1
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Pascolini G, Di Zenzo G, Morani P, Didona B, Panebianco A. Ectoderm-derived findings in Aymè-Gripp syndrome. J Dermatol 2024; 51:e162-e163. [PMID: 38131236 DOI: 10.1111/1346-8138.17053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Giulia Pascolini
- Rare Skin Diseases Center, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - Giovanni Di Zenzo
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - Paolo Morani
- Italian Society for Hair Science and Restoration (S.I.TRI.), Florence, Italy
| | - Biagio Didona
- Rare Skin Diseases Center, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - Annarita Panebianco
- Medical Direction, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
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2
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Pascolini G, Di Zenzo G, Panebianco A, Didona B, Gozes I. Extended phenotypic characterization of a novel Helsmoortel-van der Aa syndrome case series. Am J Med Genet A 2024; 194:e63539. [PMID: 38204290 DOI: 10.1002/ajmg.a.63539] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/19/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024]
Abstract
The neurodevelopmental disorder known as Helsmoortel-van der Aa syndrome (HVDAS, MIM#616580) or ADNP syndrome (Orphanet, ORPHA:404448) is a multiple congenital anomaly (MCA) condition, reported as a syndrome in 2014, associated with deleterious variants in the ADNP gene (activity-dependent neuroprotective protein; MIM*611386) in several children. First reported in the turn of the century, ADNP is a protein with crucial functions for the normal development of the central nervous system and with pleiotropic effects, explaining the multisystemic character of the syndrome. Affected individuals present with striking facial dysmorphic features and variable congenital defects. Herein, we describe a novel case series of HVDAS Italian patients, illustrating their clinical findings and the related genotype-phenotype correlations. Interestingly, the cutaneous manifestations are also extensively expanded, giving an important contribution to the clinical characterization of the condition, and highlighting the relation between skin abnormalities and ADNP defects.
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Affiliation(s)
- Giulia Pascolini
- Rare Diseases Center, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - Giovanni Di Zenzo
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - Annarita Panebianco
- Medical Direction, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - Biagio Didona
- Rare Diseases Center, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - Illana Gozes
- Elton Laboratory for Molecular Neuroscience, Department of Human Molecular Genetics and Biochemistry, Faculty of Medicine, Adams Super Center for Brain Studies and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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3
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Moro F, Sinagra JLM, Salemme A, Fania L, Mariotti F, Pira A, Didona B, Di Zenzo G. Pemphigus: trigger and predisposing factors. Front Med (Lausanne) 2023; 10:1326359. [PMID: 38213911 PMCID: PMC10783816 DOI: 10.3389/fmed.2023.1326359] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/29/2023] [Indexed: 01/13/2024] Open
Abstract
Pemphigus is a life-threatening autoimmune blistering disease affecting skin and mucous membranes. Despite its etiopathogenesis remains largely unknown, several trigger and predisposing factors have been reported. Pemphigus is caused by autoantibodies that target desmoglein 1 and desmoglein 3, impacting desmosome function. However, circulating autoantibodies are often the consequence of a precipitating factor that occurs in predisposed individuals. This review aims to describe and discuss almost all trigger and predisposing factors reported as possible or probable cause of the disease. Among the reported trigger factors that may induce or exacerbate pemphigus, we have found of particular interest: drug intake (especially thiol- and phenol-containing compounds), vaccines, infections, as well as some reports about pregnancy, radiations, emotional stress, pesticides and physical trauma. Moreover, we discuss the possible role of food intake in pemphigus onset and particular attention is given to dietary factors containing thiol, phenol and tannin compounds. A trigger factor is "the straw that breaks the camel's back," and often acts together with predisposing factors. Here we discuss how pemphigus onset may be influenced by genetic susceptibility and comorbidities like thyroid diseases, malignancies and other autoimmune disorders. To identify other hitherto unknown trigger and predisposing factors, well designed prospective studies are needed. In this context, future research should explore their connection with the aim to advance our understanding of pemphigus pathogenesis.
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Affiliation(s)
- Francesco Moro
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
- Dermatology Clinic, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Jo Linda Maria Sinagra
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
- Dermatology Clinic, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Adele Salemme
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Luca Fania
- Dermatology Clinic, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Feliciana Mariotti
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Anna Pira
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Biagio Didona
- Rare Diseases Unit, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Giovanni Di Zenzo
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
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4
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Peyronel F, Haroche J, Campochiaro C, Pegoraro F, Amoura Z, Tomelleri A, Mazzariol M, Papo M, Cavalli G, Benigno GD, Fenaroli P, Grigoratos C, Mengoli MC, Bonometti A, Berti E, Savino G, Cives M, Neri I, Pacinella G, Tuttolomondo A, Marano M, Muratore F, Manfredi A, Broccoli A, Zinzani PL, Didona B, Massaccesi C, Buono A, Ammirati E, Di Lernia V, Dagna L, Vaglio A, Cohen-Aubart F. Epidemiology and geographic clustering of Erdheim-Chester disease in Italy and France. Blood 2023; 142:2119-2123. [PMID: 37871575 DOI: 10.1182/blood.2023021670] [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: 06/29/2023] [Revised: 09/07/2023] [Accepted: 09/24/2023] [Indexed: 10/25/2023] Open
Abstract
This geoepidemiological study, performed in Italy and France, shows that Erdheim-Chester disease is increasingly diagnosed and cases cluster in specific geographic areas, namely southern Italy and central France. Disease frequency inversely correlates with the Human Development Index.
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Affiliation(s)
- Francesco Peyronel
- Nephrology and Dialysis Unit, Azienda Ospedaliera Universitaria Meyer IRCCS, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Julien Haroche
- Sorbonne University, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Internal Medicine Department 2, French National Referral Center for Rare Systemic Diseases and Histiocytoses, Centre d'immunologie et des maladies infectieuses (Cimi INSERM Unité Mixte de Recherche Scientifique-1135), Paris, France
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Zahir Amoura
- Sorbonne University, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Internal Medicine Department 2, French National Referral Center for Rare Systemic Diseases and Histiocytoses, Centre d'immunologie et des maladies infectieuses (Cimi INSERM Unité Mixte de Recherche Scientifique-1135), Paris, France
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Matthias Papo
- Sorbonne University, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Internal Medicine Department 2, French National Referral Center for Rare Systemic Diseases and Histiocytoses, Centre d'immunologie et des maladies infectieuses (Cimi INSERM Unité Mixte de Recherche Scientifique-1135), Paris, France
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | | | - Paride Fenaroli
- Nephrology and Dialysis Unit, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Reggio Emilia, Reggio Emilia, Italy
| | | | - Maria C Mengoli
- Operative Unit of Pathology, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Reggio Emilia, Reggio Emilia, Italy
| | - Arturo Bonometti
- Pathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Clinical and Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Emilio Berti
- Dermatology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gustavo Savino
- Ocular Oncology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- Università Cattolica del Sacro Cuore, UCSC, Rome, Italy
| | - Mauro Cives
- Division of Medical Oncology, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro," Bari, Italy
| | - Iria Neri
- Dermatology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Gaetano Pacinella
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Antonino Tuttolomondo
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Massimo Marano
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesco Muratore
- Rheumatology Unit, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Andreina Manfredi
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Policlinico of Modena, Modena, Italy
| | - Alessandro Broccoli
- Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Pier L Zinzani
- Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Biagio Didona
- Istituto Dermopatico dell'Immacolata-Istituto di Ricovero e Cura a Carattere Scientifico Rare Disease Center, Rome, Italy
| | | | - Andrea Buono
- De Gasperis Cardio Center, Transplant Center, Niguarda Hospital, Milan, Italy
| | - Enrico Ammirati
- De Gasperis Cardio Center, Transplant Center, Niguarda Hospital, Milan, Italy
- Department of Health Sciences, University of Milan-Bicocca, Monza, Italy
| | - Vito Di Lernia
- Dermatology Unit, S. Maria Nuova, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Reggio Emilia, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Azienda Ospedaliera Universitaria Meyer IRCCS, Florence, Italy
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Fleur Cohen-Aubart
- Sorbonne University, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Internal Medicine Department 2, French National Referral Center for Rare Systemic Diseases and Histiocytoses, Centre d'immunologie et des maladies infectieuses (Cimi INSERM Unité Mixte de Recherche Scientifique-1135), Paris, France
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5
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Pascolini G, Fortugno P, Chandramouli B, Didona B, Castiglia D. Defining the clinical spectrum of ichthyosis follicularis, atrichia and photophobia clinical association type 1 (IFAP1). Eur J Dermatol 2023; 33:564-566. [PMID: 38297940 DOI: 10.1684/ejd.2023.4548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Giulia Pascolini
- Rare Skin Diseases Center, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - Paola Fortugno
- Human Functional Genetics Laboratory, IRCCS San Raffaele, Rome, Italy, San Raffaele University, Rome, Italy
| | | | - Biagio Didona
- Rare Skin Diseases Center, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - Daniele Castiglia
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
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6
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D’Astolto R, Quintarelli L, Corrà A, Caproni M, Fania L, Di Zenzo G, Didona B, Gasparini G, Cozzani E, Feliciani C. Environmental factors in autoimmune bullous diseases with a focus on seasonality: new insights. Dermatol Reports 2023; 15:9641. [PMID: 37753233 PMCID: PMC10518530 DOI: 10.4081/dr.2023.9641] [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] [Received: 12/03/2022] [Accepted: 02/08/2023] [Indexed: 09/28/2023] Open
Abstract
Autoimmune bullous diseases are a heterogeneous group of rare conditions clinically characterized by the presence of blisters and/or erosions on the skin and the mucous membranes. Practically, they can be divided into two large groups: the pemphigoid group and the pemphigus group, depending on the depth of the autoimmune process on the skin. A family history of autoimmune diseases can often be found, demonstrating that genetic predisposition is crucial for their development. Moreover, numerous environmental risk factors, such as solar radiation, drugs, and infections, are known. This study aimed to evaluate how seasonality can affect the trend of bullous pemphigoid and pemphigus vulgaris, especially considering the number of hospitalizations recorded over the course of individual months. The total number of hospitalizations in the twelve months of the year was evaluated. Moreover, blood chemistry assay and, for some patients, enzyme-linked immunosorbent assay were executed to evaluate antibodies. Regarding the severity of the disease, the bullous pemphigoid area index and the pemphigus disease area index score systems were used. Results showed a complex interplay between environmental factors such as seasons and autoimmune conditions.
