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Li Q, Yang Z, Chen K, Zhao M, Long H, Deng Y, Hu H, Jia C, Wu M, Zhao Z, Zhu H, Zhou S, Zhao M, Cao P, Zhou S, Song Y, Tang G, Liu J, Jiang J, Liao W, Zhou W, Yang B, Xiong F, Zhang S, Gao X, Jiang Y, Zhang W, Zhang B, He YL, Ran L, Zhang C, Wu W, Suolang Q, Luo H, Kang X, Wu C, Jin H, Chen L, Guo Q, Gui G, Li S, Si H, Guo S, Liu HY, Liu X, Ma GZ, Deng D, Yuan L, Lu J, Zeng J, Jiang X, Lyu X, Chen L, Hu B, Tao J, Liu Y, Wang G, Zhu G, Yao Z, Xu Q, Yang B, Wang Y, Ding Y, Yang X, Kai H, Wu H, Lu Q. Human-multimodal deep learning collaboration in 'precise' diagnosis of lupus erythematosus subtypes and similar skin diseases. J Eur Acad Dermatol Venereol 2024. [PMID: 38619440 DOI: 10.1111/jdv.20031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/09/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Lupus erythematosus (LE) is a spectrum of autoimmune diseases. Due to the complexity of cutaneous LE (CLE), clinical skin image-based artificial intelligence is still experiencing difficulties in distinguishing subtypes of LE. OBJECTIVES We aim to develop a multimodal deep learning system (MMDLS) for human-AI collaboration in diagnosis of LE subtypes. METHODS This is a multi-centre study based on 25 institutions across China to assist in diagnosis of LE subtypes, other eight similar skin diseases and healthy subjects. In total, 446 cases with 800 clinical skin images, 3786 multicolor-immunohistochemistry (multi-IHC) images and clinical data were collected, and EfficientNet-B3 and ResNet-18 were utilized in this study. RESULTS In the multi-classification task, the overall performance of MMDLS on 13 skin conditions is much higher than single or dual modals (Sen = 0.8288, Spe = 0.9852, Pre = 0.8518, AUC = 0.9844). Further, the MMDLS-based diagnostic-support help improves the accuracy of dermatologists from 66.88% ± 6.94% to 81.25% ± 4.23% (p = 0.0004). CONCLUSIONS These results highlight the benefit of human-MMDLS collaborated framework in telemedicine by assisting dermatologists and rheumatologists in the differential diagnosis of LE subtypes and similar skin diseases.
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Affiliation(s)
- Qianwen Li
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhi Yang
- Key Laboratory of Intelligent Computing and Information Processing of Ministry of Education, Xiangtan University, Xiangtan, China
| | - Kaili Chen
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ming Zhao
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hai Long
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yueming Deng
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Haoran Hu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chen Jia
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Meiyu Wu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhidan Zhao
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Huan Zhu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Suqing Zhou
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Mingming Zhao
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Pengpeng Cao
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shengnan Zhou
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yang Song
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Guishao Tang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Juan Liu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jiao Jiang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Wei Liao
- Department of Dermatology, Hunan Children's Hospital, Changsha, China
| | - Wenhui Zhou
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Bingyi Yang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Feng Xiong
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Suhan Zhang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaofei Gao
- Department of Dermatology, Hunan Children's Hospital, Changsha, China
| | - Yiqun Jiang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Wei Zhang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Bo Zhang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Yan-Ling He
- Department of Dermatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Liwei Ran
- Department of Dermatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chunlei Zhang
- Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - Wenting Wu
- Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - Quzong Suolang
- Department of Dermatology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Hanhuan Luo
- Department of Dermatology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Xiaojing Kang
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Caoying Wu
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Hongzhong Jin
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lei Chen
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qing Guo
- Department of Dermatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Guangji Gui
- Department of Dermatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shanshan Li
- Department of Dermatology, The First Bethune Hospital of Jilin University, Changchun, China
| | - Henan Si
- Department of Dermatology, The First Bethune Hospital of Jilin University, Changchun, China
| | - Shuping Guo
- Department of Dermatology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Hong-Ye Liu
- Department of Dermatology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiguang Liu
- Department of Dermatology, The Hei Long Jiang Provincial Hospital, Harbin, China
| | - Guo-Zhang Ma
- Department of Dermatology, The Hei Long Jiang Provincial Hospital, Harbin, China
| | - Danqi Deng
- Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Limei Yuan
- Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jianyun Lu
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jinrong Zeng
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xian Jiang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyan Lyu
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Liuqing Chen
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
| | - Bin Hu
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
| | - Juan Tao
- Department of Dermatology, Wuhan Union Hospital of China, Wuhan, China
| | - Yuhao Liu
- Department of Dermatology, Wuhan Union Hospital of China, Wuhan, China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Xi'an, China
| | - Guannan Zhu
- Department of Dermatology, Xijing Hospital, Xi'an, China
| | - Zhirong Yao
- Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qianyue Xu
- Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Yu Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Yan Ding
- Hainan Provincial Hospital of Skin Disease, Haikou, China
| | - Xianxu Yang
- Hainan Provincial Hospital of Skin Disease, Haikou, China
| | - Hu Kai
- Key Laboratory of Intelligent Computing and Information Processing of Ministry of Education, Xiangtan University, Xiangtan, China
| | - Haijing Wu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qianjin Lu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
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Hu XM, Zheng SY, Mao R, Zhang Q, Wan XX, Zhang YY, Li J, Yang RH, Xiong K. Pyroptosis-related gene signature elicits immune response in rosacea. Exp Dermatol 2024; 33:e14812. [PMID: 37086043 DOI: 10.1111/exd.14812] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 04/23/2023]
Abstract
Rosacea is a complex chronic inflammatory skin disorder with high morbidity. Pyroptosis is known as a regulated inflammatory cell death. While its association with immune response to various inflammatory disorders is well established, little is known about its functional relevance of rosacea. So, we aimed to explore and enrich the pathogenesis involved in pyroptosis-related rosacea aggravations. In this study, we evaluated the pyroptosis-related patterns of rosacea by consensus clustering analysis of 45 ferroptosis-related genes (FRGs), with multiple immune cell infiltration analysis to identify the pyroptosis-mediated immune response in rosacea using GSE65914 dataset. The co-co-work between PRGs and WGCNA-revealed hub genes has established using PPI network. FRG signature was highlighted in rosacea using multi-transcriptomic and experiment analysis. Based on this, three distinct pyroptosis-related rosacea patterns (non/moderate/high) were identified, and the notably enriched pathways have revealed through GO, KEGG and GSEA analysis, especially immune-related pathways. Also, the XCell/MCPcount/ssGSEA/Cibersort underlined the immune-related signalling (NK cells, Monocyte, Neutrophil, Th2 cells, Macrophage), whose hub genes were identified through WGCNA (NOD2, MYD88, STAT1, HSPA4, CXCL8). Finally, we established a pyroptosis-immune co-work during the rosacea aggravations. FRGs may affect the progression of rosacea by regulating the immune cell infiltrations. In all, pyroptosis with its mediated immune cell infiltration is a critical factor during the development of rosacea.
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Affiliation(s)
- Xi-Min Hu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China
| | - Sheng-Yuan Zheng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Rui Mao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Qi Zhang
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China
| | - Xin-Xing Wan
- Department of Endocrinology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Yi-Ya Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ji Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Rong-Hua Yang
- Department of Burn and Plastic Surgery, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Kun Xiong
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China
- Hunan Key Laboratory of Ophthalmology, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Emergency and Trauma, Ministry of Education, College of Emergency and Trauma, Hainan Medical University, Haikou, China
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Chen C, Wang P, Zhang L, Liu X, Zhang H, Cao Y, Wang X, Zeng Q. Exploring the Pathogenesis and Mechanism-Targeted Treatments of Rosacea: Previous Understanding and Updates. Biomedicines 2023; 11:2153. [PMID: 37626650 PMCID: PMC10452301 DOI: 10.3390/biomedicines11082153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
Rosacea is a chronic inflammatory skin disease characterized by recurrent erythema, flushing, telangiectasia, papules, pustules, and phymatous changes in the central area of the face. Patients with this condition often experience a significant negative impact on their quality of life, self-esteem, and overall well-being. Despite its prevalence, the pathogenesis of rosacea is not yet fully understood. Recent research advances are reshaping our understanding of the underlying mechanisms of rosacea, and treatment options based on the pathophysiological perspective hold promise to improve patient outcomes and reduce incidence. In this comprehensive review, we investigate the pathogenesis of rosacea in depth, with a focus on emerging and novel mechanisms, and provide an up-to-date overview of therapeutic strategies that target the diverse pathogenic mechanisms of rosacea. Lastly, we discuss potential future research directions aimed at enhancing our understanding of the condition and developing effective treatments.
