1
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Brandling-Bennett HA, Arkin LM, Chiu YE, Hebert AA, Callen JP, Castelo-Soccio L, Co DO, Cordoro KM, Curran ML, Dalrymple AM, Flohr C, Gordon KB, Hanna D, Irvine AD, Kim S, Kirkorian AY, Lara-Corrales I, Lindstrom J, Paller AS, Reyes M, Begolka WS, Tom WL, Van Voorhees AS, Vleugels RA, Lee LW, Davies O, Siegfried EC. Executive summary: Consensus treatment guidelines for the use of methotrexate for inflammatory skin disease in pediatric patients. J Am Acad Dermatol 2024; 90:1271-1275. [PMID: 38342248 PMCID: PMC11096036 DOI: 10.1016/j.jaad.2023.12.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 02/13/2024]
Affiliation(s)
- Heather A Brandling-Bennett
- Seattle Children's Hospital, Seattle, Washington; Division of Dermatology, Department of Pediatrics, University of Washington, Seattle, Washington.
| | - Lisa M Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Yvonne E Chiu
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Adelaide A Hebert
- Department of Dermatology, UTHealth McGovern Medical School at Houston, Houston, Texas
| | - Jeffrey P Callen
- Department of Dermatology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Leslie Castelo-Soccio
- Dermatology Branch, National Institutes of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Dominic O Co
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Megan L Curran
- Division of Rheumatology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Austin M Dalrymple
- Division of Rheumatology, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri; SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri
| | - Carsten Flohr
- Department of Paediatric Dermatology, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Ken B Gordon
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Alan D Irvine
- Department of Paediatric Dermatology, Trinity College Dublin, Dublin, Ireland
| | - Susan Kim
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - A Yasmine Kirkorian
- Department of Dermatology, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia; Children's National Hospital, Washington, District of Columbia
| | - Irene Lara-Corrales
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jill Lindstrom
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Melissa Reyes
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland
| | | | - Wynnis L Tom
- Departments of Dermatology and Pediatrics, University of California, San Diego School of Medicine, San Diego, California; Rady Children's Hospital-San Diego, San Diego, California
| | - Abby S Van Voorhees
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Ruth Ann Vleugels
- Brigham and Women's Hospital, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Lara Wine Lee
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina
| | - Olivia Davies
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Elaine C Siegfried
- Division of Rheumatology, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri; SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri
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2
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Mohanty C, Prasad A, Cheng L, Arkin LM, Shields BE, Drolet B, Kendziorski C. SpatialView: an interactive web application for visualization of multiple samples in spatial transcriptomics experiments. Bioinformatics 2024; 40:btae117. [PMID: 38444087 PMCID: PMC10957517 DOI: 10.1093/bioinformatics/btae117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/06/2023] [Accepted: 03/04/2024] [Indexed: 03/07/2024] Open
Abstract
MOTIVATION Spatial transcriptomics (ST) experiments provide spatially localized measurements of genome-wide gene expression allowing for an unprecedented opportunity to investigate cellular heterogeneity and organization within a tissue. Statistical and computational frameworks exist that implement robust methods for pre-processing and analyzing data in ST experiments. However, the lack of an interactive suite of tools for visualizing ST data and results currently limits the full potential of ST experiments. RESULTS To fill the gap, we developed SpatialView, an open-source web browser-based interactive application for visualizing data and results from multiple 10× Genomics Visium ST experiments. We anticipate SpatialView will be useful to a broad array of clinical and basic science investigators utilizing ST to study disease. AVAILABILITY AND IMPLEMENTATION SpatialView is available at https://github.com/kendziorski-lab/SpatialView (and https://doi.org/10.5281/zenodo.10223907); a demo application is available at https://www.biostat.wisc.edu/˜kendzior/spatialviewdemo/.
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Affiliation(s)
- Chitrasen Mohanty
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, United States
| | - Aman Prasad
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Lingxin Cheng
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, United States
| | - Lisa M Arkin
- Department of Dermatology, University of Wisconsin-Madison, Madison, WI 53715, United States
| | - Bridget E Shields
- Department of Dermatology, University of Wisconsin-Madison, Madison, WI 53715, United States
| | - Beth Drolet
- Department of Dermatology, University of Wisconsin-Madison, Madison, WI 53715, United States
| | - Christina Kendziorski
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, United States
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3
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Martinez-Cabriales S, Coulombe J, Aaron M, Hussain SH, Linggonegoro D, Lara-Corrales I, Barootes H, Brandling-Bennett H, Covelli I, Kirkorian AY, Shah N, Castelo-Soccio L, McKenzie P, Arkin LM, Heinze A, Liy-Wong C, Travis N, Rieder M, Del Pozzo-Magana BR, Schoch JJ, Monir R, Glick SA, Uwakwe L, Skillman S, Hekman DP, Lethebe BC, Ramien ML. Preliminary summary and reclassification of cases from the Pediatric Research of Management in Stevens-Johnson syndrome and Epidermonecrolysis (PROMISE) study: A North American, multisite retrospective cohort. J Am Acad Dermatol 2024; 90:635-637. [PMID: 37926378 DOI: 10.1016/j.jaad.2023.08.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 08/18/2023] [Accepted: 08/27/2023] [Indexed: 11/07/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - Isabela Covelli
- Seattle Children's Hospital/University of Washington, Seattle, Washington
| | | | - Nidhi Shah
- Children's National Hospital, Washington, DC
| | | | - Paige McKenzie
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lisa M Arkin
- University of Wisconsin-Madison, Madison, Wisconsin
| | - Adam Heinze
- University of Wisconsin-Madison, Madison, Wisconsin
| | - Carmen Liy-Wong
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nicole Travis
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | | | | | | | - Sharon A Glick
- SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Laura Uwakwe
- SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Sarah Skillman
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Dan P Hekman
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Michele L Ramien
- Alberta Children's Hospital, Calgary, Alberta, Canada; University of Calgary, Calgary Alberta, Canada.
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4
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Shaw KS, Rajeh A, Le T, Kahn PJ, Oza VS, Arkin LM, Vleugels RA. Anifrolumab for Adolescent Discoid Lupus Erythematosus. JAMA Netw Open 2023; 6:e2338200. [PMID: 37851448 PMCID: PMC10585408 DOI: 10.1001/jamanetworkopen.2023.38200] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/01/2023] [Indexed: 10/19/2023] Open
Abstract
This case series describes the outcomes among adolescent patients with systemic lupus erythematosus and refractory discoid lupus erythematosus treated with anifrolumab.
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Affiliation(s)
- Katharina S. Shaw
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Section of Dermatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ahmad Rajeh
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Todd Le
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Philip J. Kahn
- Division of Pediatric Rheumatology, Department of Pediatrics, Hassenfeld Children’s Hospital at NYU Langone Health, New York University Grossman School of Medicine, New York
| | - Vikash S. Oza
- Division of Pediatric Rheumatology, Department of Pediatrics, Hassenfeld Children’s Hospital at NYU Langone Health, New York University Grossman School of Medicine, New York
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York
| | - Lisa M. Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Dermatology Program, Division of Immunology, Boston Children’s Hospital, Boston, Massachusetts
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5
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Siegfried EC, Arkin LM, Chiu YE, Hebert AA, Callen JP, Castelo-Soccio L, Co DO, Cordoro KM, Curran ML, Dalrymple AM, Flohr C, Gordon KB, Hanna D, Irvine AD, Kim S, Kirkorian AY, Lara-Corrales I, Lindstrom J, Paller AS, Reyes M, Begolka WS, Tom WL, Van Voorhees AS, Vleugels RA, Lee LW, Davies OMT, Brandling-Bennett HA. Methotrexate for inflammatory skin disease in pediatric patients: Consensus treatment guidelines. Pediatr Dermatol 2023; 40:789-808. [PMID: 37316462 DOI: 10.1111/pde.15327] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/26/2023] [Indexed: 06/16/2023]
Abstract
Methotrexate (MTX) is a readily accessible drug, first used in 1948 and employed for a wide variety of indications since then. However, despite widespread off-label use, FDA labeling does not include approved indications for the use of MTX for many inflammatory skin diseases in pediatric patients, including morphea, psoriasis, atopic dermatitis, and alopecia areata, among others. Without published treatment guidelines, some clinicians may be hesitant to use MTX off-label, or uncomfortable prescribing MTX in this population. To address this unmet need, an expert consensus committee was convened to develop evidence- and consensus-based guidelines for use of MTX to treat pediatric inflammatory skin disease. Clinicians with experience and expertise in clinical research, drug development, and treating inflammatory skin disease in pediatric patients with MTX were recruited. Five committees were created based on major topic areas: (1) indications and contraindications, (2) dosing, (3) interactions with immunizations and medications, (4) adverse effects (potential for and management of), and (5) monitoring needs. Pertinent questions were generated and addressed by the relevant committee. The entire group participated in a modified Delphi process to establish agreement on recommendations for each question. The committee developed 46 evidence- and consensus-based recommendations, each with >70% agreement among members, across all five topics. These are presented in tables and text, along with a discussion of supporting literature, and level of evidence. These evidence- and consensus-based recommendations will support safe and effective use of MTX for the underserved population of pediatric patients who may benefit from this valuable, time-honored medication.
