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Torosian A, Albucker SJ, Gowda G, Boh E, Bitar C. Cutaneous T-cell lymphoma (CTCL) patients' understanding of illness and perception of follow-up. Int J Dermatol 2023; 62:e645-e647. [PMID: 37548249 DOI: 10.1111/ijd.16799] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/26/2023] [Accepted: 07/14/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Arman Torosian
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Geetha Gowda
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Erin Boh
- Department of Dermatology, Tulane Medicine Center, New Orleans, LA, USA
| | - Carole Bitar
- Department of Dermatology, Tulane Medicine Center, New Orleans, LA, USA
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2
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Whittington CP, Saleh JS, Schadler E, Bitar C, Wang F, Andea AA. Cutaneous malakoplakia arising on the ankle of a patient with pyoderma gangrenosum. J Cutan Pathol 2023; 50:942-946. [PMID: 37615213 DOI: 10.1111/cup.14519] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023]
Abstract
Malakoplakia is a rare chronic inflammatory condition that most commonly involves the urogenital tract. Cutaneous malakoplakia is extremely rare and many patients diagnosed with skin involvement are immunosuppressed. While the clinical presentation of cutaneous malakoplakia is variable, the histopathologic features are quite distinct and include sheets of closely packed dermal histiocytes with foamy-appearing cytoplasm and Michaelis-Gutmann bodies that are positive with certain immunohistochemical stains. While the exact pathogenesis of malakoplakia is unknown, it has been associated with certain bacterial infections. Treatment generally involves a combination of surgery and antimicrobial agents and/or modulation of immunosuppressant therapy if appropriate. Herein, the authors report a unique case of cutaneous malakoplakia arising in a patient on chronic immunosuppressive therapy for the management of pyoderma gangrenosum.
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Affiliation(s)
- Carli P Whittington
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
- Departments of Pathology and Dermatology, Indiana University, Indianapolis, Indiana, USA
| | - Jasmine S Saleh
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric Schadler
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Carole Bitar
- Departments of Pathology and Dermatology, Tulane University, New Orleans, Louisiana, USA
| | - Frank Wang
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Aleodor A Andea
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
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3
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Bourgeois JC, Beer J, Choi SH, Bitar C. Epidemiology of Chronic Dermatologic Conditions in Skin of Color. J Drugs Dermatol 2023; 22:e21-e23. [PMID: 37943262 DOI: 10.36849/jdd.7131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Across the board, common dermatologic conditions disproportionately affect patients of color. While the causes of these disparities have been tied to the environment, societal structure, access to care, health literacy, and biological factors, there is limited understanding of the extent and impact of dermatologic healthcare inequity. This study provides a resource on the epidemiology of common dermatologic diseases across racial lines and points out current lapses in scientific understanding of the disparate impact of certain conditions. This study will review epidemiological data on atopic dermatitis (AD), adult acne, pseudofolliculitis, dermatophytosis, psoriasis, vitiligo, melasma, hyperpigmentation, keloids, hidradenitis suppurativa (HS), basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. J Drugs Dermatol. 2023;22(11):e21-e23 doi:10.36849/JDD.7131e.
