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Le ST, Herbert S, Haughton R, Nava J, Toussi A, Ji-Xu A, Maverakis E. Rituximab and Omalizumab Combination Therapy for Bullous Pemphigoid. JAMA Dermatol 2024; 160:107-109. [PMID: 37991748 PMCID: PMC10666039 DOI: 10.1001/jamadermatol.2023.4508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/21/2023] [Indexed: 11/23/2023]
Abstract
This research letter reports on a case series of 10 patients with bullous pemphigoid treated with rituximab combined with omalizumab.
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Affiliation(s)
- Stephanie T. Le
- Department of Dermatology, University of California, Davis, Sacramento
| | - Samantha Herbert
- Department of Dermatology, University of California, Davis, Sacramento
| | - Reneé Haughton
- Department of Dermatology, University of California, Davis, Sacramento
| | - Jordan Nava
- Department of Dermatology, University of California, Davis, Sacramento
| | - Atrin Toussi
- Department of Dermatology, University of California, Davis, Sacramento
| | - Antonio Ji-Xu
- Department of Dermatology, University of California, Davis, Sacramento
| | - Emanual Maverakis
- Department of Dermatology, University of California, Davis, Sacramento
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2
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Marusina AI, Ji-Xu A, Le ST, Toussi A, Tsoi LC, Li Q, Luxardi G, Nava J, Downing L, Leal AR, Kuzminykh NY, Kruglinskaya O, Brüggen MC, Adamopoulos IE, Merleev AA, Gudjonsson JE, Maverakis E. Cell-Specific and Variant-Linked Alterations in Expression of ERAP1, ERAP2, and LNPEP Aminopeptidases in Psoriasis. J Invest Dermatol 2023; 143:1157-1167.e10. [PMID: 36716917 DOI: 10.1016/j.jid.2023.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 12/22/2022] [Accepted: 01/07/2023] [Indexed: 01/29/2023]
Abstract
ERAP1, ERAP2, and LNPEP are aminopeptidases implicated in autoimmune pathophysiology. In this study, we show that ERAP2 is upregulated and ERAP1 is downregulated in patients with psoriasis who are homozygous for autoimmune-linked variants of ERAP. We also demonstrate that aminopeptidase expression is not uniform in the skin. Specifically, the intracellular antigen-processing aminopeptidases ERAP1 and ERAP2 are strongly expressed in basal and early spinous layer keratinocytes, whereas granular layer keratinocytes expressed predominantly LNPEP, an aminopeptidase specialized in the processing of extracellular antigens for presentation to T cells. In psoriasis, basal keratinocytes also expressed the T-cell- and monocyte-attracting chemokine, CCL2, and the T-cell-supporting cytokine, IL-15. In contrast, TGF-β1 was the major cytokine expressed by healthy control basal keratinocytes. SFRP2-high dermal fibroblasts were also noted to have an ERAP2-high expression phenotype and elevated HLA-C. In psoriasis, the SFRP2-high fibroblast subpopulation also expressed elevated CXCL14. From these results, we postulate that (i) an increased ERAP2/ERAP1 ratio results in altered antigen processing, a potential mechanism by which ERAP risk alleles predispose individuals to autoimmunity; (ii) ERAP2-high expressing cells display a unique major histocompatibility complex-bound peptidome generated from intracellular antigens; and (iii) the granular layer peptidome is skewed toward extracellular antigens.
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Affiliation(s)
- Alina I Marusina
- Department of Dermatology, University of California, Davis, Sacramento, California, USA
| | - Antonio Ji-Xu
- Department of Dermatology, University of California, Davis, Sacramento, California, USA
| | - Stephanie T Le
- Department of Dermatology, University of California, Davis, Sacramento, California, USA
| | - Atrin Toussi
- Department of Dermatology, University of California, Davis, Sacramento, California, USA
| | - Lam C Tsoi
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Qinyuan Li
- Department of Dermatology, University of California, Davis, Sacramento, California, USA
| | - Guillaume Luxardi
- Department of Dermatology, University of California, Davis, Sacramento, California, USA
| | - Jordan Nava
- Department of Dermatology, University of California, Davis, Sacramento, California, USA
| | - Lauren Downing
- Department of Dermatology, University of California, Davis, Sacramento, California, USA
| | - Annie R Leal
- Department of Dermatology, University of California, Davis, Sacramento, California, USA
| | - Nikolay Y Kuzminykh
- Institute of Biochemical Physics, Russian Academy of Science, Moscow, Russia
| | | | - Marie-Charlotte Brüggen
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland; Swiss Institute for Allergy Research, Davos, Switzerland
| | - Iannis E Adamopoulos
- Division of Rheumatology and Clinical Immunology, Harvard Medical School, Beth Israel Medical Deaconess Center, Boston, Massachusetts, USA
| | - Alexander A Merleev
- Department of Dermatology, University of California, Davis, Sacramento, California, USA
| | | | - Emanual Maverakis
- Department of Dermatology, University of California, Davis, Sacramento, California, USA.
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3
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Liakos W, Ji-Xu A, Artounian K, Downing L, Nava J, Toussi A, Le S, Maverakis E. 378 Real-world utilization of Delphi consensus diagnostic criteria for pyoderma gangrenosum referrals. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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4
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Merleev AA, Le ST, Alexanian C, Toussi A, Xie Y, Marusina AI, Watkins SM, Patel F, Billi AC, Wiedemann J, Izumiya Y, Kumar A, Uppala R, Kahlenberg JM, Liu FT, Adamopoulos IE, Wang EA, Ma C, Cheng MY, Xiong H, Kirane A, Luxardi G, Andersen B, Tsoi LC, Lebrilla CB, Gudjonsson JE, Maverakis E. Biogeographic and disease-specific alterations in epidermal lipid composition and single cell analysis of acral keratinocytes. JCI Insight 2022; 7:159762. [PMID: 35900871 PMCID: PMC9462509 DOI: 10.1172/jci.insight.159762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The epidermis is the outermost layer of skin. Here, we used targeted lipid profiling to characterize the biogeographic alterations of human epidermal lipids across 12 anatomically distinct body sites, and we used single-cell RNA-Seq to compare keratinocyte gene expression at acral and nonacral sites. We demonstrate that acral skin has low expression of EOS acyl-ceramides and the genes involved in their synthesis, as well as low expression of genes involved in filaggrin and keratin citrullination (PADI1 and PADI3) and corneodesmosome degradation, changes that are consistent with increased corneocyte retention. Several overarching principles governing epidermal lipid expression were also noted. For example, there was a strong negative correlation between the expression of 18-carbon and 22-carbon sphingoid base ceramides. Disease-specific alterations in epidermal lipid gene expression and their corresponding alterations to the epidermal lipidome were characterized. Lipid biomarkers with diagnostic utility for inflammatory and precancerous conditions were identified, and a 2-analyte diagnostic model of psoriasis was constructed using a step-forward algorithm. Finally, gene coexpression analysis revealed a strong connection between lipid and immune gene expression. This work highlights (a) mechanisms by which the epidermis is uniquely adapted for the specific environmental insults encountered at different body surfaces and (b) how inflammation-associated alterations in gene expression affect the epidermal lipidome.
