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Greif C, Gibson RS, Kimball AB, Holcomb ZE, Porter ML. Evaluating minority representation across health care settings in hidradenitis suppurativa and psoriasis. Int J Womens Dermatol 2024; 10:e129. [PMID: 38240009 PMCID: PMC10796135 DOI: 10.1097/jw9.0000000000000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 11/11/2023] [Indexed: 01/22/2024] Open
Abstract
Background Females and minorities have been underrepresented in clinical research despite legislative efforts, including in hidradenitis suppurativa (HS) and psoriasis (PsO) clinical trials. Objective To identify differences in demographic breakdowns of HS and PsO patients between health care settings to uncover any causative health disparities. Methods This study reports racial, ethnic, and sex of HS and PsO patient populations across the emergency department (ED), inpatient, clinical trial, and registry settings. In addition, 95% confidence intervals are used as proxies of statistical significance to compare demographics between settings. Results Female, Hispanic, and Black patients were underrepresented in HS clinical trials compared to their population prevalence (female: 63.7% vs 73.5%; Hispanic: 3.8% vs 12.0%; Black: 9.1% vs 20.3%). Female and Black patients were underrepresented in PsO trials compared to their population prevalence (female: 33.0% vs 54.8%; Black: 2.2% vs 5.7%). Black patients were overrepresented in the inpatient and ED settings in HS (inpatient vs ED vs population prevalence: 49.9% vs 49.9% vs 20.3%) and in the inpatient setting in PsO (inpatient vs population prevalence: 19.8% vs 5.7%). Limitations The main limitation is the reliability and generalizability of the published studies used to compare demographics across settings. Conclusion Underrepresentation of females and minorities in HS and PsO clinical trials is consistent with published literature. Overrepresentation of Black patients in acute care settings is likely multifactorial.
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Affiliation(s)
- Charlotte Greif
- Preliminary Internal Medicine Program, Internal Medicine Department, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ruby S. Gibson
- Tulane Dermatology Program, Dermatology Department, Tulane University School of Medicine, New Orleans, Louisiana
| | - Alexa B. Kimball
- Dermatology Department, Harvard Medical School, Clinical Laboratory for Epidemiology and Applied Research in Skin, Boston, Massachusetts
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Zachary E. Holcomb
- Department of Medicine, Carilion Clinic, Section of Dermatology, Roanoke, Virginia
- Dermatology Department, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
| | - Martina L. Porter
- Dermatology Department, Harvard Medical School, Clinical Laboratory for Epidemiology and Applied Research in Skin, Boston, Massachusetts
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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2
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Holcomb ZE, Steinbrink JM, Zaas AK, Betancourt M, Tenor JL, Toffaletti DL, Alspaugh JA, Perfect JR, McClain MT. Transcriptional Profiles Elucidate Differential Host Responses to Infection with Cryptococcus neoformans and Cryptococcus gattii. J Fungi (Basel) 2022; 8:jof8050430. [PMID: 35628686 PMCID: PMC9143552 DOI: 10.3390/jof8050430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Many aspects of the host response to invasive cryptococcal infections remain poorly understood. In order to explore the pathobiology of infection with common clinical strains, we infected BALB/cJ mice with Cryptococcus neoformans, Cryptococcus gattii, or sham control, and assayed host transcriptomic responses in peripheral blood. Infection with C. neoformans resulted in markedly greater fungal burden in the CNS than C. gattii, as well as slightly higher fungal burden in the lungs. A total of 389 genes were significantly differentially expressed in response to C. neoformans infection, which mainly clustered into pathways driving immune function, including complement activation and TH2-skewed immune responses. C. neoformans infection demonstrated dramatic up-regulation of complement-driven genes and greater up-regulation of alternatively activated macrophage activity than seen with C gattii. A 27-gene classifier was built, capable of distinguishing cryptococcal infection from animals with bacterial infection due to Staphylococcus aureus with 94% sensitivity and 89% specificity. Top genes from the murine classifiers were also differentially expressed in human PBMCs following infection, suggesting cross-species relevance of these findings. The host response, as manifested in transcriptional profiles, informs our understanding of the pathophysiology of cryptococcal infection and demonstrates promise for contributing to development of novel diagnostic approaches.
