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Walker AM, Joseph A, Nelson J, Orfaly VE, Stoos E, Geller A, Bailey E, Savory S, Leachman S, Jacobe H. Examining the Role of Estheticians in Skin Cancer Surveillance. Dermatology 2023; 240:59-64. [PMID: 37926076 DOI: 10.1159/000531974] [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: 09/28/2022] [Accepted: 07/05/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Melanoma and non-melanoma skin cancer are significant causes of mortality. Previous studies regarding skin cancer education in nonmedical professionals have shown increases in favorable attitudes and likelihood of approaching clients about concerning lesions with training. However, few studies have investigated the use of estheticians in skin cancer screening. OBJECTIVES The objective of this study was to develop an education course to train estheticians to recognize concerning lesions, to assess the baseline knowledge of estheticians toward skin cancer detection, and to determine the effect that our curriculum has on lesion detection. METHODS We administered an education course and corresponding cross-sectional surveys to estheticians to evaluate current knowledge and assess for improvements in attitudes and behaviors regarding skin cancer detection. RESULTS Of 504 estheticians, most estheticians (85-98%) indicated the correct level of concern for "extremely concerning" lesions on pre- and post-training surveys. Estheticians were more likely to recommend that their client see a medical professional if they previously attended a course on skin cancer (p = 0.012) or had greater than 1 year of work experience (p < 0.001). After completion of the training module, most participants felt "very comfortable," suggesting that clients see a doctor for a suspicious lesion. CONCLUSION Our findings suggest that estheticians are capable of indicating the appropriate level of concern for abnormal lesions. Estheticians may serve as a valuable screening partner for dermatologists in the detection of skin cancer.
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Affiliation(s)
- Amanda M Walker
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, Texas, USA
| | - Adrienne Joseph
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, Texas, USA
| | - Jacob Nelson
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA,
| | - Victoria E Orfaly
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Elizabeth Stoos
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Allan Geller
- Harvard T.H. Chan School of Public Health Department of Public Health Practice, Boston, Massachusetts, USA
| | - Elizabeth Bailey
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Stephanie Savory
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, Texas, USA
| | - Sancy Leachman
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Heidi Jacobe
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, Texas, USA
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Xing E, Ma F, Wasikowski R, Billi AC, Gharaee-Kermani M, Fox J, Dobry C, Victory A, Sarkar MK, Xing X, Plazyo O, Chen HW, Barber G, Jacobe H, Tsou PS, Modlin RL, Varga J, Kahlenberg JM, Tsoi LC, Gudjonsson JE, Khanna D. Pansclerotic morphea is characterized by IFN-γ responses priming dendritic cell fibroblast crosstalk to promote fibrosis. JCI Insight 2023; 8:e171307. [PMID: 37471168 PMCID: PMC10543736 DOI: 10.1172/jci.insight.171307] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023] Open
Abstract
Pansclerotic morphea (PSM) is a rare, devastating disease characterized by extensive soft tissue fibrosis, secondary contractions, and significant morbidity. PSM pathogenesis is unknown, and aggressive immunosuppressive treatments rarely slow disease progression. We aimed to characterize molecular mechanisms driving PSM and to identify therapeutically targetable pathways by performing single-cell and spatial RNA-Seq on 7 healthy controls and on lesional and nonlesional skin biopsies of a patient with PSM 12 months apart. We then validated our findings using immunostaining and in vitro approaches. Fibrotic skin was characterized by prominent type II IFN response, accompanied by infiltrating myeloid cells, B cells, and T cells, which were the main IFN-γ source. We identified unique CXCL9+ fibroblasts enriched in PSM, characterized by increased chemokine expression, including CXCL9, CXCL10, and CCL2. CXCL9+ fibroblasts were related to profibrotic COL8A1+ myofibroblasts, which had enriched TGF-β response. In vitro, TGF-β and IFN-γ synergistically increased CXCL9 and CXCL10 expression, contributing to the perpetuation of IFN-γ responses. Furthermore, cell-to-cell interaction analyses revealed cDC2B DCs as a key communication hub between CXCL9+ fibroblasts and COL8A1+ myofibroblasts. These results define PSM as an inflammation-driven condition centered on type II IFN responses. This work identified key pathogenic circuits between T cells, cDC2Bs, and myofibroblasts, and it suggests that JAK1/2 inhibition is a potential therapeutic option in PSM.
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Affiliation(s)
| | - Feiyang Ma
- Department of Dermatology
- Division of Rheumatology, Department of Internal Medicine; and
| | - Rachael Wasikowski
- Department of Dermatology
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | | | - Amanda Victory
- Division of Rheumatology, Department of Internal Medicine; and
| | | | | | | | - Henry W. Chen
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Grant Barber
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Heidi Jacobe
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Pei-Suen Tsou
- Division of Rheumatology, Department of Internal Medicine; and
| | - Robert L. Modlin
- Division of Dermatology, Department of Medicine, UCLA, Los Angeles, California, USA
| | - John Varga
- Division of Rheumatology, Department of Internal Medicine; and
- University of Michigan SSc Program, Ann Arbor, Michigan, USA
| | - J. Michelle Kahlenberg
- Department of Dermatology
- Division of Rheumatology, Department of Internal Medicine; and
- Taubman Institute, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Lam C. Tsoi
- Department of Dermatology
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Johann E. Gudjonsson
- Department of Dermatology
- Division of Rheumatology, Department of Internal Medicine; and
- Taubman Institute, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Dinesh Khanna
- Division of Rheumatology, Department of Internal Medicine; and
- University of Michigan SSc Program, Ann Arbor, Michigan, USA
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Werner G, Sanyal A, Mirizio E, Hutchins T, Tabib T, Lafyatis R, Jacobe H, Torok KS. Single-Cell Transcriptome Analysis Identifies Subclusters with Inflammatory Fibroblast Responses in Localized Scleroderma. Int J Mol Sci 2023; 24:9796. [PMID: 37372943 DOI: 10.3390/ijms24129796] [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: 04/29/2023] [Revised: 05/19/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Localized scleroderma (LS) is an autoimmune disease with both inflammatory and fibrotic components causing an abnormal deposition of collagen in the skin and underlying tissue, often leading to disfigurement and disability. Much of its pathophysiology is extrapolated from systemic sclerosis (SSc) since the histopathology findings in the skin are nearly identical. However, LS is critically understudied. Single-cell RNA sequencing (scRNA seq) technology provides a novel way to obtain detailed information at the individual cellular level, overcoming this barrier. Here, we analyzed the affected skin of 14 patients with LS (pediatric and adult) and 14 healthy controls. Fibroblast populations were the focus, since they are the main drivers of fibrosis in SSc. We identified 12 fibroblast subclusters in LS, which overall had an inflammatory gene expression (IFN and HLA-associated genes). A myofibroblast-like cluster (SFRP4/PRSS23) was more prevalent in LS subjects and shared many upregulated genes expressed in SSc-associated myofibroblasts, though it also had strong expression of CXCL9/10/11, known CXCR3 ligands. A CXCL2/IRF1 cluster identified was unique to LS, with a robust inflammatory gene signature, including IL-6, and according to cell communication analysis are influenced by macrophages. In summary, potential disease-propagating fibroblasts and associated gene signatures were identified in LS skin via scRNA seq.