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Bitar C, Ninh T, Brag K, Foutouhi S, Radosta S, Meyers J, Baddoo M, Liu D, Stumpf B, Harms PW, Saba NS, Boh E. Apremilast in Recalcitrant Cutaneous Dermatomyositis: A Nonrandomized Controlled Trial. JAMA Dermatol 2022; 158:1357-1366. [PMID: 36197661 PMCID: PMC9535502 DOI: 10.1001/jamadermatol.2022.3917] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/26/2022] [Indexed: 01/13/2023]
Abstract
Importance Cutaneous disease in dermatomyositis has no standardized treatment approach and so presents a challenging task for patients and clinicians. Objective To study the efficacy and safety of apremilast as an add-on therapy in patients with recalcitrant cutaneous dermatomyositis. Design, Setting, and Participants This phase 2a, open-label, single-arm nonrandomized controlled trial was conducted at a single center from June 2018 to June 2021. Participants were 8 patients with recalcitrant cutaneous dermatomyositis, defined by a cutaneous disease activity severity index (CDASI) score greater than 5 despite treatment with steroids, steroid-sparing agents, or both. Data were analyzed from June 2018 to June 2021. Interventions Apremilast 30 mg orally twice daily was added to ongoing treatment regimens. Main Outcomes and Measures The primary outcome was the overall response rate (ORR) at 3 months. Key secondary outcomes were the safety and toxicity of apremilast and the durability of response at 6 months. The CDASI, muscle score, dermatology life quality index (DLQI), and depression assessments were performed at baseline and regularly until month 7. Skin biopsies were performed at baseline and 3 months after apremilast (defined as 3 months into active apremilast therapy) and tested for gene expression profiling and immunohistochemical stains. Adverse events were assessed using the Common Terminology Criteria for Adverse Events version 5.0. Results Among 8 patients with recalcitrant cutaneous dermatomyositis (all women; mean [SD] age, 54 [15.9] years), a response was found at 3 months after apremilast among 7 patients (ORR, 87.5%). The mean (SD) decrease in CDASI was 12.9 (6.3) points at 3 months (P < .001). Apremilast was well tolerated, with no grade 3 or higher adverse events. Sequencing of RNA was performed on skin biopsies taken from 7 patients at baseline and at 3 months after therapy. Appropriate negative (ie, no primary antibody) and positive (ie, tonsil and spleen) controls were stained in parallel with each set of slides studied. Of 39 076 expressed genes, there were 195 whose expression changed 2-fold or more at P < .01 (123 downregulated and 72 upregulated genes). Gene set enrichment analysis identified 13 pathways in which apremilast was associated with downregulated expression, notably signal transducers and activators of transcription 1 (STAT1), STAT3, interleukin 4 (IL-4), IL-6, IL-12, IL-23, interferon γ (IFNγ), and tumor necrosis factor α (TNFα) pathways. In immunohistochemical staining, there was a mean (SD) decrease in phosphorylation levels STAT1 (22.3% [28.3%] positive cells) and STAT3 (13.4% [11.6%] positive cells) at the protein level, a downstream signaling pathway for the downregulated cytokines. Conclusions and Relevance These findings suggest that apremilast was a safe and efficacious add-on treatment in recalcitrant dermatomyositis, with an overall response rate of 87.5% and associations with downregulation of multiple inflammatory pathways. Trial Registration ClinicalTrials.gov Identifier: NCT03529955.
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Affiliation(s)
- Carole Bitar
- Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Thien Ninh
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Katherine Brag
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Stella Radosta
- Deming Department of Medicine, Tulane University, New Orleans, Louisiana
| | - Jade Meyers
- School of Medicine, Tulane University, New Orleans, Louisiana
| | - Melody Baddoo
- Department of Pathology and Laboratory Medicine, Tulane University, New Orleans, Louisiana
- Tulane Cancer Center, Tulane University, New Orleans, Louisiana
| | - Delong Liu
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Brittany Stumpf
- Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Paul W. Harms
- Department of Pathology, University of Michigan, Ann Arbor
| | - Nakhle S. Saba
- Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University, New Orleans, Louisiana
| | - Erin Boh
- Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana
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5
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Torosian A, Ly L, Murina A, Bitar C. A case of cutaneous Mycobacterium llatz e rense. JAAD Case Rep 2022; 31:53-55. [PMID: 36505039 PMCID: PMC9731971 DOI: 10.1016/j.jdcr.2022.11.005] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Arman Torosian
- Correspondence to: Arman Torosian, BS, Department of Dermatology, Tulane School of Medicine, 1430 Tulane Ave, #8036, New Orleans, LA 70112.