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Affiliation(s)
- Roberto D’Astolto
- Section of Dermatology, Department of Medicine and Surgery, University of Parma
| | - Lavinia Quintarelli
- Section of Dermatology, Department of Medicine and Surgery, University of Parma
| | - Alberto Corrà
- Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence
| | - Marzia Caproni
- Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence
| | - Luca Fania
- IDI-IRCCS, Dermatological Research Hospital, Rome
| | | | | | - Giulia Gasparini
- Section of Dermatology, Department of Health Sciences, University of Genoa
- Dermatology Unit, San Martino Polyclinic Hospital IRCCS, Genoa, Italy
| | - Emanuele Cozzani
- Section of Dermatology, Department of Health Sciences, University of Genoa
- Dermatology Unit, San Martino Polyclinic Hospital IRCCS, Genoa, Italy
| | - Claudio Feliciani
- Section of Dermatology, Department of Medicine and Surgery, University of Parma
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7
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Didona D, Solimani F, Caposiena Caro RD, Sequeira Santos AM, Hinterseher J, Kussini J, Cunha T, Hertl M, Didona B. Dermatomyositis: a comprehensive review of clinical manifestations, serological features, and therapeutic approaches. Ital J Dermatol Venerol 2023; 158:84-98. [PMID: 37153943 DOI: 10.23736/s2784-8671.23.07458-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Dermatomyositis (DM) is an autoimmune disorder, which belongs to a group of rare autoimmune dermatoses characterized by different skin features and variable muscle involvement. We recognize four main variants of DM: classic DM, clinically amyopathic DM, paraneoplastic DM, and juvenile DM. Clinically, patients show several skin features, but heliotrope rash, and violaceous papules located at the interphalangeal or metacarpophalangeal joints (Gottron's papules) are the most frequently observed. Together with skin features, patients show muscle involvement, most commonly with symmetrical weakness of the proximal muscles. DM belongs to the facultative paraneoplastic dermatoses and a wide range of solid or hematologic malignancies can be detected in DM patients. Serologically, a wide range of autoantibodies can be detected in patients with DM. Indeed, distinct serotypes can be related to specific phenotypes with specific clinical features, carrying a different risk for systemic involvement and for malignancies. Systemic corticosteroids are still considered the first-line approach, but several steroid-sparing agents, such as methotrexate, azathioprine or mycophenolate mofetil, have been reported as effective in treating DM. Furthermore, new class of drugs, such as monoclonal antibodies, purified immunoglobulins or Janus kinase inhibitors are becoming more relevant in the clinical practice or are currently under investigation. In this work, we aim to offer a clinical overview of the diagnostic workout, the characteristics of DM variants, the role of autoantibodies in DM, and the management of this life-threatening systemic disorder.
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Affiliation(s)
- Dario Didona
- Department of Dermatology and Allergology, Philipps University of Marburg, Marburg, Germany -
| | - Farzan Solimani
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin BIH, Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Julia Hinterseher
- Department of Dermatology and Allergology, Philipps University of Marburg, Marburg, Germany
| | - Jacqueline Kussini
- Department of Dermatology and Allergology, Philipps University of Marburg, Marburg, Germany
| | - Tomas Cunha
- Department of Dermatology and Allergology, Philipps University of Marburg, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps University of Marburg, Marburg, Germany
| | - Biagio Didona
- Department of Dermatology, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, Rome, Italy
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8
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Ingen-Housz-Oro S, Schmidt V, Ameri MM, Abe R, Brassard A, Mostaghimi A, Paller AS, Romano A, Didona B, Kaffenberger BH, Ben Said B, Thong BYH, Ramsay B, Brezinova E, Milpied B, Mortz CG, Chu CY, Sotozono C, Gueudry J, Fortune DG, Dridi SM, Tartar D, Do-Pham G, Gabison E, Phillips EJ, Lewis F, Salavastru C, Horvath B, Dart J, Setterfield J, Newman J, Schulz JT, Delcampe A, Brockow K, Seminario-Vidal L, Jörg L, Watson MP, Gonçalo M, Lucas M, Torres M, Noe MH, Hama N, Shear NH, O’Reilly P, Wolkenstein P, Romanelli P, Dodiuk-Gad RP, Micheletti RG, Tiplica GS, Sheridan R, Rauz S, Ahmad S, Chua SL, Flynn TH, Pichler W, Le ST, Maverakis E, Walsh S, French LE, Brüggen MC. Post-acute phase and sequelae management of epidermal necrolysis: an international, multidisciplinary DELPHI-based consensus. Orphanet J Rare Dis 2023; 18:33. [PMID: 36814255 PMCID: PMC9945700 DOI: 10.1186/s13023-023-02631-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Long-term sequelae are frequent and often disabling after epidermal necrolysis (Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)). However, consensus on the modalities of management of these sequelae is lacking. OBJECTIVES We conducted an international multicentric DELPHI exercise to establish a multidisciplinary expert consensus to standardize recommendations regarding management of SJS/TEN sequelae. METHODS Participants were sent a survey via the online tool "Survey Monkey" consisting of 54 statements organized into 8 topics: general recommendations, professionals involved, skin, oral mucosa and teeth, eyes, genital area, mental health, and allergy workup. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). Results were analyzed according to the RAND/UCLA Appropriateness Method. RESULTS Fifty-two healthcare professionals participated. After the first round, a consensus was obtained for 100% of 54 initially proposed statements (disagreement index < 1). Among them, 50 statements were agreed upon as 'appropriate'; four statements were considered 'uncertain', and ultimately finally discarded. CONCLUSIONS Our DELPHI-based expert consensus should help guide physicians in conducting a prolonged multidisciplinary follow-up of sequelae in SJS-TEN.
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Affiliation(s)
- S. Ingen-Housz-Oro
- grid.412116.10000 0004 1799 3934Department of Dermatology, AP-HP, Henri Mondor Hospital, 1 Rue Gustave Eiffel, 94000 Créteil, France ,ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.410511.00000 0001 2149 7878EpiDermE, Université Paris Est Créteil, Créteil, France
| | - V. Schmidt
- grid.410567.1University Hospital Basel, Basel, Switzerland ,grid.7400.30000 0004 1937 0650Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - M. M. Ameri
- grid.7400.30000 0004 1937 0650Faculty of Medicine, University of Zurich, Zurich, Switzerland ,grid.412004.30000 0004 0478 9977Department of Dermatology, University Hospital Zurich, Zurich, Switzerland ,grid.507894.70000 0004 4700 6354Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - R. Abe
- grid.260975.f0000 0001 0671 5144Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - A. Brassard
- grid.413079.80000 0000 9752 8549Department of Dermatology, UC Davis Medical Center, Sacramento, CA USA
| | - A. Mostaghimi
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, Boston, MA USA
| | - A. S. Paller
- grid.16753.360000 0001 2299 3507Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - A. Romano
- grid.419843.30000 0001 1250 7659Oasi Research Institute-IRCCS, Troina, Italy
| | - B. Didona
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.419457.a0000 0004 1758 0179Rare Disease Unit, I Dermatology Division, Istituto Dermopatico Dell’Immacolata, IRCCS, Rome, Italy
| | - B. H. Kaffenberger
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.412332.50000 0001 1545 0811The Ohio State University Wexner Medical Center Division of Dermatology, Upper Arlington, OH USA
| | - B. Ben Said
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,Department of Dermatology, CHU Edouard Herriot, Lyon, France
| | - B. Y. H. Thong
- grid.240988.f0000 0001 0298 8161Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - B. Ramsay
- grid.415522.50000 0004 0617 6840Department of Dermatology, University Hospital Limerick, Limerick, Ireland
| | - E. Brezinova
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.10267.320000 0001 2194 0956First Department of Dermatovenereology, Masaryk University Faculty of Medicine, St. Ann’s Faculty Hospital in Brno, Brno, Czech Republic
| | - B. Milpied
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.412041.20000 0001 2106 639XDepartment of Adult and Pediatric Dermatology, Bordeaux University Hospitals, Bordeaux, France
| | - C. G. Mortz
- grid.7143.10000 0004 0512 5013Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - C. Y. Chu
- grid.19188.390000 0004 0546 0241Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, 10002 Taiwan
| | - C. Sotozono
- grid.272458.e0000 0001 0667 4960Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Hirokoji-Agaru, Kawaramach-Dori, Kamigyo-Ku, Kyoto, 602-0841 Japan
| | - J. Gueudry
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.417615.0Department of Ophthalmology, CHU Charles-Nicolle, Rouen, France
| | - D. G. Fortune
- grid.10049.3c0000 0004 1936 9692Department of Psychology, University of Limerick, Limerick, Ireland
| | - S. M. Dridi
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.416670.2MICORALIS Laboratory, Department of Periodontology, Faculty of Dentistry, Côte d’Azur University, Saint Roch Hospital, Nice, France
| | - D. Tartar
- grid.27860.3b0000 0004 1936 9684Department of Dermatology, University of California Davis, Sacramento, CA USA
| | - G. Do-Pham
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.414145.10000 0004 1765 2136Department of Internal Medicine, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - E. Gabison
- grid.417888.a0000 0001 2177 525XFondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - E. J. Phillips
- grid.1025.60000 0004 0436 6763Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, WA Australia ,grid.412807.80000 0004 1936 9916Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
| | - F. Lewis
- grid.425213.3St John’s Institute of Dermatology, Guy’s and St Thomas’ Hospital, London, UK
| | - C. Salavastru
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Department of Paediatric Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - B. Horvath
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.4830.f0000 0004 0407 1981Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - J. Dart
- grid.83440.3b0000000121901201Moorfields Eye Hospital NHS Foundation Trust, The UCL Institute of Ophthalmology, London, UK
| | - J. Setterfield
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.420545.20000 0004 0489 3985Department of Oral Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - J. Newman
- grid.429705.d0000 0004 0489 4320Department of Dermatology, King’s College Hospital NHS Foundation Trust, London, UK
| | - J. T. Schulz
- grid.32224.350000 0004 0386 9924Division of Burns, Massachusetts General Hospital, Boston, 02114 USA
| | - A. Delcampe
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.417615.0Department of Ophthalmology, CHU Charles-Nicolle, Rouen, France ,grid.417888.a0000 0001 2177 525XFondation Ophtalmologique Adolphe de Rothschild, Paris, France ,grid.411119.d0000 0000 8588 831XDepartment of Ophthalmology, CHU Bichat-Claude Bernard, Paris, France
| | - K. Brockow
- grid.6936.a0000000123222966Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - L. Seminario-Vidal
- grid.170693.a0000 0001 2353 285XDepartment of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, FL USA