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Affiliation(s)
- Giffin Werner
- Department of Pediatrics (Rheumatology), University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Anwesha Sanyal
- Department of Pediatrics (Rheumatology), University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Emily Mirizio
- Department of Pediatrics (Rheumatology), University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Theresa Hutchins
- Department of Pediatrics (Rheumatology), University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Tracy Tabib
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Robert Lafyatis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Kathryn S Torok
- Department of Pediatrics (Rheumatology), University of Pittsburgh, Pittsburgh, PA 15224, USA
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Zigler CK, Lin L, Ardalan K, Jacobe H, Lane S, Li SC, Luca NJC, Prajapati VH, Schollaert K, Teske N, Torok K. Cross-sectional quantitative validation of the pediatric Localized Scleroderma Quality of Life Instrument (LoSQI): A disease-specific patient-reported outcome measure. J Eur Acad Dermatol Venereol 2023. [PMID: 36950970 DOI: 10.1111/jdv.19059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The Localized Scleroderma Quality of Life Instrument (LoSQI) is a disease-specific patient-reported outcome (PRO) measure designed for children and adolescents with localized scleroderma (LS; morphea). This tool was developed using rigorous PRO methods and previously cognitively tested in a sample of pediatric patients with LS. OBJECTIVE The purpose of this study was to evaluate the psychometric properties of the LoSQI in a clinical setting. METHODS Cross-sectional data from four specialized clinics in the US and Canada were included in the analysis. Evaluation included reliability of scores, internal structure of the survey, evidence of convergent and divergent validity, and test-retest reliability. RESULTS One-hundred ten patients with LS (age: 8-20 years) completed the LoSQI. Both exploratory and confirmatory factor analysis supported the use of two sub-scores: Pain & Physical Functioning and Body Image & Social Support. Correlations with other PRO measures were consistent with pre-specified hypotheses. LIMITATIONS This study did not evaluate longitudinal validity or responsiveness of scores. CONCLUSION Results from a representative sample of children and adolescents with LS continue to support the validity of the LoSQI when used in a clinical setting. Future work to evaluate the responsiveness is ongoing.
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Affiliation(s)
- C K Zigler
- Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA
| | - L Lin
- Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA
| | - K Ardalan
- Duke University School of Medicine, Department of Pediatrics, Durham, NC, USA
- Northwestern University Feinberg School of Medicine/Ann & Robert H. Lurie Children's Hospital of Chicago, Departments of Pediatrics and Medical Social Sciences, Chicago, IL, USA
| | - H Jacobe
- UT Southwestern Medical Center, Department of Dermatology, Dallas, TX, USA
| | - S Lane
- University of Pittsburgh, School of Education, Pittsburgh, PA, USA
| | - S C Li
- Joseph M. Sanzari Children's Hospital, Hackensack Meridian School of Medicine, Department of Pediatrics, Hackensack, NJ, USA
| | - N J C Luca
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Section of Pediatric Rheumatology, Department of Pediatrics, Calgary, AB, Canada
| | - V H Prajapati
- Section of Pediatric Rheumatology, Department of Pediatrics, Calgary, AB, Canada
- Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Dermatology Research Institute, Calgary, AB, Canada
- Skin Health & Wellness Centre, Calgary, AB, Canada
- Probity Medical Research, Calgary, AB, Canada
| | - K Schollaert
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA
| | - N Teske
- Oregon Health & Science University School of Medicine, Department of Dermatology, OR, USA
| | - K Torok
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA
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Chen HW, Coias J, Walker AM, Prasad S, Ma L, Hynan LS, Jacobe H. Patients with limited life expectancy are biopsied for keratinocyte cancers at similar frequency to healthy patients. Dermatology 2023:000530103. [PMID: 36921586 DOI: 10.1159/000530103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 03/06/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND In many fields of medicine, guidelines recommend reduced cancer screening in patients of advanced age and limited life expectancy (LLE). In dermatology, there are currently no guidelines for adjusted evaluation and management practices of keratinocyte cancer (KC) in patients with LLE. Little is known regarding evaluation and management patterns and frequency of biopsies in these patients. OBJECTIVE We sought to determine if dermatology providers biopsy LLE patients with similar frequency to their age-matched peers and quantify frequency of associated complications. METHODS This was a retrospective cohort study of evaluations for skin cancer quantified by skin biopsy frequency for skin cancer at the North Texas Veteran Affairs Health System dermatology clinic for 3062 patients between 2005-2009, including a 5-year follow-up period. Life expectancy was quantified by the validated Charlson Comorbidity Index (CCI) with a Deyo adaptation. RESULTS There was no significant difference in biopsy frequency of KC in LLE vs non-LLE patients in most age-controlled groups, with increased biopsy frequency in LLE patients in the 65-74 age category (p=0.02). There was also an increased risk of complications from biopsy in the 75-84 (many comorbidities subgroup: RR=3.27, p=0.002; some comorbidities subgroup: RR=2.26, p=0.048) and 65-74 (many comorbidities subgroup: RR=1.52, p=0.004) age group when compared to age matched healthy controls. CONCLUSION Biopsy frequency is similar or increased in patients with LLE compared with age-matched controls, with increased frequency of complications. Further studies are needed to understand the underlying factors driving these practice patterns.
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García-Romero MT, Tollefson M, Pope E, Brandling-Bennett HA, Paller AS, Keimig E, Arkin L, Wanat KA, Humphrey SR, Werth VP, Oza V, Jacobe H, Fett N, Cordoro KM, Medina-Vera I, Chiu YE. Development and Validation of the Morphea Activity Measure in Patients With Pediatric Morphea. JAMA Dermatol 2023; 159:299-307. [PMID: 36753150 PMCID: PMC9909574 DOI: 10.1001/jamadermatol.2022.6365] [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: 08/31/2022] [Accepted: 12/12/2022] [Indexed: 02/09/2023]
Abstract
Importance Morphea is an insidious inflammatory disorder of the skin and deeper tissues. Determining disease activity is challenging yet important to medical decision-making and patient outcomes. Objective To develop and validate a scoring tool, the Morphea Activity Measure (MAM), to evaluate morphea disease activity of any type or severity that is easy to use in clinical and research settings. Design, Setting, and Participants This pilot diagnostic study was conducted from September 9, 2019, to March 6, 2020, in 2 phases: development and validation. During the development phase, 14 morphea experts (dermatologists and pediatric dermatologists) used a Delphi consensus method to determine items that would be included in the MAM. The validation phase included 8 investigators who evaluated the tool in collaboration with 14 patients with pediatric morphea (recruited from a referral center [Medical College of Wisconsin]) during a 1-day in-person meeting on March 6, 2020. Main Outcomes and Measures During the development phase, online survey items were evaluated by experts in morphea using a Likert scale (score range, 0-10, with 0 indicating not important and 10 indicating very important); agreement was defined as a median score of 7.0 or higher, disagreement as a median score of 3.9 or lower, and no consensus as a median score of 4.0 to 6.9. During the validation phase, reliability (interrater and intrarater agreement using intraclass correlation coefficients), validity (using the content validity index and κ statistics as well as correlations with the modified Localized Scleroderma Severity Index and the Physician Global Assessment of Activity using Spearman ρ coefficients), and viability (using qualitative interviews of investigators who used the MAM tool) were evaluated. Descriptive statistics were used for quantitative variables. Data on race and ethnicity categories were collected but not analyzed because skin color was more relevant for the purposes of this study. Results Among 14 survey respondents during the development phase, 9 (64.3%) were pediatric dermatologists and 5 (35.7%) were dermatologists. After 2 rounds, a final tool was developed comprising 10 items that experts agreed were indicative of morphea activity (new lesion in the past 3 months, enlarging lesion in the past 3 months, linear lesion developing progressive atrophy in the past 3 months, erythema, violaceous rim or color, warmth to the touch, induration, white-yellow or waxy appearance, shiny white wrinkling, and body surface area). The validation phase was conducted with 14 patients (median age, 14.5 years [range, 8.0-18.0 years]; 8 [57.1%] female), 2 dermatologists, and 6 pediatric dermatologists. Interrater and intrarater agreement for MAM total scores was good, with intraclass correlation coefficients of 0.844 (95% CI, 0.681-0.942) for interrater agreement and 0.856 (95% CI, 0.791-0.901) for intrarater agreement. Correlations between the MAM and the modified Localized Scleroderma Severity Index (Spearman ρ = 0.747; P < .001) and the MAM and the Physician Global Assessment of Activity (Spearman ρ = 0.729; P < .001) were moderately strong. In qualitative interviews, evaluators agreed that the tool was easy to use, measured morphea disease activity at a single time point, and should be responsive to changes in morphea disease activity over multiple time points. Conclusions and Relevance In this study, the MAM was found to be a reliable, valid, and viable tool to measure pediatric morphea activity. Further testing to assess validity in adults and responsiveness to change is needed.