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Bitar C, Menge TD, Chan MP. Cutaneous manifestations of lupus erythematosus: A practical clinicopathologic review for pathologists. Histopathology 2021; 80:233-250. [PMID: 34197657 DOI: 10.1111/his.14440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
Accurate diagnosis of connective tissue diseases is often challenging and relies on careful correlation between clinical and histopathologic features, direct immunofluorescence studies, and laboratory workup. Lupus erythematosus (LE) is a prototype of connective tissue disease with a variety of cutaneous and systemic manifestations. Microscopically, cutaneous LE is classically characterized by an interface dermatitis, although other histopathologic patterns also exist depending on the clinical presentation, location, and chronicity of the skin lesions. In this article, we review the clinical, serologic, histopathologic, and direct immunofluorescence findings in LE-specific and LE-nonspecific skin lesions, with an emphasis on lesser known variants, newly described features, and helpful ancillary studies. This review will guide general pathologists and dermatopathologists in accurately diagnosing and subclassifying cutaneous LE.
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Affiliation(s)
- Carole Bitar
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tyler D Menge
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - May P Chan
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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7
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Talia J, Bitar C, Wang Y, Whitfield ML, Khanna D. A Case of Recalcitrant Linear Morphea Responding to Subcutaneous Abatacept. J Scleroderma Relat Disord 2021; 6:194-198. [PMID: 34337154 PMCID: PMC8320776 DOI: 10.1177/2397198320983240] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/02/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Linear morphea is an inflammatory condition that is often treated with systemic glucocorticoids and methotrexate, with mycophenolate mofetil being used as an alternative agent. However, there are few published reports on beneficial effect of abatacept for refractory disease. We present a case of a woman in her 30s who presented with linear morphea on her scalp, with a notable response following the addition of subcutaneous abatacept. METHODS Computational analysis was performed comparing the immune cell scores of skin biopsies from 5 morphea skin biopsies from 3 unique patients and 15 healthy control skin biopsies. P < 0.05 was considered statistically significant. RESULTS Immune cell scores demonstrated a statistically significant enrichment of activated CD4 memory T cells, M1 macrophages, monocytes, and memory B cells comparing skin biopsies of morphea vs healthy controls (p < 0.05 for all). DISCUSSION Abatacept may be considered for recalcitrant cases of morphea. Our computational analysis supports a well-designed study to assess abatacept as first line therapy.
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Affiliation(s)
- Jordan Talia
- Department of Dermatology, University of
Michigan, Ann Arbor, MI, USA
| | - Carole Bitar
- Department of Pathology, University of
Michigan, Ann Arbor, MI, USA
| | - Yue Wang
- Department of Biomedical Data Science and
Department of Molecular & Systems Biology, Dartmouth Geisel School of Medicine, Hanover,
NH, USA
| | - Michael L Whitfield
- Department of Biomedical Data Science and
Department of Molecular & Systems Biology, Dartmouth Geisel School of Medicine, Hanover,
NH, USA
| | - Dinesh Khanna
- Division of Rheumatology, Department of
Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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8
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Chen L, Eckert A, Cavigli A, Tracey V, Bitar C, Lauth M, Williams L. Assessing the Prevalence of Post-Traumatic Stress Disorder in Survivors of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Skinmed 2021; 19:238-239. [PMID: 34303399] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Lauren Chen
- Department of Dermatology, Tulane University School of Medicine, New Orleans, LA
| | - Auston Eckert
- Department of Dermatology, Tulane University School of Medicine, New Orleans, LA
| | - Amy Cavigli
- Department of Dermatology, Tulane University School of Medicine, New Orleans, LA
| | - Virginia Tracey
- Department of Dermatology, Tulane University School of Medicine, New Orleans, LA
| | - Carole Bitar
- Department of Dermatology, Tulane University School of Medicine, New Orleans, LA
| | - Michael Lauth
- Department of Dermatology, Tulane University School of Medicine, New Orleans, LA
| | - Laura Williams
- Department of Dermatology, Tulane University School of Medicine, New Orleans, LA;
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Abstract
Cutaneous manifestations are common across the spectrum of autoimmune diseases. Connective tissue diseases manifesting in the skin are often difficult to classify and require integration of clinical, histopathologic, and serologic findings. This review focuses on the current understanding of the molecular and immune drivers involved in the pathogenesis of cutaneous lupus erythematosus, dermatomyositis, scleroderma/systemic sclerosis, and mixed connective tissue disease. Recent research advances have led to the emergence of new ancillary tools and useful diagnostic clues of which dermatopathologists should be aware to improve diagnostic accuracy for these diseases.