| | - L. Jörg
- grid.412004.30000 0004 0478 9977Department of Dermatology, University Hospital Zurich, Zurich, Switzerland ,grid.5734.50000 0001 0726 5157Division of Allergology and Clinical Immunology, Department of Pneumology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - M. P. Watson
- grid.439257.e0000 0000 8726 5837Cornea and External Eye Disease Service, Moorfields Eye Hospital, London, UK
| | - M. Gonçalo
- grid.28911.330000000106861985Department of Dermatology, Coimbra University Hospital Center, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M. Lucas
- grid.1012.20000 0004 1936 7910Medical School, University of Western Australia, Perth, WA 6009 Australia ,grid.3521.50000 0004 0437 5942Department of Immunology, Sir Charles Gairdner Hospital, Pathwest Laboratory Medicine, Perth, WA 6009 Australia
| | - M. Torres
- grid.452525.1Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - M. H. Noe
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - N. Hama
- grid.260975.f0000 0001 0671 5144Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - N. H. Shear
- grid.17063.330000 0001 2157 2938Department of Dermatology, University of Toronto, Toronto, ON Canada ,grid.413104.30000 0000 9743 1587Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - P. O’Reilly
- grid.10049.3c0000 0004 1936 9692Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - P. Wolkenstein
- grid.412116.10000 0004 1799 3934Department of Dermatology, AP-HP, Henri Mondor Hospital, 1 Rue Gustave Eiffel, 94000 Créteil, France ,ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
| | - P. Romanelli
- grid.26790.3a0000 0004 1936 8606Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, FL USA
| | - R. P. Dodiuk-Gad
- grid.6451.60000000121102151Dermatology Department, Emek Medical Center, Bruce Rappaport Faculty of Medicine, Technion - Institute of Technology, Haifa, Israel ,grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, Canada
| | - R. G. Micheletti
- grid.25879.310000 0004 1936 8972Department of Dermatology and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - G. S. Tiplica
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,2Nd Department of Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - R. Sheridan
- grid.415829.30000 0004 0449 5362Burn Service, Boston Shriners Hospital for Children, Boston, MA USA ,grid.32224.350000 0004 0386 9924Division of Burns, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Surgery, Harvard Medical School, Boston, MA USA
| | - S. Rauz
- grid.6572.60000 0004 1936 7486Academic Unit of Ophthalmology, Birmingham and Midland Eye Centre, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - S. Ahmad
- grid.83440.3b0000000121901201Moorfields Eye Hospital NHS Foundation Trust, The UCL Institute of Ophthalmology, London, UK
| | - S. L. Chua
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.412563.70000 0004 0376 6589Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - T. H. Flynn
- grid.460892.10000 0004 0389 5639Ophthalmology, Bon Secours Hospital, Cork, Ireland
| | - W. Pichler
- grid.482939.dADR-AC GmbH, Bern, Switzerland
| | - S. T. Le
- grid.413079.80000 0000 9752 8549Department of Dermatology, UC Davis Medical Center, Sacramento, CA USA
| | - E. Maverakis
- grid.413079.80000 0000 9752 8549Department of Dermatology, UC Davis Medical Center, Sacramento, CA USA
| | - S. Walsh
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.429705.d0000 0004 0489 4320Department of Dermatology, King’s College Hospital NHS Foundation Trust, London, UK
| | - L. E. French
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.411095.80000 0004 0477 2585Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany ,grid.26790.3a0000 0004 1936 8606Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL USA
| | - M. C. Brüggen
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.7400.30000 0004 1937 0650Faculty of Medicine, University of Zurich, Zurich, Switzerland ,grid.412004.30000 0004 0478 9977Department of Dermatology, University Hospital Zurich, Zurich, Switzerland ,grid.507894.70000 0004 4700 6354Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
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9
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Moro F, Mariotti F, Pira A, De Luca N, Didona B, Pagnanelli G, Di Zenzo G. Case report: Bullous pemphigoid arising in a patient with scleroderma and multiple sclerosis. Front Med (Lausanne) 2022; 9:1055045. [PMID: 36569153 PMCID: PMC9773387 DOI: 10.3389/fmed.2022.1055045] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Background Bullous pemphigoid (BP) is the most common autoimmune-blistering disease, clinically characterized by erythematous urticarial plaques, blisters, and intense pruritus, induced by autoantibodies against two proteins of the dermo-epidermal junction, BP180 and BP230. A large number of autoimmune diseases are reported in the literature as BP comorbidities, such as multiple sclerosis, but only a few cases are in association with scleroderma and none in association with both. Case presentation We present the case of a 68-year-old woman affected by multiple sclerosis and scleroderma who developed severe bullous pemphigoid with a bullous pemphigoid disease area index of 60 and high titers of anti-BP180 and anti-BP230 autoantibodies by enzyme-linked immunosorbent assays. After 2 months of therapy with both intravenous and oral corticosteroids, the active lesions of bullous pemphigoid were remitted with no relapse. Conclusion Autoimmune diseases affecting the skin or organs where BP180 and BP230 are present could trigger an immune response to these antigens through an epitope-spreading phenomenon and, over the years, induce bullous pemphigoid onset.
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Affiliation(s)
- Francesco Moro
- Dermatology Unit, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy,Molecular and Cell Biology Laboratory, IDI-IRCCS, Rome, Italy
| | | | - Anna Pira
- Molecular and Cell Biology Laboratory, IDI-IRCCS, Rome, Italy
| | - Naomi De Luca
- Molecular and Cell Biology Laboratory, IDI-IRCCS, Rome, Italy
| | - Biagio Didona
- Dermatology Unit, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Gianluca Pagnanelli
- Dermatology Unit, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Giovanni Di Zenzo
- Molecular and Cell Biology Laboratory, IDI-IRCCS, Rome, Italy,*Correspondence: Giovanni Di Zenzo,
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10
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Scala E, Condorelli AG, Scala A, Caprini E, Didona B, Paganelli R, Castiglia D. IgE Sensitization Profile in Patients with Netherton Syndrome. Int Arch Allergy Immunol 2022; 183:1291-1296. [PMID: 36108599 DOI: 10.1159/000526409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/03/2022] [Accepted: 08/03/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Scant data are currently available on the allergen-specific immunoglobulin (Ig)E sensitization profile in primary immunodeficiencies with hyper IgE. Netherton syndrome (NS, OMIM 266500) is an extremely rare form of congenital ichthyosis characterized by congenital scaly erythroderma, hair abnormalities, and deregulated IgE reactivity associated with severe atopic manifestations. OBJECTIVE The aim of this study was to evaluate the feasibility and reliability of a multiplex proteomic approach in the detection of specific IgE in NS. METHODS Specific IgE was evaluated in 10 individuals with an established molecular diagnosis of NS using an allergenic molecules microarray (immuno-solid-phase allergen chip). RESULTS Polireactivity to airway allergens, mainly house dust mites and olive tree pollen, and food allergens were observed in NS. Eighty per cent of patients were responsive to LTP or profilins. A clinical history suggestive of severe egg, milk, and fish allergy was confirmed by reactivity to the thermostable molecules Gal d 1, Bod 8, and parvalbumin Gad c 1, respectively. Latex reactivity was associated with Hev b 5 and 6 reactivity. Two distinct clusters of reactivity were observed after hierarchical analysis. Extremely high IgE levels (> 10,000 kU/L) do not affect the results obtained with microarrays. CONCLUSION IgE multiplex evaluation allows (i) to profile IgE polyreactivity pictures, in the presence of LTP and profilin sensitization, (ii) to verify the clinical history of food allergy to milk, egg, and seafood, (iii) to confirm the allergic events associated with latex exposure, and (iv) to disclose the presence of preclinical sensitizations in patients affected by primary immunodeficiencies with hyper IgE, such as the NS.
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Affiliation(s)
- Enrico Scala
- Clinical and Laboratory Molecular Allergy Unit - IDI - IRCCS, Rome, Italy
| | - Angelo Giuseppe Condorelli
- Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Scala
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisabetta Caprini
- Clinical and Laboratory Molecular Allergy Unit - IDI - IRCCS, Rome, Italy
| | - Biagio Didona
- Clinical and Laboratory Molecular Allergy Unit - IDI - IRCCS, Rome, Italy
| | - Roberto Paganelli
- Internal Medicine, UniCamillus, International Medical University, Rome, Italy
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11
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Grimaldi M, Perino F, Moretta G, Antonelli F, Paradisi A, Ricci F, Abeni D, Didona B, Fania L. Cutaneous Rosai-Dorfman disease after Covid 19 vaccination treated with thalidomide. Dermatol Ther 2022; 35:e15864. [PMID: 36175132 PMCID: PMC9539010 DOI: 10.1111/dth.15864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Marta Grimaldi
- U.O.C. Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | - Gaia Moretta
- IDI-IRCCS, Dermatological Research Hospital, Rome
| | - Flaminia Antonelli
- U.O.C. Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Andrea Paradisi
- U.O.C. Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | | | | | - Luca Fania
- IDI-IRCCS, Dermatological Research Hospital, Rome
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12
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Di Zenzo G, Floriddia G, Rossi S, Mariotti F, Primerano A, Condorelli AG, Didona B, Castiglia D. Case report: bullous pemphigoid development underlies dystrophic epidermolysis bullosa disease worsening. Front Immunol 2022; 13:929286. [PMID: 35967298 PMCID: PMC9374178 DOI: 10.3389/fimmu.2022.929286] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/04/2022] [Indexed: 11/18/2022] Open
Abstract
Autoimmune response to cutaneous basement membrane components superimposed on a genetic skin fragility disease, hereditary epidermolysis bullosa (EB), has been described, but its effects on disease course remain unclear. We report a 69-year-old individual with congenital skin fragility and acral trauma-induced blistering that had suddenly worsened with the onset of severe itch and diffuse spontaneous inflammatory blisters. Next-generation sequencing identified compound heterozygous null and missense COL7A1 mutations, allowing the diagnosis of recessive dystrophic EB. However, the patient’s clinical history prompted us to investigate whether he might have developed a pathological autoimmune response against basement membrane components. Tissue-bound and circulating IgG antibodies to the major bullous pemphigoid (BP) antigen, BP180, were detected in the patient’s skin and serum, respectively, consistent with a diagnosis of BP. Corticosteroid therapy was initiated resulting in remission of BP manifestations. EB patients presenting rapid disease worsening should be investigated for the development of a concomitant autoimmune blistering disease.