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Affiliation(s)
| | | | | | | | | | | | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200040, China
| | - Qingyu Zeng
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200040, China
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4
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Xu Q, Qiu Y, Lu Z, Yu H, Ling B, Li Y, Gu Y, Yao Z. Centrifugal lipodystrophy on a spectrum with lupus erythematosus panniculitis in children and efficacy and safety of hydroxychloroquine: A clinicopathological study. Dermatol Ther 2022; 35:e15825. [PMID: 36100983 DOI: 10.1111/dth.15825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/18/2022] [Accepted: 09/12/2022] [Indexed: 11/27/2022]
Abstract
This study aimed to investigate the relationship between centrifugal lipodystrophy (CLD) and lupus erythematosus panniculitis (LEP), and the efficacy and safety of hydroxychloroquine (HCQ) for treating CLD in children. A total of 29 cases clinically diagnosed as CLD (n=24) and CLD/LEP overlap (n=5) were enrolled and all were confirmed by skin biopsies of CLD and LEP. The clinicopathological findings, clinical outcomes and prognosis with the treatment of HCQ between CLD and LEP were compared. All 29 cases (male: female=1:1.6; median age at onset: 3 years) had cutaneous lesions of centrifugally expanding lipoatrophy, of which five cases overlapped with LEP lesions presented as erythematous indurated plaque (n=2), subcutaneous nodules (n=2) and alopecia along Blaschko's lines (n=1). Antinuclear antibodies were found in six (25.0%) CLD and two (40.0%) overlapped patients (P=.597). Histopathologically, of the 24 cases of CLD, 14 (58.5%) exhibited subcutis loss or mild lobular inflammation. Ten (41.7%) cases displayed lobular panniculitis with moderate to dense lymphohistiocytic infiltrate and plasma cells, similar to the five cases of overlap. Small clusters of CD123 positive plasmacytoid dendritic cells were found in 62.5% (5/8) of CLD and 66.7% (2/3) of overlap cases (P>.99). HCQ (5 mg/kg/d) treatment showed improvement in 91.3% (21/23) of CLD and all overlap cases, including 4 cases unresponsive to previous oral glucocorticosteroid treatment. Our findings suggested that CLD and LEP represent a spectrum within the same disease. HCQ (5 mg/kg/d) was effective and safe for treating CLD (age>1.5 years), and early treatment and a regular long-term follow-up are essential. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Qianyue Xu
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yangyang Qiu
- Department of Dermatology, Xiamen Branch, Zhongshan Hospital, Fudan University, Fujian, China
| | - Zhiyong Lu
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Yu
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Ling
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Li
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Gu
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhirong Yao
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Liu L, Chen Y, Chen J, Xue Y, Chen T, Li Y, Shao X, Chen J. Association between frontal fibrosing Alopecia and Rosacea: Results from clinical observational studies and gene expression profiles. Front Immunol 2022; 13:985081. [PMID: 36091020 PMCID: PMC9448884 DOI: 10.3389/fimmu.2022.985081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIn recent years, frontal fibrosing alopecia (FFA), a type of scarring alopecia, has attracted increasing attention. Several studies have reported the frequent occurrence of rosacea in FFA; however, the association between FFA and rosacea and the underlying pathogenesis have not been thoroughly clarified. Thus, this study aimed to quantify these relationships and investigate their shared molecular mechanisms.MethodsWe evaluated the association between FFA and rosacea by analyzing clinical data from nine observational studies. We then analyzed the gene expression profiles of FFA and rosacea. First, differential expression analysis and weighted gene co-expression network analysis were used to identify the common differentially expressed genes (DEGs). Later, we conducted a functional enrichment analysis and protein-protein interaction network and used seven algorithms to identify hub genes. Then, we performed a correlation analysis between the hub genes and the gene set variation analysis scores of common pathways in the gene set enrichment analysis (GSEA). The results were validated using different datasets. Finally, transcription factors were predicted and verified, and CIBERSORT and single-sample GSEA were used to estimate the infiltrating immune cells.ResultsPatients with FFA had significantly higher odds for rosacea (pooled odds ratio [OR], 2.46; 95% confidence interval [CI], 1.78–3.40), and the pooled prevalence of rosacea in patients with FFA was 23% (95% CI, 14–23%). Furthermore, we identified 115 co-DEGs and 13 hub genes (CCR5, CCL19, CD2, CD38, CD83, CXCL8, CXCL9, CXCL10, CXCL11, CXCR4, IRF1, IRF8, and PTPRC). Seven pathways showed a high correlation with these hub genes. In addition, one TF, STAT1, was highly expressed in both diseases, and the results of the immune infiltration analysis indicated the importance of M1 macrophages and effector memory CD8+ T cells.ConclusionThis study contributes to the understanding of the relationship between FFA and rosacea, and based on the hub genes, we reveal the potential pathologies shared by the two diseases. This finding provides new insights of underlying molecular mechanisms and it may inspire future research on this comorbidity.