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Affiliation(s)
- Carole Bitar
- Department of Pathology, University of Michigan, 2800 Plymouth Road, NCRC Building 35, Ann Arbor, MI 48109, USA
| | - May P Chan
- Department of Pathology, University of Michigan, 2800 Plymouth Road, NCRC Building 35, Ann Arbor, MI 48109, USA.
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10
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Bitar C, Hile G, Brown NA, Fullen DR, Lowe L, Tejasvi T, Wilcox RA, Harms PW, Chan MP, Bresler SC, Hristov AC. Immunophenotypic switch in cutaneous T-cell lymphoma: A series of three cases and review of the literature. J Cutan Pathol 2021; 48:986-994. [PMID: 33856064 DOI: 10.1111/cup.14026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 12/24/2022]
Abstract
Primary cutaneous T-cell lymphoma (CTCL) comprises a heterogeneous group of neoplasms with variable clinical behavior. Immunophenotypic switch (IS) is a phenomenon that occurs during lymphoma progression and is defined by an alteration in the immunophenotypic expression of a tumor with retention of its genotypic signature. This has been well-recognized in hematopoietic neoplasms; however, it has been rarely reported in CTCL and its clinical implications are not well understood. We present the clinical, histopathologic, immunophenotypic, and genetic findings of three cases of CTCL that demonstrated IS post treatment with variable outcomes. We add our cases to the small number previously reported to increase awareness of this phenomenon and its diagnostic challenge.
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Affiliation(s)
- Carole Bitar
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Grace Hile
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Noah A Brown
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Douglas R Fullen
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lori Lowe
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Trilokraj Tejasvi
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryan A Wilcox
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Paul W Harms
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - May P Chan
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott C Bresler
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexandra C Hristov
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
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11
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Bitar C, Chan MP, Harms PW, Fullen DR, Gudjonsson JE, Eshaq M, Renati S, Nikle AB, Allen A, Hawkins SD, Huerta T, Lowe L, Andea AA. Cutaneous manifestations of hospitalized coronavirus disease 2019 patients: a report of six cases with clinicopathologic features and viral RNA in situ hybridization. J Eur Acad Dermatol Venereol 2020; 34:e656-e659. [PMID: 32534469 PMCID: PMC7323164 DOI: 10.1111/jdv.16741] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- C Bitar
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - M P Chan
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - P W Harms
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - D R Fullen
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - J E Gudjonsson
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - M Eshaq
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - S Renati
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - A B Nikle
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - A Allen
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - S D Hawkins
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - T Huerta
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - L Lowe
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - A A Andea
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
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12
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Bitar C, Olivier K, Lee C, Vincent B, Martin J. Acute graft-vs-host disease following liver transplantation. Cutis 2019; 103:E8-E11. [PMID: 31348462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Acute graft-vs-host disease (GVHD) is a T cell-mediated reaction in which donor T lymphocytes attack host tissue in the setting of immunosuppression. The most common cause of acute GVHD is allogeneic stem cell transplantation, with solid-organ transplantation being a much less common cause. Early diagnosis and treatment are imperative to decrease morbidity and mortality. Dermatologists play a fundamental role in the diagnosis of this condition because skin involvement is among the earliest signs of acute GVHD. We present a case of acute GVHD following liver transplantation, focusing on diagnostic criteria and a comparison to acute GVHD following hematopoietic stem cell transplantation.
