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MMW Fortschritte Der Medizin May 2022
Topics: Anosmia; COVID-19; Dermatologic Agents; Glucocorticoids; Humans; Olfaction Disorders; Smell
PubMed: 35513640
DOI: 10.1007/s15006-022-1124-4 -
Biomolecules Feb 2020The skin represents an indispensable barrier between the organism and the environment and is the first line of defense against exogenous insults. The transcription... (Review)
Review
The skin represents an indispensable barrier between the organism and the environment and is the first line of defense against exogenous insults. The transcription factor NRF2 is a central regulator of cytoprotection and stress resistance. NRF2 is activated in response to oxidative stress by reactive oxygen species (ROS) and electrophiles. These electrophiles oxidize specific cysteine residues of the NRF2 inhibitor KEAP1, leading to KEAP1 inactivation and, subsequently, NRF2 activation. As oxidative stress is associated with inflammation, the NRF2 pathway plays important roles in the pathogenesis of common inflammatory diseases and cancer in many tissues and organs, including the skin. The electrophile and NRF2 activator dimethyl fumarate (DMF) is an established and efficient drug for patients suffering from the common inflammatory skin disease psoriasis and the neuro-inflammatory disease multiple sclerosis (MS). In this review, we discuss possible molecular mechanisms underlying the therapeutic activity of DMF and other NRF2 activators. Recent evidence suggests that electrophiles not only activate NRF2, but also target other inflammation-associated pathways including the transcription factor NF-κB and the multi-protein complexes termed inflammasomes. Inflammasomes are central regulators of inflammation and are involved in many inflammatory conditions. Most importantly, the NRF2 and inflammasome pathways are connected at different levels, mainly antagonistically.
Topics: Animals; Dermatologic Agents; Dimethyl Fumarate; Electrons; Humans; Inflammasomes; Kelch-Like ECH-Associated Protein 1; NF-E2-Related Factor 2; NF-kappa B; Reactive Oxygen Species; Skin Diseases
PubMed: 32053878
DOI: 10.3390/biom10020271 -
Dermatologic Therapy Nov 2020In the era of staggering speed in development of the novel coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2... (Review)
Review
In the era of staggering speed in development of the novel coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we have reviewed the dermatologists' tools at hand for their utility (and potential risks) in patients affected by COVID-19. This review aims to shed light on the antiviral and proviral potential of drugs routinely used in dermatology to modulate COVID-19. The literature search included peer-reviewed articles published in the English language (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) from January 1990 to March 2020 and by reference lists of respective articles. Somewhat to our surprise, we have found that several of our drugs widely used in dermatology have antiviral potential. On the other hand, we also frequently use immunosuppressive drugs in our dermatologic patients that potentially pose them at increased risk for COVID-19.
Topics: Antiviral Agents; COVID-19; Dermatologic Agents; Dermatology; Humans; Immunosuppressive Agents; SARS-CoV-2; COVID-19 Drug Treatment
PubMed: 32537852
DOI: 10.1111/dth.13833 -
Dermatology Online Journal Dec 2012Morbihan disease, which consists of solid facial edema, is a rare complication of rosacea, a common cutaneous disorder in middle-aged individuals. The characteristic...
Morbihan disease, which consists of solid facial edema, is a rare complication of rosacea, a common cutaneous disorder in middle-aged individuals. The characteristic features of Morbihan disease are its chronic course, typical clinical picture, lack of specific laboratory and histopathologic findings, and refractoriness to therapeutic measures. Since its initial description in 1957, only a small number of cases have been reported in the dermatologic literature. We report a 54-year-old man who developed a two-year duration of erythema and edema that affects the upper and mid face, with accentuation in the periorbital region. Patch tests excluded an allergic contact dermatitis and histopathologic investigation showed small, nodular clusters of epithelioid cells in the dermis that were consistent with sarcoidal granulomata. A diagnosis of Morbihan disease was made owing to the combination of clinical and histopathologic findings. Therapeutic options for the disease remain unsatisfactory and treatments reported in the literature include systemic glucocorticoids, oral tetracyclines, thalidomide, isotretinoin, ketotifen, and clofazimine. Our patient failed a six-to-seven months course of minocycline prior to presentation and has since experienced improvement on gradually-increasing doses of isotretinoin.
Topics: Chronic Disease; Dermatologic Agents; Dermis; Edema; Erythema; Face; Histiocytes; Humans; Isotretinoin; Lymphocytes; Male; Middle Aged
PubMed: 23286817
DOI: No ID Found -
Journal Der Deutschen Dermatologischen... Dec 2013Cutaneous and systemic plasmacytosis is a rare disorder observed mainly in Japanese that features an infiltration of mature plasma cells in various organ systems. In... (Review)
Review
Cutaneous and systemic plasmacytosis is a rare disorder observed mainly in Japanese that features an infiltration of mature plasma cells in various organ systems. In addition to the skin, lymph nodes and bone marrow are regularly affected. Laboratory tests show a polyclonal hypergammaglobulinemia. The cutaneous morphology is characterized by red to dark brown macules, papules and plaques a few centimeters in diameter, usually distributed symmetrically on the face, neck and back. Etiology and pathogenesis are not known. It is speculated that a reactive dysfunction of plasma cells may be triggered by various stimuli, such as interleukin 6. Treatment of cutaneous and systemic plasmacytosis is difficult. A standardized treatment concept does not yet exist. Topical corticosteroids and calcineurin inhibitors are mainly used.