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Affiliation(s)
| | - Megha Tollefson
- Department of Pediatrics, Mayo Clinic and Mayo Clinic Children’s Center, Rochester, Minnesota
- Department of Dermatology, Mayo Clinic and Mayo Clinic Children’s Center, Rochester, Minnesota
| | - Elena Pope
- Dermatology Section, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Heather A. Brandling-Bennett
- Division of Dermatology, Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington
- Department of Medicine, School of Medicine, University of Washington, Seattle
| | - Amy S. Paller
- Department of Dermatology, Northwestern University, Chicago, Illinois
- Department of Pediatrics, Northwestern University, Chicago, Illinois
- Department of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Lisa Arkin
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin, Madison, Madison
| | - Karolyn A. Wanat
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | | | - Victoria P. Werth
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Vikash Oza
- Ronald O. Perelman Department of Dermatology, Grossman School of Medicine, New York University, New York
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Nicole Fett
- Department of Dermatology, Oregon Health and Science University, Portland
| | - Kelly M. Cordoro
- Department of Dermatology, School of Medicine, University of California, San Francisco, San Francisco
| | - Isabel Medina-Vera
- Department of Research Methodology, National Institute of Pediatrics, Mexico City
| | - Yvonne E. Chiu
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee
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Joseph AK, Walker AM, Irek M, Berry E, Argenbright K, Jacobe H. Knowledge, attitudes, and behaviors of nail technicians in detecting acral lentiginous melanoma. J Cosmet Dermatol 2022; 21:6449-6452. [PMID: 35531786 DOI: 10.1111/jocd.15068] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/05/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Adrienne K Joseph
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas, USA
| | - Amanda M Walker
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas, USA
| | - Melissa Irek
- Moncrief Cancer Institute, Fort Worth, Texas, USA
| | - Emily Berry
- Moncrief Cancer Institute, Fort Worth, Texas, USA
| | - Keith Argenbright
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas, USA
- Moncrief Cancer Institute, Fort Worth, Texas, USA
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas, USA
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Chen H, Walker A, Schollaert-Fitch K, Torok K, Jacobe H. 191 Clinical characteristics associated with functional abnormalities in pediatric and adult morphea: A cross-sectional study. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Walker A, Teske N, Zigler C, Jacobe H. 162 Validation of a patient-reported outcome measure in adults with morphea. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.169] [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: 11/29/2022]
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10
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Prasad S, Black S, Chen HW, Joseph A, Latour E, Berry E, Irek M, Argenbright K, Jacobe H, Savory S. Beliefs and barriers to care of primary care practitioners towards melanoma screening and education in rural Texas. J Am Acad Dermatol 2022; 87:1102-1104. [DOI: 10.1016/j.jaad.2021.12.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/12/2021] [Accepted: 12/24/2021] [Indexed: 10/31/2022]
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Desai Y, Jaki T, Beresford MW, Burnett T, Eleftheriou D, Jacobe H, Leone V, Li S, Mozgunov P, Ramanan AV, Torok KS, Anderson ME, Anton J, Avcin T, Felton J, Foeldvari I, Laguda B, McErlane F, Shaw L, Zulian F, Pain CE. Prior elicitation of the efficacy and tolerability of Methotrexate and Mycophenolate Mofetil in Juvenile Localised Scleroderma. AMRC Open Res 2021; 3:20. [PMID: 38708070 PMCID: PMC11064983 DOI: 10.12688/amrcopenres.13008.1] [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] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 05/07/2024]
Abstract
Background Evidence is lacking for safe and effective treatments for juvenile localised scleroderma (JLS). Methotrexate (MTX) is commonly used first line and mycophenolate mofetil (MMF) second line, despite a limited evidence base. A head to head trial of these two medications would provide data on relative efficacy and tolerability. However, a frequentist approach is difficult to deliver in JLS, because of the numbers needed to sufficiently power a trial. A Bayesian approach could be considered. Methods An international consensus meeting was convened including an elicitation exercise where opinion was sought on the relative efficacy and tolerability of MTX compared to MMF to produce prior distributions for a future Bayesian trial. Secondary aims were to achieve consensus agreement on critical aspects of a future trial. Results An international group of 12 clinical experts participated. Opinion suggested superior efficacy and tolerability of MMF compared to MTX; where most likely value of efficacy of MMF was 0.70 (95% confidence interval (CI) 0.34-0.90) and of MTX was 0.68 (95% CI 0.41-0.8). The most likely value of tolerability of MMF was 0.77 (95% CI 0.3-0.94) and of MTX was 0.62 (95% CI 0.32-0.84). The wider CI for MMF highlights that experts were less sure about relative efficacy and tolerability of MMF compared to MTX. Despite using a Bayesian approach, power calculations still produced a total sample size of 240 participants, reflecting the uncertainty amongst experts about the performance of MMF. Conclusions Key factors have been defined regarding the design of a future Bayesian approach clinical trial including elicitation of prior opinion of the efficacy and tolerability of MTX and MMF in JLS. Combining further efficacy data on MTX and MMF with prior opinion could potentially reduce the pre-trial uncertainty so that, when combined with smaller trial sample sizes a compelling evidence base is available.
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Affiliation(s)
- Yasin Desai
- MPS Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, LA1 4YF, UK
| | - Thomas Jaki
- MPS Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, LA1 4YF, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, L12 2AP, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Thomas Burnett
- MPS Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, LA1 4YF, UK
| | - Despina Eleftheriou
- University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Paediatric Rheumatology, Great Ormond St Hospital NHS Foundation Trust, London, WC1N 3JH, UK
| | - Heidi Jacobe
- UT Southwestern Medical Center, Dallas, Texas, TX 75390, USA
| | - Valentina Leone
- Paediatric Rheumatology Department, Leeds Children Hospital (Leeds Teaching Hospitals) and University of Leeds, Leeds, LS1 3EX, UK
| | - Suzanne Li
- Department of Pediatrics, Joseph M. Sanzari Children’s Hospital, Hackensack University Medical Center & Hackensack Meridian School of Medicine, Hackensack, New Jersey, NJ 07601, USA
| | - Pavel Mozgunov
- MPS Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, LA1 4YF, UK
| | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Translational Health Sciences, Bristol, BS1 3NU, UK
| | - Kathryn S Torok
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Marina E Anderson
- Department of Rheumatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L9 7AL, UK
- Lancaster Medical School, Lancaster University, Lancaster, LA1 4YF, UK
| | - Jordi Anton
- Pediatric Rheumatology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Barcelona, 08007, UK
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre, Ljubljana, 1000 Ljubljana, Slovenia
| | - Jessie Felton
- Department of Dermatology, Brighton and Sussex University Hospitals & Royal Alexandra Children’s Hospital, Brighton, BN2 1DH, UK
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescence Rheumatology, Hamburg, 22081 Hamburg, Germany
| | - Bisola Laguda
- Department of Paediatric Dermatology, Chelsea and Westminster Hospital, London, SW10 9NH, UK
| | - Flora McErlane
- Department of Paediatric Rheumatology, Great North Children's Hospital, Newcastle, NE1 4LP, UK
| | - Lindsay Shaw
- Department of Paediatric Rheumatology, Great Ormond St Hospital NHS Foundation Trust, London, WC1N 3JH, UK
- University Hospitals Bristol NHS Foundation Trust & Translational Health Sciences, Bristol, BS1 3NU, UK
| | - Francesco Zulian
- Department of Woman's and Child's Health, University of Padova, Padua, 35122 Padua, Italy
| | - Clare E Pain
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, L12 2AP, UK
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Burger E, Jacobe H. 26765 Myelin basic protein autoantibodies as a biomarker in morphea. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Abbas L, Joseph A, Jacobe H. 571 Morphea in patients of color: A cross sectional study of the morphea in adults and children (MAC) cohort. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Barber G, O'Brien J, Chen H, Jacobe H. 698 Validation of CXCL9 as a biomarker in morphea. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.728] [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: 10/21/2022]
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15
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Abbas L, Joseph A, Glaser D, Mathew D, Torok K, Derderian C, Jacobe H. 306 Outcomes of surgical correction of facial morphea: A cross-sectional analysis. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.328] [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: 10/21/2022]
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16
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Mirizio E, Tabib T, Wang X, Chen W, Liu C, Lafyatis R, Jacobe H, Torok KS. Correction to: Single-cell transcriptome conservation in a comparative analysis of fresh and cryopreserved human skin tissue: pilot in localized scleroderma. Arthritis Res Ther 2021; 23:101. [PMID: 33823906 PMCID: PMC8022423 DOI: 10.1186/s13075-021-02490-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
- Emily Mirizio
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tracy Tabib
- Division of Rheumatology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xinjun Wang
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wei Chen
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christopher Liu
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Lafyatis
- Division of Rheumatology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kathryn S Torok
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA. .,Division of Rheumatology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. .,University of Pittsburgh Medical Center Children's Hospital of Pittsburgh Faculty Pavilion, 3rd floor, Office 3117 4401 Penn Avenue, Pittsburgh, PA, 15237, USA.