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Affiliation(s)
- Alexander A Merleev
- Department of Dermatology, University of California, Davis, Sacramento, United States of America
| | - Stephanie T Le
- Department of Dermatology, University of California, Davis, Sacramento, United States of America
| | - Claire Alexanian
- Department of Dermatology, University of California, Davis, Sacramento, United States of America
| | - Atrin Toussi
- Department of Dermatology, University of California, Davis, Sacramento, United States of America
| | - Yixuan Xie
- Department of Chemistry, University of California, Davis, Sacramento, United States of America
| | - Alina I Marusina
- Department of Dermatology, University of California, Davis, Sacramento, United States of America
| | | | - Forum Patel
- Department of Dermatology, University of California, Davis, Sacramento, United States of America
| | - Allison C Billi
- Department of Dermatology, University of Michigan, Ann Arbor, United States of America
| | - Julie Wiedemann
- Department of Dermatology, University of California, Irvine, Irvine, United States of America
| | - Yoshihiro Izumiya
- Department of Dermatology, University of California, Davis, Sacramento, United States of America
| | - Ashish Kumar
- Department of Dermatology, University of California, Davis, Sacramento, United States of America
| | - Ranjitha Uppala
- Department of Dermatology, University of Michigan, Ann Arbor, United States of America
| | - J Michelle Kahlenberg
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, United States of America
| | - Fu-Tong Liu
- Department of Dermatology, University of California, Davis, Sacramento, United States of America
| | - Iannis E Adamopoulos
- Department of Rheumatology, University of California, Davis, Sacramento, United States of America
| | - Elizabeth A Wang
- Department of Dermatology, University of California, Davis, Sacramento, United States of America
| | - Chelsea Ma
- Department of Dermatology, University of California, Davis, Sacramento, United States of America
| | - Michelle Y Cheng
- Department of Dermatology, University of California, Davis, Sacramento, United States of America
| | - Halani Xiong
- Verso Biosciences, Davis, United States of America
| | - Amanda Kirane
- Department of Surgery, University of California, Davis, Sacramento, United States of America
| | - Guillaume Luxardi
- Department of Dermatology, University of California, Davis, Sacramento, United States of America
| | - Bogi Andersen
- Department of Dermatology, University of California, Irvine, Irvine, United States of America
| | - Lam C Tsoi
- Department of Dermatology, University of Michigan, Ann Arbor, United States of America
| | - Carlito B Lebrilla
- Department of Chemistry, University of California, Davis, Sacramento, United States of America
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan, Ann Arbor, United States of America
| | - Emanual Maverakis
- Department of Dermatology, University of California, Davis, Sacramento, United States of America
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5
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Merleev A, Ji-Xu A, Toussi A, Tsoi LC, Le ST, Luxardi G, Xing X, Wasikowski R, Liakos W, Brüggen MC, Elder JT, Adamopoulos IE, Izumiya Y, Riera-Leal A, Li Q, Kuzminykh NY, Kirane A, Marusina AI, Gudjonsson JE, Maverakis E. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a psoriasis susceptibility locus that is negatively related to IL36G. JCI Insight 2022; 7:141193. [PMID: 35862195 PMCID: PMC9462487 DOI: 10.1172/jci.insight.141193] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/18/2022] [Indexed: 11/17/2022] Open
Abstract
Proprotein convertase subtilisin/kexin type-9 (PCSK9) is a posttranslational regulator of the LDL receptor (LDLR). Recent studies have proposed a role for PCSK9 in regulating immune responses. Using RNA-Seq–based variant discovery, we identified a possible psoriasis-susceptibility locus at 1p32.3, located within PCSK9 (rs662145 C > T). This finding was verified in independently acquired genomic and RNA-Seq data sets. Single-cell RNA-Seq (scRNA-Seq) identified keratinocytes as the primary source of PCSK9 in human skin. PCSK9 expression, however, was not uniform across keratinocyte subpopulations. scRNA-Seq and IHC demonstrated an epidermal gradient of PCSK9, with expression being highest in basal and early spinous layer keratinocytes and lowest in granular layer keratinocytes. IL36G expression followed the opposite pattern, with expression highest in granular layer keratinocytes. PCSK9 siRNA knockdown experiments confirmed this inverse relationship between PCSK9 and IL36G expression. Other immune genes were also linked to PCSK9 expression, including IL27RA, IL1RL1, ISG20, and STX3. In both cultured keratinocytes and nonlesional human skin, homozygosity for PCSK9 SNP rs662145 C > T was associated with lower PCSK9 expression and higher IL36G expression, when compared with heterozygous skin or cell lines. Together, these results support PCSK9 as a psoriasis-susceptibility locus and establish a putative link between PCSK9 and inflammatory cytokine expression.
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Affiliation(s)
- Alexander Merleev
- Department of Dermatology, University of California at Davis, Sacramento, United States of America
| | - Antonio Ji-Xu
- Department of Dermatology, University of California at Davis, Sacramento, United States of America
| | - Atrin Toussi
- Department of Dermatology, University of California at Davis, Sacramento, United States of America
| | - Lam C Tsoi
- The University of Michigan Medical School, Ann Arbor, United States of America
| | - Stephanie T Le
- Department of Dermatology, University of California at Davis, Sacramento, United States of America
| | - Guillaume Luxardi
- Department of Dermatology, University of California at Davis, Sacramento, United States of America
| | - Xianying Xing
- Department of Dermatology, The University of Michigan Medical School, Ann Arbor, United States of America
| | - Rachael Wasikowski
- Department of Dermatology, The University of Michigan Medical School, Ann Arbor, United States of America
| | - William Liakos
- Department of Dermatology, University of California at Davis, Sacramento, United States of America
| | | | - James T Elder
- The University of Michigan Medical School, Ann Arbor, United States of America
| | - Iannis E Adamopoulos
- Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States of America
| | - Yoshihiro Izumiya
- Department of Biochemistry and Molecular Medicine, University of California at Davis, Sacramento, United States of America
| | - Annie Riera-Leal
- Department of Dermatology, University of California at Davis, Sacramento, United States of America
| | - Qinyuan Li
- Department of Dermatology, University of California at Davis, Sacramento, United States of America
| | - Nikolay Yu Kuzminykh
- Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, Russian Federation
| | - Amanda Kirane
- Department of Surgical Oncology, University of California at Davis, Sacramento, United States of America
| | - Alina I Marusina
- Department of Dermatology, University of California at Davis, Sacramento, United States of America
| | - Johann E Gudjonsson
- The University of Michigan Medical School, Ann Arbor, United States of America
| | - Emanual Maverakis
- Department of Dermatology, University of California at Davis, Sacramento, United States of America
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6
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Ji-Xu A, Liakos W, Artounian K, Downing L, Nava J, Toussi A, Le ST, Maverakis E. Real-world utilization of Delphi consensus diagnostic criteria for suspected pyoderma gangrenosum. Clin Exp Dermatol 2022; 47:1873-1875. [PMID: 35699684 DOI: 10.1111/ced.15298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio Ji-Xu
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - William Liakos
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Kimberly Artounian
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Lauren Downing
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Jordan Nava
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Atrin Toussi
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Stephanie T Le
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Emanual Maverakis
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
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7
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Zganjar A, Toussi A, Ziegelmann M, Yang D, Manka M, Kohler T, Helo S, Trost L. Efficacy of RestoreX penile traction therapy in improving penile length and erectile function post prostatectomy. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.03.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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8