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Affiliation(s)
- Giovanni Di Zenzo
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
| | - Giovanna Floriddia
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
| | - Sabrina Rossi
- Pathology Unit, Department of Laboratories, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Feliciana Mariotti
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
| | - Alessia Primerano
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
| | - Angelo Giuseppe Condorelli
- Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Biagio Didona
- Rare Skin Disease Center, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
| | - Daniele Castiglia
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
- *Correspondence: Daniele Castiglia,
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13
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Dellambra E, Cordisco S, Delle Monache F, Bondanza S, Teson M, Nicodemi EM, Didona B, Condorelli AG, Camerino G, Castiglia D, Guerra L. RSPO1-mutated keratinocytes from palmoplantar keratoderma display impaired differentiation, alteration of cell-cell adhesion, EMT-like phenotype and invasiveness properties: implications for squamous cell carcinoma susceptibility in patients with 46XX disorder of sexual development. Orphanet J Rare Dis 2022; 17:275. [PMID: 35854363 PMCID: PMC9295301 DOI: 10.1186/s13023-022-02434-2] [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] [Received: 04/05/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background Secreted R-spondin (RSPO) proteins play a key role in reproductive organ development, epithelial stem cell renewal and cancer induction by reinforcing canonical Wnt signaling. We have previously reported that palmoplantar keratoderma (PPK), predisposition to cutaneous squamous cell carcinoma (SCC) development and sex reversal segregate as autosomal recessive trait in patients carrying RSPO1-mutations. Although our previous findings suggested that RSPO1 secreted from fibroblasts regulates keratinocyte growth or differentiation, the role of this protein in the epidermis remains largely unexplored. Our study was aimed at expanding the phenotypic, molecular and functional characterization of RSPO1-mutated skin and keratinocytes. Results Cultured primary keratinocytes from PPK skin of a RSPO1-mutated XX-sex reversed patient displayed highly impaired differentiation and epithelial-mesenchymal transition (EMT)-like phenotype. Interestingly, RSPO1-mutated PPK skin expressed markers of increased proliferation, dedifferentiation and altered cell–cell adhesion. Furthermore, all these signs were more evident in SCC specimens of the patient. Cultured PPK patient’s keratinocytes exhibited increased expression of cell‒matrix adhesion proteins and extracellular matrix remodeling enzymes. Moreover, they showed invasiveness properties in an organotypic skin model in presence of PPK fibroblasts, which behave like cancer-associated fibroblasts. However, the co-culture with normal fibroblasts or treatment with the recombinant RSPO1 protein did not revert or reduce the EMT-like phenotype and invasion capability of PPK keratinocytes. Notably, RSPO1-mutated PPK fibroblasts induced a hyperproliferative and dedifferentiated phenotype of age-matched normal control plantar keratinocytes. Wnt signaling has a key role in both PPK promotion and SCC development. Accordingly, Wnt mediators were differentially expressed in both PPK keratinocytes and skin specimens of RSPO1-mutated patient compared to control. Conclusions Altogether our data indicate that the absence of RSPO1 in patients with 46XX disorder of sexual development affects the skin microenvironment and epidermal integrity, thus contributing to the risk of SCC tumorigenesis in palmoplantar regions exposed to major frictional stresses. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02434-2.
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Affiliation(s)
- Elena Dellambra
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico Dell'Immacolata, IDI-IRCCS, Via dei Monti di Creta 104, 00167, Rome, Italy.
| | - Sonia Cordisco
- Advent SRL, Via Pontina KM 30.600, Pomezia, Italy.,Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesca Delle Monache
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico Dell'Immacolata, IDI-IRCCS, Via dei Monti di Creta 104, 00167, Rome, Italy
| | - Sergio Bondanza
- Center for Regenerative Medicine Stefano Ferrari, Holostem Terapie Avanzate S.R.L., 41125, Modena, Italy
| | - Massimo Teson
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico Dell'Immacolata, IDI-IRCCS, Via dei Monti di Creta 104, 00167, Rome, Italy
| | - Ezio Maria Nicodemi
- Plastic Surgery Division, Istituto Dermopatico Dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - Biagio Didona
- Rare Skin Disease Center, Istituto Dermopatico Dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - Angelo Giuseppe Condorelli
- Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
| | - Giovanna Camerino
- Dipartimento di Patologia Umana ed Ereditaria, Sezione di Biologia Generale e Genetica Medica, Università Di Pavia, Via Forlanini 14, 27100, Pavia, Italy
| | - Daniele Castiglia
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico Dell'Immacolata, IDI-IRCCS, Via dei Monti di Creta 104, 00167, Rome, Italy
| | - Liliana Guerra
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico Dell'Immacolata, IDI-IRCCS, Via dei Monti di Creta 104, 00167, Rome, Italy
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14
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Salemme A, Fania L, Scarabello A, Caproni M, Marzano AV, Cozzani E, Feliciani C, De Simone C, Papini M, Satta RR, Parodi A, Mariotti F, Lechiancole S, Genovese G, Passarelli F, Festa F, Bellei B, Provini A, Donatella Sordi, Pallotta S, Abeni D, Mazzanti C, Didona B, Di Zenzo G. Gliptin-associated bullous pemphigoid shows peculiar features of anti-BP180 and -BP230 humoral response: results from a multicenter study. J Am Acad Dermatol 2022; 87:56-63. [PMID: 35240229 DOI: 10.1016/j.jaad.2022.02.036] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/25/2022] [Accepted: 02/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recently, several case-control studies demonstrated an association between gliptins and bullous pemphigoid (BP) occurrence. Data on clinical and immunological features of gliptin-associated bullous pemphigoid (GABP) are controversial. OBJECTIVE This study aims to clinically and immunologically characterize a large cohort of GABP patients to get insight into the pathophysiology of this emerging drug-induced variant of BP. METHODS Seventy-four GABP patients were prospectively enrolled and characterized from nine different Italian Dermatology Units between 2013 and 2020. RESULTS Our findings demonstrate that in GABP patients: i) the non-inflammatory phenotype which is characterized by low amounts of circulating and skin infiltrating eosinophils is frequently found; ii) IgG, IgE and IgA humoral response to BP180 and BP230 antigens is reduced in frequency and titers when compared with idiopathic BP; iii) IgG reactivity targets multiple BP180 epitopes other than NC16A. LIMITATIONS A limitation of the study is the control group that did not comprise only type 2 diabetes mellitus BP patients. CONCLUSIONS GABP patients show peculiar features of anti-BP180 and -BP230 humoral response laying the foundations for diagnostic improvements and to get novel insights into understanding the mechanism of BP onset.
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Affiliation(s)
- Adele Salemme
- Molecular and Cell Biology Laboratory, IDI-IRCCS, Rome, Italy
| | - Luca Fania
- First Dermatology Clinic, IDI-IRCCS, Rome, Italy
| | | | - Marzia Caproni
- Rare Diseases Unit, Section of Dermatology, Department of Health Sciences, USL Toscana Centro, European Reference Network-Skin Member, University of Florence, Florence, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Emanuele Cozzani
- DiSSal, Dermatology Clinic, University of Genoa, San Martino Policlinic Hospital-IRCCS, Genoa, Italy
| | - Claudio Feliciani
- Dermatology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Clara De Simone
- Institute of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università del Sacro Cuore, Rome, Italy
| | - Manuela Papini
- Dermatologic Clinic of Terni, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Rosanna Rita Satta
- Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Aurora Parodi
- DiSSal, Dermatology Clinic, University of Genoa, San Martino Policlinic Hospital-IRCCS, Genoa, Italy
| | | | | | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | | | | | - Barbara Bellei
- Laboratory of Cutaneous Physiopathology and Integrated Center for Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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15
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Maronese CA, Caproni M, Moltrasio C, Genovese G, Vezzoli P, Sena P, Previtali G, Cozzani E, Gasparini G, Parodi A, Atzori L, Antiga E, Maglie R, Moro F, Mariotti EB, Corrà A, Pallotta S, Didona B, Marzano AV, Di Zenzo G. Bullous Pemphigoid Associated With COVID-19 Vaccines: An Italian Multicentre Study. Front Med (Lausanne) 2022; 9:841506. [PMID: 35295599 PMCID: PMC8918943 DOI: 10.3389/fmed.2022.841506] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [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: 12/22/2021] [Accepted: 02/03/2022] [Indexed: 01/06/2023] Open
Abstract
Bullous pemphigoid (BP) is an autoimmune bullous disease caused by circulating autoantibodies toward the hemidesmosomal antigens BP180 and BP230. Cases of BP have been described following vaccinations against tetanus, poliomyelitis, diphtheria, influenza, pneumococcus, meningococcus, hepatitis B and rabies. The putative mechanism by which COVID-19-vaccines may induce BP has not been clarified. An Italian multicentre study was conducted to collect clinical, histopathological and immunopathological data of patients with BP associated with COVID-19-vaccines. Twenty-one cases were collected, including 9 females and 12 males (M/F = 1.3) with a median age at diagnosis of 82 years. Seventeen patients received the COMIRNATY Pfizer-BioNTech vaccine, two the Moderna mRNA-1273 vaccine, one the ChAdOx1/nCoV-19-AstraZeneca/ Vaxzevria vaccine and one received the first dose with the ChAdOx1/nCoV-19-AstraZeneca/Vaxzevria vaccine and the second dose with the COMIRNATY Pfizer-BioNTech vaccine. Median latency time between the first dose of anti-SARS-CoV-2 vaccine and the onset of cutaneous manifestations was 27 days. Median BPDAI at onset was 42. Eleven out of seventeen patients (65%) had positive titres for anti-BP180 antibodies with a median value of 106.3 U/mL on ELISA; in contrast, only five out of seventeen (29%) were positive for anti-BP230 antibodies, with a median of 35.3 U/mL. In conclusion, in terms of mean age, disease severity at diagnosis and clinical phenotype vaccine-associated BP patients seem to be similar to idiopathic BP with an overall benign course with appropriate treatment. On the other hand, the slight male predominance and the reduced humoral response to BP230 represent peculiar features of this subset of patients.
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Affiliation(s)
- Carlo Alberto Maronese
- Dermatology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Marzia Caproni
- Rare Diseases Unit, Section of Dermatology, Department of Health Sciences, Unità Sanitaria Locale Toscana Centro, European Reference Network-Skin Member, University of Florence, Florence, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giovanni Genovese
- Dermatology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Pamela Vezzoli
- Dermatology Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paolo Sena
- Dermatology Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giulia Previtali
- Clinical Chemistry Laboratory, Department of Clinical Pathology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Emanuele Cozzani
- DiSSal, Dermatology Clinic, University of Genoa, San Martino Policlinic Hospital- Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Giulia Gasparini
- DiSSal, Dermatology Clinic, University of Genoa, San Martino Policlinic Hospital- Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Aurora Parodi
- DiSSal, Dermatology Clinic, University of Genoa, San Martino Policlinic Hospital- Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Laura Atzori
- Dermatology Clinic, Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Emiliano Antiga
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Roberto Maglie
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Francesco Moro
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata - Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | | | - Alberto Corrà
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Sabatino Pallotta
- Dermatology Clinic, Istituto Dermopatico dell'Immacolata - Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Biagio Didona
- Rare Disease Unit, Istituto Dermopatico dell'Immacolata - Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Di Zenzo
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata - Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy,*Correspondence: Giovanni Di Zenzo
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16
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Fortugno P, Monetta R, Belli M, Botti E, Angelucci F, Palmerini MG, Annarita NS, De Luca C, Ceccarini M, Salvatore M, Bianchi L, Macioce P, Teson M, Ricci F, Network IUD, Macchiarelli G, Didona B, Costanzo A, Castiglia D, Brancati F. RIPK4 regulates cell–cell adhesion in epidermal development and homeostasis. Hum Mol Genet 2022; 31:2535-2547. [DOI: 10.1093/hmg/ddac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/01/2022] [Accepted: 02/22/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Epidermal development and maintenance are finely regulated events requiring a strict balance between proliferation and differentiation. Alterations in these processes give rise to human disorders such as cancer or syndromes with skin and annexes defects, known as ectodermal dysplasias (EDs). Here, we studied the functional effects of two novel receptor-interacting protein kinase 4 (RIPK4) missense mutations identified in siblings with an autosomal recessive ED with cutaneous syndactyly, palmoplantar hyperkeratosis and orofacial synechiae. Clinical overlap with distinct EDs caused by mutations in transcription factors (i.e. p63 and interferon regulatory factor 6, IRF6) or nectin adhesion molecules was noticed. Impaired activity of the RIPK4 kinase resulted both in altered epithelial differentiation and defective cell adhesion. We showed that mutant RIPK4 resulted in loss of PVRL4/nectin-4 expression in patient epidermis and primary keratinocytes, and demonstrated that PVRL4 is transcriptionally regulated by IRF6, a RIPK4 phosphorylation target. In addition, defective RIPK4 altered desmosome morphology through modulation of plakophilin-1 and desmoplakin. In conclusion, this work implicates RIPK4 kinase function in the p63-IRF6 regulatory loop that controls the proliferation/differentiation switch and cell adhesion, with implications in ectodermal development and cancer.