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Affiliation(s)
- Carole Bitar
- Department of Dermatology, Tulane University, New Orleans, Louisiana, USA
| | - Kathryn Olivier
- Department of Dermatology, Louisiana State University, New Orleans, USA
| | - Caroline Lee
- Department of Dermatology, Louisiana State University, New Orleans, USA
| | - Bethany Vincent
- Department of Dermatology, Ochsner Medical Center, Jefferson, Louisiana, USA
| | - Julie Martin
- Department of Dermatology, Ochsner Medical Center, Jefferson, Louisiana, USA
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13
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Bitar C, Maghfour J, Ho-Pham H, Stumpf B, Boh E. Apremilast as a potential treatment for moderate to severe dermatomyositis: A retrospective study of 3 patients. JAAD Case Rep 2019; 5:191-194. [PMID: 30740504 PMCID: PMC6357541 DOI: 10.1016/j.jdcr.2018.11.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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] [Indexed: 12/19/2022] Open
Affiliation(s)
- Carole Bitar
- Department of Dermatology, Tulane University, New Orleans, Louisiana
| | | | - Hoang Ho-Pham
- Louisiana State University School of Medicine, New Orleans, Louisiana
| | - Brittany Stumpf
- Department of Dermatology, Tulane University, New Orleans, Louisiana
| | - Erin Boh
- Department of Dermatology, Tulane University, New Orleans, Louisiana
- Correspondence to: Erin Boh, MD, PhD, Department of Dermatology, Tulane University School of Medicine, 1430 Tulane Ave, No. 8036, New Orleans, LA 70112.
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14
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Bitar C, Murina A. Reply: Commentary on letter to the editor from Drago et al. JAAD Case Rep 2018; 4:817. [PMID: 30271871 PMCID: PMC6160618 DOI: 10.1016/j.jdcr.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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15
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Affiliation(s)
- Carole Bitar
- Department of Dermatology, Tulane University, New Orleans, Louisiana
| | - Azeen Sadeghian
- Department of Dermatology, Tulane University, New Orleans, Louisiana
| | - Lacey Sullivan
- Department of Dermatopathology, Tulane University, New Orleans, Louisiana
| | - Andrea Murina
- Department of Dermatology, Tulane University, New Orleans, Louisiana
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16
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Bitar C, Farooqui MZH, Valdez J, Saba NS, Soto S, Bray A, Marti G, Wiestner A, Cowen EW. Hair and Nail Changes During Long-term Therapy With Ibrutinib for Chronic Lymphocytic Leukemia. JAMA Dermatol 2017; 152:698-701. [PMID: 26982511 DOI: 10.1001/jamadermatol.2016.0225] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
IMPORTANCE Ibrutinib, a Bruton tyrosine kinase inhibitor, is a new targeted agent approved by the US Food and Drug Administration for the treatment of chronic lymphocytic leukemia (CLL), mantle cell lymphoma, and Waldenström macroglobulinemia. Ibrutinib is overall well tolerated but long-term treatment is required until disease progression or intolerable toxic effects occur. Little is known regarding its cutaneous adverse effects. OBJECTIVE To describe the hair and nail manifestations associated with the long-term use of ibrutinib for the treatment of CLL. DESIGN, SETTING, AND PARTICIPANTS Prospective study of 66 patients with CLL enrolled in a single-arm phase 2 clinical trial of ibrutinib for CLL between March 2014 and October 2015 at the National Institutes of Health. MAIN OUTCOMES AND MEASURES The primary outcome, nail and hair changes associated with ibrutinib therapy, was assessed by an 11-question survey. In addition, the severity of nail changes was determined from a 0 to 3 rating scale for both onychoschizia and onychorrhexis. RESULTS Among 66 patients (43 men and 23 women with ages ranging from 55 to 85 years), 44 (67%) reported brittle fingernails at a median of 6.5 (95% CI, 6-12) months after starting ibrutinib therapy. Fifteen patients (23%) developed brittle toenails after a median of 9 (95% CI, 6-15) months of ibrutinib therapy. Textural hair changes were reported in 17 patients (26%), at a median of 9 (95% CI, 6-12) months of ibrutinib treatment. CONCLUSIONS AND RELEVANCE Hair and nail abnormalities are commonly associated with ibrutinib and appear several months after initiating therapy. Ibrutinib inhibits Bruton tyrosine kinase by covalently binding to cysteine 481. Whether ibrutinib affects the hair and nails by binding and altering cysteine-rich proteins of hair and nails or by means of another mechanism remains unknown. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01500733.