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Zganjar A, Toussi A, Ziegelmann M, Yang D, Manka M, Kohler T, Helo S, Trost L. Efficacy of RestoreX Penile Traction Therapy in Improving Penile Length and Erectile Function Post Prostatectomy. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Noe MH, Wan MT, Mostaghimi A, Gelfand JM, Agnihothri R, Armstrong AW, Bhutani T, Bridges A, Brownstone N, Butt M, Duffin KPC, Carr C, Creadore A, DeNiro KL, Desai S, Dominguez AR, Duffy EK, Fairley JA, Femia A, Gudjonsson JE, Kaffenberger JA, Katz KL, Kirby JS, Le ST, Martinez E, Maverakis E, Myers B, Naik HB, Nelson CA, Ortega-Loayza AG, Plovanich ME, Rangel LK, Ravi V, Reddy VD, Saleh JZ, Sandhu JK, Shakshouk H, Shields BE, Sharif-Sidi Z, Smith J, Steahr A, Toussi A, Wanat KA, Wang B, Wei BM, Weinhammer A, Worswick SD, Yang A. Evaluation of a Case Series of Patients With Palmoplantar Pustulosis in the United States. JAMA Dermatol 2021; 158:68-72. [PMID: 34878495 DOI: 10.1001/jamadermatol.2021.4635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Palmoplantar pustulosis (PPP) is a is a chronic, orphan disease with limited epidemiological data. Objective To describe the clinical characteristics, treatments, longitudinal disease course, and health care utilization in adults with PPP across the US. Design, Setting, and Participants This retrospective, longitudinal case series from 20 academic dermatology practices in the US included a consecutive sample of 197 adults who met the European Rare and Severe Psoriasis Expert Network consensus definition for PPP between January 1, 2007, and December 31, 2018. Data analysis was performed June 2020 to December 2020. Main Outcomes and Measures The primary outcome was to describe the patient characteristics, associated medical comorbidities, treatment patterns, complications, and PPP-specific health care utilization. Results Of 197 patients, 145 (73.6%) were female, and the mean (SD) age at presentation was 53.0 (12.6) years, with a mean (SD) follow-up time of 22.1 (28.0) months. On initial presentation, 95 (48.2%) patients reported skin pain, and 39 (19.8%) reported difficulty using hands and/or feet. Seventy patients (35.5%) were treated with systemic treatments, and use of more than 20 different systemic therapies was reported. In patients with at least 6 months of follow-up (n = 128), a median (IQR) of 3.7 (4-10) dermatology visits per year were reported; 24 (18.8%) patients had 5 or more visits during the study period. Conclusions and Relevance In this case series, PPP was associated with persistent symptoms, continued health care utilization, and a lack of consensus regarding effective treatments, emphasizing the unmet medical need in this population. Additional research is necessary to understand treatment response in these patients.
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Affiliation(s)
- Megan H Noe
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marilyn T Wan
- Department of Internal Medicine, Memorial Hospital West, Pembroke Pines, Florida
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - Ritesh Agnihothri
- Department of Dermatology, University of Rochester, School of Medicine & Dentistry, Rochester, New York
| | - April W Armstrong
- Department of Dermatology, Keck Hospital of USC, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Tina Bhutani
- Department of Dermatology, UCSF Medical Center, University of California San Francisco School of Medicine
| | - Alina Bridges
- Department of Dermatology, Mayo Clinic Graduate School of Education, Rochester, Minnesota.,Richfield Laboratory of Dermatopathology, Dermpath Diagnostics, Cincinnati, Ohio
| | - Nicholas Brownstone
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco
| | - Melissa Butt
- Department of Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | | | | | - Andrew Creadore
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Katherine L DeNiro
- Division of Dermatology, Department of Medicine, University of Washington, Seattle
| | - Sheena Desai
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | - Arturo R Dominguez
- Departments of Dermatology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Emily K Duffy
- Division of Dermatology, Department of Medicine, University of Washington, Seattle
| | - Janet A Fairley
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City
| | - Alisa Femia
- Ronald O. Perelman Department of Dermatology, NYU Langone Hospitals, New York University Grossman School of Medicine, New York, New York
| | | | | | - Kimberly L Katz
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Stephanie T Le
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento
| | | | - Emanual Maverakis
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento
| | - Bridget Myers
- University of California San Francisco School of Medicine
| | - Haley B Naik
- Department of Dermatology, UCSF Medical Center, University of California San Francisco School of Medicine
| | - Caroline A Nelson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University School of Medicine, Portland
| | - Molly E Plovanich
- Department of Dermatology, University of Rochester, School of Medicine & Dentistry, Rochester, New York
| | - Lauren K Rangel
- Ronald O. Perelman Department of Dermatology, NYU Langone Hospitals, New York University Grossman School of Medicine, New York, New York
| | - Vignesh Ravi
- Department of Dermatology, Keck Hospital of USC, University of Southern California Keck School of Medicine, Los Angeles, California
| | | | - Jamal Z Saleh
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Jeena K Sandhu
- Department of Dermatology, Keck Hospital of USC, University of Southern California Keck School of Medicine, Los Angeles, California.,Division of Dermatology, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
| | - Hadir Shakshouk
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Bridget E Shields
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin, Madison
| | | | - Jacob Smith
- Oregon Health and Science University School of Medicine, Portland
| | - Amanda Steahr
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City
| | - Atrin Toussi
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento
| | - Karolyn A Wanat
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Bo Wang
- Department of Dermatology, University of Michigan, Ann Arbor
| | - Brian M Wei
- Yale School of Medicine, New Haven, Connecticut
| | - Annika Weinhammer
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Scott D Worswick
- Department of Dermatology, Keck Hospital of USC, University of Southern California Keck School of Medicine, Los Angeles, California
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10
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Siddiqui F, Liakos W, Toussi A, Downing L, Tran M, Nava J, Le ST, Maverakis E. Pyoderma gangraenosum nach Kolektomie bei Patienten mit entzündlichen Darmerkrankungen. J Dtsch Dermatol Ges 2021; 19:1508-1509. [PMID: 34661353 DOI: 10.1111/ddg.14568_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Fariha Siddiqui
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - William Liakos
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Atrin Toussi
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Lauren Downing
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Monica Tran
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Jordan Nava
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Stephanie T Le
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Emanual Maverakis
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
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11
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Liakos W, Toussi A, Merleev A, Marusina A, Leal AR, Le S, Maverakis E. LB712 Transcriptomic profiling of Necrobiotic Xanthogranuloma and Necrobiosis Lipoidica provides insight into pathogenic role of T and B cells. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.07.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Siddiqui F, Liakos W, Toussi A, Downing L, Tran M, Nava J, Le ST, Maverakis E. Pyoderma gangrenosum after colectomy in patients with inflammatory bowel disease. J Dtsch Dermatol Ges 2021; 19:1508-1509. [PMID: 34363317 DOI: 10.1111/ddg.14568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Fariha Siddiqui
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - William Liakos
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Atrin Toussi
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Lauren Downing
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Monica Tran
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Jordan Nava
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Stephanie T Le
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Emanual Maverakis
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
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13
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Alexanian C, Liakos W, Toussi A, Kao J, Cheng MY, Wang EA, Nava J, Tran M, Marusina AI, Merleev AA, Leal AR, Fung MA, Le ST, Luxardi G, Maverakis E. Immune profiling of lupus miliaris disseminatus faciei and successful management with anti-tumour necrosis factor therapy. Clin Exp Dermatol 2021; 46:910-914. [PMID: 33864395 DOI: 10.1111/ced.14684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Abstract
Lupus miliaris disseminatus faciei (LMDF) is a chronic inflammatory dermatosis of unknown aetiology, most often seen in young adults. Although many treatments for LMDF exist, treatment guidelines have not been developed, and response to therapy is generally unpredictable. We present the results of transcriptomic analysis of LMDF lesional skin, which revealed a variety of differentially expressed genes linking LMDF to alterations in innate and adaptive T helper 1 immunity. Immunohistochemical analysis was also performed, identifying similar changes in T-cell immune responses. Given evidence for increased tumour necrosis factor (TNF) pathway activity, our patient, who had previously been refractory to multiple treatments, was initiated on TNF inhibitor therapy with excellent response. This characterization of the LMDF immune response may lead to improved treatment of this condition.