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Affiliation(s)
- Elaine C Siegfried
- SSM Cardinal Glennon Children's Hospital, St. Louis, Missouri, USA
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Lisa M Arkin
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Yvonne E Chiu
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Adelaide A Hebert
- UTHealth McGovern Medical School at Houston, Houston, Texas, United States
| | - Jeffrey P Callen
- University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Leslie Castelo-Soccio
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- University of Pennsylvania Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dominic O Co
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Megan L Curran
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Austin M Dalrymple
- SSM Cardinal Glennon Children's Hospital, St. Louis, Missouri, USA
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Carsten Flohr
- Department of Paediatric Dermatology, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Ken B Gordon
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - Susan Kim
- University of California, San Francisco, California, USA
| | - A Yasmine Kirkorian
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
| | | | - Jill Lindstrom
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Melissa Reyes
- US Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland, USA
| | | | - Wynnis L Tom
- University of California, San Diego School of Medicine, San Diego, California, USA
- Rady Children's Hospital-San Diego, San Diego, California, USA
| | | | - Ruth Ann Vleugels
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lara Wine Lee
- Medical University of South Carolina, Charleston, South Carolina, USA
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6
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Nihal A, Comstock JR, Holland KE, Singh AM, Seroogy CM, Arkin LM. Clearance of atypical cutaneous manifestations of hyper-IgE syndrome with dupilumab. Pediatr Dermatol 2022; 39:940-942. [PMID: 35734823 PMCID: PMC10084161 DOI: 10.1111/pde.15072] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
Abstract
Hyper-IgE syndromes (HIES) are a heterogeneous group of rare primary immunodeficiency diseases classically characterized by the triad of atopic dermatitis, and recurrent cutaneous and pulmonary infections. Autosomal dominant, loss-of-function STAT3 pathogenic variants are the most common genetic cause, which lead to deficiency of Th17 lymphocytes, impaired interferon gamma production, and IL-10 signal transduction, and an unbalanced IL-4 state. Dupilumab, a monoclonal antibody to the IL-4a receptor, inhibits both IL-4 and IL-13, and has been shown to improve atopic dermatitis and other manifestations of HIES including asthma and allergic bronchopulmonary aspergillosis. We present a pediatric patient with HIES who presented predominantly with eosinophilic folliculitis, recurrent cutaneous infections, and other non-eczematous findings and achieved sustained clearance with dupilumab.
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Affiliation(s)
- Aman Nihal
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jeanette R Comstock
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kristen E Holland
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anne Marie Singh
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Division of Allergy, Immunology & Rheumatology, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Christine M Seroogy
- Division of Allergy, Immunology & Rheumatology, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Lisa M Arkin
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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7
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Davies OMT, Ng AT, Tran J, Blumenthal S, Arkin LM, Nopper AJ, Cottrell CE, Garzon M, Siegel DH, Frieden IJ, Drolet BA. Early-onset hypertension associated with extensive cutaneous capillary malformations harboring postzygotic variants in GNAQ and GNA11. Pediatr Dermatol 2022; 39:914-919. [PMID: 36440997 PMCID: PMC10087926 DOI: 10.1111/pde.15103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/22/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Cutaneous capillary malformations (CMs) describe a group of vascular birthmarks with heterogeneous presentations. CMs may present as an isolated finding or with other associations, including glaucoma and leptomeningeal angiomatosis (i.e., Sturge-Weber syndrome) or pigmentary birthmarks (i.e., phakomatosis pigmentovascularis). The use of targeted genetic sequencing has revealed that postzygotic somatic variations in GNAQ and GNA11 at codon 183 are associated with CMs. We report five patients with early-onset hypertension and discuss possible pathogenesis of hypertension. METHODS Twenty-nine patients with CMs, confirmed GNAQ/11 postzygotic variants, and documented past medical history were identified from a multi-institutional vascular anomalies study. Early-onset hypertension was defined as hypertension before the age of 55 years. Clinical data were reviewed for evidence of hypertension, such as documentation of diagnosis or elevated blood pressure measurements. RESULTS Five of the 29 patients identified as having GNAQ/11 postzygotic variants had documented early-onset hypertension. Three individuals harbored a GNAQ p.R183Q variant, and two individuals harbored a GNA11 p.R183C variant. All individuals had extensive cutaneous CMs involving the trunk and covering 9%-56% of their body surface area. The median age of hypertension diagnosis was 15 years (range 11-24 years), with three individuals having renal abnormalities on imaging. CONCLUSIONS Early-onset hypertension is associated with extensive CMs harboring somatic variations in GNAQ/11. Here, we expand on the GNAQ/11 phenotype and hypothesize potential mechanisms driving hypertension. We recommend serial blood pressure measurements in patients with extensive CMs on the trunk and extremities to screen for early-onset hypertension.
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Affiliation(s)
- Olivia M T Davies
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashley T Ng
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jennifer Tran
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Shoshana Blumenthal
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lisa M Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Amy J Nopper
- Department of Dermatology, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Catherine E Cottrell
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA.,Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Maria Garzon
- Department of Dermatology, Columbia University, New York, New York, USA
| | - Dawn H Siegel
- Departments of Dermatology and (by courtesy) Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ilona J Frieden
- Department of Dermatology, University of California-San Francisco, San Francisco, California, USA
| | - Beth A Drolet
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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8
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Ng AT, Moon JJ, Steidl OR, Bussan H, Tran JM, Luong G, Nihal A, Kenfield M, Frere J, TenOever BR, Costa da Silva AC, Mays JW, Cowen EW, Drolet BA, Singh AM, Arkin LM. Pernio and early SARS-CoV-2 variants: natural history of a prospective cohort and the role of interferon. Br J Dermatol 2022; 187:617-619. [PMID: 35653263 PMCID: PMC9347790 DOI: 10.1111/bjd.21693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/18/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Abstract
Cases of new-onset pernio and recurrences in our cohort align tightly with trends in mean 7-day COVID-19 positivity in Wisconsin and mean temperature in Madison, Wisconsin by month.
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Affiliation(s)
- Ashley T. Ng
- Department of Dermatology, School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - John J. Moon
- Department of Dermatology, School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Olivia R. Steidl
- Division of Allergy & Immunology, Department of Pediatrics, School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Hailey Bussan
- Department of Pathology and Laboratory Medicine, School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Jennifer M. Tran
- Department of Dermatology, School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - George Luong
- Department of Dermatology, School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Aman Nihal
- Department of Dermatology, School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Meaghan Kenfield
- Department of Dermatology, School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Justin Frere
- Department of MicrobiologyNew York University, Langone HealthNew YorkNY10016USA
| | | | | | | | | | - Beth A. Drolet
- Department of Dermatology, School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Anne Marie Singh
- Division of Allergy & Immunology, Department of Pediatrics, School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Lisa M. Arkin
- Department of Dermatology, School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWIUSA
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9
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Bolze A, Mogensen TH, Zhang SY, Abel L, Andreakos E, Arkin LM, Borghesi A, Brodin P, Hagin D, Novelli G, Okada S, Peter J, Renia L, Severe K, Tiberghien P, Vinh DC, Cirulli ET, Casanova JL, Hsieh EWY. Decoding the Human Genetic and Immunological Basis of COVID-19 mRNA Vaccine-Induced Myocarditis. J Clin Immunol 2022; 42:1354-1359. [PMID: 36207567 PMCID: PMC9546418 DOI: 10.1007/s10875-022-01372-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/23/2022] [Indexed: 11/14/2022]
Affiliation(s)
| | - Trine H Mogensen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Shen-Ying Zhang
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- Université Paris Cité, Imagine Institute, Paris, France
| | - Laurent Abel
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- Université Paris Cité, Imagine Institute, Paris, France
| | - Evangelos Andreakos
- Laboratory of Immunobiology, Center of Clinical Research, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Lisa M Arkin
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Alessandro Borghesi
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Petter Brodin
- SciLifeLab, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - David Hagin
- Allergy and Clinical Immunology Unit, Department of Medicine, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, University of Tel-Aviv, Tel-Aviv, Israel
| | - Giuseppe Novelli
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133, Rome, Italy
| | - Satoshi Okada
- Department of Pediatrics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Jonny Peter
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Cape Town, Cape Town, South Africa
| | - Laurent Renia
- A*STAR Infectious Diseases Labs, Agency for Science, Technology and Research, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore, Singapore
| | - Karine Severe
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Pierre Tiberghien
- Etablissement Francais du Sang, La Plaine-St Denis, France
- UMR 1098 RIGHT, Inserm EFS, Université de Franche-Comté, Besançon, France
| | - Donald C Vinh
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
- Infectious Disease Susceptibility Program, Research Institute, McGill University Health Centre, Montréal, Québec, Canada
| | | | | | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- Université Paris Cité, Imagine Institute, Paris, France
- Department of Pediatrics, Necker Hospital for Sick Children, Paris, France
- Howard Hughes Medical Institute, New York, NY, USA
| | - Elena W Y Hsieh
- Department of Pediatrics, Section of Allergy and Immunology, University of Colorado Anschutz Medical Campus, School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
- Department of Immunology and Microbiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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10
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Li JC, Arkin LM, Makhija MM, Singh AM. Prevalence of food allergy diagnosis in pediatric patients with atopic dermatitis referred to allergy and/or dermatology subspecialty clinics. J Allergy Clin Immunol Pract 2022; 10:2469-2471. [PMID: 35690370 DOI: 10.1016/j.jaip.2022.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/05/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Jennifer Chen Li
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Lisa M Arkin
- Department of Dermatology, University of Wisconsin-Madison, Madison, Wis
| | - Melanie M Makhija
- Department of Pediatrics, Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital and Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Anne Marie Singh
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of Wisconsin-Madison, Madison, Wis.