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Affiliation(s)
- Lin Liu
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yangmei Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiayi Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuzhou Xue
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Tingqiao Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxin Li
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyi Shao
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jin Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Jin Chen,
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Li Q, Yang M, Chen K, Zhou S, Zhou S, Wu H. Tight correlation of 5-hydroxymethylcytosine expression with the scarring damage of discoid lupus erythematosus. Lupus 2022; 31:1306-1316. [PMID: 35817588 DOI: 10.1177/09612033221114761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Cutaneous lupus erythematosus (CLE) is a heterogenous skin disease. The two most common subtypes are discoid LE (DLE) characterized by scarring skin damage and acute CLE (ACLE) presenting with transiently reversible skin lesions. It remains unknown what causes the difference of skin lesions. Studies have shown the existence of tissue-specific 5-Hydroxymethylcytosine (5 hmC)-modified regions in human tissues, which may affect the tissue-related diseases. Here, we aim to assess the expression of 5 hmc in DLE and ACLE lesions and explore the relationship of 5 hmc with scarring damage in DLE. METHODS 84 CLE samples were included in the study. We evaluated the skin damage score and reviewed the histopathologic sections. Immunohistochemical staining was performed to detect the expression of 5 hmc in the appendage and periappendageal inflammatory cells. The 5 hmc expression in periappendageal lymphocytic cells was investigated by multi-spectrum immunohistochemistry staining. RESULTS Scarring/atrophy was the most significant damage in differentiating the DLE from ACLE. Perifollicular inflammatory infiltration was present in all patients with DLE scarring alopecia (DLESA). The 5 hmc expression in the appendage and periappendageal inflammatory cells was significantxly increased in DLESA than ACLE. Similar expression pattern was seen in the staining of IFN-alpha/beta Receptor (IFNAR). The expression of 5 hmc in the appendage was positively correlated with that in the periappendageal inflammatory cells. There was an increased 5 hmc expression in lymphocytes cluster around hair follicle consisting of CD4+ cells, CD8+ cells, and CD19+ cells in DLESA lesions. CONCLUSION These data demonstrate a close association of the expression pattern of 5 hmc with the histopathological characteristic distribution, and with the type I interferons (IFNs) signals in DLESA, supporting the importance of 5 hmc in the amplification of appendage damage and periappendageal inflammation, thereby offering a novel insight into the scarring damage of DLE and the heterogeneity of CLE skin lesions.
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Affiliation(s)
- Qianwen Li
- Department of Dermatology, 70566The Second Xiangya Hospital of Central South University, Changsha, China.,12570The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China
| | - Ming Yang
- Department of Dermatology, 70566The Second Xiangya Hospital of Central South University, Changsha, China
| | - Kaili Chen
- Department of Dermatology, 70566The Second Xiangya Hospital of Central South University, Changsha, China.,12570The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China
| | - Suqing Zhou
- Department of Dermatology, 70566The Second Xiangya Hospital of Central South University, Changsha, China.,12570The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China
| | - Shengnan Zhou
- Department of Dermatology, 70566The Second Xiangya Hospital of Central South University, Changsha, China.,12570The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China
| | - Haijing Wu
- Department of Dermatology, 70566The Second Xiangya Hospital of Central South University, Changsha, China.,12570The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China
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7
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Forton FM. Rosacea, an infectious disease: why rosacea with papulopustules should be considered a demodicosis. A narrative review. J Eur Acad Dermatol Venereol 2022; 36:987-1002. [DOI: 10.1111/jdv.18049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
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Demirbaş A, Yümer Y, Elmas ÖF, Ulutaş Demirbaş G, Atasoy M, Türsen Ü, Dursun R, Lotti T. Relationship between rosacea and chronic obstructive pulmonary disease: Rosacea and comorbidities. J Cosmet Dermatol 2021; 21:2255-2262. [PMID: 34411396 DOI: 10.1111/jocd.14389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/01/2021] [Accepted: 08/05/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Rosacea is a chronic inflammatory skin disease that has been reported to be associated with many systemic disorders including respiratory diseases. AIMS This study aims to investigate respiratory function in patients with rosacea. PATIENTS/METHODS Patients with rosacea and age- and gender-matched healthy volunteers were included in this cross-sectional study. Spirometric pulmonary function tests including the percentage of forced vital capacity (FVC%), percentage of forced expiratory volume in one second (FEV 1%), forced expiratory flow at 25-75% of FVC (FEF 25-75%), and FEV 1/FVC ratio was assessed in both patient and controls. The potential relationship between rosacea severity and pulmonary functions was assessed. RESULTS A total of 120 patients with rosacea and 120 healthy controls were enrolled in the study. Compared to the controls, FEV 1%, FEV 1/FVC%, and FEF 25-75% values were significantly lower in patients with rosacea. Lower FEV 1/FVC% values were found to be associated with disease severity. FEV 1%, FEV 1/FVC%, and FEF 25-75% values were found to be more useful in differentiating the patients from healthy subjects. CONCLUSIONS This study showed that patients with rosacea may have abnormal respiratory function compared to healthy subjects. Besides, disease severity was associated with worse respiratory functions. We believe that patients with rosacea, particularly those with additional risk factors, should be screened for respiratory disorders.