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Affiliation(s)
- C Alexanian
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - W Liakos
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - A Toussi
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - J Kao
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - M Y Cheng
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - E A Wang
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - J Nava
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - M Tran
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - A I Marusina
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - A A Merleev
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - A R Leal
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - M A Fung
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA.,Department of, Pathology, University of California, Davis, Sacramento, CA, USA
| | - S T Le
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - G Luxardi
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - E Maverakis
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
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14
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Barton VR, Toussi A, Awasthi S, Kiuru M. Treatment of pediatric alopecia areata: A systematic review. J Am Acad Dermatol 2021; 86:1318-1334. [PMID: 33940103 PMCID: PMC8556406 DOI: 10.1016/j.jaad.2021.04.077] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
Background: Alopecia areata (AA) is an autoimmune, nonscarring hair loss disorder with slightly greater prevalence in children than adults. Various treatment modalities exist; however, their evidence in pediatric AA patients is lacking. Objective: To evaluate the evidence of current treatment modalities for pediatric AA. Methods: We conducted a systematic review on the PubMed database in October 2019 for all published articles involving patients <18 years old. Articles discussing AA treatment in pediatric patients were included, as were articles discussing both pediatric and adult patients, if data on individual pediatric patients were available. Results: Inclusion criteria were met by 122 total reports discussing 1032 patients. Reports consisted of 2 randomized controlled trials, 4 prospective comparative cohorts, 83 case series, 2 case-control studies, and 31 case reports. Included articles assessed the use of aloe, apremilast, anthralin, anti-interferon gamma antibodies, botulinum toxin, corticosteroids, contact immunotherapies, cryotherapy, hydroxychloroquine, hypnotherapy, imiquimod, Janus kinase inhibitors, laser and light therapy, methotrexate, minoxidil, phototherapy, psychotherapy, prostaglandin analogs, sulfasalazine, topical calcineurin inhibitors, topical nitrogen mustard, and ustekinumab. Limitations: English-only articles with full texts were used. Manuscripts with adult and pediatric data were only incorporated if individual-level data for pediatric patients were provided. No meta-analysis was performed. Conclusion: Topical corticosteroids are the preferred first-line treatment for pediatric AA, as they hold the highest level of evidence, followed by contact immunotherapy. More clinical trials and comparative studies are needed to further guide management of pediatric AA and to promote the potential use of pre-existing, low-cost, and novel therapies, including Janus kinase inhibitors.
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Affiliation(s)
- Virginia R Barton
- Department of Dermatology, University of California Davis, Sacramento, California
| | - Atrin Toussi
- Department of Dermatology, University of California Davis, Sacramento, California
| | - Smita Awasthi
- Department of Dermatology, University of California Davis, Sacramento, California; Department of Pediatrics, University of California Davis, Sacramento, California
| | - Maija Kiuru
- Department of Dermatology, University of California Davis, Sacramento, California; Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, California.
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15
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Brüggen MC, Le ST, Walsh S, Toussi A, de Prost N, Ranki A, Didona B, Colin A, Horváth B, Brezinova E, Milpied B, Moss C, Bodemer C, Meyersburg D, Salavastru C, Tiplica GS, Howard E, Bequignon E, Bouwes Bavinck JN, Newman J, Gueudry J, Nägeli M, Zaghbib K, Pallesen K, Bygum A, Joly P, Wolkenstein P, Chua SL, Le Floch R, Shear NH, Chu CY, Hama N, Abe R, Chung WH, Shiohara T, Ardern-Jones M, Romanelli P, Phillips EJ, Stern RS, Cotliar J, Micheletti RG, Brassard A, Schulz JT, Dodiuk-Gad RP, Dominguez AR, Paller AS, Seminario-Vidal L, Mostaghimi A, Noe MH, Worswick S, Tartar D, Sheridan R, Kaffenberger BH, Shinkai K, Maverakis E, French LE, Ingen-Housz-Oro S. Supportive care in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: an international, multidisciplinary Delphi-based consensus. Br J Dermatol 2021; 185:616-626. [PMID: 33657677 DOI: 10.1111/bjd.19893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Supportive care is the cornerstone of management of adult and paediatric Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, consensus on the modalities of supportive care is lacking. OBJECTIVES Our aim in this international multicentric Delphi exercise was to establish a multidisciplinary expert consensus to standardize recommendations regarding supportive care in the acute phase of SJS/TEN. METHODS Participants were sent a survey via the online tool SurveyMonkey, consisting of 103 statements organized into 11 topics: multidisciplinary team composition, suspect drug management, infection prevention, fluid resuscitation and prevention of hypothermia, nutritional support, pain and psychological distress management, management of acute respiratory failure, local skincare, ophthalmological management, management of other mucosa, and additional measures. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). The results were analysed according to the RAND/UCLA Appropriateness Method. RESULTS Forty-five participants from 13 countries (on three continents) participated. After the first round, a consensus was obtained for 82.5% of the 103 initially proposed statements. After the second round, a final consensus was obtained for 102 statements. CONCLUSIONS We have reached an international Delphi-based consensus on best supportive care practice for SJS/TEN. Our expert consensus should help guide physicians in treating patients with SJS/TEN and thereby improve short-term prognosis and the risk of sequelae.