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11
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Carmona-Rivera C, Zhang Y, Dobbs K, Markowitz TE, Dalgard CL, Oler AJ, Claybaugh DR, Draper D, Truong M, Delmonte OM, Licciardi F, Ramenghi U, Crescenzio N, Imberti L, Sottini A, Quaresima V, Fiorini C, Discepolo V, Lo Vecchio A, Guarino A, Pierri L, Catzola A, Biondi A, Bonfanti P, Poli Harlowe MC, Espinosa Y, Astudillo C, Rey-Jurado E, Vial C, de la Cruz J, Gonzalez R, Pinera C, Mays JW, Ng A, Platt A, Drolet B, Moon J, Cowen EW, Kenney H, Weber SE, Castagnoli R, Magliocco M, Stack MA, Montealegre G, Barron K, Fink DL, Kuhns DB, Hewitt SM, Arkin LM, Chertow DS, Su HC, Notarangelo LD, Kaplan MJ. Multicenter analysis of neutrophil extracellular trap dysregulation in adult and pediatric COVID-19. JCI Insight 2022; 7:160332. [PMID: 35852866 PMCID: PMC9534551 DOI: 10.1172/jci.insight.160332] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/14/2022] [Indexed: 12/02/2022] Open
Abstract
Dysregulation in neutrophil extracellular trap (NET) formation and degradation may play a role in the pathogenesis and severity of COVID-19; however, its role in the pediatric manifestations of this disease, including multisystem inflammatory syndrome in children (MIS-C) and chilblain-like lesions (CLLs), otherwise known as “COVID toes,” remains unclear. Studying multinational cohorts, we found that, in CLLs, NETs were significantly increased in serum and skin. There was geographic variability in the prevalence of increased NETs in MIS-C, in association with disease severity. MIS-C and CLL serum samples displayed decreased NET degradation ability, in association with C1q and G-actin or anti-NET antibodies, respectively, but not with genetic variants of DNases. In adult COVID-19, persistent elevations in NETs after disease diagnosis were detected but did not occur in asymptomatic infection. COVID-19–affected adults displayed significant prevalence of impaired NET degradation, in association with anti-DNase1L3, G-actin, and specific disease manifestations, but not with genetic variants of DNases. NETs were detected in many organs of adult patients who died from COVID-19 complications. Infection with the Omicron variant was associated with decreased NET levels when compared with other SARS-CoV-2 strains. These data support a role for NETs in the pathogenesis and severity of COVID-19 in pediatric and adult patients.
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Affiliation(s)
- Carmelo Carmona-Rivera
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
| | - Yu Zhang
- Human Immunological Diseases Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID); and
| | | | | | - Clifton L. Dalgard
- Department of Anatomy, Physiology & Genetics, School of Medicine, and the American Genome Center, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA
| | - Andrew J. Oler
- Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, NIAID, NIH, Bethesda, Maryland, USA
| | - Dillon R. Claybaugh
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
| | | | | | | | | | - Ugo Ramenghi
- Department of Public Health and Pediatric Sciences and
| | - Nicoletta Crescenzio
- Pediatric Hematology, “Regina Margherita” Children Hospital, University of Turin, Turin, Italy
| | - Luisa Imberti
- Centro di Ricerca Emato-oncologica AIL, Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alessandra Sottini
- Centro di Ricerca Emato-oncologica AIL, Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Virginia Quaresima
- Centro di Ricerca Emato-oncologica AIL, Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Chiara Fiorini
- Centro di Ricerca Emato-oncologica AIL, Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Valentina Discepolo
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Alfredo Guarino
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Luca Pierri
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Andrea Catzola
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Andrea Biondi
- Department of Pediatrics, University of Milano-Bicocca, European Reference Network (ERN) PaedCan, EuroBloodNet, MetabERN, Fondazione MBBM/Ospedale San Gerardo, Monza, Italy
| | - Paolo Bonfanti
- Department of Infectious Diseases, San Gerardo Hospital–University of Milano-Bicocca, Monza, Italy
| | - Maria C. Poli Harlowe
- Programa de Inmunogenética e Inmunología Traslacional, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Hospital Roberto del Rio, Santiago, Chile
| | | | | | - Emma Rey-Jurado
- Programa de Inmunogenética e Inmunología Traslacional, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Cecilia Vial
- Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Programa Hantavirus, Instituto de Ciencias e Innovación en Medicina, Santiago, Chile
| | - Javiera de la Cruz
- Programa de Inmunogenética e Inmunología Traslacional, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Ricardo Gonzalez
- Pediatric Intensive Care Unit, Hospital Exequiel Gonzalez Cortés, Santiago, Chile
| | - Cecilia Pinera
- Infectious Diseases Unit, Hospital Dr. Exequiel González Cortés, Región Metropolitana, Chile
- Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Jacqueline W. Mays
- National Institute of Dental and Craniofacial Research (NIDCR), NIH, Bethesda, Maryland, USA
| | - Ashley Ng
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Andrew Platt
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, and Laboratory of Immunoregulation, NIAID, NIH, Bethesda, Maryland, USA
| | | | | | - Beth Drolet
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - John Moon
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | | | | | | | - Mary Magliocco
- Molecular Development of the Immune System Section, Laboratory of Immune System Biology, NIAID; and
| | - Michael A. Stack
- Molecular Development of the Immune System Section, Laboratory of Immune System Biology, NIAID; and
| | - Gina Montealegre
- Division of Clinical Research, NIAID, NIH, Bethesda, Maryland, USA
| | - Karyl Barron
- Division of Clinical Research, NIAID, NIH, Bethesda, Maryland, USA
| | - Danielle L. Fink
- Applied/Developmental Research Directorate, Frederick and National Laboratory for Cancer Research, National Cancer Institute (NCI), NIH, Frederick, Maryland, USA
| | - Douglas B. Kuhns
- Applied/Developmental Research Directorate, Frederick and National Laboratory for Cancer Research, National Cancer Institute (NCI), NIH, Frederick, Maryland, USA
| | - Stephen M. Hewitt
- Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, USA
| | - Lisa M. Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Daniel S. Chertow
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, and Laboratory of Immunoregulation, NIAID, NIH, Bethesda, Maryland, USA
| | - Helen C. Su
- Human Immunological Diseases Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID); and
| | | | - Mariana J. Kaplan
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
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12
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Ni Z, Prasad A, Chen S, Halberg RB, Arkin LM, Drolet BA, Newton MA, Kendziorski C. SpotClean adjusts for spot swapping in spatial transcriptomics data. Nat Commun 2022; 13:2971. [PMID: 35624112 PMCID: PMC9142522 DOI: 10.1038/s41467-022-30587-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/10/2022] [Indexed: 01/22/2023] Open
Abstract
Spatial transcriptomics is a powerful and widely used approach for profiling the gene expression landscape across a tissue with emerging applications in molecular medicine and tumor diagnostics. Recent spatial transcriptomics experiments utilize slides containing thousands of spots with spot-specific barcodes that bind RNA. Ideally, unique molecular identifiers (UMIs) at a spot measure spot-specific expression, but this is often not the case in practice due to bleed from nearby spots, an artifact we refer to as spot swapping. To improve the power and precision of downstream analyses in spatial transcriptomics experiments, we propose SpotClean, a probabilistic model that adjusts for spot swapping to provide more accurate estimates of gene-specific UMI counts. SpotClean provides substantial improvements in marker gene analyses and in clustering, especially when tissue regions are not easily separated. As demonstrated in multiple studies of cancer, SpotClean improves tumor versus normal tissue delineation and improves tumor burden estimation thus increasing the potential for clinical and diagnostic applications of spatial transcriptomics technologies.