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Bayers S, Orseth M, Prasad S, Hynan LS, Berry E, Argenbright K, Jacobe H, Savory S. Community-based melanoma screening: A pilot study for the development of an educational curriculum for nonphysician providers. J Am Acad Dermatol 2021; 86:1111-1112. [PMID: 33795146 DOI: 10.1016/j.jaad.2021.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 02/04/2021] [Accepted: 02/14/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Stephanie Bayers
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Meredith Orseth
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Smriti Prasad
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Linda S Hynan
- Departments of Population and Data Sciences, Division of Biostatistics and Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Emily Berry
- Moncrief Cancer Institute, Fort Worth, Texas
| | - Keith Argenbright
- Moncrief Cancer Institute, Fort Worth, Texas; Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stephanie Savory
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Chiu YE, Shmuylovich L, Kiguradze T, Anderson K, Sibbald C, Tollefson M, Kunzler E, Tom WL, Bond K, Ahmad RC, Garcia-Romero MT, Irfan M, Kollman K, Hunt R, Stein SL, Arkin L, Wong V, Pope E, Jacobe H, Brandling-Bennett HA, Cordoro KM, Bercovitch L, Rangel SM, Liu X, Szabo A, Paller AS. Body site distribution of pediatric-onset morphea and association with extracutaneous manifestations. J Am Acad Dermatol 2021; 85:38-45. [PMID: 33689776 DOI: 10.1016/j.jaad.2021.03.017] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The distribution of pediatric-onset morphea and site-based likelihood for extracutaneous complications has not been well characterized. OBJECTIVE To characterize the lesional distribution of pediatric-onset morphea and to determine the sites with the highest association of extracutaneous manifestations. METHODS A retrospective cross-sectional study was performed. Using clinical photographs, morphea lesions were mapped onto body diagrams using customized software. RESULTS A total of 823 patients with 2522 lesions were included. Lesions were more frequent on the superior (vs inferior) anterior aspect of the head and extensor (vs flexor) extremities. Linear morphea lesions were more likely on the head and neck, whereas plaque and generalized morphea lesions were more likely on the trunk. Musculoskeletal complications were more likely with lesions on the extensor (vs flexor) extremity (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.2-3.4), whereas neurologic manifestations were more likely with lesions on the anterior (vs posterior) (OR, 2.8; 95% CI, 1.7-4.6) and superior (vs inferior) aspect of the head (OR, 2.3; 95% CI, 1.6-3.4). LIMITATIONS Retrospective nature and the inclusion of only patients with clinical photographs. CONCLUSION The distribution of pediatric-onset morphea is not random and varies with body site and within individual body sites. The risk stratification of extracutaneous manifestations by body site may inform decisions about screening for extracutaneous manifestations, although prospective studies are needed.
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Affiliation(s)
- Yvonne E Chiu
- Departments of Dermatology and Pediatrics, Section of Pediatric Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Leonid Shmuylovich
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
| | - Tina Kiguradze
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Cathryn Sibbald
- The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Megha Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Elaine Kunzler
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas
| | - Wynnis L Tom
- Departments of Dermatology and Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, California
| | - Kelsie Bond
- Department of Pediatrics, Division of Dermatology, Seattle Children's Hospital and University of Washington, San Francisco, California
| | - Regina-Celeste Ahmad
- Department of Dermatology, Section of Pediatric Dermatology, University of California San Francisco, San Francisco, California
| | | | - Mahwish Irfan
- Department of Dermatology, Nationwide Children's Hospital, Columbus, Ohio
| | - Kaitlyn Kollman
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Raegan Hunt
- Departments of Dermatology and Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Sarah L Stein
- Departments of Medicine and Pediatrics, Section of Dermatology, University of Chicago, Chicago, Illinois
| | - Lisa Arkin
- Departments of Dermatology and Pediatrics, University of Wisconsin, Madison, Wisconsin
| | - Vivian Wong
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Elena Pope
- The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas
| | - Heather A Brandling-Bennett
- Department of Pediatrics, Division of Dermatology, Seattle Children's Hospital and University of Washington, San Francisco, California
| | - Kelly M Cordoro
- Department of Dermatology, Section of Pediatric Dermatology, University of California San Francisco, San Francisco, California
| | - Lionel Bercovitch
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Stephanie M Rangel
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xuerong Liu
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Orfaly VE, Berry EG, Stoos ER, Latour E, Becevic M, Black SM, Ferris LK, Geller A, Jacobe H, Nelson KC, Prasad S, Savory S, Smith EH, Swetter SM, Weinstock MA, Xu S, Leachman SA. Melanoma toolkit for early detection for primary care providers: A pilot study. Pigment Cell Melanoma Res 2021; 34:984-986. [PMID: 33638298 PMCID: PMC8647840 DOI: 10.1111/pcmr.12968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/28/2021] [Accepted: 02/16/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Victoria E Orfaly
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Elizabeth G Berry
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Elizabeth R Stoos
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Emile Latour
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Mirna Becevic
- Department of Dermatology, University of Missouri School of Medicine, Columbia, MO, USA
| | - Samantha M Black
- Department of Dermatology, University of Texas Southwestern Medical Center, Houston, TX, USA
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alan Geller
- Department of Public Health Practice, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kelly C Nelson
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Smriti Prasad
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Stephanie Savory
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Emily H Smith
- Department of Dermatology, University of Missouri School of Medicine, Columbia, MO, USA
| | - Susan M Swetter
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Palo Alto, CA, USA
| | - Martin A Weinstock
- Department of Dermatology, Providence VA Medical Center and Brown University, Providence, RI, USA
| | - Shuai Xu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sancy A Leachman
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
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20
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Arthur M, Fett NM, Latour E, Jacobe H, Kunzler E, Florez-Pollack S, Houser J, Sharma S, Prasad S, Femia A, Stern MJ, Pappas-Taffer LK, Gaffney R, Fernandez AP, Knabel D, Cardones AR, Leung N, Laumann A, Yu JM, Zhao J, Vleugels RA, Tkachenko E, Lo K. Evaluation of the Effectiveness and Tolerability of Mycophenolate Mofetil and Mycophenolic Acid for the Treatment of Morphea. JAMA Dermatol 2020; 156:521-528. [PMID: 32236497 PMCID: PMC7113833 DOI: 10.1001/jamadermatol.2020.0035] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance First-line systemic therapy for morphea includes methotrexate with or without systemic corticosteroids. When this regimen is ineffective, not tolerated, or contraindicated, a trial of mycophenolate mofetil (MMF) or mycophenolic acid (MPA)-referred to herein as mycophenolate-is recommended; however, evidence to support this recommendation remains weak. Objective To evaluate the effectiveness and tolerability of mycophenolate for the treatment of morphea. Design, Setting, and Participants A retrospective cohort study was conducted from January 1, 1999, to December 31, 2018, among 77 patients with morphea from 8 institutions who were treated with mycophenolate. Main Outcomes and Measures The primary outcome was morphea disease activity, severity, and response at 0, 3 to 6, and 9 to 12 months of mycophenolate treatment. A secondary outcome was whether mycophenolate was a well-tolerated treatment of morphea. Results There were 61 female patients (79%) and 16 male patients (21%) in the study, with a median age at disease onset of 36 years (interquartile range, 16-53 years) and median diagnostic delay of 8 months (interquartile range, 4-14 months). Generalized morphea (37 [48%]), pansclerotic morphea (12 [16%]), and linear morphea of the trunk and/or extremities (9 [12%]) were the most common subtypes of morphea identified. Forty-one patients (53%) had an associated functional impairment, and 49 patients (64%) had severe disease. Twelve patients received initial treatment with mycophenolate as monotherapy or combination therapy and 65 patients received mycophenolate after prior treatment was ineffective (50 of 65 [77%]) or poorly tolerated (21 of 65 [32%]). Treatments prior to mycophenolate included methotrexate (48 of 65 [74%]), systemic corticosteroids (42 of 65 [65%]), hydroxychloroquine (20 of 65 [31%]), and/or phototherapy (14 of 65 [22%]). After 3 to 6 months of mycophenolate treatment, 66 of 73 patients had stable (n = 22) or improved (n = 44) disease. After 9 to 12 months of treatment, 47 of 54 patients had stable (n = 14) or improved (n = 33) disease. Twenty-seven patients (35%) achieved disease remission at completion of the study. Treatments received in conjunction with mycophenolate were frequent. Mycophenolate was well tolerated. Gastrointestinal adverse effects were the most common (24 [31%]); cytopenia (3 [4%]) and infection (2 [3%]) occurred less frequently. Conclusions and Relevance This study suggests that mycophenolate is a well-tolerated and beneficial treatment of recalcitrant, severe morphea.