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Affiliation(s)
- Paola Fortugno
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
- Human Functional Genomics, IRCCS San Raffaele Roma, 00163 Rome, Italy
| | - Rosanna Monetta
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | | | - Elisabetta Botti
- Dermatology Unit, Department of Systems Medicine, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Francesco Angelucci
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Maria Grazia Palmerini
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Nottola Stefania Annarita
- Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, Sapienza University, 00185 Rome, Italy
| | - Chiara De Luca
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Marina Ceccarini
- National Center Rare Diseases, Undiagnosed Rare Diseases Interdepartmental Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Marco Salvatore
- National Center Rare Diseases, Undiagnosed Rare Diseases Interdepartmental Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Luca Bianchi
- Dermatology Unit, Department of Systems Medicine, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Pompeo Macioce
- Department of Neurosciences & Undiagnosed Rare Diseases Interdepartmental Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Massimo Teson
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, 00167 Rome, Italy
| | - Francesco Ricci
- Department of Dermatology, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, 00167 Rome, Italy
| | | | - Guido Macchiarelli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Biagio Didona
- Rare Skin Disease Center, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, 00167 Rome, Italy
| | - Antonio Costanzo
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy
- Skin Pathology Laboratory, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
| | - Daniele Castiglia
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, 00167 Rome, Italy
| | - Francesco Brancati
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
- Human Functional Genomics, IRCCS San Raffaele Roma, 00163 Rome, Italy
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17
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Didona D, Paolino G, Di Zenzo G, Didona B, Pampena R, Di Nicola MR, Mercuri SR. Pemphigus Vulgaris: Present and Future Therapeutic Strategies. Dermatol Pract Concept 2022; 12:e2022037. [PMID: 35223181 PMCID: PMC8824520 DOI: 10.5826/dpc.1201a37] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/08/2022] Open
Abstract
Pemphigus vulgaris (PV) belongs to the group of autoimmune blistering diseases. PV can affect not only mucous membranes, but also the skin and it is characterized by serum IgG autoantibodies against desmoglein 1 and 3, two major components of desmosomes. The introduction of glucocorticoids improved dramatically the prognosis of patients affected by PV. However, long-term use of high dose corticosteroids and adjuvant steroid-sparing immunosuppressants can lead to several adverse events. Rituximab, a chimeric anti-CD20 monoclonal antibody, has been recently approved as in-label therapy for PV, leading to an improvement of the prognosis and higher remission rate. Furthermore, other anti B-cell therapies and several anti-CD20 biosimilars have been introduced in the clinical practice. We focused on present and future therapeutic approaches in PV.
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Affiliation(s)
- Dario Didona
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | | | | | | | - Riccardo Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy
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18
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Goebeler M, Bata-Csörgő Z, De Simone C, Didona B, Remenyik E, Reznichenko N, Stoevesandt J, Ward ES, Parys W, de Haard H, Dupuy P, Verheesen P, Schmidt E, Joly P. Treatment of pemphigus vulgaris and foliaceus with efgartigimod, a neonatal Fc receptor inhibitor: a phase II multicentre, open-label feasibility trial. Br J Dermatol 2021; 186:429-439. [PMID: 34608631 DOI: 10.1111/bjd.20782] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pemphigus vulgaris and pemphigus foliaceus are potentially life-threatening autoimmune disorders triggered by IgG autoantibodies against mucosal and epidermal desmogleins. There is an unmet need for fast-acting drugs that enable patients to achieve early sustained remission with reduced corticosteroid reliance. OBJECTIVES To investigate efgartigimod, an engineered Fc fragment that inhibits the activity of the neonatal Fc receptor, thereby reducing serum IgG levels, for treating pemphigus. METHODS Thirty-four patients with mild-to-moderate pemphigus vulgaris or foliaceus were enrolled in an open-label phase II adaptive trial. In sequential cohorts, efgartigimod was dosed at 10 or 25 mg kg-1 intravenously with various dosing frequencies, as monotherapy or as add-on therapy to low-dose oral prednisone. Safety endpoints comprised the primary outcome. The study is registered at ClinicalTrials.gov (identifier NCT03334058). RESULTS Adverse events were mostly mild and were reported by 16 of 19 (84%) patients receiving efgartigimod 10 mg kg-1 and 13 of 15 (87%) patients receiving 25 mg kg-1 , with similar adverse event profiles between dose groups. A major decrease in serum total IgG and anti-desmoglein autoantibodies was observed and correlated with improved Pemphigus Disease Area Index scores. Efgartigimod, as monotherapy or combined with prednisone, demonstrated early disease control in 28 of 31 (90%) patients after a median of 17 days. Optimized, prolonged treatment with efgartigimod in combination with a median dose of prednisone 0·26 mg kg-1 per day (range 0·06-0·48) led to complete clinical remission in 14 of 22 (64%) patients within 2-41 weeks. CONCLUSIONS Efgartigimod was well tolerated and exhibited an early effect on disease activity and outcome parameters, providing support for further evaluation as a therapy for pemphigus.
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Affiliation(s)
- M Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Z Bata-Csörgő
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - C De Simone
- Department of Dermatology, Catholic University of the Sacred Heart, Policlinic A. Gemelli, Rome, Italy
| | - B Didona
- Dermatopathic Institute of the Immaculate, Rome, Italy
| | - E Remenyik
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - N Reznichenko
- Zaporizhzhya State Medical University, Zaporizhzhya, Ukraine
| | - J Stoevesandt
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - E S Ward
- Centre for Cancer Immunology, University of Southampton, Southampton, UK
| | | | | | | | | | - E Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - P Joly
- Department of Dermatology, Rouen University Hospital, Rouen, France
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19
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Kridin K, Brüggen MC, Chua SL, Bygum A, Walsh S, Nägeli MC, Kucinskiene V, French L, Tétart F, Didona B, Milpied B, Ranki A, Salavastru C, Brezinová E, Divani-Patel S, Lorentzen T, Nagel JL, Valiukeviciene S, Karpaviciute V, Tiplica GS, Oppel E, Oschmann A, de Prost N, Vorobyev A, Ingen-Housz-Oro S. Assessment of Treatment Approaches and Outcomes in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Insights From a Pan-European Multicenter Study. JAMA Dermatol 2021; 157:1182-1190. [PMID: 34431984 DOI: 10.1001/jamadermatol.2021.3154] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe drug reactions associated with a high rate of mortality and morbidity. There is no consensus on the treatment strategy. Objective To explore treatment approaches across Europe and outcomes associated with the SJS/TEN disease course, as well as risk factors and culprit drugs. Design, Setting, and Participants A retrospective pan-European multicenter cohort study including 13 referral centers belonging to the ToxiTEN ERN-skin subgroup was conducted. A total of 212 adults with SJS/TEN were included between January 1, 2015, and December 31, 2019, and data were collected from a follow-up period of 6 weeks. Main Outcomes and Measures Risk factors for severe acute-phase complications (acute kidney failure, septicemia, and need for mechanical ventilation) and mortality 6 weeks following admission were evaluated using a multivariable-adjusted logistic regression model. One tool used in evaluation of severity was the Score of Toxic Epidermal Necrolysis (SCORTEN), which ranges from 0 to 7, with 7 the highest level of severity. Results Of 212 patients (134 of 211 [63.7%] women; mean [SD] age, 51.0 [19.3] years), the mean (SD) body surface area detachment was 27% (32.8%). In 176 (83.0%) patients, a culprit drug was identified. Antibiotics (21.2%), followed by anticonvulsants (18.9%), nonsteroidal anti-inflammatory drugs (11.8%), allopurinol (11.3%), and sulfonamides (10.4%), were the most common suspected agents. Treatment approaches ranged from best supportive care only (38.2%) to systemic glucocorticoids (35.4%), intravenous immunoglobulins (23.6%), cyclosporine (10.4%), and antitumor necrosis factor agents (3.3%). Most patients (63.7%) developed severe acute-phase complications. The 6-week mortality rate was 20.8%. Maximal body surface area detachment (≥30%) was found to be independently associated with severe acute-phase complications (fully adjusted odds ratio [OR], 2.49; 95% CI, 1.21-5.12; P = .01) and SCORTEN greater than or equal to 2 was significantly associated with mortality (fully adjusted OR, 10.30; 95% CI, 3.82-27.78; P < .001). Cyclosporine was associated with a higher frequency of greater than or equal to 20% increase in body surface area detachment in the acute phase (adjusted OR, 3.44; 95% CI, 1.12-10.52; P = .03) and an increased risk of infections (adjusted OR, 7.16; 95% CI, 1.52-33.74; P = .01). Systemic glucocorticoids and intravenous immunoglobulins were associated with a decreased risk of infections (adjusted OR, 0.40; 95% CI, 0.18-0.88; P = .02). No significant difference in 6-week mortality was found between treatment groups. Conclusions and Relevance This cohort study noted differences in treatment strategies for SJS/TEN in Europe; the findings suggest the need for prospective therapeutic studies to be conducted and registries to be developed.