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Grants
- R01 GM102756 NIGMS NIH HHS
- P30 CA014520 NCI NIH HHS
- P50 HD105353 NICHD NIH HHS
- UL1 TR002373 NCATS NIH HHS
- P50 CA278595 NCI NIH HHS
- NIH GM102756 (Z.N., C.K.), NIH UL1TR002373 (A.P., B.A.D.), 2020 UW-ICTR Translational Pilot Award (A.P., L.M.A., B.A.D.), NIH/NCI 1 R01 CA220004-01 (R.B.H.), 2020 Dermatology Foundation Pediatric Dermatology Career Development Award (L.M.A.), 2019 Sturge Weber Foundation Lisa's Research Award (L.M.A.), NSF 2023239-DMS (M.A.N.), NIH 1P01CA250972-01 (M.A.N.), NIH 1P50HD105353-01 (M.A.N.)
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Affiliation(s)
- Zijian Ni
- Department of Statistics, University of Wisconsin-Madison, Madison, WI, USA
| | - Aman Prasad
- Department of Dermatology, University of Wisconsin-Madison, Madison, WI, USA
| | - Shuyang Chen
- Department of Statistics, University of Wisconsin-Madison, Madison, WI, USA
| | - Richard B Halberg
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Department of Oncology, University of Wisconsin-Madison, Madison, WI, USA
| | - Lisa M Arkin
- Department of Dermatology, University of Wisconsin-Madison, Madison, WI, USA
| | - Beth A Drolet
- Department of Dermatology, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael A Newton
- Department of Statistics, University of Wisconsin-Madison, Madison, WI, USA
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Christina Kendziorski
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA.
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13
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Ezeh N, Ardalan K, Buhr KA, Nguyen C, Al Ahmed O, Ardoin SP, Barton V, Bell S, Brandling-Bennett H, Castelo-Soccio L, Chiu YE, Chong BF, Lara-Corrales I, Cintosun A, Curran ML, Diaz LZ, Elman SA, Faith EF, Garcia-Romero MT, Grossman-Kranseler J, Hogeling M, Hudson AD, Hunt RD, Ibler EM, Marques MC, Monir RL, Oza V, Paller AS, Putterman E, Rodriguez-Salgado P, Schoch JJ, Truong A, Wang J, Lee LW, Vleugels RA, Klein-Gitelman MS, von Scheven E, Werth VP, Arkin LM. Cross-Sectional Characteristics of Pediatric-Onset Discoid Lupus Erythematosus: Results of a Multicenter, Retrospective Cohort Study. J Am Acad Dermatol 2022; 87:559-566. [PMID: 35487332 PMCID: PMC10082546 DOI: 10.1016/j.jaad.2022.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/15/2022]
Abstract
• Discoid lupus may be associated with SLE. In this study, most children with discoid lupus did not have systemic disease. Concurrent SLE was highest in female adolescents (>10 years of age) with generalized discoid lupus, who had clinically aggressive disease. • Discoid lupus in adolescence should prompt thorough evaluation for SLE.
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Affiliation(s)
- N Ezeh
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - K Ardalan
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, Departments of Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine/Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - K A Buhr
- Department of Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - C Nguyen
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - O Al Ahmed
- Department of Pediatrics, Nationwide Children's Hospital/Ohio State University, Columbus OH
| | - S P Ardoin
- Department of Pediatrics, Nationwide Children's Hospital/Ohio State University, Columbus OH
| | - V Barton
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, SC
| | - S Bell
- Department of Pediatrics, Division of Rheumatology, University of California at San Francisco, San Francisco, CA
| | - H Brandling-Bennett
- Division of Dermatology; Department of Pediatrics, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, WA
| | - L Castelo-Soccio
- Children's Hospital of Philadelphia, Department of Pediatrics, Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Y E Chiu
- Departments of Dermatology (Section of Pediatric Dermatology) and Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - B F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Pediatrics, Division of Allergy/Immunology/Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - I Lara-Corrales
- Department of Pediatrics, Section of Dermatology, The Hospital for Sick Children/University of Toronto, Toronto, ON
| | - A Cintosun
- Department of Pediatrics, Section of Dermatology, The Hospital for Sick Children/University of Toronto, Toronto, ON
| | - M L Curran
- Department of Pediatrics, Section of Rheumatology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO
| | - L Z Diaz
- Department of Pediatrics, Division of Dermatology, Dell Medical School/Dell Children's Hospital, Austin, TX
| | - S A Elman
- Department of Dermatology, Boston's Children Hospital/Harvard Medical School, Boston, MA
| | - E Fernandez Faith
- Department of Pediatrics, Nationwide Children's Hospital/Ohio State University, Columbus OH
| | - M T Garcia-Romero
- Department of Dermatology, National Institute for Pediatrics, Mexico City, MX
| | - J Grossman-Kranseler
- Division of Dermatology; Department of Pediatrics, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, WA
| | - M Hogeling
- Department of Dermatology, University of California at Los Angeles, Los Angeles, CA
| | - A D Hudson
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX
| | - R D Hunt
- Department of Dermatology and Pediatrics, Texas Children's Hospital, Houston, TX
| | - E M Ibler
- Departments of Dermatology (Section of Pediatric Dermatology) and Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - M C Marques
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - R L Monir
- Department of Dermatology, University of Florida School of Medicine, Gainesville, FL
| | - V Oza
- Departments of Pediatrics and Dermatology, New York University Grossman School of Medicine, New York, NY
| | - A S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine/Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - E Putterman
- Children's Hospital of Philadelphia, Department of Pediatrics, Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - P Rodriguez-Salgado
- Department of Dermatology, National Institute for Pediatrics, Mexico City, MX
| | - J J Schoch
- Department of Dermatology, University of Florida School of Medicine, Gainesville, FL
| | - A Truong
- Department of Dermatology, University of California at Los Angeles, Los Angeles, CA
| | - J Wang
- Departments of Pediatrics and Dermatology, New York University Grossman School of Medicine, New York, NY
| | - L Wine Lee
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, SC
| | - R A Vleugels
- Department of Dermatology, Boston's Children Hospital/Harvard Medical School, Boston, MA
| | - M S Klein-Gitelman
- Department of Pediatrics, Northwestern University Feinberg School of Medicine/Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - E von Scheven
- Department of Pediatrics, Division of Rheumatology, University of California at San Francisco, San Francisco, CA
| | - V P Werth
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania and Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - L M Arkin
- Departments of Dermatology and Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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14
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Carmona-Rivera C, Zhang Y, Dobbs K, Markowitz TE, Dalgard CL, Oler AJ, Claybaugh DR, Draper D, Truong M, Delmonte OM, Licciardi F, Ramenghi U, Crescenzio N, Imberti L, Sottini A, Quaresima V, Fiorini C, Discepolo V, Lo Vecchio A, Guarino A, Pierri L, Catzola A, Biondi A, Bonfanti P, Poli Harlowe MC, Espinosa Y, Astudillo C, Rey-Jurado E, Vial C, de la Cruz J, Gonzalez R, Pinera C, Mays JW, Ng A, Platt A, Drolet B, Moon J, Cowen EW, Kenney H, Weber SE, Castagnoli R, Magliocco M, Stack MA, Montealegre G, Barron K, Hewitt SM, Arkin LM, Chertow DS, Su HC, Notarangelo LD, Kaplan MJ. Multicenter analysis of neutrophil extracellular trap dysregulation in adult and pediatric COVID-19. medRxiv 2022:2022.02.24.22271475. [PMID: 35262093 PMCID: PMC8902885 DOI: 10.1101/2022.02.24.22271475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Dysregulation in neutrophil extracellular trap (NET) formation and degradation may play a role in the pathogenesis and severity of COVID-19; however, its role in the pediatric manifestations of this disease including MIS-C and chilblain-like lesions (CLL), otherwise known as "COVID toes", remains unclear. Studying multinational cohorts, we found that, in CLL, NETs were significantly increased in serum and skin. There was geographic variability in the prevalence of increased NETs in MIS-C, in association with disease severity. MIS-C and CLL serum samples displayed decreased NET degradation ability, in association with C1q and G-actin or anti-NET antibodies, respectively, but not with genetic variants of DNases. In adult COVID-19, persistent elevations in NETs post-disease diagnosis were detected but did not occur in asymptomatic infection. COVID-19-affected adults displayed significant prevalence of impaired NET degradation, in association with anti-DNase1L3, G-actin, and specific disease manifestations, but not with genetic variants of DNases. NETs were detected in many organs of adult patients who died from COVID-19 complications. Infection with the Omicron variant was associated with decreased levels of NETs when compared to other SARS-CoV-2 strains. These data support a role for NETs in the pathogenesis and severity of COVID-19 in pediatric and adult patients. Summary NET formation and degradation are dysregulated in pediatric and symptomatic adult patients with various complications of COVID-19, in association with disease severity. NET degradation impairments are multifactorial and associated with natural inhibitors of DNase 1, G-actin and anti-DNase1L3 and anti-NET antibodies. Infection with the Omicron variant is associated with decreased levels of NETs when compared to other SARS-CoV-2 strains.