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Affiliation(s)
- M-C Brüggen
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Christine Kühne Center for Allergy Research and Education, Davos, Switzerland.,ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France
| | - S T Le
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - S Walsh
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Department of Dermatology, King's College Hospital, London, UK
| | - A Toussi
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - N de Prost
- Intensive Care Unit, AP-HP, Henri Mondor Hospital, Créteil, France.,Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France
| | - A Ranki
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Department of Skin and Allergic Diseases, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - B Didona
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,First Dermatology Division, Institute Dermopatico dell'Immacolata (I.D.I.) - IRCCS, Via Monti di Creta 104, Rome, 00167, Italy
| | - A Colin
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.,Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - B Horváth
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - E Brezinova
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Department of Dermatovenereology, St Ann's University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - B Milpied
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.,Department of Dermatology, CHU Bordeaux, Bordeaux, France
| | - C Moss
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Birmingham Children's Hospital and University of Birmingham, Birmingham, UK
| | - C Bodemer
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.,Department of Dermatology, AP-HP, Necker Hospital, Paris, France
| | - D Meyersburg
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - C Salavastru
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Department of Paediatric Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - G-S Tiplica
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Department of Dermatology II, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - E Howard
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Birmingham Children's Hospital and University of Birmingham, Birmingham, UK
| | - E Bequignon
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, AP-HP, Henri Mondor Hospital, Créteil, France
| | - J N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - J Newman
- Macmillan Skin Cancer CNS, Normanby Building, Denmark Hill, London, UK
| | - J Gueudry
- Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.,Ophthalmology Department, Hospital Charles Nicolle, EA7510, UFR Santé, Rouen University, Rouen, France
| | - M Nägeli
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - K Zaghbib
- Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.,Department of Psychiatry, AP-HP, Henri Mondor-Albert Chenevier Hospitals, Cr, France
| | - K Pallesen
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Department of Dermatology, Aarhus University Hospital, Palle Juul-Jensens, Aarhus, Denmark
| | - A Bygum
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Clinical Institute, University of Southern Denmark, Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - P Joly
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.,Department of Dermatology, CHU Charles, Nicolle, Rouen, France
| | - P Wolkenstein
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.,Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - S-L Chua
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Le Floch
- Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.,Réanimation Chirurgicale et des Brûlés, PTMC, CHU Nantes, Nantes, France
| | - N H Shear
- Division of Clinical Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C-Y Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - N Hama
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - R Abe
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - W-H Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - T Shiohara
- Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan
| | - M Ardern-Jones
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - P Romanelli
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - E J Phillips
- Department of Medicine & Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - R S Stern
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - R G Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - A Brassard
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - J T Schulz
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - R P Dodiuk-Gad
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A R Dominguez
- Department of Dermatology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - A S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - L Seminario-Vidal
- Department of Dermatology, University of South Florida, Cutaneous Oncology Program, Moffitt Cancer Center, Tampa, FL, USA
| | - A Mostaghimi
- Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - M H Noe
- Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S Worswick
- Keck-USC School of Medicine, Los Angeles, CA, USA
| | - D Tartar
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - R Sheridan
- Burn Surgery Service, Shriners Burns Hospital, Sumner Redstone Burn Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - B H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, Ohio State University, Columbus, OH, USA
| | - K Shinkai
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - E Maverakis
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - L E French
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Dermatology and Allergy, University Hospital of Munich, LMU, Munich, Germany
| | - S Ingen-Housz-Oro
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.,Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.,Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Universit, EpiDermE, Créteil, France
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16
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Toussi A, Le ST, Merleev AA, Marusina AI, Luxardi G, Downing L, Tran M, Kiuru MH, Maverakis E. Porphyria cutanea tarda presenting as a lichenoid eruption. Photodermatol Photoimmunol Photomed 2020; 37:233-235. [PMID: 33305390 DOI: 10.1111/phpp.12640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Atrin Toussi
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA.,School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Stephanie T Le
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Alexander A Merleev
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Alina I Marusina
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Guillaume Luxardi
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Lauren Downing
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Monica Tran
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Maija H Kiuru
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA.,Department of Pathology, University of California, Davis, Sacramento, CA, USA
| | - Emanual Maverakis
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
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17
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Toussi A, Merleev A, Barton V, Le S, Marusina AI, Luxardi G, Tsoi L, Gudjonsson JE, Maverakis E. 17083 Identification of psoriasis-protective IL-17D variant associated with increased IL-17D and FAM19A5 expression in psoriatic skin. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Liakos W, Siddiqui F, Toussi A, Le S, Kian S, Li Q, Leal AR, Maverakis E. Osteonecrosis of the calvarium: When clear margins are an impractical goal. Dermatol Ther 2020; 33:e14278. [DOI: 10.1111/dth.14278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/17/2020] [Accepted: 08/30/2020] [Indexed: 11/26/2022]
Affiliation(s)
- William Liakos
- Department of Dermatology University of California, Davis Sacramento California USA
| | - Fariha Siddiqui
- Department of Dermatology University of California, Davis Sacramento California USA
| | - Atrin Toussi
- Department of Dermatology University of California, Davis Sacramento California USA
| | - Stephanie Le
- Department of Dermatology University of California, Davis Sacramento California USA
| | - Sara Kian
- Department of Human Biology University of California, San Diego La Jolla California USA
| | - Qinyuan Li
- Department of Dermatology University of California, Davis Sacramento California USA
| | - Annie Riera Leal
- Department of Dermatology University of California, Davis Sacramento California USA
| | - Emanual Maverakis
- Department of Dermatology University of California, Davis Sacramento California USA
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19
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Toussi A, Ma C, Tartar DM. Livedo racemosa secondary to hyaluronic acid injection. Dermatol Online J 2020. [DOI: 10.5070/d32610050467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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20
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Toussi A, Ma C, Tartar DM. Livedo racemosa secondary to hyaluronic acid injection. Dermatol Online J 2020; 26:13030/qt78f4g57m. [PMID: 33147673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 06/11/2023] Open
Abstract
Iatrogenic vascular occlusion secondary to filler injection, such as with hyaluronic acid, is a known but rare, entity. It typically occurs in the setting of facial cosmetic procedures but has also been described in the setting of osteoarthritis. We present a patient with ankle osteoarthritis who developed an asymmetric, reticular, livedoid eruption after intraarticular injection with hyaluronic acid. She was diagnosed with livedo racemosa secondary to vascular occlusion and placed on low molecular weight heparin. Later, a transition to low-dose daily aspirin maintained the improvement.
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Affiliation(s)
| | | | - Danielle M Tartar
- Department of Dermatology, University of California, Davis, Sacramento, CA.
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21
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Toussi A, Maverakis N, Le ST, Sarkar S, Raychaudhuri SK, Raychaudhuri SP. Updated therapies for the management of Psoriatic Arthritis. Clin Immunol 2020; 220:108536. [PMID: 32681979 DOI: 10.1016/j.clim.2020.108536] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/05/2020] [Accepted: 07/08/2020] [Indexed: 02/08/2023]
Abstract
Psoriatic arthritis (PsA) is a large volume of our clinical practice and its management can be challenging. Traditional DMARDs have been used over last six decades and observational studies have substantiated an effective use of many of these drugs. However, in last two decades use of anti-TNF agents has brought a new dimension in treatment of PsA and in many other autoimmune diseases. Regulatory role of the Th17 cells and its cytokines in the pathogenesis of PsA has successfully paved the foundations of anti-IL antibody based therapies in PsA. Newer therapies targeting the IL-23/IL-17 cytokines and its signaling proteins are now in development and bringing new promises for management of PsA. Herein, we provide an overview of the landscape of drug therapies, including IL-17, IL-12/23, IL-23 inhibitors, and janus kinase (JAK) inhibitors, as well as those in development, such as RORγt inhibitors, anti-NGF agents, mTOR inhibitors and T cell ion-channel blockers.
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Affiliation(s)
- Atrin Toussi
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States; School of Medicine, University of California, Davis, Sacramento, CA, United States
| | | | - Stephanie T Le
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - Soumajyoti Sarkar
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis, Sacramento, CA, United States
| | - Smriti K Raychaudhuri
- School of Medicine, University of California, Davis, Sacramento, CA, United States; Division of Rheumatology and Immunology, VA Sacramento Medical Center, CA, United States
| | - Siba P Raychaudhuri
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States; Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis, Sacramento, CA, United States; Division of Rheumatology and Immunology, VA Sacramento Medical Center, CA, United States.