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Affiliation(s)
- Megan Arthur
- Department of Dermatology, University of Nebraska, Omaha
| | - Nicole M Fett
- Department of Dermatology, Oregon Health & Science University, Portland
| | - Emile Latour
- Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern, Dallas
| | - Elaine Kunzler
- Department of Dermatology, University of Texas Southwestern, Dallas
| | | | - Jacob Houser
- Department of Dermatology, University of Texas Southwestern, Dallas
| | - Shivani Sharma
- Department of Dermatology, University of Texas Southwestern, Dallas
| | - Smriti Prasad
- Department of Dermatology, University of Texas Southwestern, Dallas
| | - Alisa Femia
- Department of Dermatology, New York University Langone Medical Center, New York
| | - Marleigh J Stern
- Department of Dermatology, New York University Langone Medical Center, New York
| | | | - Rebecca Gaffney
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | | | - Daniel Knabel
- Department of Dermatology, The Cleveland Clinic, Cleveland, Ohio
| | | | - Nicole Leung
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Anne Laumann
- Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Jeong Min Yu
- Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Jeffrey Zhao
- Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elizabeth Tkachenko
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kelly Lo
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
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Mirizio E, Tabib T, Wang X, Chen W, Liu C, Lafyatis R, Jacobe H, Torok KS. Single-cell transcriptome conservation in a comparative analysis of fresh and cryopreserved human skin tissue: pilot in localized scleroderma. Arthritis Res Ther 2020; 22:263. [PMID: 33168063 PMCID: PMC7654179 DOI: 10.1186/s13075-020-02343-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/04/2020] [Indexed: 01/15/2023] Open
Abstract
Background The purpose of this study was to assess variability in cell composition and cell-specific gene expression in the skin of patients with localized scleroderma (LS) utilizing CryoStor® CS10 in comparison to RPMI to produce adequate preservation of tissue samples and cell types of interest for use in large-scale multi-institutional collaborations studying localized scleroderma and other skin disorders. Methods We performed single-cell RNA sequencing on paired skin biopsy specimens from 3 patients with LS. Each patient with one sample cryopreserved in CryoStor® CS10 and one fresh in RPMI media using 10× Genomics sequencing. Results Levels of cell viability and yield were comparable between CryoStor® CS10 (frozen) and RPMI (fresh) preserved cells. Furthermore, gene expression between preservation methods was collectively significantly correlated and conserved across all 18 identified cell cluster populations. Conclusion Comparable cell population and transcript expression yields between CryoStor® CS10 and RPMI preserved cells support the utilization of cryopreserved skin tissue in single-cell analysis. This suggests that employing standardized cryopreservation protocols for the skin tissue will help facilitate multi-site collaborations looking to identify mechanisms of disease in disorders characterized by cutaneous pathology.
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Affiliation(s)
- Emily Mirizio
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tracy Tabib
- Division of Rheumatology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xinjun Wang
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wei Chen
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christopher Liu
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Lafyatis
- Division of Rheumatology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kathryn S Torok
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA. .,Division of Rheumatology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. .,University of Pittsburgh Medical Center Children's Hospital of Pittsburgh Faculty Pavilion, 3rd floor, Office 3117 4401 Penn Avenue, PA, 15237, Pittsburgh, USA.
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22
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Saag KG, de Villiers TJ, Alexandersen P, Jacobe H, Kovarik C, Werth VP, Leung A, Desai-Merchant A, Mattaliano J, Gurner D. Morphea-like skin lesions reported in the phase 3 Long-Term Odanacatib Fracture Trial (LOFT) in postmenopausal women with osteoporosis. J Am Acad Dermatol 2020; 84:1113-1119. [PMID: 32553680 DOI: 10.1016/j.jaad.2020.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Kenneth G Saag
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Tobias J de Villiers
- Mediclinic Panorama and Department of Obstetrics and Gynaecology, University of Stellenbosch, Cape Town, South Africa
| | | | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Carrie Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Victoria P Werth
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Abstract
There is a long history of utilization of phototherapy for treatment of skin conditions. Because of its longer wavelength, UVA1 phototherapy is able to penetrate into the dermis and subcutis. This depth of penetration, combined with its unique immunomodulating properties, makes UVA1 an effective treatment modality for many immune-mediated skin diseases. In some cases, it performs better than other types of phototherapy.
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Affiliation(s)
- Smriti Prasad
- University of Texas at Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9069, USA
| | - Jennifer Coias
- University of Texas at Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9069, USA
| | - Henry W Chen
- University of Texas at Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9069, USA
| | - Heidi Jacobe
- University of Texas at Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9069, USA.
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Sadeghpour M, Sung SM, Jacobe H, Kimball AB. Career satisfaction of leaders in academic dermatology: Results from a national survey. Int J Womens Dermatol 2020; 6:25-29. [PMID: 32025557 PMCID: PMC6997821 DOI: 10.1016/j.ijwd.2019.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/08/2019] [Accepted: 09/11/2019] [Indexed: 11/26/2022] Open
Abstract
Background A positive correlation between leadership roles and job satisfaction has been noted in some areas of business. Since senior leaders in academic dermatology appear to be more satisfied than their junior colleagues, a similar relationship may be important in dermatology. Objective To determine if there is an association between leadership roles and career satisfaction of academic dermatologists. Methods A cross-sectional, anonymous survey was mailed to 1263 academic dermatologists across the US. Participants were questioned on demographics and career satisfaction. Academic rank and position was compared with career satisfaction. Results The leadership cohort was comprised of 140 (77%) men and 41 (23%) women (p < 0.01). Leaders were significantly more satisfied in their careers than non-leaders (65% versus 36%, p < 0.01), and were also less likely to leave academia. Factors related to career satisfaction included satisfaction with the promotion process (p < 0.01), presence of career development programs (p < 0.02), physician health (p < 0.01), and the ability to achieve balance in one's personal and professional lives (p = 0.01). Our analysis also demonstrated a gender gap within the leadership sector, with female leaders reporting less satisfaction overall with their career (44% versus 71%, p < 0.01), with the tenure/promotion process at their institutions (89% vs. 68%, respectively, p < 0.01), as well as their personal and professional balance (49% vs. 80%, p < 0.01) compared to their male leaders counterparts respectively. However, there was no difference in the likelihood of leaving academia between male and female leaders. Conclusion Academic leaders overall had higher career satisfaction than non-leaders, and were more likely to stay within academia. Despite this, patterns of gender disparities in the academic dermatology leadership persist with males outnumbering females in the leadership pool, and male leaders reporting higher levels of satisfaction compared to their female counterparts, as well as perceiving fewer challenges in finding balance between their personal and professional lives.