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Affiliation(s)
- Abdullah Demirbaş
- Department of Dermatology, Evliya Çelebi Training and Research Hospital, Kütahya Health Sciences University, Kütahya, Turkey
| | - Yusuf Yümer
- Department of Pulmonary Diseases, Konya Numune Hospital, Konya, Turkey
| | - Ömer Faruk Elmas
- Department of Dermatology, Kırıkkale University, Kırıkkale, Turkey
| | - Gözde Ulutaş Demirbaş
- Department of Dermatology, Evliya Çelebi Training and Research Hospital, Kütahya Health Sciences University, Kütahya, Turkey
| | - Mustafa Atasoy
- Department of Dermatology, Kayseri City Hospital, Health Science University, Kayseri, Turkey
| | - Ümit Türsen
- Department of Dermatology, Mersin University, Mersin, Turkey
| | - Recep Dursun
- Department of Dermatology, Necmettin Erbakan University, Konya, Turkey
| | - Torello Lotti
- Department of Dermatology, Guglielmo Marconi University, Rome, Italy
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Chanprapaph K, Pomsoong C, Tankunakorn J, Eden C, Suchonwanit P, Rutnin S. Comparative Analyses of Clinical Features, Histopathology, and CD123 Immunohistochemistry of Oral Lupus Erythematosus, Lichen Planus, and Other Lichenoid Lesions. Dermatology 2021; 238:464-475. [PMID: 34515092 DOI: 10.1159/000517971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Oral lupus erythematosus (OLE) and oral lichen planus (OLP) are among the common causes of oral lichenoid lesions (OLLs). The differential diagnosis among causes of OLLs, particularly between OLE and OLP, is challenging as they have significant clinical and histopathological overlap. OBJECTIVES To compare and summarize the clinical, histopathological, and direct immunofluorescence (DIF) findings between OLE, OLP, and other OLLs and to explore the diagnostic value of CD123 immunohistochemistry. METHODS A retrospective study on patients with OLE, OLP, and other OLLs was performed between January 2014 and December 2019. The baseline characteristics, the clinical, histopathological, and DIF features, as well as CD123 immunohistochemistry for plasmacytoid dendritic cells (PDCs) were statistically analyzed and compared between groups. RESULTS Of 70 patients, 12 had OLE, 39 had OLP, and 19 had other OLLs. Oral erosions/ulcers were the most common findings in all three groups. Red macules, telangiectases, and discoid plaques were more common in OLE patients, while OLP cases were typified by reticulated patches (p < 0.05). Additionally, white patches were found more often in other OLLs than in both OLE and OLP (p = 0.002). Histologically, mucosal atrophy, basal vacuolization, and perivascular infiltrate were observed in OLE, whereas OLP specimens possessed mucosal hyperplasia, hypergranulosis, and compact orthokeratosis (p < 0.05). Mucosal spongiosis was a histologic feature that favored other OLLs over OLE and OLP (p < 0.001). Data on DIF were nonspecific for all three conditions. For immunohistochemical staining, the median number of total CD123+ PDCs was observed to be higher in OLE than OLP in the mucosal-submucosal junction (MSJ) (p = 0.021), the superficial perivascular area (p = 0.026), and the superficial and deep perivascular areas (p = 0.001). Likewise, PDCs in clusters ≥2+ were seen in significantly higher numbers on OLE than OLP along the MSJ (p = 0.002), the superficial perivascular area (p < 0.001), as well as the superficial and deep perivascular areas (p = 0.011). CD123+ PDCs were found to be significantly more numerous in both OLE and OLP than other OLLs in all of the abovementioned areas (all p < 0.05). CONCLUSION While there are some differences in the clinicopathological features between OLE, OLP, as well as other OLLs, a significant overlap remains. The quantity and distribution pattern of CD123 immunohistochemical staining has a diagnostic implication in differentiating OLE from OLP and other OLLs.
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Affiliation(s)
- Kumutnart Chanprapaph
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Cherrin Pomsoong
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jutamas Tankunakorn
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chime Eden
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suthinee Rutnin
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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10
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Deng Z, Xu S, Peng Q, Sha K, Xiao W, Liu T, Zhang Y, Wang B, Xie H, Chen M, Li J. Aspirin alleviates skin inflammation and angiogenesis in rosacea. Int Immunopharmacol 2021; 95:107558. [PMID: 33743316 DOI: 10.1016/j.intimp.2021.107558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/18/2021] [Accepted: 03/01/2021] [Indexed: 01/09/2023]
Abstract
Rosacea is a chronic, relapsing inflammatory skin disease featured by abnormal activation of immune responses, vascular dysfunction and prominent permeability barrier alterations. Aspirin, as the first nonsteroidal anti-inflammatory drug (NSAID), is widely used for various inflammatory conditions due to its anti-inflammatory and anti-angiogenic properties. However, its effects on rosacea are unclear. In this study, we demonstrated that aspirin dramatically improved pathological phenotypes in LL37-induced rosacea-like mice. The RNA-sequencing analysis revealed that aspirin alleviated rosacea-like skin dermatitis mainly via modulating immune responses. Mechanically, we showed that aspirin decreased the production of chemokines and cytokines associated with rosacea, and suppressed the Th1- and Th17-polarized immune responses in LL37-induced rosacea-like mice. Besides, aspirin administration decreased the microvessels density and the VEGF expression in rosacea-like skin. We further demonstrated that aspirin inhibited the activation of NF-κB signaling and the release of its downstream pro-inflammatory cytokines. Collectively we showed that aspirin exerts a curative effect on rosacea by attenuating skin inflammation and angiogenesis, suggesting a promising therapeutic candidate for the treatment of rosacea.