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Affiliation(s)
- Zachary E. Holcomb
- Harvard Combined Dermatology Residency Program, Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Julie M. Steinbrink
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA; (A.K.Z.); (M.B.); (J.L.T.); (D.L.T.); (J.A.A.); (J.R.P.); (M.T.M.)
- Correspondence:
| | - Aimee K. Zaas
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA; (A.K.Z.); (M.B.); (J.L.T.); (D.L.T.); (J.A.A.); (J.R.P.); (M.T.M.)
| | - Marisol Betancourt
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA; (A.K.Z.); (M.B.); (J.L.T.); (D.L.T.); (J.A.A.); (J.R.P.); (M.T.M.)
| | - Jennifer L. Tenor
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA; (A.K.Z.); (M.B.); (J.L.T.); (D.L.T.); (J.A.A.); (J.R.P.); (M.T.M.)
| | - Dena L. Toffaletti
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA; (A.K.Z.); (M.B.); (J.L.T.); (D.L.T.); (J.A.A.); (J.R.P.); (M.T.M.)
| | - J. Andrew Alspaugh
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA; (A.K.Z.); (M.B.); (J.L.T.); (D.L.T.); (J.A.A.); (J.R.P.); (M.T.M.)
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - John R. Perfect
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA; (A.K.Z.); (M.B.); (J.L.T.); (D.L.T.); (J.A.A.); (J.R.P.); (M.T.M.)
| | - Micah T. McClain
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA; (A.K.Z.); (M.B.); (J.L.T.); (D.L.T.); (J.A.A.); (J.R.P.); (M.T.M.)
- Infectious Diseases Section, Medical Service, Durham Veteran’s Affairs Medical Center, Durham, NC 27705, USA
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3
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Affiliation(s)
- Zachary E Holcomb
- Harvard Combined Dermatology Residency Program, Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sadaf Hussain
- Dermatology Program, Boston Children's Hospital, Boston, Massachusetts
| | - Jennifer T Huang
- Dermatology Program, Boston Children's Hospital, Boston, Massachusetts
| | - Sophia Delano
- Dermatology Program, Boston Children's Hospital, Boston, Massachusetts
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Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, debilitating inflammatory skin disorder characterized by nodules, abscesses, fistulae, and significant scarring in intertriginous areas rich in apocrine glands. Immunomodulator drugs, including biologics, are a mainstay of treatment for this disease. AREAS COVERED This review details the safety profiles of various biologic therapies currently available commercially that have been tried for HS as assessed in clinical trials and observational studies. As the only Food and Drug Administration (FDA)-approved medication for the treatment of moderate-to-severe HS, adalimumab is discussed in the most detail. Additional biologic medications, including tumor necrosis factor α (TNFα) inhibitors, interleukin 1 (IL-1) inhibitors, IL-12 and IL-23 inhibitors, IL-17 inhibitors, and IL-23 inhibitors, are discussed as well. Safety concerns in special populations, including pregnant women and children, are outlined. EXPERT OPINION Existing data support excellent short-term and long-term safety profiles for adalimumab, although caution must be taken with use in high-risk patient populations, including those with chronic infections or increased risk of malignancy. Based on their safety data for other indications, additional biologic agents appear safe in HS as well. However, further research is needed to fully understand the safety profiles of these medications in the HS population.
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Affiliation(s)
- Zachary E Holcomb
- Department of Dermatology, Massachusetts General Hospital, Harvard Combined Dermatology Residency Program, Boston, MA, USA
| | - Martina L Porter
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Dermatology, Harvard Medical School, Boston, MA, USA
| | - Alexa B Kimball
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Dermatology, Harvard Medical School, Boston, MA, USA
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Holcomb ZE, Santillan MR, Morss-Walton PC, Salian P, Her MJ, Giannotti NM, Kimball AB, Porter ML. Risk of COVID-19 in dermatologic patients receiving long-term immunomodulatory therapy. J Am Acad Dermatol 2020; 83:1215-1218. [PMID: 32622141 PMCID: PMC7329682 DOI: 10.1016/j.jaad.2020.06.999] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Zachary E Holcomb
- Harvard Combined Dermatology Residency Program, Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Monica Rosales Santillan
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Peyton C Morss-Walton
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts
| | - Prerna Salian
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Min Ji Her
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nicole M Giannotti
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Northeastern University, Boston, Massachusetts
| | - Alexa B Kimball
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Martina L Porter
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts.