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Affiliation(s)
- Carmelo Carmona-Rivera
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Yu Zhang
- Human Immunological Diseases Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, MD, USA
| | | | - Tovah E. Markowitz
- Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, NIAID, NIH, Bethesda, MD
- Axle Informatics, Bethesda, MD, USA
| | - Clifton L. Dalgard
- Department of Anatomy, Physiology & Genetics, School of Medicine, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD and The American Genome Center, USUHS, Bethesda, MD, USA
| | - Andrew J. Oler
- Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, NIAID, NIH, Bethesda, MD
| | - Dillon R. Claybaugh
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH), Bethesda, MD, USA
| | | | | | | | - Francesco Licciardi
- Department of Public Health and Pediatric Sciences, “Regina Margherita” Children’s Hospital, University of Turin, Turin, Italy
| | - Ugo Ramenghi
- Department of Public Health and Pediatric Sciences, “Regina Margherita” Children’s Hospital, University of Turin, Turin, Italy
| | - Nicoletta Crescenzio
- Pediatric Hematology, “Regina Margherita” Children Hospital, University of Turin, Turin, Italy
| | - Luisa Imberti
- Centro di Ricerca Emato-oncologica AIL (CREA), Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alessandra Sottini
- Centro di Ricerca Emato-oncologica AIL (CREA), Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Virginia Quaresima
- Centro di Ricerca Emato-oncologica AIL (CREA), Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Chiara Fiorini
- Centro di Ricerca Emato-oncologica AIL (CREA), Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Valentina Discepolo
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Alfredo Guarino
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Luca Pierri
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Andrea Catzola
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Andrea Biondi
- Department of Pediatrics, University of Milano-Bicocca, European Reference Network (ERN) PaedCan, EuroBloodNet, MetabERN, Fondazione MBBM/Ospedale San Gerardo, Monza, Italy
| | - Paolo Bonfanti
- Department of Infectious Diseases, San Gerardo Hospital–University of Milano-Bicocca, Monza, Italy
| | - Maria Cecilia Poli Harlowe
- Programa de Inmunogenética e Inmunología Traslacional, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Hospital Roberto del Rio, Santiago, Chile
| | | | | | - Emma Rey-Jurado
- Programa de Inmunogenética e Inmunología Traslacional, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Cecilia Vial
- Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Programa Hantavirus, Instituto de Ciencias e Innovación en Medicina, Santiago, Chile
| | - Javiera de la Cruz
- Programa de Inmunogenética e Inmunología Traslacional, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Ricardo Gonzalez
- Pediatric Intensive Care Unit, Hospital Exequiel Gonzalez Cortés, Santiago, Chile
| | - Cecilia Pinera
- Infectious Diseases Unit, Hospital Dr. Exequiel González Cortés, Región Metropolitana, Chile
- Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Jacqueline W. Mays
- National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD, USA
| | - Ashley Ng
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Andrew Platt
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, and Laboratory of Immunoregulation, NIAID, NIH, Bethesda, MD, USA
| | | | | | - Beth Drolet
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - John Moon
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Edward W. Cowen
- Molecular Development of the Immune System Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD
| | | | | | | | | | | | | | - Karyl Barron
- Division of Clinical Research, NIAID, NIH, Bethesda, MD
| | - Stephen M. Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Lisa M. Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel S. Chertow
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, and Laboratory of Immunoregulation, NIAID, NIH, Bethesda, MD, USA
| | - Helen C. Su
- Human Immunological Diseases Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, MD, USA
| | | | - Mariana J. Kaplan
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH), Bethesda, MD, USA
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15
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Arkin LM, Moon JJ, Tran JM, Asgari S, O'Farrelly C, Casanova JL, Cowen EW, Mays JW, Singh AM, Drolet BA. From Your Nose to Your Toes: A Review of Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic‒Associated Pernio. J Invest Dermatol 2021; 141:2791-2796. [PMID: 34561087 PMCID: PMC8279931 DOI: 10.1016/j.jid.2021.05.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/04/2023]
Abstract
Despite thousands of reported patients with pandemic-associated pernio, low rates of seroconversion and PCR positivity have defied causative linkage to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Pernio in uninfected children is associated with monogenic disorders of excessive IFN-1 immunity, whereas severe COVID-19 pneumonia can result from insufficient IFN-1. Moreover, SARS-CoV-2 spike protein and robust IFN-1 response are seen in the skin of patients with pandemic-associated pernio, suggesting an excessive innate immune skin response to SARS-CoV-2. Understanding the pathophysiology of this phenomenon may elucidate the host mechanisms that drive a resilient immune response to SARS-CoV-2 and could produce relevant therapeutic targets.
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Affiliation(s)
- Lisa M Arkin
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - John J Moon
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jennifer M Tran
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Samira Asgari
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Cliona O'Farrelly
- Comparative Immunology, School of Biochemistry and Immunology, Trinity College Dublin, Dublin, Ireland
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York, USA; Howard Hughes Medical Institute, The Rockefeller University, New York, New York, USA
| | - Edward W Cowen
- Dermatology branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, Maryland, USA
| | - Jacqueline W Mays
- Oral Immunobiology Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Anne Marie Singh
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Beth A Drolet
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.
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16
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Chang CA, Perrier R, Kurek KC, Estrada-Veras J, Lehman A, Yip S, Hendson G, Diamond C, Pinchot JW, Tran JM, Arkin LM, Drolet BA, Napier MP, O'Neill SA, Balci TB, Keppler-Noreuil KM. Novel findings and expansion of phenotype in a mosaic RASopathy caused by somatic KRAS variants. Am J Med Genet A 2021; 185:2829-2845. [PMID: 34056834 DOI: 10.1002/ajmg.a.62356] [Citation(s) in RCA: 12] [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: 02/16/2021] [Revised: 04/16/2021] [Accepted: 05/04/2021] [Indexed: 11/11/2022]
Abstract
Mosaic KRAS variants and other RASopathy genes cause oculoectodermal, encephalo-cranio-cutaneous lipomatosis, and Schimmelpenning-Feuerstein-Mims syndromes, and a spectrum of vascular malformations, overgrowth and other associated anomalies, the latter of which are only recently being characterized. We describe eight individuals in total (six unreported cases and two previously reported cases) with somatic KRAS variants and variably associated features. Given the findings of somatic overgrowth (in seven individuals) and vascular or lymphatic malformations (in eight individuals), we suggest mosaic RASopathies (mosaic KRAS variants) be considered in the differential diagnosis for individuals presenting with asymmetric overgrowth and lymphatic or vascular anomalies. We expand the association with embryonal tumors, including the third report of embryonal rhabdomyosarcoma, as well as novel findings of Wilms tumor and nephroblastomatosis in two individuals. Rare or novel findings in our series include the presence of epilepsy, polycystic kidneys, and T-cell deficiency in one individual, and multifocal lytic bone lesions in two individuals. Finally, we describe the first use of targeted therapy with a MEK inhibitor for an individual with a mosaic KRAS variant. The purposes of this report are to expand the phenotypic spectrum of mosaic KRAS-related disorders, and to propose possible mechanisms of pathogenesis, and surveillance of its associated findings.
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Affiliation(s)
- Caitlin A Chang
- Department of Medical Genetics, BC Women and Children's Hospital, Vancouver, British Columbia, Canada
| | - Renee Perrier
- Department of Medical Genetics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Kyle C Kurek
- Department of Pathology, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Juvianee Estrada-Veras
- Medical Genetics Service, Walter Reed National Military Medical Center, Henry M. Jackson Foundation for the Advancement of Military Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Anna Lehman
- Department of Medical Genetics, BC Women and Children's Hospital, Vancouver, British Columbia, Canada
| | - Stephen Yip
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Glenda Hendson
- Department of Pathology, BC Women and Children's Hospital, Vancouver, British Columbia, Canada
| | - Carol Diamond
- Department of Hematology-Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jason W Pinchot
- Department of Interventional Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jennifer M Tran
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lisa M Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Beth A Drolet
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Melanie P Napier
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Sarah A O'Neill
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Tugce B Balci
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Kim M Keppler-Noreuil
- Division of Genetics and Metabolism, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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17
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Abstract
Port-wine birthmarks (PWBs) are progressive vascular malformations with significant disfigurement and psychosocial morbidity; early light-based treatment has shown improved outcomes in the pediatric population. Somatic mosaic mutations underly the progressive nature of PWBs and explain the significant differences in response and heterogeneity of vessel architecture in the pediatric population when compared to the adult cohort. Here, we summarize a review of pediatric specific literature on the various light-based treatment modalities, including pulsed dye laser, near-infrared lasers, and intense pulsed light, providing the various indications, tips, advantages, and disadvantages for the pediatric dermatologist.