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Affiliation(s)
- Zhili Deng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratary of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Key Laboratory of Molecular Radiation Oncology Hunan Province, Changsha, Hunan, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Central South University, Changsha, Hunan, China
| | - San Xu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratary of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Key Laboratory of Molecular Radiation Oncology Hunan Province, Changsha, Hunan, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Central South University, Changsha, Hunan, China
| | - Qinqin Peng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ke Sha
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenqin Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tangxiele Liu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yiya Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratary of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; Key Laboratory of Molecular Radiation Oncology Hunan Province, Changsha, Hunan, China
| | - Ben Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratary of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; Key Laboratory of Molecular Radiation Oncology Hunan Province, Changsha, Hunan, China
| | - Hongfu Xie
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratary of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Key Laboratory of Molecular Radiation Oncology Hunan Province, Changsha, Hunan, China
| | - Mengting Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratary of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Key Laboratory of Molecular Radiation Oncology Hunan Province, Changsha, Hunan, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Central South University, Changsha, Hunan, China.
| | - Ji Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratary of Aging Biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Key Laboratory of Molecular Radiation Oncology Hunan Province, Changsha, Hunan, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Central South University, Changsha, Hunan, China; Department of Dermatology, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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11
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Bitar C, Chan MP. Connective Tissue Diseases in the Skin: Emerging Concepts and Updates on Molecular and Immune Drivers of Disease. Surg Pathol Clin 2021; 14:237-249. [PMID: 34023103 DOI: 10.1016/j.path.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Cutaneous manifestations are common across the spectrum of autoimmune diseases. Connective tissue diseases manifesting in the skin are often difficult to classify and require integration of clinical, histopathologic, and serologic findings. This review focuses on the current understanding of the molecular and immune drivers involved in the pathogenesis of cutaneous lupus erythematosus, dermatomyositis, scleroderma/systemic sclerosis, and mixed connective tissue disease. Recent research advances have led to the emergence of new ancillary tools and useful diagnostic clues of which dermatopathologists should be aware to improve diagnostic accuracy for these diseases.
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Affiliation(s)
- Carole Bitar
- Department of Pathology, University of Michigan, 2800 Plymouth Road, NCRC Building 35, Ann Arbor, MI 48109, USA
| | - May P Chan
- Department of Pathology, University of Michigan, 2800 Plymouth Road, NCRC Building 35, Ann Arbor, MI 48109, USA.
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12
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Rakhshan A, Momenpour N, Dadkhahfar S, Gheisari M. Histopathological and immunohistochemical features of facial papules in frontal fibrosing alopecia. Clin Exp Dermatol 2021; 46:1248-1254. [PMID: 33837578 DOI: 10.1111/ced.14670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/01/2021] [Accepted: 04/04/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Facial papules (FPs) are considered to be created by the inflammatory process, which involves facial vellus hairs, in frontal fibrosing alopecia. AIM To demonstrate the histopathological features of FPs and the composition of the inflammatory infiltrate. METHODS In total, 18 patients with FPs were enrolled in the study after histopathological confirmation of lichen planopilaris. Histopathological evaluation of the specimens was performed by two dermatopathologists. The samples were immunostained with CD4, CD8 and CD123 monoclonal antibodies, and the percentage and proportion of cells stained with these markers were investigated. RESULTS A follicular lichenoid reaction and perifollicular fibrosis were present in all cases. Vellus hairs were detected in 83.3% of biopsy specimens (15 cases), all of which were involved by the inflammation. The majority of the follicles (72%) revealed follicular plugs. Reduction and destruction of elastic fibres were visible in the perifollicular (adventitial) and the papillary dermis (100% and 78% of specimens, respectively). Prominent sebaceous glands and dilated ducts were detected in 78% and 72% of samples, respectively. CD4-positive T cells formed 67.72% and CD8-positive T cells 32.28% of the infiltrate, and the mean CD4/CD8 ratio was 2.48. In 13 (72.2%) biopsy specimens < 10% of the infiltrate was positive for CD123 marker. CONCLUSIONS Perifollicular inflammation, fibrosis and elastic-fibre destruction were constant histopathological features of FPs; furthermore, prominent sebaceous glands were present in the majority of samples. We also observed a CD4-positive predominance in the infiltrate.