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Affiliation(s)
- Mona Sadeghpour
- University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, United States
| | - Sarah M Sung
- The Polyclinic, Department of Dermatology, Seattle, WA, United States
| | - Heidi Jacobe
- Department of Dermatology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Alexa B Kimball
- CLEARS, Department of Dermatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
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Kourosh AS, Vasquez R, Osoro M, Jacobe H. Carpal tunnel syndrome as an early finding in systemic sclerosis: An algorithm for referral prior to surgical intervention. Int J Womens Dermatol 2019. [DOI: 10.1016/j.ijwd.2019.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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26
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O'Brien J, Goldman S, Jacobe H. 628 Magnetic resonance imaging for assessment of disease activity in morphea. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Shmuylovich L, Paller A, Kiguradze T, Anderson K, Sibbald C, Tollefson M, Kunzler E, Tom W, Hedlund K, Ahmad R, Garcia-Romero M, Irfan M, Kollman K, Hunt R, Stein S, Arkin L, Wong V, Pope E, Jacobe H, Brandling-Bennet H, Cordoro K, Bercovitch L, Chiu Y. 385 Patterning of linear morphea on the face and neck: Blaschkoid or not? J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kunzler E, Florez-Pollack S, Teske N, O'Brien J, Prasad S, Jacobe H. Linear morphea: Clinical characteristics, disease course, and treatment of the Morphea in Adults and Children cohort. J Am Acad Dermatol 2019; 80:1664-1670.e1. [PMID: 31005342 DOI: 10.1016/j.jaad.2019.01.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 08/22/2018] [Revised: 12/05/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Prospective, longitudinal studies examining the features of linear morphea are limited. OBJECTIVE To utilize the Morphea in Adults and Children cohort to determine clinical characteristics, impact on life quality, and disease course of linear morphea in a prospective, longitudinal manner. METHODS Characteristics of linear morphea versus other subtypes were compared in a cross-sectional manner. Next, linear morphea participants were examined in depth over a 3-year period. RESULTS Linear morphea was the most common morphea subtype (50.1%, 291/581) in the cohort. Deep involvement was more common in linear (64.3%, 187/291) than other morphea subtypes. Linear morphea participants with deep involvement were more likely to have a limitation in range of motion (28.6%, 55/192) than those without (11.1%, 11/99, P < .001). Adult-onset disease occurred in 32.6% (95/291) of those with linear morphea. Frequency of deep involvement was similar between pediatric (66.8%, 131/196) and adult-onset linear morphea (58.9%, 56/95, P = .19). Quality of life and disease activity scores improved over time, while damage stabilized with treatment. LIMITATIONS Results of the study are associative, and the University of Texas Southwestern Medical Center is a tertiary referral center. CONCLUSION A substantial number of linear morphea patients have adult-onset disease. In all age groups, linear morphea with deep involvement was associated with functional limitations.
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Affiliation(s)
- Elaine Kunzler
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas; Northeast Ohio Medical University, Rootstown, Ohio
| | | | - Noelle Teske
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jack O'Brien
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Smriti Prasad
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Li SC, Li X, Pope E, Stewart K, Higgins GC, Rabinovich CE, O’Neil KM, Haines KA, Laxer RM, Punaro M, Jacobe H, Andrews T, Wittkowski K, Nyirenda T, Foeldvari I, Torok KS. New Features for Measuring Disease Activity in Pediatric Localized Scleroderma. J Rheumatol 2018; 45:1680-1688. [DOI: 10.3899/jrheum.171381] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 11/22/2022]
Abstract
Objective.To identify clinical features that define disease activity in pediatric localized scleroderma (LS), and determine their specificity and importance.Methods.We conducted a multicenter prospective study of patients with active and inactive LS skin lesions. A standardized evaluation of a single designated study lesion per subject was performed at 3 visits. We evaluated the pattern and correlation between assessed features and physician’s global assessments of activity (PGA-A).Results.Ninety of 103 subjects had evaluable data; 66 had active and 24 inactive disease. Subjects had similar age of onset, sex, and disease patterns. Linear scleroderma was the most common subtype. Features specific for active disease included erythema, violaceous color, tactile warmth, abnormal skin texture, and disease extension. Scores for these variables changed over time and correlated with PGA-A of the lesion. Active and inactive lesions could not be distinguished by the presence or level of skin thickening, either of lesion edge or center. However, in active lesions, skin thickening scores did correlate with PGA–A scores. Regression analysis identified the combination of erythema, disease extension, violaceous color, skin thickening, and abnormal texture as predictive of PGA-A at study entry. Damage features were common irrespective of activity status.Conclusion.We identified variables strongly associated with disease activity, expanding upon those used in current measures, and determined their relative importance in physician activity scoring. Skin thickening was found to lack specificity for disease activity. These results will help guide development of a sensitive, responsive activity tool to improve care of patients with LS.
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Teske N, Jacobe H. 598 Using the localized scleroderma cutaneous assessment tool to classify morphea by severity and identify clinically significant change in disease. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.606] [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: 10/17/2022]
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Teske N, Welser J, Jacobe H. Skin mapping for the classification of generalized morphea. J Am Acad Dermatol 2018; 78:351-357. [DOI: 10.1016/j.jaad.2016.08.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 08/19/2016] [Accepted: 08/24/2016] [Indexed: 10/18/2022]
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Feetham HJ, Jeong HS, McKesey J, Wickless H, Jacobe H. Skin care and cosmeceuticals: Attitudes and trends among trainees and educators. J Cosmet Dermatol 2017; 17:220-226. [DOI: 10.1111/jocd.12460] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
- H Jill Feetham
- Department of Dermatology; UT Southwestern Medical Center; Dallas TX USA
| | - H Sam Jeong
- Department of Dermatology; UT Southwestern Medical Center; Dallas TX USA
| | - Jacqueline McKesey
- Department of Dermatology; UT Southwestern Medical Center; Dallas TX USA
- Department of Internal Medicine; University of California San Diego; San Diego CA USA
| | - Heather Wickless
- Department of Dermatology; UT Southwestern Medical Center; Dallas TX USA
| | - Heidi Jacobe
- Department of Dermatology; UT Southwestern Medical Center; Dallas TX USA
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Walker D, Susa JS, Currimbhoy S, Jacobe H. Histopathological changes in morphea and their clinical correlates: Results from the Morphea in Adults and Children Cohort V. J Am Acad Dermatol 2017; 76:1124-1130. [PMID: 28285783 DOI: 10.1016/j.jaad.2016.12.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 05/05/2016] [Revised: 12/07/2016] [Accepted: 12/11/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Histopathological features in morphea (localized scleroderma) and their clinical correlates are poorly described. OBJECTIVE We sought to systematically describe histologic changes of morphea in a large, well-annotated cohort and determine the association between histopathology and clinical features. METHODS This was a cross-sectional study of 83 patients enrolled in the Morphea in Adults and Children cohort. The main outcome measure was the association of microanatomical location and degree of sclerosis and inflammation seen on histologic samples with patient-reported symptoms and physician-based measures of severity. RESULTS Pattern of sclerosis was associated with morphea subtype, the presence of patient-reported symptoms, and functional limitation. A bottom-heavy pattern of sclerosis was associated with pain and tightness (P = .0039 and .001, respectively). These symptoms were not associated with a top-heavy pattern. Severe inflammation may be associated with pain and functional limitation (P = .073 for both). LIMITATIONS Small sample size limits ability to detect associations, particularly in subgroups. CONCLUSIONS Histopathological examination of morphea may assist in identifying patients who may require additional monitoring and treatment. Features such as patterns of sclerosis and severity of inflammation should be included in pathology reports to help aid in clinical management.
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Affiliation(s)
- Daniel Walker
- Department of Dermatology, University of Arkansas, Fayetteville, Arkansas
| | - Joseph S Susa
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sharif Currimbhoy
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Felton S, Adinoff B, Jeon-Slaughter H, Jacobe H. The significant health threat from tanning bed use as a self-treatment for psoriasis. J Am Acad Dermatol 2016; 74:1015-7. [PMID: 27085235 DOI: 10.1016/j.jaad.2015.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 09/09/2015] [Accepted: 09/13/2015] [Indexed: 10/21/2022]
Affiliation(s)
- Sarah Felton
- Institute of Inflammation and Repair, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Bryon Adinoff
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas; Mental Health Service, VA North Texas Health Care System, Dallas, Texas
| | | | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Rainwater Y, Jacobe H, Hosler G. LB810 Characterization of cell-type specific expression of CXCR3 ligands in morphea. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.05.064] [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: 10/21/2022]
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Aubert PM, Seibyl JP, Price JL, Harris TS, Filbey FM, Jacobe H, Devous MD, Adinoff B. Dopamine efflux in response to ultraviolet radiation in addicted sunbed users. Psychiatry Res 2016; 251:7-14. [PMID: 27085608 PMCID: PMC5241090 DOI: 10.1016/j.pscychresns.2016.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 04/03/2016] [Accepted: 04/05/2016] [Indexed: 01/21/2023]
Abstract
Compulsive tanning despite awareness of ultraviolet radiation (UVR) carcinogenicity may represent an "addictive" behavior. Many addictive disorders are associated with alterations in dopamine (D2/D3) receptor binding and dopamine reactivity in the brain's reward pathway. To determine if compulsive tanners exhibited neurobiologic responses similar to other addictive disorders, this study assessed basal striatal D2/D3 binding and UVR-induced striatal dopamine efflux in ten addicted and ten infrequent tanners. In a double-blind crossover trial, UVR or sham UVR was administered in separate sessions during brain imaging with single photon emission computerized tomography (SPECT). Basal D2/D3 receptor density and UVR-induced dopamine efflux in the caudate were assessed using (123)I-iodobenzamide ((123)I-IBZM) binding potential non-displaceable (BPnd). Basal BPnd did not significantly differ between addicted and infrequent tanners. Whereas neither UVR nor sham UVR induced significant changes in bilateral caudate BPnd in either group, post-hoc analyses revealed left caudate BPnd significantly decreased (reflecting increased dopamine efflux) in the addicted tanners - but not the infrequent tanners - during the UVR session only. Bilateral ∆BPnd correlated with tanning severity only in the addicted tanners. These preliminary findings are consistent with a stronger neural rewarding response to UVR in addicted tanners, supporting a cutaneous-neural connection driving excessive sunbed use.