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Affiliation(s)
- Jennifer M Tran
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kristen M Kelly
- Department of Dermatology, University of California Irvine, Irvine, CA, USA
| | - Beth A Drolet
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Andrew C Krakowski
- Department of Dermatology, St. Luke's University Health Network, Easton, PA, USA
| | - Lisa M Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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18
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Eickstaedt JB, Starke S, Krakora D, Hinshaw M, Arkin LM. Clearance of pediatric actinic prurigo with dupilumab. Pediatr Dermatol 2020; 37:1176-1178. [PMID: 32869345 DOI: 10.1111/pde.14311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/24/2020] [Accepted: 07/03/2020] [Indexed: 12/22/2022]
Abstract
Actinic prurigo is a rare, idiopathic chronic photodermatosis of childhood characterized by excoriated papules, nodules, and plaques in sun-exposed areas. It is notoriously difficult to treat. The disorder involves a type IV hypersensitivity reaction driven by both Th1 and Th2 inflammatory pathways, the latter of which leads to secretion of IL-4, IL-5, IL-13, and production of B cells, IgE, and IgG4. Dupilumab, an IL-4 receptor antagonist, disrupts the Th2 pathway. We present a pediatric patient with severe, recalcitrant actinic prurigo who achieved rapid and sustained clearance with dupilumab.
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Affiliation(s)
- Joshua B Eickstaedt
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Samuel Starke
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Dan Krakora
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Molly Hinshaw
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lisa M Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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19
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Comstock JR, Buhalog B, Peebles JK, Hinshaw MA, Co DO, Arkin LM. Lipoatrophic panniculitis in an adolescent. Pediatr Dermatol 2020; 37:572-573. [PMID: 32198786 DOI: 10.1111/pde.14127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lipoatrophic panniculitis (LP) is a rare childhood panniculitis characterized by sclerotic, atrophic plaques on the extremities. We present a case of LP diagnosed during the inflammatory phase that was difficult to distinguish clinically from eosinophilic fasciitis. This report adds to the limited phenotypic spectrum of LP by differentiating the clinical features of disease activity from disease damage and highlighting the importance of biopsy in establishing a diagnosis.
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Affiliation(s)
- Jeanette R Comstock
- School of Medicine & Public Health, University of Wisconsin, Madison, Wisconsin
| | - Brittany Buhalog
- Department of Dermatology, University of Wisconsin, Madison, Wisconsin
| | - J Klint Peebles
- Department of Dermatology, University of Wisconsin, Madison, Wisconsin
| | - Molly A Hinshaw
- Department of Dermatology, University of Wisconsin, Madison, Wisconsin
| | - Dominic O Co
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin, Madison, Wisconsin
| | - Lisa M Arkin
- Departments of Dermatology and Pediatrics, University of Wisconsin, Madison, Wisconsin
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20
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Akinshemoyin Vaughn OL, Siegel DH, Chiu YE, DeBord LC, Hogeling M, Hunt RD, Nguyen C, Sokumbi O, Verbsky JW, Arkin LM. Clinical and histologic presentation of pediatric reactive granulomatous dermatitis. Pediatr Dermatol 2020; 37:498-503. [PMID: 32115758 DOI: 10.1111/pde.14137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/08/2020] [Accepted: 02/11/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To characterize the clinical and histologic presentation of reactive granulomatous dermatitis (RGD) in the pediatric population. METHODS In this multicenter retrospective chart review, 7 pediatric patients with biopsy-proven RGD were identified. Photographs, histology reports, and clinical course were reviewed to discover patterns in demographics, comorbid conditions, autoimmune sequelae, drug exposures, infections, morphology, and histologic features. RESULTS Overall, 7 patients were included and analyzed. Most were female and Hispanic. All presented with a similar dermatologic phenotype previously described in the adult literature including macular erythema and annular, pink to violaceous, edematous papules and plaques, often involving proximal extremities and extensor joints. All biopsies demonstrated variable collagen alteration and a perivascular interstitial infiltrate of histiocytes with or without mucin. Neutrophils or karyorrhexic debris were present in 4/7 of the biopsies, and eosinophils were occasionally seen (2/7 cases). In all cases, RGD was associated with active SLE or led to a new diagnosis, and initiation of systemic treatment improved cutaneous disease. CONCLUSIONS Pediatric RGD was more common in female patients and ethnic minorities, and strongly associated with SLE. Clinical and histologic presentations were consistent across all cases with only minor variations, suggesting that recognition and confirmation might be expedited by familiarity with these dominant patterns. Diagnosis of RGD in pediatric patients should prompt screening for SLE.
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Affiliation(s)
| | - Dawn H Siegel
- Section of Pediatric Dermatology, Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yvonne E Chiu
- Section of Pediatric Dermatology, Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Logan C DeBord
- Departments of Dermatology and Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Marcia Hogeling
- Division of Dermatology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Raegan D Hunt
- Departments of Dermatology and Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Cordellia Nguyen
- Departments of Dermatology and Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Olayemi Sokumbi
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - James W Verbsky
- Division of Rheumatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lisa M Arkin
- Departments of Dermatology and Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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21
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Theisen E, Lee DE, Pei S, Schauder DM, Chiu YE, Brandling-Bennett H, Curran ML, Klein-Gitelman M, Co DO, Arkin LM. Hypergammaglobulinemic purpura of Waldenström in children. Pediatr Dermatol 2020; 37:467-475. [PMID: 32104943 DOI: 10.1111/pde.14120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hypergammaglobulinemic purpura of Waldenström (HGPW), a rare cutaneous eruption characterized by the triad of recurrent episodes of lower extremity petechiae, symptoms of stinging and burning, and lower extremity edema, is poorly described in children. Some children have been reported to follow a benign course, while others are eventually diagnosed with fulminant rheumatologic disease. OBJECTIVES To determine the distinguishing features of HGPW including the spectrum of disease manifestations and clinical outcomes. METHODS This is a multicenter, retrospective case series of six children with HGPW combined with a literature review of 45 previously published pediatric cases. RESULTS Most children were eventually diagnosed with systemic disease (63%) or developed autoantibody accumulation suggestive of evolving disease (71%). The most common diagnoses were Sjogren's syndrome and systemic lupus erythematosus. The mean duration between onset of cutaneous eruption and diagnosis of systemic disease was 5.6 years, underscoring that HPGW patients often present with a rash that precedes the development of systemic symptoms. CONCLUSIONS Diagnosis of HGPW should prompt initial screening for rheumatologic disease with long-term rheumatology follow-up, as the majority of patients present with evolving manifestations of systemic disease.
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Affiliation(s)
- Erin Theisen
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Dylan E Lee
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Susan Pei
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Yvonne E Chiu
- Departments of Dermatology (Pediatric Dermatology) and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Megan L Curran
- Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - Marisa Klein-Gitelman
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dominic O Co
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Lisa M Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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22
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Kushner CJ, Tarazi M, Gaffney RG, Feng R, Ardalan K, Brandling-Bennett HA, Castelo-Soccio L, Chang JC, Chiu YE, Gmuca S, Hunt RD, Kahn PJ, Knight AM, Mehta J, Pearson DR, Treat JR, Wan J, Yeguez AC, Concha JSS, Patel B, Okawa J, Arkin LM, Werth VP. AB002. Evaluation of the reliability and validity of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) in pediatric cutaneous lupus among pediatric dermatologists and rheumatologists. Ann Transl Med 2019. [DOI: 10.21037/atm.2019.ab002] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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23
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Arkin LM, Buhr K, Brandling-Bennett H, Chiu Y, Chong B, Curran M, Hunt R, Paller AS, Werth VP, Klein-Gitelman M, von Scheven E, Ardalan K. Practice-based differences in paediatric discoid lupus erythematosus. Br J Dermatol 2019; 181:805-810. [PMID: 30768778 DOI: 10.1111/bjd.17780] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Children with discoid lupus erythematosus (DLE) are at risk for disfigurement and progression to systemic lupus erythematosus (SLE). Consensus is lacking regarding optimal care for children with DLE. OBJECTIVES The aim of this study was to compare practice patterns among paediatric dermatologists/rheumatologists treating paediatric DLE. METHODS An online survey was sent to 292 paediatric rheumatologists in the Childhood Arthritis and Rheumatology Research Alliance and 200 paediatric dermatologists in the Pediatric Dermatology Research Alliance. Consensus was defined as ≥ 70% agreement. RESULTS Survey response rates were 38% (76 of 200) for dermatology and 21% (60 of 292) for rheumatology. Both specialties agreed that screening labs should include complete blood counts with differential, urinalysis, complement levels, erythrocyte sedimentation rate, antinuclear antibody and other autoantibodies, hepatic function and renal function/electrolytes. Both specialties agreed that arthritis or nephritis should prompt intensified evaluation for SLE. No other patient features achieved consensus as disease-modifying risk factors. Hydroxychloroquine was agreed upon as first-line systemic therapy, but consensus was lacking for second- or third-line treatment. CONCLUSIONS We found few areas of consensus and significant practice differences between paediatric dermatologists and rheumatologists treating DLE. Knowledge gaps include risk factors for SLE, optimal screening and treatment of refractory skin disease.