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Affiliation(s)
- Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Marie-Charlotte Brüggen
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Medical Campus Davos, Davos, Switzerland.,ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France
| | - Ser-Ling Chua
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France.,Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Anette Bygum
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France.,Department of Dermatology and Allergy Center, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Sarah Walsh
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France.,Department of Dermatology, King's College Hospital, London, United Kingdom
| | - Mirjam C Nägeli
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Vesta Kucinskiene
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France.,Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LUHS), Hospital of LUHS Kauno Klinikos, European Reference Network for Rare and Complex Diseases of the Skin members, Kaunas, Lithuania.,Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Lars French
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France.,Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany.,Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Florence Tétart
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France.,Toxic Bullous Dermatoses and Severe Drug Reactions reference center, TOXIBUL FIMARAD network, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France.,Department of Dermatology, Inserm U519, Rouen University Hospital, Rouen, France
| | - Biagio Didona
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France.,Rare Disease Unit, I Dermatology Division, Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy
| | - Brigitte Milpied
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France.,Toxic Bullous Dermatoses and Severe Drug Reactions reference center, TOXIBUL FIMARAD network, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France.,Department of Dermatology, Saint André Hospital, Bordeaux, France
| | - Annamari Ranki
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France.,Department of Dermatology, Allergology and Venereology, University of Helsinki, Helsinki, Finland.,Helsinki University Hospital, Inflammation Center, Helsinki, Finland
| | - Carmen Salavastru
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France.,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Pediatric Dermatology, Colentina Clinical Hospital, Bucharest, Romania
| | - Eva Brezinová
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France.,First Department of Dermatovenereology, Masaryk University Faculty of Medicine, St Ann's Faculty Hospital in Brno, Brno, Czech Republic
| | - Sapna Divani-Patel
- Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Tine Lorentzen
- Department of Dermatology and Allergy Center, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Julie Loft Nagel
- Department of Dermatology and Allergy Center, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Skaidra Valiukeviciene
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LUHS), Hospital of LUHS Kauno Klinikos, European Reference Network for Rare and Complex Diseases of the Skin members, Kaunas, Lithuania.,Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Viktorija Karpaviciute
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - George-Sorin Tiplica
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France.,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Eva Oppel
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany
| | - Anna Oschmann
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany
| | - Nicolas de Prost
- Toxic Bullous Dermatoses and Severe Drug Reactions reference center, TOXIBUL FIMARAD network, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France.,Intensive care unit, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Artem Vorobyev
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France.,Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Saskia Ingen-Housz-Oro
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France.,Toxic Bullous Dermatoses and Severe Drug Reactions reference center, TOXIBUL FIMARAD network, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France.,Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,University Paris-Est Créteil EpiDermE, Créteil, France
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20
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Goebeler M, Bata-Csörgo Z, de Simone C, Didona B, Remenyik E, Reznichenko N, Schmidt E, Stoevesandt J, Ward E, Parys W, de Haard H, Dupuy P, Verheesen P, Joly P. LB773 Treating pemphigus vulgaris (PV) and foliaceus (PF) by inhibiting the neonatal Fc receptor: Phase 2 multicentre open-label trial with efgartigimod. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.07.039] [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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21
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Moretta G, Moro F, Fania L, Didona B. Generalized acquired cutis laxa and urticarial dermatosis associated with k-chain IgA micromolecular myeloma. Dermatol Reports 2021; 13:9146. [PMID: 34497701 PMCID: PMC8404424 DOI: 10.4081/dr.2021.9146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/22/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Gaia Moretta
- IDI-IRCCS, Dermatological Research Hospital, Rome, Italy
| | - Francesco Moro
- IDI-IRCCS, Dermatological Research Hospital, Rome, Italy
| | - Luca Fania
- IDI-IRCCS, Dermatological Research Hospital, Rome, Italy
| | - Biagio Didona
- IDI-IRCCS, Dermatological Research Hospital, Rome, Italy
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22
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Scala E, Fania L, Bernardini F, Calarco R, Chiloiro S, Di Campli C, Erculei S, Giani M, Giordano M, Panebianco A, Passarelli F, Trovè A, Verkhovskaia S, Russo G, Sgadari A, Didona B, Abeni D. Pleomorphicskin eruptions in a COVID-19 affected patient: Case report and review of the literature. Immun Inflamm Dis 2021; 9:617-621. [PMID: 33942541 PMCID: PMC8239764 DOI: 10.1002/iid3.382] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 12/03/2022]
Abstract
The coronavirus disease (COVID‐19), during its course, may involve several organs, including the skin with a petechial skin rash, urticaria and erythematous rash, or varicella‐like eruption, representing an additional effect of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, as commonly observed in other viral diseases. Considering that symptomatic patients with COVID‐19 generally undergo multidrug treatments, the occurrence of a possible adverse drug reaction presenting with cutaneous manifestations should be contemplated. Pleomorphic skin eruptions occurred in a 59‐year‐old Caucasian woman, affected by a stable form of chronic lymphocytic leukemia, and symptomatic SARS‐CoV‐2 infection, treated with a combination of hydroxychloroquine sulfate, darunavir, ritonavir, sarilumb, omeprazole, ceftriaxone, high‐flow oxygen therapy devices, filgrastim (Zarzio®) as a single injection, and enoxaparin. The patient stopped all treatment but oxygen and enoxaparin were continued and the patient received a high‐dose Desametasone with complete remission of dermatological impairment in 10 days. It is very important to differentially diagnose COVID‐19 disease‐related cutaneous manifestations, where is justified to continue the multidrug antiviral treatment, from those caused by an adverse drug reaction, where it would be necessary to identify the possible culprit drug and to start appropriate antiallergic treatment.
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Affiliation(s)
- Enrico Scala
- Covid Unit, Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - Luca Fania
- Covid Unit, Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - Filippo Bernardini
- Covid Unit, Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - Rodolfo Calarco
- Covid Unit, Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - Sabrina Chiloiro
- Covid Unit, Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | | | - Sabrina Erculei
- Covid Unit, Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - Mauro Giani
- Covid Unit, Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - Marzia Giordano
- Covid Unit, Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | | | | | - Andrea Trovè
- Covid Unit, Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - Sofia Verkhovskaia
- Covid Unit, Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - Giandomenico Russo
- Covid Unit, Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - Antonio Sgadari
- Covid Unit, Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - Biagio Didona
- Covid Unit, Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - Damiano Abeni
- Covid Unit, Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
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23
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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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24
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Sinagra JL, Vedovelli C, Binazzi R, Salemme A, Moro F, Mazzanti C, Didona B, Di Zenzo G. Case Report: Complete and Fast Recovery From Severe COVID-19 in a Pemphigus Patient Treated With Rituximab. Front Immunol 2021; 12:665522. [PMID: 33936104 PMCID: PMC8087171 DOI: 10.3389/fimmu.2021.665522] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/29/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is characterized by a severe pulmonary disease due to severe acute respiratory syndrome (SARS)-CoV-2 infection. For clinicians involved in the management of patients with chronic autoimmune diseases the risk linked to the conditions itself and to drug-induced immunosuppression during the COVID-19 pandemic is a major topic. Pemphigus is a rare autoimmune blistering disease (AIBD) of the skin and mucous membranes caused by autoantibodies to desmosomal components, desmoglein 1 and 3. Among immunosuppressant therapies, rituximab (RTX) is considered a highly effective treatment with a favorable safety profile, but it induces a prolonged B-cell depletion that can lead to higher susceptibility to infections. For this reason, concerns about its use during the pandemic have been raised. We describe a case of a pemphigus patient in which RTX-induced B cell depletion led to the severe inflammatory phase, whereas corticosteroid treatment allowed a favorable outcome.
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Affiliation(s)
| | - Claudio Vedovelli
- Department of Infectious Diseases, Central Hospital of Bolzano, Bolzano, Italy
| | - Raffaella Binazzi
- Department of Infectious Diseases, Central Hospital of Bolzano, Bolzano, Italy
| | - Adele Salemme
- Molecular and Cell Biology Laboratory IDI-IRCCS, Rome, Italy
| | - Francesco Moro
- Molecular and Cell Biology Laboratory IDI-IRCCS, Rome, Italy
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25
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Fania L, Provini A, Rota L, Mazzanti C, RIcci F, Panebianco A, Ricci F, Ruggeri S, Didona B. Eosinophilic annular erythema: Report of four cases. Dermatol Ther 2020; 33:e14369. [PMID: 33025705 DOI: 10.1111/dth.14369] [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] [Received: 06/09/2020] [Revised: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Luca Fania
- Dermatology Department, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - Alessia Provini
- Dermatology Department, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - Lucrezia Rota
- Dermatology Department, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - Cinzia Mazzanti
- Dermatology Department, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - Francesca RIcci
- Laboratory of Dermatopathology, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | | | - Francsesco Ricci
- Melanoma Unit, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - Salvatore Ruggeri
- Dermatology Department, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - Biagio Didona
- Dermatology Department, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
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26
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Didona D, Fania L, Di Zenzo G, Didona B. Erythromycin-induced pemphigus foliaceus successfully treated with etanercept. Dermatol Ther 2020; 33:e14201. [PMID: 32808715 DOI: 10.1111/dth.14201] [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] [Received: 07/31/2020] [Accepted: 08/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Dario Didona
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Luca Fania
- Department of Dermatology, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, Rome, Italy
| | - Giovanni Di Zenzo
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, Rome, Italy
| | - Biagio Didona
- Department of Dermatology, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, Rome, Italy
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27
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Cosimati A, Rossi L, Didona D, Forcella C, Didona B. Bullous pemphigoid in elderly woman affected by non-small cell lung cancer treated with pembrolizumab: A case report and review of literature. J Oncol Pharm Pract 2020; 27:727-733. [PMID: 32772795 DOI: 10.1177/1078155220946370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Immunotherapy has changed the management of patients with various types of malignancies (melanoma, renal, lung, and bladder cancers) but immune checkpoint inhibitors may be associated with several adverse events. Up to 20% of patients treated with immune checkpoint inhibitors may develop dermatological immune-related adverse events, mostly rashes and pruritus but rarely even bullous pemphigoid. CASE REPORT We report a case of an elderly patient with advanced non-small cell lung cancer in therapy with pembrolizumab, 200 mg/body every three weeks. After 26 cycles of therapy, the patient developed widespread itching and then after 28 cycles she developed strained blisters filled with serous fluids on predominantly erythematous skin with suspicious of bullous pemphigoid.Management and outcome: Skin biopsy confirms bullous pemphigoid, so we decided to permanently discontinue therapy with pembrolizumab and the patient is currently on therapy with doxycycline, nicotinamide, and clobetasol propionate with good regression of symptoms and cutaneous lesions. DISCUSSION In the literature, the first case of bullous pemphigoid induced by pembrolizumab has been described in 2015. On Pubmed, from 2015 to date, we have found 19 cases of bullous pemphigoid during pembrolizumab therapy but only three of them are related to non-small cell lung cancer, adding our patient we reach a total of 20 cases. It could be interesting to investigate if there is a specific relationship between the appearance of itching and the development of bullous pemphigoid.
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Affiliation(s)
| | - Luigi Rossi
- UOC of Oncology-ASL Latina-Distretto 1, University of Rome "Sapienza," Aprilia (LT), Italy
| | - Dario Didona
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Chiara Forcella
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
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28
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Didona D, Fania L, Didona B, Eming R, Hertl M, Di Zenzo G. Paraneoplastic Dermatoses: A Brief General Review and an Extensive Analysis of Paraneoplastic Pemphigus and Paraneoplastic Dermatomyositis. Int J Mol Sci 2020; 21:ijms21062178. [PMID: 32245283 PMCID: PMC7139382 DOI: 10.3390/ijms21062178] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 02/06/2023] Open
Abstract
Skin manifestations of systemic disease and malignancy are extremely polymorphous. Clinicians should be familiarized with paraneoplastic dermatoses in order to perform an early diagnosis of the underlying neoplasm. Lack of familiarity with cutaneous clues of internal malignancy may delay diagnosis and treatment of cancer. In this review, we described several paraneoplastic dermatoses and discussed extensively two paradigmatic ones, namely paraneoplastic pemphigus and paraneoplastic dermatomyositis.
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Affiliation(s)
- Dario Didona
- Department of Dermatology and Allergology, Philipps University, 35043 Marburg, Germany; (R.E.); (M.H.)
