Search

Lichen planus is a condition characterized by the development of intensely itchy skin lesions. This skin disorder is associated with the activation of immune cells which act against the epidermal cells located in the outer layer of the skin. Immune CD4 T cells and antigen-presenting cells, such as Langerhans cells and macrophages, accumulate within the dermal and epidermal skin layers. A skin condition similar to lichen planus occurs in bone marrow transplant patients who develop graft-versus-host disease, a pathological reaction between the recipient and transplanted tissue. This suggests that an autoimmune reaction, in which immune cells attack body tissues or cells, may contribute to the disease process in lichen planus. CD4 T cells may interact with the Langerhans cells or macrophages, resulting in the production of T cells that destroy keratinocytes, skin cells that produce the tough protein called keratin in the skin. The drug cyclosporine counteracts the activity of CD4 T cells and may be beneficial in treating lichen planus. Previous studies have shown that oral cyclosporine is effective in treating severe lichen planus. The effect of cyclosporine on immune cells within the skin lesions of five patients with severe lichen planus was examined. Cyclosporine, given orally in low doses for 15 days, decreased the total number of T cells and immune cells containing the receptor site for interleukin 2, a substance that activates the growth of T cells. These changes were associated with an improvement in the symptoms of the patients. These findings are consistent with CD4 T cells and antigen-presenting cells having a role in the disease process of lichen planus. The effectiveness of cyclosporine in treating lichen planus may be related to the ability of cyclosporine to inhibit CD4 T cells. (Consumer Summary produced by Reliance Medical Information, Inc.)

ABSTRACTBackground: The susceptibility of patients with chronic plaque psoriasis and the risks or benefits related to the use of biological therapies for COVID-19 are unknown.Few data about prevalence, clinical course and outcomes of COVID-19 among psoriatic patients were reported. The aims of this study were 1) to assess the prevalence and severity of COVID-19 in psoriatic patients treated with biologic agents during the first phase of the emergency (22 February to 22 April 2020) in Italy, and 2) to report the clinical outcomes of patients who have been exposed to individuals with confirmed SARS-CoV-2 infection.Methods: Patients with moderate-to-severe chronic plaque psoriasis, aged ≥18 years and undergoing treatment with biologic agents as of 22 February 2020, were eligible to be included in PSO-BIO-COVID study. Demographic and clinical characteristics of patients using any biologic for psoriasis treatment between 22 February and 22 April 2020 were registered.Results: A total of 12,807 psoriatic patients were included in the PSO-BIO-COVID study.In this cohort 26 patients (0.2%) had a swab confirmation of SARS-CoV-2 infection. Eleven patients required hospitalization and two died.Conclusion: The incidence of COVID-19 observed in our cohort of psoriatic patients (0.2%) is similar to that seen in the general population (0.31%) in Italy. However, the course of the disease was mild in most patients. Biological therapies may likely lessen ‘cytokine storm’ of COVID-19, which sometimes lead to multiple organ failure, ARDS, and death.

Atopic dermatitis is a chronic, relapsing, non-contiguous, exudative eczema/dermatitis, which represents a complex, multi-factorial disorder, due to an impairment of the stratum corneumbarrier. Currently available drugs have a low skin bioavailability and may give rise to severe adverse events. Nanotechnologies, including nano-particles, liposomes, nano-gels, nano-mixtures, nano-emulsions and other nano-carriers, offer unprecedented solutions to these issues, enabling: i) the management of different clinical forms of atopic dermatitis, especially the recalcitrant ones, i) a better bio-availability and trans-dermal drug targeted delivery at the inflammation site, ii) dose control, iii) significant improvements both in clinical symptoms and immune responses, iv) with less adverse events being reported and a better safety profile. However, some nano-sized structures could amplify and even worsen symptoms in particularly susceptible individuals. Furthermore, most studies included in the present systematic review have been conducted in-vitroor in-vivo, with few randomized controlled clinical trials (RCTs). Future investigations should adopt this design in order to enable scholars achieving robust findings and evidence. Therefore, given the above-mentioned shortcomings, further research in the field is urgently warranted.

Toxic metals are not so rare but are often neglected causes of alopecia areata in men and women. Thallium, arsenic, selenium, and mercury are the most common cause of metals-related alopecia, which is what Vicky Yu and colleagues’ found. Other than the presence of thallium, arsenic, mercury, and selenium, cadmium, bismuth, lithium, and copper should also be taken into account when dermatologists are considering toxic metals as a potential cause of alopecia areata in humans.

There is a need for validated tools to assess health-related quality of life (HRQoL) in routine clinical practice.