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Affiliation(s)
- L M Arkin
- Department of Dermatology and Pediatrics, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, U.S.A
| | - K Buhr
- Department of Biostatistics, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, U.S.A
| | - H Brandling-Bennett
- Department of Dermatology and Pediatrics, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, U.S.A
| | - Y Chiu
- Department of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, WI, U.S.A
| | - B Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A
| | - M Curran
- Department of Pediatrics, University of Colorado, Denver, CO, U.S.A
| | - R Hunt
- Department of Pediatrics and Dermatology, Baylor College of Medicine, Houston, TX, U.S.A
| | - A S Paller
- Department of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A
| | - V P Werth
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, U.S.A.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A
| | - M Klein-Gitelman
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A
| | - E von Scheven
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, U.S.A
| | - K Ardalan
- Department of Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A
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24
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Affiliation(s)
- Maureen Riegert
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Daniel M O'Connell
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Lisa M Arkin
- Department of Dermatology.,Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
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25
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Kushner CJ, Tarazi M, Gaffney RG, Feng R, Ardalan K, Brandling-Bennett HA, Castelo-Soccio L, Chang JC, Chiu YE, Gmuca S, Hunt RD, Kahn PJ, Knight AM, Mehta J, Pearson DR, Treat JR, Wan J, Yeguez AC, Concha JSS, Patel B, Okawa J, Arkin LM, Werth VP. Evaluation of the reliability and validity of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) in paediatric cutaneous lupus among paediatric dermatologists and rheumatologists. Br J Dermatol 2018; 180:165-171. [PMID: 30033560 DOI: 10.1111/bjd.17012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) is a reliable outcome measure for cutaneous lupus erythematosus (CLE) in adults used in clinical trials. However, it has not been validated in children, limiting clinical trials for paediatric CLE. OBJECTIVES This study aimed to validate the CLASI in paediatrics. METHODS Eleven paediatric patients with CLE, six dermatologists and six rheumatologists participated. The physicians were trained to use the CLASI and Physician's Global Assessment (PGA), and individually rated all patients using both tools. Each physician reassessed two randomly selected patients. Within each physician group, the intraclass correlation coefficient (ICC) was calculated to assess the reliability of each measure. RESULTS CLASI activity scores demonstrated excellent inter- and intrarater reliability (ICC > 0·90), while the PGA activity scores had good inter-rater reliability (ICC 0·73-0·77) among both specialties. PGA activity scores showed excellent (ICC 0·89) and good intrarater reliability (ICC 0·76) for dermatologists and rheumatologists, respectively. Limitations of this study include the small sample size of patients and potential recall bias during the physician rerating session. CONCLUSIONS CLASI activity measurement showed excellent inter- and intrarater reliability in paediatric CLE and superiority over the PGA. These results demonstrate that the CLASI is a reliable and valid outcome instrument for paediatric CLE.
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Affiliation(s)
- C J Kushner
- Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, U.S.A.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A
| | - M Tarazi
- Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, U.S.A.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A
| | - R G Gaffney
- Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, U.S.A.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A
| | - R Feng
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - K Ardalan
- Department of Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A
| | - H A Brandling-Bennett
- Department of Pediatrics and Dermatology, University of Washington School of Medicine, Seattle, WA, U.S.A
| | - L Castelo-Soccio
- Section of Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A
| | - J C Chang
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A
| | - Y E Chiu
- Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, WI, U.S.A
| | - S Gmuca
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A
| | - R D Hunt
- Departments of Dermatology and Pediatrics, Baylor College of Medicine, Houston, TX, U.S.A
| | - P J Kahn
- Department of Pediatrics, Division of Rheumatology, NYU Langone Medical Center, New York, NY, U.S.A
| | - A M Knight
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A
| | - J Mehta
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A
| | - D R Pearson
- Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, U.S.A.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A
| | - J R Treat
- Section of Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A
| | - J Wan
- Section of Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A
| | - A C Yeguez
- Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, U.S.A
| | - J S S Concha
- Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, U.S.A.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A
| | - B Patel
- Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, U.S.A.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A
| | - J Okawa
- Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, U.S.A.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A
| | - L M Arkin
- Departments of Dermatology and Pediatrics, University of Wisconsin School of Medicine, Madison, WI, U.S.A
| | - V P Werth
- Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, U.S.A.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A
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Brin Hermans L, Shields BE, Garland CB, Aagaard-Kienitz B, Wargowski D, Kovarik C, Arkin LM. Increasing Access to High Value Care: Preventing Complications in Common Disorders. Telemed J E Health 2018; 25:423-424. [PMID: 30096025 DOI: 10.1089/tmj.2018.0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Most infantile hemangiomas (IHs), the most common vascular tumors of childhood, evolve without complications; however 10% to 12% require specialty referral for treatment. To emphasize the complications of late referral, we present a case of necrotizing infection within a segmental IH leading to sepsis. Early evaluation by a pediatric dermatologist could have prevented this life-threatening and disfiguring complication. We discuss how teledermatology would enable rapid triage of such critical cases in underserved areas, increasing access to high-value care and optimizing outcomes for our most vulnerable patients.
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Affiliation(s)
- Lauren Brin Hermans
- 1 Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Bridget E Shields
- 1 Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Catharine B Garland
- 2 Division of Plastic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Beverly Aagaard-Kienitz
- 3 Department of Neurosurgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David Wargowski
- 4 Division of Genetics, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Carrie Kovarik
- 5 Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Lisa M Arkin
- 1 Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,6 Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Thareja S, Kollmann K, Ardalan K, Klein-Gitelman MS, Paller AS, Arkin LM. Oral Macrolides for the Dermatologic Manifestations of Blau Syndrome. JAMA Dermatol 2017; 153:1066-1067. [DOI: 10.1001/jamadermatol.2017.2172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Shalini Thareja
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois2Emory University School of Medicine, Atlanta, Georgia
| | - Kaitlyn Kollmann
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kaveh Ardalan
- Division of Rheumatology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois4Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois5Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marisa S. Klein-Gitelman
- Division of Rheumatology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois4Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amy S. Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois4Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lisa M. Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison7Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
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Coughlin CC, Roy SM, Arkin LM, Adzick NS, Yan AC, De León DD, Rubin AI. Iatrogenic Necrolytic Migratory Erythema in an Infant with Congenital Hyperinsulinism. Pediatr Dermatol 2016; 33:e43-7. [PMID: 26648573 DOI: 10.1111/pde.12741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Necrolytic migratory erythema (NME) is a rare cutaneous finding characterized by painful, pruritic, scaly red patches and plaques, bullae, and superficial erosions. Typically NME is a paraneoplastic phenomenon associated with glucagonoma. We report the exceptional case of an infant who developed iatrogenic NME arising secondary to glucagon therapy for congenital hyperinsulinism.
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Affiliation(s)
- Carrie C Coughlin
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
| | - Sani M Roy
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lisa M Arkin
- Department of Dermatology, Rush University Medical Center, Chicago, Illinois
| | - N Scott Adzick
- Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Albert C Yan
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Diva D De León
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adam I Rubin
- Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Arkin LM, Ansell L, Rademaker A, Curran ML, Miller ML, Wagner A, Kenner-Bell BM, Chamlin SL, Mancini AJ, Klein-Gitelman M, Paller AS. The natural history of pediatric-onset discoid lupus erythematosus. J Am Acad Dermatol 2015; 72:628-33. [PMID: 25648823 DOI: 10.1016/j.jaad.2014.12.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 07/30/2014] [Revised: 12/18/2014] [Accepted: 12/21/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pediatric discoid lupus erythematosus (DLE) is rare. The risk of progression to systemic lupus erythematosus (SLE) is uncertain. OBJECTIVE We sought to determine the risk of progression of pediatric DLE to SLE and to characterize its phenotype. METHODS This was a retrospective review of 40 patients with DLE. RESULTS Six (15%) of 40 patients presented with DLE as a manifestation of concurrent SLE. Of the remaining 34, 9 (26%) eventually met SLE criteria and 15 (44%) developed laboratory abnormalities without meeting SLE criteria. Only 10 (29%) maintained skin-limited disease. The average age at progression to SLE was 11 years, with greatest risk in the first year after DLE diagnosis. Most (89%) patients with SLE met diagnostic criteria with mucocutaneous disease (discoid lesions, malar rash, oral and nasal ulcers, photosensitivity), positive antibodies, and/or cytopenia without developing end-organ damage over 5 years of median follow-up. LIMITATIONS The study was retrospective. CONCLUSIONS In pediatric patients, DLE carries a significant risk of progression to SLE but may predict a milder phenotype of systemic disease. All patients require careful monitoring for SLE, particularly within the first year of diagnosis.