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Affiliation(s)
- Pamela M Aubert
- Department of Dermatology, University of Texas Southwestern, Dallas, TX, USA
| | - John P Seibyl
- Institute for Neurodegenerative Disorders, Molecular Neuroimaging, LLC, and Yale University, New Haven, MA, USA
| | - Julianne L Price
- Department of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | - Thomas S Harris
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | | | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern, Dallas, TX, USA
| | - Michael D Devous
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA; Avid Radiopharmaceuticals, Inc, Philadelphia, PA, USA
| | - Bryon Adinoff
- Department of Psychiatry, University of Texas Southwestern, Dallas, TX, USA; VA North Texas Health Care System, Dallas, TX, USA.
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Endo J, Strickland N, Grewal S, Vandergriff T, Keenan T, Longley BJ, Jacobe H. Correspondence: The association between morphea profunda and monoclonal gammopathy: A case series. Dermatol Online J 2016; 22:13030/qt857261f5. [PMID: 27136633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 03/15/2016] [Indexed: 06/05/2023] Open
Abstract
It is known that eosinophilic fasciitis can be associated with monoclonal gammopathy. There is clinical similarity between eosinophilic fasciitis and morphea profunda, but it is unclear whether morphea profunda might be associated with monoclonal gammopathy. The temporal quantification of gammopathy in morphea profunda has not been well characterized. We describe four patients with morphea profunda that were associated with monoclonal gammopathy. Three were associated with monoclonal IgG protein and one with IgM. No patients in our series developed myeloma. In conclusion, the association of monoclonal gammopathy is not unique to eosinophilic fasciitis and scleromyxedema. Further studies are necessary to characterize further the relationship between the two conditions.
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Endo J, Strickland N, Grewal S, Vandergriff T, Keenan T, Longley BJ, Jacobe H. Correspondence: The association between morphea profunda and monoclonal gammopathy: A case series. Dermatol Online J 2016. [DOI: 10.5070/d3223030372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Jacobe H, Ahn C, Arnett FC, Reveille JD. Erratum. Arthritis Rheumatol 2015; 67:751. [PMID: 26340306 DOI: 10.1002/art.39050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In the article by Jacobe et al published in the November 2014 issue of Arthritis & Rheumatology (pages 3170-3177), a row listing the (nonexistent) allele DQA1*03:00 was inadvertently included in Tables 3, 5, and 6, as the result of a typographical error.
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Strickland N, Patel G, Strickland A, Jacobe H. Attitudes and trends in the treatment of morphea: a national survey. J Am Acad Dermatol 2015; 72:727-8. [PMID: 25773412 DOI: 10.1016/j.jaad.2014.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/14/2014] [Accepted: 11/18/2014] [Indexed: 01/01/2023]
Affiliation(s)
- Nicole Strickland
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gopal Patel
- Aesthetic Dermatology Associates, Riddle Hospital, Media, Pennsylvania
| | - Amanda Strickland
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Abstract
BACKGROUND Little is known about the health-related quality of life (HRQoL) of patients with morphoea, and previous studies have yielded conflicting results. OBJECTIVES To determine the impact of morphoea on HRQoL, and clinical and demographic correlates of HRQoL in adults. METHODS This was a cross-sectional survey (n = 73) of the Morphea in Adults and Children cohort. RESULTS Morphoea impairs HRQoL in adults. Patients were most impaired by emotional well-being and concerns that the disease would progress to internal organs. Patients with morphoea had worse skin-specific HRQoL than those with nonmelanoma skin cancer, vitiligo and alopecia (lowest P < 0·01). Participants had significantly worse global HRQoL scores than the general U.S. population for all subscales (all P < 0·01), with the exception of bodily pain. Comorbidity (r = 0·35-0·51, all P < 0·01), and symptoms of pruritus (r = 0·38-0·64, all P < 0·01) and pain (r = 0·46-0·74, all P < 0·01) were associated with impairment in multiple domains of skin-specific and global HRQoL. Physician-based measures of disease severity correlated with patient-reported HRQoL. CONCLUSIONS Patients with morphoea experience a negative impact on HRQoL, particularly if symptoms (pruritus and pain) or concerns regarding internal manifestations are present. Providers should be aware of this when evaluating and treating patients.
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Affiliation(s)
- N K Klimas
- Department of Dermatology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd., Dallas, TX, 75390-9096, U.S.A
| | - A D Shedd
- ProPath Associates, Dallas, TX, U.S.A
| | - I H Bernstein
- Department of Clinical Science, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd., Dallas, TX, 75390-9096, U.S.A
| | - H Jacobe
- Department of Dermatology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd., Dallas, TX, 75390-9096, U.S.A
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Condie D, Grabell D, Jacobe H. Comparison of outcomes in adults with pediatric-onset morphea and those with adult-onset morphea: a cross-sectional study from the morphea in adults and children cohort. Arthritis Rheumatol 2015; 66:3496-504. [PMID: 25156342 DOI: 10.1002/art.38853] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 08/14/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Few studies have examined outcomes in adults with pediatric-onset morphea. The objective of the present study was to compare clinical outcomes and health-related quality of life (HRQOL) in adults with onset of morphea in childhood to those in patients with adult onset of morphea. METHODS Participants in the study were drawn from the Morphea in Adults and Children cohort and included 68 adults with pediatric-onset morphea and 234 patients with adult-onset morphea. Outcome measures included the Localized Scleroderma Cutaneous Assessment Tool (LoSCAT), physical examination findings, and HRQOL questionnaires. RESULTS Adults with pediatric-onset morphea were younger, had longer disease duration, and were more likely to have the linear subtype of morphea. Patients with pediatric-onset disease were less likely to have active disease. Among patients with active disease, those with pediatric-onset morphea had less disease activity as measured by the LoSCAT. Patients with pediatric-onset disease had higher severity of disease damage when measured by the physician's global assessment of damage, but had similar levels of disease damage when measured by the Localized Scleroderma Skin Damage Index. Patients with pediatric-onset disease had more favorable HRQOL scores for all measures, all of which were statistically significantly different from those in patients with adult-onset morphea. CONCLUSION Adults with pediatric-onset morphea differ from patients with adult-onset disease with respect to disease subtype, severity of disease activity and damage, and levels of HRQOL.