An open clinical study on hospitalized patients was carried out to determine the effectiveness of cyclosporine, a drug that suppresses the immune system, on severe psoriasis. Disease status, as determined by the Psoriasis Area and Severity Index (PASI) and by measurement of several blood chemistry variables, was reviewed weekly in all subjects, and, in addition, analysis of small skin biopsies was performed on about half the group. The biopsies were examined for presence of different cell types and were evaluated for blood cell function, with emphasis on factors associated with the cell-mediated immune response. Results indicated that most (12/13) patients went into remission and that improvement in their appearance was almost complete after 20 days of treatment. Patients with psoriatic arthropathy (joint inflammation) experienced relief of pain and improved function. Most substances quantified in blood tests remained within normal levels. The majority of cells found under the psoriatic lesions were immune cells, namely T cells, with a prevalence of active T helper cells, and the number of these diminished as treatment progressed. Changes in other cell types associated with the cell-mediated immune response were noted. These results are in agreement with other studies on the effects of cyclosporine on psoriasis. Side effects of this drug can be dangerous, and its use in psoriasis patients should be restricted to patients who can be carefully observed. (Consumer Summary produced by Reliance Medical Information, Inc.)

To evaluate the efficacy of a highly concentrated Lactobacillus salivariuspreparation containing a gelling complex formed by Streptococcus thermophilusST10 and tara gum in the treatment of atopic dermatitis (AD).

Background: Contact dermatitis (CD) is a chronic disease with a significant impact on quality of life (QoL). There have been relatively few reports in the literature on specific QoL outcomes for patients suffering from CD. Objectives: To develop a new instrument specifically designed to measure QoL in CD and to investigate which disease features could strongly influence QoL. Methods: Three hundred seventy-two patients affected by CD were administered a 20-item questionnaire, which comprised some questions taken and modified from the Dermatology Life Quality Index and the Skindex 16. Six more items were added. Univariate analysis and a chi-square test were performed. Results: Females reported lower QoL scores than males. Three aspects (itching, discomfort, and difficulty in daily activities) were strongly associated with a poor QoL; even if patients who experienced difficulty in using their hands at work had a poor QoL, the statistical significance was very low. Conclusion: A CD-specific questionnaire can be used to understand a priori the impact on psychological behaviour of the patient and can lead to specific choices, such as the appropriate therapy to be used, the evaluation of treatment efficacy, the choice of preventive devices, and the comparison with QoL of other dermatoses. [ABSTRACT FROM AUTHOR]

Cyclosporin A (CsA) has been proved to be effective in the treatment of severe cutaneous psoriasis and psoriatic arthritis (PsA). In psoriasis, CsA therapy can be used as: (1) intermittent short-course therapy; (2) continuous long-term therapy; (3) crisis intervention; and (4) a combination of sequential and rotational therapy. Several open prospective studies have shown the short-term efficacy of CsA in PsA. While there were no randomized controlled trials (RCT) comparing CsA to placebo, 3 published controlled trials compared CsA to other disease modifying antirheumatic drugs (DMARD). These studies support the efficacy of CsA in patients with PsA and peripheral arthritis. However, no conclusions can be drawn on the efficacy of CsA for dactylitis and axial disease. Long-term studies have shown the persistent efficacy and safety of CsA in PsA. The beneficial effects of CsA in angiogenesis-related diseases such as PsA and cutaneous psoriasis may also be mediated by its ability to block the angiogenic effects induced by vascular endothelial growth factor.

We measured mitogenic activity of whole blood serum and platelet-poor plasma-derived serum of a group of 10 patients with progressive systemic sclerosis and of 8 controls. Mitogenic activity of plasma-derived serum was greater in patients than in controls, in the absence of other signs of platelet activation. This increased activity was inhibited by specific antibodies, anti-platelet derived growth factor, suggesting that circulating levels of platelet-derived growth factor may be present in progressive systemic sclerosis patients. Platelet-derived growth factor, released either by platelets or by monocytes, might play a role in the pathogenesis of scleroderma.

Psoriasis is an inflammatory skin disease with a chronic relapsing course. In about 20%-30% of psoriatic patients, disease severity requires systemic treatment, which carries a huge economic and management burden for the healthcare system. The decision to employ systemic treatment, reserved for severe or extensive forms, needs to be weighed carefully and is influenced by factors from the host. Each form of treatment, i.e., photochemotherapy, cyclosporin A, methotrexate, acitretin - considered the traditional psoriatic treatments - should be evaluated for each specific clinical condition.