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22
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Le S, Marusina A, Toussi A, Downing L, Tran M, Maverakis N, Luxardi G, Tsoi A, Gudjonsson J, Merleev A, Maverakis E. 035 Biogeographical differences in gene segment usage. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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23
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Toussi A, Merleev A, Yamada D, Shi Z, Le S, Marusina A, Luxardi G, Adamopoulos I, Hwang S, Gudjonsson J, Maverakis E. 284 Identification of psoriasis-protective chemokine, FAM19A5, and IL17D expression in psoriatic skin. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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24
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Toussi A, Barton VR, Le ST, Agbai ON, Kiuru M. Psychosocial and psychiatric comorbidities and health-related quality of life in alopecia areata: A systematic review. J Am Acad Dermatol 2020; 85:162-175. [PMID: 32561373 DOI: 10.1016/j.jaad.2020.06.047] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/14/2020] [Accepted: 06/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Alopecia areata (AA) is an immune-mediated disease resulting in nonscarring hair loss. Systematic reviews on the psychosocial and psychiatric comorbidities, health-related quality of life, and interventions targeting psychosocial well-being are limited. OBJECTIVE To conduct a systematic review of the psychosocial comorbidities, health-related quality of life, and treatment options targeting psychosocial well-being in adult and pediatric AA patients. METHODS A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines within the PubMed database. Specific search terms included, but were not limited to, alopecia areata, psychosocial, psychiatry, and quality of life. Studies were then evaluated for their design and categorized into corresponding levels of evidence according to the guidelines adapted from the Oxford Center for Evidence Based Medicine. FINDINGS Seventy-three reports met inclusion criteria, involving approximately 414,319 unique participants. AA patients were found to have psychiatric comorbidities, particularly anxiety and depression. Health-related quality of life is reduced in AA patients, but data on pediatric AA quality of life are limited. Psychotherapy is often recommended as adjuvant treatment. CONCLUSION AA has substantial psychosocial impact on patients and results in reduced health-related quality of life. Addressing this should be an active part of treatment.
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Affiliation(s)
- Atrin Toussi
- Department of Dermatology, University of California, Davis, Sacramento, California; School of Medicine, University of California, Davis, Sacramento, California
| | - Virginia R Barton
- Department of Dermatology, University of California, Davis, Sacramento, California
| | - Stephanie T Le
- Department of Dermatology, University of California, Davis, Sacramento, California
| | - Oma N Agbai
- Department of Dermatology, University of California, Davis, Sacramento, California
| | - Maija Kiuru
- Department of Dermatology, University of California, Davis, Sacramento, California; Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, California.
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25
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Toussi A, Mans N, Welborn J, Kiuru M. Germline mutations predisposing to melanoma. J Cutan Pathol 2020; 47:606-616. [PMID: 32249949 DOI: 10.1111/cup.13689] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 12/11/2022]
Abstract
Nearly 15% of melanomas occur in patients with a family history and a subset of these patients have a germline mutation in a melanoma predisposing gene. CDKN2A mutations are responsible for the majority of hereditary melanoma, but many other susceptibility genes have been discovered in recent years, including CDK4, TERT, ACD, TERF2IP, POT1, MITF, MC1R, and BAP1. Additionally, melanoma risk is increased in mixed cancer syndromes caused by mutations in PTEN, BRCA2, BRCA1, RB1, and TP53. While early onset, multiple tumors, and family cancer history remain the most valuable clinical clues for hereditary melanoma, characteristic epithelioid cytology of melanocytic tumors may suggest an underlying BAP1 mutation. Herein, we review the clinical and histopathologic characteristics of melanocytic tumors associated with these germline mutations and discuss the role of genetic counseling.
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Affiliation(s)
- Atrin Toussi
- Department of Dermatology, University of California, Davis, Sacramento, California, USA
| | - Nicole Mans
- Hereditary Cancer Program, Comprehensive Cancer Center, University of California, Davis, Sacramento, California, USA
| | - Jeanna Welborn
- Hereditary Cancer Program, Comprehensive Cancer Center, University of California, Davis, Sacramento, California, USA
| | - Maija Kiuru
- Department of Dermatology, University of California, Davis, Sacramento, California, USA.,Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, California, USA
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Garza N, Toussi A, Wilson M, Shahlaie K, Martin R. The Increasing Age of TBI Patients at a Single Level 1 Trauma Center and the Discordance Between GCS and CT Rotterdam Scores in the Elderly. Front Neurol 2020; 11:112. [PMID: 32153493 PMCID: PMC7045038 DOI: 10.3389/fneur.2020.00112] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/31/2020] [Indexed: 01/12/2023] Open
Abstract
Introduction: Traumatic brain injury (TBI) is frequently encountered in geriatric patients, but there is a paucity of data describing TBI in the elderly. Here, we show the age of patients with TBI is increasing at our medical center and discuss the relationship between age and injury severity with patient outcomes. Methods: This is a retrospective analysis of 3,179 adult patients with TBI treated at the University of California, Davis Level 1 Trauma Center between 2009 and 2016. Age, Glasgow Coma Scale (GCS), and CT Rotterdam Scores were recorded. Age was analyzed as both a continuous and categorical variable (18-34, 35-50, 51-65, >65 years-old). Extended Glasgow Outcome Scale was obtained at 3 and 6 months and dichotomized into favorable and unfavorable outcomes. Multivariable general linear regression models, chi-square, logistic regression analyses and ANOVA were used for statistical analyses; a p < 0.05 was considered significant. Results: The mean age of patients was 52.2 ± 21.9 years with a male predominance (69%). There was a significant trend (p = 0.002) toward an increase in mean age each year, increasing by 4.4 years (p = 0.008) over the course of the analysis. Older patients had a higher mean GCS compared to younger patients with the same CT Rotterdam Score (p = 0.027), this becoming more pronounced with worse CT Rotterdam Scores. The >65 group had a 4-fold increased risk for unfavorable outcome when compared to the 18-34 group, this effect being most pronounced after mild TBI. Conclusions: The mean age of TBI patients is increasing at our trauma center. The largest disparity in outcomes across age was seen in patients with a mild GCS and low CT Rotterdam Scores, suggesting that these markers of injury severity may underestimate the severity of injury in the elderly population. This information highlights the need for clinical trials and validation of outcome markers in geriatric TBI.
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Affiliation(s)
- Nicholas Garza
- School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Atrin Toussi
- School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Machelle Wilson
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Sacramento, CA, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, United States
| | - Ryan Martin
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, United States.,Department of Neurology, University of California, Davis, Sacramento, CA, United States
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Barton V, Le S, Wang J, Toussi A, Sood A, Maverakis E. Peristomal ulcers misdiagnosed as pyoderma gangrenosum: a common error. J Eur Acad Dermatol Venereol 2020; 34:e108-e110. [DOI: 10.1111/jdv.16034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- V.R. Barton
- Department of Dermatology University of California Davis Medical Center Sacramento CA USA
| | - S.T. Le
- Department of Dermatology University of California Davis Medical Center Sacramento CA USA
| | - J.Z. Wang
- Department of Dermatology University of California Davis Medical Center Sacramento CA USA
| | - A. Toussi
- Department of Dermatology University of California Davis Medical Center Sacramento CA USA
| | - A. Sood
- Department of Dermatology University of California Davis Medical Center Sacramento CA USA
| | - E. Maverakis
- Department of Dermatology University of California Davis Medical Center Sacramento CA USA
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28
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Toussi A, Savage J, Alom M, Sharma K, Ziegelmann M, Trost L. 025 Efficacy of RestoreX Penile Traction Therapy in Improving Penile Length and Erectile Function Post Prostatectomy. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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29
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Toussi A, Le S, Barton V, Ma C, Cheng M, Sukhov A, Wilken R, Patel F, Wang E, Maverakis E. Successful Management of Anti-TNF-Induced Psoriasis Despite Continuation of Therapy in a Pyoderma Gangrenosum Patient. J Drugs Dermatol 2020; 19:199-201. [DOI: 10.36849/jdd.2020.4662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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30
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Toussi A, Merleev A, Barton VR, Le ST, Marusina A, Luxardi G, Kirma J, Xing X, Adamopoulos IE, Fung MA, Raychaudhuri SP, Shimoda M, Gudjonsson JE, Maverakis E. Transcriptome mining and B cell depletion support a role for B cells in psoriasis pathophysiology. J Dermatol Sci 2019; 96:181-184. [PMID: 31780313 DOI: 10.1016/j.jdermsci.2019.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
Affiliation(s)
- A Toussi
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States; University of California, School of Medicine, Davis, Sacramento, CA, United States
| | - A Merleev
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - V R Barton
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - S T Le
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - A Marusina
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - G Luxardi
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - J Kirma
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - X Xing
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - I E Adamopoulos
- Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, Sacramento, CA, United States
| | - M A Fung
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States; Department of Pathology, University of California, Davis, Sacramento, CA, United States
| | - S P Raychaudhuri
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States; Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, Sacramento, CA, United States
| | - M Shimoda
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - J E Gudjonsson
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - E Maverakis
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States.