- Correspondence: ; Tel.: +49-(6421)-58-64882; Fax: +49-(6421)-58-62902
| | - Luca Fania
- First Dermatology Division, IDI-IRCCS, 00167 Rome, Italy;
| | | | - Rüdiger Eming
- Department of Dermatology and Allergology, Philipps University, 35043 Marburg, Germany; (R.E.); (M.H.)
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps University, 35043 Marburg, Germany; (R.E.); (M.H.)
| | - Giovanni Di Zenzo
- Molecular and Cell Biology Laboratory, IDI-IRCCS, 00167 Rome, Italy;
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29
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Sampogna F, Fania L, Mazzanti C, Pallotta S, Panebianco A, Mastroeni S, Didona B, Abeni D. The impact of hidradenitis suppurativa on general health is higher than that of hypertension, congestive heart failure, type 2 diabetes, myocardial infarction and depression. J Eur Acad Dermatol Venereol 2020; 34:e386-e388. [DOI: 10.1111/jdv.16290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- F. Sampogna
- Clinical Epidemiology Unit IDI‐IRCCS Rome Italy
| | - L. Fania
- First Dermatology Clinic IDI‐IRCCS Rome Italy
| | - C. Mazzanti
- First Dermatology Clinic IDI‐IRCCS Rome Italy
| | - S. Pallotta
- Fifth Dermatology Clinic IDI‐IRCCS Rome Italy
| | | | | | - B. Didona
- First Dermatology Clinic IDI‐IRCCS Rome Italy
| | - D. Abeni
- Clinical Epidemiology Unit IDI‐IRCCS Rome Italy
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30
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Fania L, Provini A, Salemme A, Sinagra JL, Guerra L, Mazzanti C, Didona B, Castiglia D, Di Zenzo G. Development of bullous pemphigoid in junctional epidermolysis bullosa. J Eur Acad Dermatol Venereol 2020; 34:e146-e148. [PMID: 31709656 DOI: 10.1111/jdv.16057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- L Fania
- First Dermatologic Division, IDI-IRCCS, Rome, Italy
| | - A Provini
- First Dermatologic Division, IDI-IRCCS, Rome, Italy
| | - A Salemme
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
| | - J L Sinagra
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
| | - L Guerra
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
| | - C Mazzanti
- First Dermatologic Division, IDI-IRCCS, Rome, Italy
| | - B Didona
- First Dermatologic Division, IDI-IRCCS, Rome, Italy
| | - D Castiglia
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
| | - G Di Zenzo
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
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31
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Didona D, Paradisi A, Abeni D, Didona B. 114 Use of etanercept in toxic epidermal necrolysis: a single center experience in a cohort of 30 patients. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.118] [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: 10/26/2022]
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32
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Fortugno P, Monetta R, Angelucci F, Camerota L, Botti E, Moretti F, Bianchi L, Didona B, Castiglia D, Brancati F. 092 Novel biallelic RIPK4 mutations cause ectodermal dysplasia with cutaneous syndactyly. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.096] [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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33
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Sampogna F, Fania L, Mazzanti C, Caggiati A, Pallotta S, Panebianco A, Mastroeni S, Didona B, Pintori G, Abeni D. The Broad-Spectrum Impact of Hidradenitis Suppurativa on Quality of Life: A Comparison with Psoriasis. Dermatology 2019; 235:308-314. [PMID: 31121589 DOI: 10.1159/000496604] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 09/25/2018] [Accepted: 01/03/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM Hidradenitis suppurativa (HS) is a chronic skin disease with a heavy impact on patients' quality of life (QoL). The aim of this study was to evaluate in detail the QoL impact of HS comparing it with other skin conditions, and in particular with psoriasis. METHODS Patients with a diagnosis of HS were recruited. QoL was measured using the Skindex-17 questionnaire. RESULTS Data were available for 69 HS patients. HS had the worst QoL among several skin conditions. Compared to psoriasis the mean symptom score was 69.4 versus 53.7, and the mean psychosocial score was 56.1 versus 32.7. Overall, the scores of patients with HS were higher than those of psoriasis patients on 16 of the 17 items of the Skindex-17. CONCLUSIONS When compared to many different skin conditions, and in particular to psoriasis, HS was the most impairing condition, even at low levels of clinical severity.
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Affiliation(s)
| | - Luca Fania
- First Dermatology Clinic, IDI-IRCCS, Rome, Italy
| | | | | | | | | | | | | | - Giusi Pintori
- Inversa Onlus, the Italian Association of Patients with Hidradenitis Suppurativa, Rome, Italy
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34
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Didona D, Paradisi A, Abeni D, Didona B. 547 Effectiveness of etanercept in the treatment of toxic epidermal necrolysis. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.623] [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: 10/27/2022]
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35
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36
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Didona D, Ruggeri S, Paolino G, Cantisani C, Caposiena Caro RD, Moliterni E, Didona B. Spiny keratoderma of the palms in a patient with diabetes mellitus type 1: what came first, the chicken or the egg? GIORN ITAL DERMAT V 2018; 153:734-735. [PMID: 30246957 DOI: 10.23736/s0392-0488.17.05654-1] [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: 11/08/2022]
Affiliation(s)
- Dario Didona
- First Dermatologic Division, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy -
| | - Salvatore Ruggeri
- First Dermatologic Division, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - Giovanni Paolino
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - Carmen Cantisani
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | | | - Elisa Moliterni
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - Biagio Didona
- First Dermatologic Division, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
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37
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Fania L, Didona D, Pacifico V, Mariotti F, De Luca N, Abeni D, Mazzanti C, Di Zenzo G, Didona B. Bullous pemphigoid with hyperkeratosis and palmoplantar keratoderma: Three cases. J Dermatol 2018; 45:1135-1140. [PMID: 30007013 DOI: 10.1111/1346-8138.14529] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 06/04/2018] [Indexed: 11/27/2022]
Abstract
The clinical features of bullous pemphigoid are extremely polymorphous. Several atypical forms of bullous pemphigoid have been described, and the diagnosis critically relies on immunopathological findings. We describe three bullous pemphigoid patients characterized by palmoplantar keratoderma, diffused hyperkeratotic cutaneous lesions and extremely high levels of immunoglobulin E serum. The diagnosis of bullous pemphigoid should be taken into account in patients presenting diffused hyperkeratotic cutaneous lesions and palmoplantar keratoderma, even in the absence of blisters. Alteration of the keratinization process, that could occur in patients with genetic mutations in desmosomal and hemidesmosomal genes, may also be due to circulating autoantibodies against hemidesmosomal proteins in these bullous pemphigoid patients.
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Affiliation(s)
- Luca Fania
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - Dario Didona
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | | | | | - Naomi De Luca
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - Damiano Abeni
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - Cinzia Mazzanti
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | | | - Biagio Didona
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
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38
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Affiliation(s)
- Dario Didona
- First Division of Dermatology, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy -
| | - Luca Fania
- First Division of Dermatology, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - Biagio Didona
- First Division of Dermatology, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
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39
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Condorelli AG, Fortugno P, Cianfarani F, Proto V, Di Zenzo G, Didona B, Zambruno G, Castiglia D. Lack of K140 immunoreactivity in junctional epidermolysis bullosa skin and keratinocytes associates with misfolded laminin epidermal growth factor-like motif 2 of the β3 short arm. Br J Dermatol 2018; 178:1416-1422. [PMID: 28561256 DOI: 10.1111/bjd.15690] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2017] [Indexed: 11/27/2022]
Abstract
Recessive mutations in the LAMA3, LAMB3 and LAMC2 genes that encode laminin-332 (LM332) (α3a, β3 and γ2 chains, respectively) cause different junctional epidermolysis bullosa (JEB) subtypes. Biallelic truncating mutations in any of these three genes usually lead to lack of protein expression resulting in the severe generalized JEB subtype, while missense or splice-site mutations in at least one allele lead to reduced expression typical of JEB generalized intermediate (JEB-gen intermed) or localized. Here, we molecularly characterized an adult patient with JEB showing negative skin staining for the anti-β3 chain monoclonal antibody K140. This antibody recognizes an as yet unidentified epitope within the laminin β3 short arm. The patient harbours a homozygous splice-site mutation resulting in highly aberrant transcripts with partial skipping of the LAMB3 exon that encodes the laminin epidermal growth factor-like motif 2 of the β3 short arm (β3-LE2). At the protein level, mutation consequences predict a misfolded β3-LE2 motif and, indeed, we found that LM332 is correctly assembled but retained in the endoplasmic reticulum (ER) where it colocalizes with the lumenal ER chaperone protein BiP, leading to dramatically reduced secretion. Lack of K140 reactivity to mutant LM332 was confirmed by immunoprecipitation and Western blot analyses. Our findings not only identify the β3-LE2 subdomain as the region recognized by K140, but also show that misfolding of LM332 structural motifs and subsequent protein retention in the ER is a common pathomechanism in JEB-gen intermed. In addition to its usefulness in antigen mapping diagnosis of JEB subtypes, this knowledge is relevant to the design of therapeutic strategies aimed at releasing ER-retained LM332 in JEB.
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Affiliation(s)
- A G Condorelli
- Genetic and Rare Diseases Research Area, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, Italy
| | - P Fortugno
- Laboratory of Molecular and Cell Biology
| | | | - V Proto
- Laboratory of Molecular and Cell Biology
| | - G Di Zenzo
- Laboratory of Molecular and Cell Biology
| | - B Didona
- Rare Skin Disease Center, Istituto Dermopatico dell'Immacolata-IRCCS, via dei Monti di Creta, , 104, 00167, Rome, Italy
| | - G Zambruno
- Genetic and Rare Diseases Research Area, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, Italy
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40
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Didona D, Mostaccioli S, Paolino G, Cantisani C, Caposiena Caro RD, Viti G, Didona B. Shiitake dermatosis in a Caucasian woman. Ital J Dermatol Venerol 2018; 153:586-588. [PMID: 29767489 DOI: 10.23736/s0392-0488.17.05591-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Dario Didona
- First Division of Dermatology, Istituto Dermopatico dell'Immacolata, Rome, Italy -
| | - Stefania Mostaccioli
- First Division of Dermatology, Istituto Dermopatico dell'Immacolata, Rome, Italy
| | | | | | | | - Giacomo Viti
- Clinic of Dermatology, Sapienza University of Rome, Rome, Italy
| | - Biagio Didona
- First Division of Dermatology, Istituto Dermopatico dell'Immacolata, Rome, Italy
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41
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Napolitano M, Abeni D, Didona B. Biologics for pityriasis rubra pilaris treatment: A review of the literature. J Am Acad Dermatol 2018; 79:353-359.e11. [PMID: 29609014 DOI: 10.1016/j.jaad.2018.03.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 02/06/2018] [Revised: 03/21/2018] [Accepted: 03/25/2018] [Indexed: 01/10/2023]
Abstract
Pityriasis rubra pilaris (PRP) is a rare inflammatory papulosquamous skin disease that is often refractory to conventional therapies. The off-label use of biologics, such as anti-tumor necrosis factor, anti-interleukin (IL) 12/IL-23, and anti-IL-17 agents, has been proven successful in the past 2 decades for PRP treatment. Our aim was to analyse the literature for the use of biologics in PRP treatment. We conducted a review by performing PubMed and ClinicalTrials.gov searches. Sixty-eight articles met our selection criteria and are herein discussed. Out of 86 PRP patients, the vast majority were treated with anti-tumor necrosis factor, anti-IL-12/IL-23, or anti-IL-17 biologics, either alone or in combination therapy. A marked-to-complete response was observed in 50%-78%, a partial response in 11%-25%, and no or poor response in 11%-25%. This review has several limitations, including small sample sizes and the lack of shared study design criteria. In some instances, PRP might have resolved spontaneously. Further, the presence of concomitant therapy or the lack of detailed data on previous treatments, makes it difficult to strictly define a therapeutic role per se of specific biologics in PRP. This review shows that biologics may be regarded as a tool for PRP treatment alone or in combination therapy although clinical trials are needed to better assess their efficacy and safety.