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Affiliation(s)
- A Rakhshan
- Department of Pathology, Shohada-e-Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - N Momenpour
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Dadkhahfar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Gheisari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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13
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Metzler-Wilson K, Wilson TE, Ausmus SM, Sventeckis AM. Effect of sensory blockade and rate of sensory stimulation on local heating induced axon reflex response in facial skin. Auton Neurosci 2021; 233:102809. [PMID: 33862476 DOI: 10.1016/j.autneu.2021.102809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/12/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
Local neuronal circuits in non-glabrous skin drive the initial increase of the biphasic cutaneous vasodilation response to fast non-noxious heating. Voltage-sensitive Na+ (NaV) channel inhibition blocks the afferent limb of the non-glabrous forearm cutaneous axon reflex. Slow local heating does not engage this response. These mechanisms have not been adequately investigated or extended into areas associated with flushing pathology. We hypothesized that despite regional differences in sensory afferents, both sensory blockade and slowing the heating rate would abate the cutaneous axon reflex-mediated vasodilator responses in facial skin. We measured skin blood flow responses (laser-Doppler flowmetry) of 6 healthy subjects (5 female) to non-noxious forearm, cheek, and forehead local heating, expressed as a percentage of cutaneous vascular conductance at plateau (CVC = flux/mean arterial pressure). We assessed CVC during fast (1 °C/30s) and slow (1 °C/10 min) local heating to 43 °C in both NaV inhibition (topical 2.5% lidocaine/prilocaine) and control conditions. NaV inhibition decreased forearm (control: 84 ± 4, block: 34 ± 9%plateau, p < 0.001) and trended toward decreased forehead (control: 90 ± 3, block: 68 ± 3%plateau, p = 0.057) initial CVC peaks but did not alter cheek responses (control: 90 ± 3, block: 92 ± 13%plateau, p = 0.862) to fast heating. Slow heating eliminated the initial CVC peak incidence for all locations, and we observed similar results with combined slow heating and NaV inhibition. Slower sensory afferent activation rate eliminated the axon reflex response in facial and non-glabrous skin, but topical sensory blockade did not block axon reflex responses in flushing-prone cheek skin. Thus, slower heating protocols are needed to abate facial, particularly cheek, axon reflex responses.
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Affiliation(s)
- Kristen Metzler-Wilson
- Department of Physical Therapy, School of Health & Human Sciences; and (2)Departments of Dermatology and Anatomy, Cell Biology, & Physiology, School of Medicine, Indiana University, Indianapolis, IN, USA; Departments of Dermatology and Anatomy, Cell Biology & Physiology, School of Medicine, Indiana University, Indianapolis, IN, USA.
| | - Thad E Wilson
- Division of Biomedical Sciences, College of Osteopathic Medicine, Marian University, Indianapolis, IN, USA; Department of Physiology and Saha Cardiovascular Research Center, College of Medicine, University of Kentucky, Lexington, KY, USA.
| | - Samantha M Ausmus
- Department of Physical Therapy, School of Health & Human Sciences; and (2)Departments of Dermatology and Anatomy, Cell Biology, & Physiology, School of Medicine, Indiana University, Indianapolis, IN, USA.
| | - Austin M Sventeckis
- Department of Physical Therapy, School of Health & Human Sciences; and (2)Departments of Dermatology and Anatomy, Cell Biology, & Physiology, School of Medicine, Indiana University, Indianapolis, IN, USA.
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14
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Bardawil T, Khalil S, Kurban M, Abbas O. Diagnostic utility of plasmacytoid dendritic cells in dermatopathology. Indian J Dermatol Venereol Leprol 2021; 87:3-13. [PMID: 33580939 DOI: 10.25259/ijdvl_638_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 03/01/2020] [Indexed: 12/11/2022]
Abstract
Differentiating cutaneous diseases that mimic each other clinically and histopathologically can at times be a challenging task for the dermatopathologist. At the same time, differentiation of entities with overlapping features may be crucial for patient management. Although not seen in normal skin, plasmacytoid dendritic cells usually infiltrate the skin in several infectious, inflammatory/autoimmune and neoplastic entities. Plasmacytoid dendritic cells can be identified in tissue using specific markers such as CD123 and/or blood-derived dendritic cell antigen-2. Plasmacytoid dendritic cells are the most potent producers of type I interferons and their activity may therefore be assessed indirectly in tissue using human myxovirus resistance protein A, a surrogate marker for type I interferon production. In recent years, accumulating evidence has established the utility of evaluating for specific plasmacytoid dendritic cell-related parameters (plasmacytoid dendritic cell content, distribution and clustering and/ or human myxovirus resistance protein A expression) as a diagnostic tool in differentiating cutaneous diseases with overlapping features such as the alopecias, lupus and its mimics, and neoplastic entities. In this review, we provide an update on the current evidence on this topic and on the contexts where this can be a useful adjunct to reach the histopathological diagnosis.