Topics: Administration, Topical; Adrenal Cortex Hormones; Calcineurin Inhibitors; Dermatologic Agents; Diagnosis, Differential; Humans; Hypergammaglobulinemia; Japan; Lymphocytosis; Plasma Cells; Skin Diseases; Treatment Outcome
PubMed: 23937389
DOI: 10.1111/ddg.12190 -
American Journal of Clinical Dermatology May 2022There has been no extensive synthesis of studies evaluating the cost of chronic hand eczema (CHE). This review evaluated the societal costs, healthcare resource... (Review)
Review
There has been no extensive synthesis of studies evaluating the cost of chronic hand eczema (CHE). This review evaluated the societal costs, healthcare resource utilisation, missed work time and job loss due to CHE. MEDLINE and 16 other databases and websites were searched in October 2020 for studies meeting prespecified inclusion criteria. Studies conducted in Europe, Australia, New Zealand or the Americas were included. Two reviewers independently assessed titles and abstracts, and full-text papers published in English between 2000 and 2020, for relevance. Data extraction was carried out by one reviewer and checked by a second reviewer. All data were based on costs between 2001 and 2013 but have been inflated to 2020 prices and converted to US dollars and Euros. A total of 30 studies (reported in 33 publications) were included in the synthesis. Mean total societal costs per year per patient ranged from $2549 (€1813) to $10,883 (€7738). Pharmacological therapy was, on average, $28.34 (€20.15) per month in Italy and $36.49 (€25.94) per month for emollients in Switzerland. Yearly treatment costs were $599.05 (€425.92) for drugs, including topical corticosteroids, topical calcineurin inhibitors, other topical treatments and oral treatments, and $178.40 for emollients, in Germany. CHE was associated with hospitalisation costs ranging from $81.86 (€58.20) per patient per month (US) to $105.04 (€74.68) per patient per month (Italy) and $639.59 (€454.75) per year (Germany). Up to 57% of patients took sick leave and up to 25% reported job loss/job change due to CHE. This review confirms the significant cost burden of CHE. Given the paucity of studies estimating the monetary costs of absenteeism, presenteeism and job loss associated with CHE, current mean societal costs are likely underestimated. Uncontrolled disease may also lead to increased costs to patients and society.
Topics: Calcineurin Inhibitors; Cost of Illness; Dermatologic Agents; Eczema; Emollients; Financial Stress; Humans
PubMed: 35258783
DOI: 10.1007/s40257-021-00669-6 -
Actas Dermo-sifiliograficas Jul 2008Biological therapies for immune based chronic inflammatory diseases, especially cytokine inhibitors such as TNF-alpha antagonists, have been acceptably well tolerated in...
Biological therapies for immune based chronic inflammatory diseases, especially cytokine inhibitors such as TNF-alpha antagonists, have been acceptably well tolerated in clinical trials with patients suffering rheumatic, dermatologic and intestinal diseases in which they have been subsequently indicated. However, the pharmacovigilance studies and long-term follow-up have clarified several aspects on their safety in the everyday clinical use. The adverse effects associated with TNF-alpha inhibitors can generally be classified into those related to the target (or class) and those related to the agent. Target-related adverse events include those potentially attributable to the immunosuppression inherent in blocking a key cytokine, a phenomenon that could increase the susceptibility to infections and neoplasms. Specific inhibition of TNF-alpha could also facilitate hepatotoxicity, production of autoantibodies, development of demyelinizing diseases and it is also possibly associated to the worsening of congestive heart failure. The side effects related to the agent itself, such as allergic reactions and immunogenicity, are idiosyncratic phenomena of each molecule. Infliximab is an IgG1 class chimeric monoclonal antibody with extensive accumulated experience in the treatment of rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, intestinal inflammatory disease and, recently, moderate-to-severe plaque psoriasis. It is also being evaluated in other inflammatory dermatitis and systemic diseases with skin expression, such as severe atopic dermatitis, pityriasis rubra pilaris, pyoderma gangrenosum, cutaneous sarcoidosis, Adult Still's disease, inverted acne and refractory graft -versus- host disease. Predisposition of infliximab-treated individuals, as occurs with other anti-TNF-alpha agents, to cause an increase of conventional pyogenic infections (of the skin and soft tissues, respiratory tract, genitourinary tracts and bacteriemias) and an increase in granulomatous and opportunistic infections due to invasive or intracellular pathogens (such as Mycobacterium tuberculosis), has been well established and quantified in the last five years. We presently know that the initiation of screening strategies of latent infections (especially tuberculosis) in the host candidate to receive anti-TNF-alpha drugs, with their corresponding early treatment to avoid reactivations, and other prophylaxis, hygiene and vaccination measures have not only minimized these risks of suffering infections but also have practically reduced and equalized the different capacity to trigger infections belonging to each one of the biological agents individually.