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Affiliation(s)
- Lisa M Arkin
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Leah Ansell
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alfred Rademaker
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Megan L Curran
- Division of Rheumatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael L Miller
- Division of Rheumatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Annette Wagner
- Division of Dermatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brandi M Kenner-Bell
- Division of Dermatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sarah L Chamlin
- Division of Dermatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anthony J Mancini
- Division of Dermatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marisa Klein-Gitelman
- Division of Rheumatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Dermatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Arkin LM, Flory JH, Shin DB, Gelfand JM, Treat JR, Allen J, Rubenstein RC, Yan AC. High prevalence of aquagenic wrinkling of the palms in patients with cystic fibrosis and association with measurable increases in transepidermal water loss. Pediatr Dermatol 2012; 29:560-6. [PMID: 22471628 DOI: 10.1111/j.1525-1470.2011.01708.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Aquagenic wrinkling of the palms (AWP) is a cutaneous phenomenon marked by the transient formation of edematous, translucent papules and plaques on the palms and fingertips within minutes of water exposure. AWP is anecdotally reported in patients with cystic fibrosis (CF) and several studies have recently confirmed this association. The primary aim of this study was to determine the prevalence of aquagenic wrinkling of the palms in subjects with cystic fibrosis (CF) compared to controls, and secondarily to evaluate for genotype-phenotype correlations among CF subjects found to have AWP. Fifty-one children with CF and 25 control children who were being treated for asthma underwent a 5-minute hand immersion in lukewarm water. The test for AWP was positive if subjects demonstrated >30% wrinkling over the palm. Secondary analyses explored associations with genotype, pancreatic and pulmonary function, body mass index (BMI), and sweat chloride levels. Palmar transepidermal water loss (TEWL) was also measured for all subjects with and without AWP. Forty-three of the subjects (84%) with CF demonstrated aquagenic wrinkling, in contrast to none (0%) of the controls. These results remained statistically significant when stratified for by age and race. TEWL was significantly higher in CF subjects with AWP compared to CF subjects without AWP and controls. No genotype-phenotype correlations were detected in patients with AWP, nor were there associations of AWP with other phenotypic features of CF, although these analyses were likely underpowered. Aquagenic wrinkling of the palms is prevalent in children with CF and is associated with increased TEWL.
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Affiliation(s)
- Lisa M Arkin
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Souweidane MM, Fraser JF, Arkin LM, Sondhi D, Hackett NR, Kaminsky SM, Heier L, Kosofsky BE, Worgall S, Crystal RG, Kaplitt MG. Gene therapy for late infantile neuronal ceroid lipofuscinosis: neurosurgical considerations. J Neurosurg Pediatr 2010; 6:115-22. [PMID: 20672930 PMCID: PMC3763702 DOI: 10.3171/2010.4.peds09507] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECT The authors conducted a phase I study of late infantile neuronal ceroid lipofuscinosis using an adenoassociated virus serotype 2 (AAV2) vector containing the deficient CLN2 gene (AAV2(CU)hCLN2). The operative technique, radiographic changes, and surgical complications are presented. METHODS Ten patients with late infantile neuronal ceroid lipofuscinosis disease each underwent infusion of AAV2(CU)hCLN2 (3 x 10(12) particle units) into 12 distinct cerebral locations (2 depths/bur hole, 75 minutes/infusion, and 2 microl/minute). Innovative surgical techniques were developed to overcome several obstacles for which little or no established techniques were available. Successful infusion relied on preoperative stereotactic planning to optimize a parenchymal target and diffuse administration. Six entry sites, each having 2 depths of injections, were used to reduce operative time and enhance distribution. A low-profile rigid fixation system with 6 integrated holding arms was utilized to perform simultaneous infusions within a practical time frame. Dural sealant with generous irrigation was used to avoid CSF egress with possible subdural hemorrhage or altered stereotactic registration. RESULTS Radiographically demonstrated changes were seen in 39 (65%) of 60 injection sites, confirming localization and infusion. There were no radiographically or clinically defined complications. CONCLUSIONS The neurosurgical considerations and results of this study are presented to offer guidance and a basis for the design of future gene therapy or other clinical trials in children that utilize direct therapeutic delivery.
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Affiliation(s)
- Mark M Souweidane
- Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, New York 10021, USA.
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Arkin LM, Sondhi D, Worgall S, Suh LHK, Hackett NR, Kaminsky SM, Hosain SA, Souweidane MM, Kaplitt MG, Dyke JP, Heier LA, Ballon DJ, Shungu DC, Wisniewski KE, Greenwald BM, Hollmann C, Crystal RG. Confronting the Issues of Therapeutic Misconception, Enrollment Decisions, and Personal Motives in Genetic Medicine-Based Clinical Research Studies for Fatal Disorders. Hum Gene Ther 2005; 16:1028-36. [PMID: 16149901 DOI: 10.1089/hum.2005.16.1028] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Genetic medicine-based therapies have unlocked the potential for ameliorating diseases previously considered inevitably fatal. Inherent in the clinical trials of genetic medicines are ethical issues of therapeutic misconception, enrollment decisions as they relate to the risks and benefits of research, and the complex relationships among funding sources, investigators, and the families of affected individuals. The purpose of this paper is to help define these complex issues relevant to the use of genetic medicines and to describe the strategy we have used to confront these issues in a phase I trial of adeno-associated virus-mediated gene transfer to the central nervous system of children with late infantile neuronal ceroid lipofuscinosis (LINCL), a fatal lysosomal storage disease associated with progressive neurodegeneration and death by mid-childhood. Our approach to these challenges should provide a useful paradigm for investigators initiating other genetic medicine- based studies to treat inevitably fatal diseases.
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Affiliation(s)
- Lisa M Arkin
- Department of Genetic Medicine, Weill Medical College of Cornell University, New York, NY 10021, USA
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Arkin LM, Sondhi D, Worgall S, Suh LHK, Hackett NR, Kaminsky SM, Hosain SA, Souweidane MM, Kaplitt MG, Dyke JP, Heier LA, Ballon DJ, Shungu DC, Wisniewski KE, Greenwald BM, Hollmann C, Crystal RG. Confronting the Issues of Therapeutic Misconception, Enrollment Decisions, and Personal Motives in Genetic Medicine-Based Clinical Research Studies for Fatal Disorders. Hum Gene Ther 2005. [DOI: 10.1089/hum.2005.16.ft-111] [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: 11/12/2022] Open
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35
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Sulewski ME, Robin AL, Cummings HL, Arkin LM. Effects of topical flurbiprofen on the intraocular pressure lowering effects of apraclonidine and timolol. Arch Ophthalmol 1991; 109:807-9. [PMID: 1675049 DOI: 10.1001/archopht.1991.01080060071027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We performed a prospective study that evaluated whether pretreatment with topical flurbiprofen alters the intraocular pressure (IOP) lowering effects of either topical 1% apraclonidine hydrochloride or 0.5% timolol maleate. Eighteen normal volunteers participated in this six-armed, randomized, double-masked, crossover study. All subjects received the first study medication, either bilateral 0.3% flurbiprofen or placebo (its vehicle), every 30 minutes for four applications. They next received the second study medication: either 0.5% timolol maleate (Timoptic), 1% apraclonidine hydrochloride, or placebo in both eyes. We measured IOP before the instillation of the first study medication and the second study medication (baseline), and then at 1, 3, and 6 hours later. All subjects underwent all six treatment arms. Flurbiprofen alone had no effect on IOP. Maximum IOP lowering occurred between 3 and 6 hours after timolol and apraclonidine administration. There was no difference in IOP lowering between timolol- and apraclonidine-treated eyes. Pretreatment with flurbiprofen did not affect the IOP lowering that was obtained with timolol or apraclonidine administration.
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Affiliation(s)
- M E Sulewski
- Glaucoma Services, Greater Baltimore, Medical Center, MD
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