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6
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Holcomb ZE, Yu SH, Menge TD, Nazarian RM, Jessup CJ. A Newborn Female with a Diffuse Rash. Dermatopathology (Basel) 2019; 6:189-194. [PMID: 31616659 PMCID: PMC6787425 DOI: 10.1159/000501787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/12/2019] [Indexed: 11/19/2022] Open
Abstract
Langerhans cell histiocytosis is a rare and clinically heterogeneous group of dendritic histiocytic disorders with typical onset in the neonatal period or infancy, although it can present at any age. Histiocytes accumulate in one or more organs, leading to a variable clinical presentation of disease. We report a case of biopsy-proven Langerhans cell histiocytosis in a newborn and discuss the workup and management of this disease, along with reviewing its clinical variants.
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Affiliation(s)
- Zachary E Holcomb
- Harvard Combined Dermatology Residency Program, Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sherry H Yu
- Harvard Combined Dermatology Residency Program, Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tyler D Menge
- Harvard Combined Dermatology Residency Program, Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rosalynn M Nazarian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Chad J Jessup
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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7
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Blanchard SK, Sullivan KM, Hooten JN, Holcomb ZE, Rowe Nichols K, Selim MA, Rao CL, Hall RP, Chao NJ, Cardones AR. High-dose intravenous immunoglobulin as adjuvant treatment for grade IV acute cutaneous graft-versus-host disease. Br J Dermatol 2019; 181:869-871. [PMID: 31017659 DOI: 10.1111/bjd.18028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S K Blanchard
- Department of Dermatology, Duke University Medical Center, Durham, NC, U.S.A
| | - K M Sullivan
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, U.S.A.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, U.S.A
| | - J N Hooten
- Department of Dermatology, Duke University Medical Center, Durham, NC, U.S.A
| | - Z E Holcomb
- Duke University School of Medicine, Durham, NC, U.S.A
| | - K Rowe Nichols
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, U.S.A
| | - M A Selim
- Department of Dermatology, Duke University Medical Center, Durham, NC, U.S.A.,Department of Pathology, Duke University Medical Center, Durham, NC, U.S.A
| | - C L Rao
- Department of Dermatology, Duke University Medical Center, Durham, NC, U.S.A.,Durham VA Medical Center, Durham, NC, U.S.A
| | - R P Hall
- Department of Dermatology, Duke University Medical Center, Durham, NC, U.S.A
| | - N J Chao
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, U.S.A.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, U.S.A
| | - A R Cardones
- Department of Dermatology, Duke University Medical Center, Durham, NC, U.S.A.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, U.S.A.,Durham VA Medical Center, Durham, NC, U.S.A
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8
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Affiliation(s)
- Zachary E Holcomb
- Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Saumil M Chudgar
- Duke University School of Medicine, Duke University, Durham, North Carolina, USA
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9
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Suwanpradid J, Holcomb ZE, MacLeod AS. Emerging Skin T-Cell Functions in Response to Environmental Insults. J Invest Dermatol 2016; 137:288-294. [PMID: 27784595 DOI: 10.1016/j.jid.2016.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/12/2016] [Accepted: 08/18/2016] [Indexed: 01/12/2023]
Abstract
Skin is the primary barrier between the body and the outside world, functioning not only as a physical barrier, but also as an immunologic first line of defense. A large number of T cells populate the skin. This review highlights the ability of these cutaneous T cells to regulate skin-specific environmental threats, including microbes, injuries, solar UV radiation, and allergens. Since much of this knowledge has been advanced from murine studies, we focus our review on how the mouse state has informed the human state, emphasizing the key parallels and differences.
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Affiliation(s)
- Jutamas Suwanpradid
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Zachary E Holcomb
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Amanda S MacLeod
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA; Department of Immunology, Duke University Medical Center, Durham, North Carolina, USA; Pinnell Center for Investigative Dermatology and Skin Disease Research Center, Duke University Medical Center, Durham, North Carolina, USA.
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