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Affiliation(s)
- Carole Bitar
- Department of Medicine, Tulane University, New Orleans, Louisiana2Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Mohammed Z H Farooqui
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Janet Valdez
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Nakhle S Saba
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland3Section of Hematology and Medical Oncology, Department of Medicine, Tulane University, New Orleans, Louisiana
| | - Susan Soto
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amanda Bray
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Gerald Marti
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Adrian Wiestner
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Edward W Cowen
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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El-Kehdy J, Nasr J, Bitar C, El-Habr C, Abi-Rached Megarbane H, Sammour R, Ammoury A. Don't miss this blue toe: hair tourniquet syndrome. J Eur Acad Dermatol Venereol 2015; 29:191-2. [PMID: 25671236 DOI: 10.1111/jdv.12393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Saba N, Saba J, Janbain M, Bitar C, Lipsky A, Blaya M. Cancer of the Indiana Pouch: a case report and review of the literature. Clin Genitourin Cancer 2013; 11:e30-4. [PMID: 24075928 DOI: 10.1016/j.clgc.2013.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 06/01/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Nakhle Saba
- Section of Hematology and Medical Oncology, Department of Medicine, Tulane University, New Orleans, LA
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19
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Daoud EG, Strickberger SA, Man KC, Goyal R, Deeb GM, Bolling SF, Pagani FD, Bitar C, Meissner MD, Morady F. Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery. N Engl J Med 1997; 337:1785-91. [PMID: 9400034 DOI: 10.1056/nejm199712183372501] [Citation(s) in RCA: 399] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Atrial fibrillation occurs commonly after open-heart surgery and may delay hospital discharge. The purpose of this study was to assess the use of preoperative amiodarone as prophylaxis against atrial fibrillation after cardiac surgery. METHODS In this double-blind, randomized study, 124 patients were given either oral amiodarone (64 patients) or placebo (60 patients) for a minimum of seven days before elective cardiac surgery. Therapy consisted of 600 mg of amiodarone per day for seven days, then 200 mg per day until the day of discharge from the hospital. The mean (+/-SD) preoperative total dose of amiodarone was 4.8+/-0.96 g over a period of 13+/-7 days. RESULTS Postoperative atrial fibrillation occurred in 16 of the 64 patients in the amiodarone group (25 percent) and 32 of the 60 patients in the placebo group (53 percent) (P=0.003). Patients in the amiodarone group were hospitalized for significantly fewer days than were patients in the placebo group (6.5+/-2.6 vs. 7.9+/-4.3 days, P=0.04). Nonfatal postoperative complications occurred in eight amiodarone-treated patients (12 percent) and in six patients receiving placebo (10 percent, P=0.78). Fatal postoperative complications occurred in three patients who received amiodarone (5 percent) and in two who received placebo (3 percent, P= 1.00). Total hospitalization costs were significantly less for the amiodarone group than for the placebo group ($18,375+/-$13,863 vs. $26,491+/-$23,837, P=0.03). CONCLUSIONS Preoperative oral amiodarone in patients undergoing complex cardiac surgery is well tolerated and significantly reduces the incidence of postoperative atrial fibrillation and the duration and cost of hospitalization.
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Affiliation(s)
- E G Daoud
- Department of Internal Medicine, University of Michigan Hospital, Ann Arbor, USA
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20
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Dutoy JP, Wery PE, Bitar C. [Treatment of osteitis by excision and graft of spongy bone]. Acta Orthop Belg 1982; 48:376-88. [PMID: 7046338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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21
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Delpierre J, Bitar C, Vincent A. [Restoration of elbow flexion using bipolar transfer of the greater dorsal muscle. Apropos of 1 case]. Acta Orthop Belg 1980; 46:213-8. [PMID: 7457116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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22
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Bitar C, Rombouts JJ. [Transposition of the 5th metacarpus after amputation of the 4th finger or after amputation for a tumor of the 4th finger]. Acta Orthop Belg 1979; 45:527-37. [PMID: 296868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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