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31
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Goodarzi A, Toussi A, Garza N, Lechpammer M, Brodie H, Diaz RC, Shahlaie K. Internal Acoustic Canal Stenosis Due to Hyperostosis. J Neurol Surg B Skull Base 2019; 81:216-222. [PMID: 32499994 DOI: 10.1055/s-0039-1685530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022] Open
Abstract
Background Exostoses and osteomas are benign, insidious lesions of the bone involving the internal acoustic canal (IAC). We present two cases of IAC exostoses managed with surgical decompression and review the clinical outcomes of previously reported cases in the literature. Methods A comprehensive search was conducted using PubMed Central, Web of Science Core Collection, and Google Scholar databases to identify previous reports of IAC exostoses and osteomas. A total of 26 reported cases were identified, and patient presenting symptoms, management strategies, and response to surgery was obtained when available. Results Of the 13 patients who underwent surgical decompression, 8 patients had resolution of vertigo symptoms, 10 patients had improvement of tinnitus symptoms, and all patients maintained some level of serviceable hearing. Conclusion IAC exostoses and osteomas are rare lesions that lead to insidious onset of debilitating symptoms from vestibulocochlear nerve dysfunction. Although the role of surgical decompression remains unclear, it appears that patients presenting with vertigo have more favorable response to surgical decompression as compared with those presenting with tinnitus and sensorineural hearing loss.
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Affiliation(s)
- Amir Goodarzi
- Department of Neurological Surgery, Davis School of Medicine, University of California, Sacramento, California, United States
| | - Atrin Toussi
- Department of Neurological Surgery, Davis School of Medicine, University of California, Sacramento, California, United States
| | - Nicholas Garza
- Department of Neurological Surgery, Davis School of Medicine, University of California, Sacramento, California, United States
| | - Mirna Lechpammer
- Department of Neurological Surgery, Davis School of Medicine, University of California, Sacramento, California, United States.,Department of Pathology, Davis School of Medicine, University of California, Sacramento, California, United States
| | - Hilary Brodie
- Department of Otolaryngology/Head and Neck Surgery, Davis School of Medicine, University of California, Sacramento, California, United States
| | - Rodney C Diaz
- Department of Otolaryngology/Head and Neck Surgery, Davis School of Medicine, University of California, Sacramento, California, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, Davis School of Medicine, University of California, Sacramento, California, United States
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32
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Goodarzi A, Thaci B, Toussi A, Karnati T, Kim K, Fragoso R. Glioblastoma Multiforme of the Conus Medullaris—Management Strategies and Complications. World Neurosurg 2019; 124:101-109. [PMID: 30639501 DOI: 10.1016/j.wneu.2018.12.164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 12/27/2018] [Accepted: 12/31/2018] [Indexed: 11/28/2022]
Abstract
Primary spinal glioblastoma multiforme (GBM) of the conus medullaris is a rare and devastating pathologic entity. The presenting symptoms commonly include progressive neurologic deficits in the lower extremities, bowel and bladder dysfunction, and low back pain. Histologically, these tumors have high-grade features similar to their intracranial counterparts. However, recent advancements in the field of molecular oncology have been beginning to elucidate a unique molecular blueprint for these spinal gliomas. Given the lack of standardized treatment strategies, we have presented our institutional experience in treating a small series of patients with conus medullaris GBM and have reviewed the reported data on the relevant molecular markers, management strategies, and complication avoidance for this malignant pathologic entity.
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Affiliation(s)
- Amir Goodarzi
- Department of Neurological Surgery, University of California, Davis, School of Medicine, Sacramento, California, USA.
| | - Bart Thaci
- Department of Neurological Surgery, University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Atrin Toussi
- Department of Neurological Surgery, University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Tejas Karnati
- Department of Neurological Surgery, University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Kee Kim
- Department of Neurological Surgery, University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Ruben Fragoso
- Department of Radiation-Oncology, University of California, Davis, School of Medicine, Sacramento, California, USA
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33
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Noblett DA, Chang J, Toussi A, Dublin A, Shahlaie K. Hemangioma of the Cavernous Sinus: A Case Series. J Neurol Surg Rep 2018; 79:e26-e30. [PMID: 29707473 PMCID: PMC5919774 DOI: 10.1055/s-0038-1641731] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 03/02/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction Cavernous sinus hemangiomas (CSHs) are rare, vascular, extra-axial tumors that are diagnosed with a combination of imaging and biopsy. We describe the clinical presentations, imaging findings, and management of two male patients with CSHs. Case Report Case 1 describes a 57-year-old man who presented with vision changes and cranial nerve palsies. Initial imaging and surgical biopsy were nondiagnostic. Follow-up Tc-99m tagged red blood cell (RBC) imaging supported CSH diagnosis. He was treated with surgical resection and radiotherapy. Case 2 describes a 57-year-old man who presented with chronic headache. Imaging findings were suggestive of CSH. He underwent endoscopic endonasal surgical resection and a final diagnosis of CSH was made via biopsy. Discussion CSHs often present with headache, vision changes, and cranial nerve palsies. Characteristic findings of a T2 hyperintense lesion with homogeneous contrast enhancement has been described in the literature. There is also a role for tagged RBC imaging studies in the setting of nondiagnostic imaging and biopsy. Surgical resection can be difficult due to tumor vascularity and encasement of internal carotid arteries. Stereotactic radiosurgery and adjuvant radiotherapy can play a role in the treatment of patients who have inoperable lesions or subtotal resections.
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Affiliation(s)
- Dylan A Noblett
- Departments of Radiology, University of California, Davis Medical Center, Sacramento, California, United States
| | - Jennifer Chang
- Departments of Radiology, University of California, Davis Medical Center, Sacramento, California, United States
| | - Atrin Toussi
- Departments of Neurological Surgery, University of California, Davis Medical Center, Sacramento, California, United States
| | - Arthur Dublin
- Departments of Radiology, University of California, Davis Medical Center, Sacramento, California, United States
| | - Kiarash Shahlaie
- Departments of Neurological Surgery, University of California, Davis Medical Center, Sacramento, California, United States
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Goodarzi A, Ahmadpour A, Toussi A, Shahlaie K. A Multilayered Technique for Repair of the Suboccipital Retrosigmoid Craniotomy. J Neurol Surg B Skull Base 2018; 79:508-514. [PMID: 30210980 DOI: 10.1055/s-0038-1625976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/02/2017] [Indexed: 10/17/2022] Open
Abstract
Objective Our primary objective was to retrospectively review our single institution experience using an anatomic multilayered repair of the retrosigmoid suboccipital craniotomy. Our secondary objective was to review the existing body of literature on the repair of this craniotomy and compare our outcomes to previous results. Design Retrospective review of 25 consecutive patients undergoing repair for the retrosigmoid craniotomy. Setting University of California Davis Medical Center (2010-2016). Participants A total of 25 consecutive patients who underwent retrosigmoid craniotomy and repair. Exclusion criteria included patients who were under the age of 18 years. Main Outcome Measures Main outcomes included incidence of postoperative headache, cerebrospinal fluid leak, and wound infections. Results Postoperative headache was reported in two patients in this series (8%). None of the patients in the series developed cerebrospinal fluid leak or wound infections. Mean follow-up period was 16 months. Conclusion Our multilayered anatomic repair after retrosigmoid suboccipital craniotomy results in favorable clinical results and may help reduce the risks associated with this operation.