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Affiliation(s)
- Daniel Condie
- University of Texas Southwestern Medical Center, Dallas
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Jacobe H, Ahn C, Arnett FC, Reveille JD. Major histocompatibility complex class I and class II alleles may confer susceptibility to or protection against morphea: findings from the Morphea in Adults and Children cohort. Arthritis Rheumatol 2015; 66:3170-7. [PMID: 25223600 DOI: 10.1002/art.38814] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 07/31/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the HLA class I and class II alleles of the human major histocompatibility complex showing an association with morphea (localized scleroderma) in the Morphea in Adults and Children (MAC) cohort, using a nested case-control association study. METHODS Patients with morphea were identified from the MAC cohort, and matched controls were obtained from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases Scleroderma Family Registry and DNA Repository and from the Division of Rheumatology at the University of Texas Health Science Center at Houston. HLA class II genotyping and single-strand conformational polymorphism typing were performed to identify HLA-A, B, and C alleles. Associations between HLA class I and class II alleles and morphea, as well as its subphenotypes, were determined. RESULTS Two hundred eleven patients with morphea and 726 matched controls were available for HLA class I typing, and 158 patients with morphea and 1,008 matched controls were available for HLA class II typing. The strongest associations were found with DRB1*04:04 (odds ratio [OR] 2.3, 95% confidence interval [95% CI] 1.4-4.0, P = 0.002), and HLA-B*37 conferred the highest OR among the class I alleles (OR 3.2, 95% CI 1.5-6.5, P = 0.001). Comparison of the risk allele profile in this cohort with the risk alleles previously identified in patients with systemic sclerosis, determined using the same methods and same control population, revealed one allele in common, DRB*04:04. CONCLUSION These results demonstrate that specific HLA class I and class II alleles are associated with morphea and are also likely to be associated with generalized and linear subtypes of morphea. The morphea-associated alleles are different from those found in scleroderma, suggesting that morphea is immunogenetically distinct. Risk alleles in morphea are also associated with conditions such as rheumatoid arthritis (RA) and other autoimmune conditions. Population-based studies have indicated that patients with RA have an increased risk of morphea, and therefore a common susceptibility allele may be implicated.
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Affiliation(s)
- Heidi Jacobe
- University of Texas Southwestern Medical Center, Dallas
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Grabell D, Hsieh C, Andrew R, Martires K, Kim A, Vasquez R, Jacobe H. The role of skin trauma in the distribution of morphea lesions: a cross-sectional survey of the Morphea in Adults and Children cohort IV. J Am Acad Dermatol 2014; 71:493-8. [PMID: 24880663 DOI: 10.1016/j.jaad.2014.04.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/03/2014] [Accepted: 04/08/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Skin trauma may play a role in the development of morphea lesions. The association between trauma and the distribution of cutaneous lesions has never been examined to our knowledge. OBJECTIVE We sought to determine whether patients enrolled in the Morphea in Adults and Children (MAC) cohort exhibit skin lesions distributed in areas of prior (isotopic) or ongoing (isomorphic) trauma. METHODS This was a cross-sectional analysis of the MAC cohort. RESULTS Of 329 patients in the MAC cohort, 52 (16%) had trauma-associated lesions at the onset of disease. Patients with lesions in an isotopic distribution had greater clinical severity as measured by a clinical outcome measure (mean modified Rodnan Skin Score of 13.8 vs 5.3, P = .004, 95% confidence interval 3.08-13.92) and impact on life quality (mean Dermatology Life Quality Index score 8.4 vs 4.1, P = .009, 95% confidence interval 1.18-7.50) than those with an isomorphic distribution. Most frequent associated traumas were chronic friction (isomorphic) and surgery/isotopic. LIMITATIONS Recall bias for patient-reported events is a limitation. CONCLUSION Of patients in the MAC cohort, 16% developed initial morphea lesions at sites of skin trauma. If these findings can be confirmed in additional series, they suggest that elective procedures and excessive skin trauma or friction might be avoided in these patients.
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Affiliation(s)
- Daniel Grabell
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Clifford Hsieh
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Rachel Andrew
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kathryn Martires
- Department of Dermatology, Kaiser Permanente, Los Angeles, California
| | - Andrew Kim
- Department of Medicine, Lenox Hill Hospital, New York, New York
| | - Rebecca Vasquez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Vasquez R, Jabbar A, Khan F, Buethe D, Ahn C, Jacobe H. Recurrence of morphea after successful ultraviolet A1 phototherapy: A cohort study. J Am Acad Dermatol 2013; 70:481-8. [PMID: 24365168 DOI: 10.1016/j.jaad.2013.10.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 10/07/2013] [Accepted: 10/08/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Studies support efficacy of ultraviolet (UV)A1 phototherapy, but little is known about recurrence after successful UVA1 treatment. OBJECTIVE We sought to determine the frequency of recurrent activity after UVA1 phototherapy and variables associated with recurrence. METHODS This was a case series and prospective cohort study of patients treated with UVA1 phototherapy with minimum 6 months of follow-up. Demographics, clinical features, and cumulative UVA1 dose were analyzed for association with recurrence. RESULTS Of 37 patients, 46% (n = 17) had recurrence of active morphea lesions after successful UVA1 phototherapy. Two-year and 3-year (after the last UVA1 phototherapy treatment) recurrence rates were 44.5% (95% confidence interval 30.1%-62.2%) and 48.4% (95% confidence interval 33.2%-66.1%), respectively. The only variable associated with recurrence was duration of morphea before UVA1 (P value = .02, hazard ratio 1.15, 95% confidence interval 1.06-1.27). LIMITATIONS The sample size limits conclusions. CONCLUSION With the exception of increased duration of morphea, risk of recurrence is no different in adults and children, or between morphea subtypes, skin types, and medium- to high-dose regimens. This indicates treatment doses in the medium-high UVA1 range are adequate with respect to frequency of recurrence.
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Affiliation(s)
- Rebecca Vasquez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aysha Jabbar
- Paul L. Foster School of Medicine, Texas Tech University Health Science Center at El Paso, El Paso, Texas
| | - Fatima Khan
- Paul L. Foster School of Medicine, Texas Tech University Health Science Center at El Paso, El Paso, Texas
| | - Douglas Buethe
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Chul Ahn
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Dharamsi JW, Victor S, Aguwa N, Ahn C, Arnett F, Mayes MD, Jacobe H. Morphea in adults and children cohort III: nested case-control study--the clinical significance of autoantibodies in morphea. JAMA Dermatol 2013; 149:1159-65. [PMID: 23925398 DOI: 10.1001/jamadermatol.2013.4207] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Small studies have implicated the association of specific autoantibodies with morphea subtype or severity, but no large-scale studies have been conducted. This prospective case-control study confirmed the presence of antinuclear antibodies (ANAs) and other autoantibodies in morphea but found they are of limited significance. OBJECTIVE To determine the prevalence of ANAs, extractable nuclear antigens such as antihistone antibodies (AHAs), and anti-single-stranded DNA antibodies (ssDNA abs) in patients with morphea vs a healthy control population and their association with clinical measures of morphea severity. DESIGN, SETTING, AND PARTICIPANTS Nested case-control study, conducted at the University of Texas Southwestern Medical Center, Dallas, and University of Texas Health Science Center, Houston. Study participants included individuals enrolled in the Morphea in Adults and Children (MAC) cohort and Scleroderma Family Registry and DNA Repository. MAIN OUTCOMES AND MEASURES Prevalence of ANAs, AHAs, ssDNA abs in patients with morphea vs matched controls and association of the presence of autoantibodies with clinical indicators of morphea severity. RESULTS The prevalence of ANAs, AHAs, and ssDNA abs in patients with morphea was 34%, 12%, and 8%, respectively. Antinuclear antibodies and AHAs, but not ssDNA abs, were present more frequently in cases than in controls. There was no difference in ANA prevalence among morphea subtypes. Among patients with linear morphea, the presence of autoantibodies was associated with clinical indicators of severe morphea including functional limitation (ssDNA ab, P = .005; and AHA, P = .006), extensive body surface area involvement (ssDNA ab, P = .01; and ANA, P = .005), and higher skin scores (ANA, P = .004). The presence of autoantibodies was not associated with clinical measures of morphea activity. CONCLUSIONS AND RELEVANCE Our results demonstrate that ANAs and AHAs are more prevalent among patients with morphea but are of limited clinical utility except in linear morphea, where their presence, although infrequent, is associated with greater lesion burden and functional impairment.
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Affiliation(s)
- Iona Chapman
- University of Texas Southwestern Medical Center, Dallas, USA
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Johnson W, Jacobe H. Morphea in adults and children cohort II: Patients with morphea experience delay in diagnosis and large variation in treatment. J Am Acad Dermatol 2012; 67:881-9. [DOI: 10.1016/j.jaad.2012.01.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 01/05/2012] [Accepted: 01/08/2012] [Indexed: 10/28/2022]
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