Topics: Anti-Inflammatory Agents; Antibodies, Monoclonal; Arthritis, Psoriatic; Dermatologic Agents; Follow-Up Studies; Humans; Immunosuppression Therapy; Infections; Infliximab; Product Surveillance, Postmarketing; Psoriasis; Risk Factors; Time Factors; Tuberculosis; Tumor Necrosis Factor-alpha
PubMed: 19080987
DOI: No ID Found -
American Family Physician Nov 2001Dermatomyositis is an idiopathic inflammatory myopathy with characteristic skin manifestations. Although the disorder is rare, with a prevalence of one to 10 cases per... (Review)
Review
Dermatomyositis is an idiopathic inflammatory myopathy with characteristic skin manifestations. Although the disorder is rare, with a prevalence of one to 10 cases per million in adults and one to 3.2 cases per million in children, early recognition and treatment are important ways to decrease the morbidity of systemic complications. An association with other connective tissue disorders (overlap syndrome) and malignancy make this diagnosis particularly important to primary care physicians. Patient management includes careful evaluation for underlying malignancy and liberal use of physical therapy, antihistamines, sunscreen and oral corticosteroids. Poor prognostic indicators include poorly responsive disease, delay in diagnosis and the presence of malignancy. The therapeutic goal is to maintain function and prevent or minimize sequelae.
Topics: Adult; Azathioprine; Child; Dermatologic Agents; Dermatomyositis; Diagnosis, Differential; Female; Humans; Hydroxychloroquine; Methotrexate; Polymyositis; Prednisone; Prognosis
PubMed: 11730311
DOI: No ID Found -
The Journal of Investigative... Nov 2015Selection of a therapy for a patient with alopecia areata (AA) is frequently based on the age of the patient, disease extent, perhaps disease duration, patient... (Review)
Review
Selection of a therapy for a patient with alopecia areata (AA) is frequently based on the age of the patient, disease extent, perhaps disease duration, patient expectations, cost of therapy in terms of time commitment, and financial resources, as well as the results of screening laboratory studies that rule out the presence of other co-morbidities such as anemia, low iron stores, thyroid abnormalities, low vitamin D, or other autoimmune diseases. Although there is currently no cure for AA and no universally proven therapy that induces and sustains remission, many therapies are available which can be of benefit to both affected children and adults. Before selecting a treatment for patients with extensive long-standing AA, a scalp biopsy may provide useful information about the degree of inflammation and follicle differentiation. Recent clinical and translational research observations with the systemic Janus kinase (JAK) inhibitors and interleukin-2 (IL-2) have excited the clinical and AA patient communities and have led to clinical trials, as well as to the off-label use of these more expensive and targeted systemic therapies.
Topics: Adult; Alopecia Areata; Child; Dermatologic Agents; Holistic Health; Humans; Immunotherapy; Minoxidil; Phototherapy; Steroids
PubMed: 26551946
DOI: 10.1038/jidsymp.2015.41 -
Indian Journal of Dermatology,... 2015Nocebo effect, originally denoting the negative counterpart of the placebo phenomenon, is now better defined as the occurrence of adverse effects to a therapeutic... (Review)
Review
Nocebo effect, originally denoting the negative counterpart of the placebo phenomenon, is now better defined as the occurrence of adverse effects to a therapeutic intervention because the patient expects them to develop. More commonly encountered in patients with a past negative experience, this effect stems from highly active processes in the central nervous system, mediated by specific neurotransmitters and modulated by psychological mechanisms such as expectation and conditioning. The magnitude of nocebo effect in clinical medicine is being increasingly appreciated and its relevance encompasses clinical trials as well as clinical practice. Although there is hardly any reference to the term nocebo in dermatology articles, the phenomenon is encountered routinely by dermatologists. Dermatology patients are more susceptible to nocebo responses owing to the psychological concern from visibility of skin lesions and the chronicity, unpredictable course, lack of 'permanent cure' and frequent relapses of skin disorders. While finasteride remains the prototypical drug that displays a prominent nocebo effect in dermatologic therapeutics, other drugs such as isotretinoin are also likely inducers. This peculiar phenomenon has recently been appreciated in the modulation of itch perception and in controlled drug provocation tests in patients with a history of adverse drug reactions. Considering the conflict between patients' right to information about treatment related adverse effects and the likelihood of nocebo effect stemming from information disclosure, the prospect of ethically minimizing nocebo effect remains daunting. In this article, we review the concept of nocebo effect, its postulated mechanism, relevance in clinical dermatology and techniques to prevent it from becoming a barrier to effective patient management.
Topics: Dermatologic Agents; Dermatology; Drug-Related Side Effects and Adverse Reactions; Humans; Nocebo Effect; Patient Compliance
PubMed: 25900939
DOI: 10.4103/0378-6323.155573