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Affiliation(s)
- Amir Goodarzi
- Department of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, California, United States
| | - Arjang Ahmadpour
- Department of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, California, United States
| | - Atrin Toussi
- Department of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, California, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, California, United States
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35
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Toussi A, Noblett D, Lechpammer M, Chang J, Shahlaie K. Cavernous Sinus Hemangioma: Case Report and Review. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Atrin Toussi
- Department of Neurological Surgery, University of California, Davis, California, United States
| | - Dylan Noblett
- Department of Radiology, University of California, Davis, California, United States
| | - Mirna Lechpammer
- Department of Pathology, University of California, Davis, California, United States
| | - Jennifer Chang
- Department of Radiology, University of California, Davis, California, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, California, United States
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Goodarzi A, Ahmadpour A, Toussi A, Shahlaie K. A Multilayered Technique for the Repair of a Suboccipital Retrosigmoid Craniotomy. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Amir Goodarzi
- University of California, Davis, Davis, California, United States
| | | | - Atrin Toussi
- University of California, Davis, Davis, California, United States
| | - Kiarash Shahlaie
- University of California, Davis, Davis, California, United States
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Goodarzi A, Toussi A, Lechpammer M, Lee D, Shahlaie K. Intradural Chordoma of Cerebellopontine Angle: Case Report and Review. World Neurosurg 2017; 107:1052.e11-1052.e16. [PMID: 28866065 DOI: 10.1016/j.wneu.2017.08.124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chordomas are rare, notochord-derived neoplasms. Of these tumors, intradural chordomas are exceedingly rare. Most occur within the prepontine, parasellar, or other midline intradural locations. An intradural chordoma arising from the cerebellopontine angle has not been described previously. CASE REPORT We describe the first case of an intradural chordoma originating from the left cerebellopontine angle resected over the course of 2 operations. CONCLUSIONS Intradural chordomas are rare and can arise anywhere in the posterior fossa. Lack of bony involvement on computed tomography and magnetic resonance imaging are indicative of this pathology when there is also a lack of markers indicating the presence of more common cerebellopontine angle tumors. Treatment goals should include gross total resection and possible radiation therapy.
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Affiliation(s)
- Amir Goodarzi
- Department of Neurological Surgery, University of California, Davis, California, USA
| | - Atrin Toussi
- Department of Neurological Surgery, University of California, Davis, California, USA
| | - Mirna Lechpammer
- Department of Pathology, University of California, Davis, California, USA
| | - Darrin Lee
- Department of Neurological Surgery, University of California, Davis, California, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, California, USA.
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Toussi A, Goodarzi A, Kulubya E, Lee DJ, Waldau B. Mycobacterium Genavense Granuloma Mimicking a Brain Tumor: A Case Report. Cureus 2017; 9:e1547. [PMID: 29018644 PMCID: PMC5630459 DOI: 10.7759/cureus.1547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Mycobacterium genavense (M. genavense) is a rare, non-tuberculous organism that commonly leads to gastrointestinal infections in immunocompromised patients. Only two cases of intracranial M. genavense infection have been reported to date. We describe a third case of M. genavense granuloma mimicking a right parietal intracranial mass, and review the literature on this exceedingly rare pathology.
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Affiliation(s)
- Atrin Toussi
- Neurological Surgery, University of California, Davis Medical Center
| | - Amir Goodarzi
- Neurological Surgery, University of California, Davis Medical Center
| | - Edwin Kulubya
- Neurological Surgery, University of California, Davis Medical Center
| | - Darrin J Lee
- Neurological Surgery, University of California, Davis Medical Center
| | - Ben Waldau
- Neurological Surgery, University of California, Davis Medical Center
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Meulenbroek O, Toussi A, Studenski S, Olde Rikkert M. The effect of medication on brain size: Polypharmacy is associated with gray matter atrophy. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.07.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Toussi A, Paquet N, Huber O, Frutiger S, Tissot JD, Hughes GJ, Hochstrasser DF. Polypeptide marker and disease patterns found while mapping proteins in ascitis. J Chromatogr 1992; 582:87-92. [PMID: 1491063 DOI: 10.1016/0378-4347(92)80306-b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
To assess the protein composition of ascitis, 28 samples of ascitic fluid were obtained from patients admitted to Geneva University Hospital. The samples were analysed randomly and blindly by high-resolution two-dimensional polyacrylamide gel electrophoresis. The final visual evaluation was compared with the discharged summary and diagnosis. The protein pattern of ascitis was, as expected, very similar to normal or diseased plasma, with the exception of two spots which were present in ascitic fluids but not in the 200 plasma samples analyzed in parallel. After microsequencing, they proved to be beta-fibrinogen fragments. Several diseases showed distinct patterns, especially acute pancreatitis. A group of intense spots with an apparent molecular mass between those of alpha 1-antitrypsin and beta-haptoglobin were found in all ascitic fluid from pancreatitis cases (six patients). These spots had isoelectric points similar to those of alpha 1-antitrypsin and beta-haptoglobin and microsequencing revealed that they were three different fragments of alpha 1-antitrypsin.
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Affiliation(s)
- A Toussi
- Medicine Department, Geneva University Hospital, Switzerland
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Chevrolet JC, Jolliet P, Abajo B, Toussi A, Louis M. Nasal positive pressure ventilation in patients with acute respiratory failure. Difficult and time-consuming procedure for nurses. Chest 1991; 100:775-82. [PMID: 1889272 DOI: 10.1378/chest.100.3.775] [Citation(s) in RCA: 109] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Intubation and mechanical ventilation are well-established techniques in the management of patients with acute respiratory failure; however, there are situations in which these procedures cannot be used safely for various reasons. A recently described noninvasive technique, nasal positive-pressure ventilation (NPPV), has been developed for home ventilation of certain patients with chronic ventilatory insufficiency. We hypothesized that NPPV could be used in selected patients in whom intubation and mechanical ventilation were clearly indicated, but not immediately possible, or even contraindicated. Six patients were treated with NPPV during an episode of acute respiratory failure and enrolled in a prospective study. We found that NPPV was successful in avoiding intubation, but only in the three patients suffering from a restrictive pulmonary disorder, whereas the procedure was unsuccessful in patients with obstructive disorders. Moreover, in every patient, acute NPPV was very time-consuming for the nursing staff: in patients with restrictive disorders, a nurse had to monitor a patient submitted to NPPV during 41 +/- 9 percent of the duration of ventilation and during 91 +/- 9 percent of the NPPV time in patients with obstructive disorders. We conclude that acute NPPV may be attempted in selected patients with acute respiratory failure, predominantly patients with restrictive respiratory disorders, but that this procedure is very time-consuming for nurses.
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Affiliation(s)
- J C Chevrolet
- Department of Medicine, Hôpital Cantonal Universitaire, Geneva, Switzerland
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