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Affiliation(s)
- Monica Napolitano
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy.
| | - Damiano Abeni
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy
| | - Biagio Didona
- Rare Disease Unit, I Dermatology Division, Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy
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42
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Guerra L, Castori M, Didona B, Castiglia D, Zambruno G. Hereditary palmoplantar keratodermas. Part II: syndromic palmoplantar keratodermas - Diagnostic algorithm and principles of therapy. J Eur Acad Dermatol Venereol 2018; 32:899-925. [DOI: 10.1111/jdv.14834] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/05/2018] [Indexed: 12/19/2022]
Affiliation(s)
- L. Guerra
- Laboratory of Molecular and Cell Biology; Istituto Dermopatico dell'Immacolata-IRCCS; Rome Italy
| | - M. Castori
- Division of Medical Genetics; Casa Sollievo della Sofferenza-IRCCS; San Giovanni Rotondo Italy
| | - B. Didona
- Rare Skin Disease Center; Istituto Dermopatico dell'Immacolata-IRCCS; Rome Italy
| | - D. Castiglia
- Laboratory of Molecular and Cell Biology; Istituto Dermopatico dell'Immacolata-IRCCS; Rome Italy
| | - G. Zambruno
- Genetic and Rare Diseases Research Area and Dermatology Unit; Bambino Gesù Children's Hospital-IRCCS; Rome Italy
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43
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Guerra L, Castori M, Didona B, Castiglia D, Zambruno G. Hereditary palmoplantar keratodermas. Part I. Non-syndromic palmoplantar keratodermas: classification, clinical and genetic features. J Eur Acad Dermatol Venereol 2018; 32:704-719. [PMID: 29489036 DOI: 10.1111/jdv.14902] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/09/2018] [Indexed: 12/15/2022]
Abstract
The term palmoplantar keratoderma (PPK) indicates any form of persistent thickening of the epidermis of palms and soles and includes genetic as well as acquired conditions. We review the nosology of hereditary PPKs that comprise an increasing number of entities with different prognoses, and a multitude of associated cutaneous and extracutaneous features. On the basis of the phenotypic consequences of the underlying genetic defect, hereditary PPKs may be divided into the following: (i) non-syndromic, isolated PPKs, which are characterized by a unique or predominant palmoplantar involvement; (ii) non-syndromic PPKs with additional distinctive cutaneous and adnexal manifestations, here named complex PPKs; (iii) syndromic PPKs, in which PPK is associated with specific extracutaneous manifestations. To date, the diagnosis of the different hereditary PPKs is based mainly on clinical history and features combined with histopathological findings. In recent years, the exponentially increasing use of next-generation sequencing technologies has led to the identification of several novel disease genes, and thus substantially contributed to elucidate the molecular basis of such a heterogeneous group of disorders. Here, we focus on hereditary non-syndromic isolated and complex PPKs. Syndromic PPKs are reviewed in the second part of this 2-part article, where other well-defined genetic diseases, which may present PPK among their phenotypic manifestations, are also listed and diagnostic and therapeutic approaches for PPKs are summarized.
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Affiliation(s)
- L Guerra
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - M Castori
- Division of Medical Genetics, Casa Sollievo della Sofferenza-IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - B Didona
- Rare Skin Disease Center, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - D Castiglia
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - G Zambruno
- Genetic and Rare Diseases Research Area and Dermatology Unit, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
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44
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Fania L, Salemme A, Provini A, Pagnanelli G, Collina MC, Abeni D, Didona B, Di Zenzo G, Mazzanti C. Detection and characterization of IgG, IgE, and IgA autoantibodies in patients with bullous pemphigoid associated with dipeptidyl peptidase-4 inhibitors. J Am Acad Dermatol 2018; 78:592-595. [PMID: 28987492 DOI: 10.1016/j.jaad.2017.09.051] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 09/15/2017] [Accepted: 09/20/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Luca Fania
- Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy.
| | - Adele Salemme
- Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | | | | | | | - Damiano Abeni
- Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - Biagio Didona
- Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
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45
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Fania L, Di Zenzo G, Didona B, Pilla MA, Sobrino L, Panebianco A, Mazzanti C, Abeni D. Increased prevalence of diabetes mellitus in bullous pemphigoid patients during the last decade. J Eur Acad Dermatol Venereol 2017; 32:e153-e154. [PMID: 29055144 DOI: 10.1111/jdv.14649] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- L Fania
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - G Di Zenzo
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - B Didona
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - M A Pilla
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - L Sobrino
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - A Panebianco
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - C Mazzanti
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
| | - D Abeni
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM, Rome, Italy
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46
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Napolitano M, Lembo L, Fania L, Abeni D, Didona D, Didona B. Ustekinumab treatment of pityriasis rubra pilaris: A report of five cases. J Dermatol 2017; 45:202-206. [PMID: 29080273 DOI: 10.1111/1346-8138.14114] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 09/05/2017] [Accepted: 10/02/2017] [Indexed: 11/28/2022]
Abstract
Pityriasis rubra pilaris (PRP) is a rare, chronic, inflammatory skin disease of unknown etiology. Patients refractory to conventional therapies have been treated successfully with biologic drugs such as anti-tumor necrosis factor agents. Recently, a role of the interleukin-23/T-helper 17 axis in PRP has been described. Our objective was to assess the effectiveness of ustekinumab in five patients with adult-onset PRP refractory to conventional therapies. In the present study, four patients had type I and one patient type II adult-onset PRP. They were treated with three s.c. doses of ustekinumab at weeks 0, 4 and 16. Clinical response was evaluated monthly during treatment up to a 15-month follow-up period. All patients promptly showed a decrease in erythema, follicular hyperkeratosis and scaling. After three injections, complete remission of skin lesions was achieved in four out of five cases and a significant clinical improvement was shown in one case. To the best of our knowledge, this is the largest case series reported on ustekinumab treatment in PRP. Our results, in addition to previous studies from other groups, suggest that ustekinumab may be a possible first-line treatment for PRP patients refractory to conventional therapies.
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Affiliation(s)
- Monica Napolitano
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS-FLMM, Rome, Italy
| | - Luigi Lembo
- I Dermatology Division, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS-FLMM, Rome, Italy
| | - Luca Fania
- I Dermatology Division, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS-FLMM, Rome, Italy
| | - Damiano Abeni
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS-FLMM, Rome, Italy
| | - Dario Didona
- I Dermatology Division, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS-FLMM, Rome, Italy
| | - Biagio Didona
- I Dermatology Division, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS-FLMM, Rome, Italy
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47
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Guerra L, Zambruno G, Fortugno P, Salemme A, Didona B, Di Zenzo G, Castiglia D. 213 Epidermolysis bullosa acquisita in a patient with biallelic COL7A1 mutations. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.210] [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: 11/27/2022]
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48
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Didona D, Paolino G, Pagnanelli G, Donati M, Annessi G, Didona B. Desmoplastic melanoma: a diagnostic challenge. Ital J Dermatol Venerol 2017; 153:577-578. [PMID: 28704986 DOI: 10.23736/s0392-0488.17.05577-8] [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: 11/08/2022]
Affiliation(s)
- Dario Didona
- Division of Dermatology, Istituto Dermopatico dell'Immacolata, Rome, Italy -
| | | | | | - Michele Donati
- Department of Pathology, Biomedical Campus University, Rome, Italia
| | - Giorgio Annessi
- Division of Dermatology, Istituto Dermopatico dell'Immacolata, Rome, Italy
| | - Biagio Didona
- Division of Dermatology, Istituto Dermopatico dell'Immacolata, Rome, Italy
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49
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Fania L, Ricci F, Sampogna F, Mazzanti C, Didona B, Pintori G, Abeni D. Prevalence and incidence of hidradenitis suppurativa: an exercise on indirect estimation from psoriasis data. J Eur Acad Dermatol Venereol 2017; 31:e410-e411. [DOI: 10.1111/jdv.14224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- L. Fania
- First Dermatology Clinic; Istituto Dermopatico dell'Immacolata; Istituto di Ricovero e Cura a Carattere Scientifico; Fondazione Luigi Maria Monti (IDI-IRCCS, FLMM); Rome Italy
| | - F. Ricci
- Dermatological Surgery Unit; Istituto Dermopatico dell'Immacolata; Istituto di Ricovero e Cura a Carattere Scientifico; Fondazione Luigi Maria Monti (IDI-IRCCS, FLMM); Rome Italy
| | - F. Sampogna
- Clinical Epidemiology Unit; Istituto Dermopatico dell'Immacolata; Istituto di Ricovero e Cura a Carattere Scientifico; Fondazione Luigi Maria Monti (IDI-IRCCS, FLMM); Rome Italy
| | - C. Mazzanti
- First Dermatology Clinic; Istituto Dermopatico dell'Immacolata; Istituto di Ricovero e Cura a Carattere Scientifico; Fondazione Luigi Maria Monti (IDI-IRCCS, FLMM); Rome Italy
| | - B. Didona
- First Dermatology Clinic; Istituto Dermopatico dell'Immacolata; Istituto di Ricovero e Cura a Carattere Scientifico; Fondazione Luigi Maria Monti (IDI-IRCCS, FLMM); Rome Italy
| | - G. Pintori
- Inversa Onlus; Italian Association of Patients with Hidradenitis Suppurativa; Cagliari Italy
| | - D. Abeni
- Clinical Epidemiology Unit; Istituto Dermopatico dell'Immacolata; Istituto di Ricovero e Cura a Carattere Scientifico; Fondazione Luigi Maria Monti (IDI-IRCCS, FLMM); Rome Italy
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Garelli V, Didona D, Paolino G, Didona B, Calvieri S, Rossi A. Dissecting cellulitis: responding to topical steroid and oral clindamycin. Ital J Dermatol Venerol 2017; 152:324-325. [DOI: 10.23736/s0392-0488.16.05296-2] [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]
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