of Pathology, Ankara University, Ankara, Turkey
| | - John A McGrath
- King's College London, Guy's Hospital, St John's Institute of Dermatology, London, UK
| | - Ruhi H Ilgın
- Department of Medical Genetics, Ankara University, Ankara, Turkey
| | - Ayse Boyvat
- Department of Dermatology, Ankara University, Ankara, Turkey
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Hale GI, Cohen MC, Quarrell OW, McGrath JA, Messenger AG. Coinheritance of 2 New Potentially Damaging Heterozygous COL7A1 Variants in a Family With Autosomal Dominant Epidermolysis Bullosa Pruriginosa. Pediatr Dev Pathol 2018; 21:580-584. [PMID: 29504492 DOI: 10.1177/1093526618761497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Epidermolysis bullosa pruriginosa (EBP) is a rare subtype of EB which is characterized by intense pruritus with blistering and nodular or lichenoid lesions most prominent on the lower extremities. It is caused by variants in COL7A1 which encodes for type VII collagen. There is wide phenotypic and genotypic variability between affected individuals. We report 2 potentially pathogenic variants in COL7A1 occurring on the same allele in a family with EBP and autosomal dominant inheritance. Late-onset EBP and incomplete penetrance may lead to delayed presentation in affected family members with the same variants. The broad phenotypic variability seen in EBP suggests that further genotypic and environmental factors may influence presentation. Genetic and histopathological diagnosis is essential, given the considerable overlap with clinically similar presentations such as hypertrophic lichen planus.
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Affiliation(s)
- Gordon I Hale
- 1 Department of Dermatology, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, UK
| | - Marta C Cohen
- 2 Department of Histopathology, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, UK
| | - Oliver W Quarrell
- 3 Department of Genetics, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, UK
| | - John A McGrath
- 4 St. John's Institute of Dermatology, Kings College London, London, UK
| | - Andrew G Messenger
- 1 Department of Dermatology, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, UK
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Knöpfel N, Noguera-Morel L, Hernández-Martin A, García-Martin A, García M, Mencía Á, Pedrero RM, de Lucas R, Escámez MJ, Torrelo A. Identical COL71A1 heterozygous mutations resulting in different dystrophic epidermolysis bullosa phenotypes. Pediatr Dermatol 2018; 35:e94-e98. [PMID: 29272047 DOI: 10.1111/pde.13367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Dystrophic epidermolysis bullosa is a rare blistering condition caused by mutations in the COL7A1 gene. Different clinical variants have been described, with dominant and recessive inheritance, but no consistent findings have been elucidated to establish a genotype-phenotype correlation. We present three unrelated patients with two identical pathogenic compound heterozygous mutations in the COL7A1 gene that developed different clinical forms of dystrophic epidermolysis bullosa-epidermolysis bullosa pruriginosa and mild recessive non-Hallopeau-Siemens-raising the possibility of other genetic or environmental modifying factors responsible for the phenotype of the disease.
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Affiliation(s)
- Nicole Knöpfel
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Lucero Noguera-Morel
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Adela García-Martin
- Department of Bioengineering, Universidad Carlos III de Madrid (UC3M), CIEMAT-Centro de Investigación Biomédica en Red de Enfermedades Raras (U714-CIBERER), Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (IISFJD), Madrid, Spain
| | - Marta García
- Department of Bioengineering, Universidad Carlos III de Madrid (UC3M), CIEMAT-Centro de Investigación Biomédica en Red de Enfermedades Raras (U714-CIBERER), Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (IISFJD), Madrid, Spain
| | - Ángeles Mencía
- Department of Bioengineering, Universidad Carlos III de Madrid (UC3M), CIEMAT-Centro de Investigación Biomédica en Red de Enfermedades Raras (U714-CIBERER), Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (IISFJD), Madrid, Spain
| | | | - Raúl de Lucas
- Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain
| | - Maria José Escámez
- Department of Bioengineering, Universidad Carlos III de Madrid (UC3M), CIEMAT-Centro de Investigación Biomédica en Red de Enfermedades Raras (U714-CIBERER), Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (IISFJD), Madrid, Spain
| | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Abstract
PURPOSE OF REVIEW Epidermolysis bullosa is a hereditary skin disorder characterized by skin fragility. However, the disease can manifest in many different organ systems, therefore children born with epidermolysis bullosa may have life long, complex medical needs. In this review, we will use a system-based approach to highlight important aspects of disease management and recent advancements in each of the areas. In addition, we will overview some of the cutting edge therapeutic developments in epidermolysis bullosa. RECENT FINDINGS Recent advancements in supportive care of epidermolysis bullosa with focus on wound, pain, pruritus and nutrition status were discussed. Clinical surveillance and complication prevention are critical to improve clinical outcomes. Generalized epidermolysis bullosa is a systemic disease with increased morbidity and mortality; therefore, complex care using a multidisciplinary approach will provide the greatest benefits for patients. Current targeted treatments for epidermolysis bullosa aim at restoring the skin integrity using protein, cell, and gene therapies. SUMMARY Improvement in care of epidermolysis bullosa in recent years results from keen clinical observation, novel molecular targeting, and the embracement of translational research.
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