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Affiliation(s)
- Tara Bardawil
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samar Khalil
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen Kurban
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ossama Abbas
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
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15
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Sun Y, Chen LH, Lu YS, Chu HT, Wu Y, Gao XH, Chen HD. Identification of novel candidate genes in rosacea by bioinformatic methods. Cytokine 2021; 141:155444. [PMID: 33529888 DOI: 10.1016/j.cyto.2021.155444] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/23/2020] [Accepted: 01/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Rosacea is a chronic inflammatory skin disease whose psychological consequences severely affect patient's quality of life. OBJECTIVE To identify candidate genes of rosacea for potential development of new target therapies. METHODS Gene Expression Omnibus datasets were retrieved to obtain differentially expressed genes (DEGs) between rosacea patients and healthy controls. Gene ontology (GO) analyses were used to identify functions of candidate genes. Related signaling pathways of DEGs were analyzed using Kyoto Encyclopedia of Genes and Genomes (KEGG) and gene set enrichment analysis. Protein-protein interaction (PPI) networks were applied using search tools for the retrieval of interacting genes/proteins and modulations involving PPI networks were evaluated with use of the MCODE app. RESULTS Samples from 19 rosacea patients and 10 healthy controls of dataset GSE65914 were enrolled. A total of 215 DEGs, 115 GO terms and 6 KEGG pathways were identified. A total of 182 nodes and 456 edges were enriched in PPI networks. Maximal clusters showed 15 central nodes and 96 edges. The toll-like receptor (TLR) signaling pathway was the most significant pathway detected and 5 DEGs were identified as candidate genes which included TLR2, C-C motif chemokine (CCL) 5, C-X-C motif chemokine ligand (CXCL) 9, CXCL10 and CXCL11. The results were verified in rosacea patients with use of real-time polymerase chain reaction and immunohistochemistry. Cell-type enrichment analysis revealed 8 lymphocytes that were enriched in rosacea patients. CONCLUSIONS The results suggest that both innate and adaptive immune responses were involved in the etiology of rosacea. Five DEGs in the TLR signaling pathway may serve as potential therapeutic target genes.
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Affiliation(s)
- Yan Sun
- Department of Dermatology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Liang-Hong Chen
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Yan-Song Lu
- Department of Dermatology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Hai-Tao Chu
- Department of Dermatology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Yan Wu
- Department of Dermatology, The First Hospital of China Medical University, Shenyang 110001, China.
| | - Xing-Hua Gao
- Department of Dermatology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Hong-Duo Chen
- Department of Dermatology, The First Hospital of China Medical University, Shenyang 110001, China
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16
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Dube U, Musiek A. SnapshotDx Quiz: January 2021. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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The Pathogenic Role of Demodex Mites in Rosacea: A Potential Therapeutic Target Already in Erythematotelangiectatic Rosacea? Dermatol Ther (Heidelb) 2020; 10:1229-1253. [PMID: 33095403 PMCID: PMC7649190 DOI: 10.1007/s13555-020-00458-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Indexed: 12/15/2022] Open
Abstract
Rosacea is a common facial dermatosis but its definition and classification are still unclear, especially in terms of its links with demodicosis. Triggers of rosacea (ultraviolet light, heat, spicy foods, alcohol, stress, microbes) are currently considered to induce a cascading innate and then adaptive immune response that gets out of control. Recent histological and biochemical studies support the concept that this inflammatory response is a continuum, already present from the onset of the disease, even when no clinical signs of inflammation are visible. The Demodex mite is beginning to be accepted as one of the triggers of this inflammatory cascade, and its proliferation as a marker of rosacea; moreover, the papulopustules of rosacea can be effectively treated with topical acaricidal agents. Demodex proliferation appears to be a continuum process in rosacea, and may not be clinically visible at the onset of the disease. Molecular studies suggest that Demodex may induce tolerogenic dendritic cells and collaborate with vascular endothelial growth factor (VEGF) to induce T cell exhaustion and favor its own proliferation. These interactions among VEGF, Demodex, and immunity need to be explored further and the nosology of rosacea adapted accordingly. However, treating early rosacea, with only clinically visible vascular symptoms, with an acaricide may decrease early inflammation, limit potential flare-ups following laser treatment, and prevent the ultimate development of the papulopustules of rosacea. The effectiveness of this approach needs to be confirmed by prospective controlled clinical trials with long-term follow-up. Currently, the evidence suggests that patients with only vascular symptoms of rosacea should be carefully examined for the presence of follicular scales as signs of Demodex overgrowth or pityriasis folliculorum so that these patients, at least, can be treated early with an acaricidal cream.
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18
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Psoriasis and Connective Tissue Diseases. Int J Mol Sci 2020; 21:ijms21165803. [PMID: 32823524 PMCID: PMC7460816 DOI: 10.3390/ijms21165803] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 12/16/2022] Open
Abstract
Psoriasis is a chronic systemic inflammatory disease with various co-morbidities, having been recently considered as a comprehensive disease named psoriatic disease or psoriatic syndrome. Autoimmune diseases are one form of its co-morbidities. In addition to the genetic background, shared pathogenesis including innate immunity, neutrophil extracellular trap (NETs), and type I interferon, as well as acquitted immunity such as T helper-17 (Th17) related cytokines are speculated to play a significant role in both psoriasis and connective tissue diseases. On the other hand, there are definite differences between psoriasis and connective tissue diseases, such as their pathomechanisms and response to drugs. Therefore, we cannot expect that one stone kills two birds, and thus caution is necessary when considering whether the administered drug for one disease is effective or not for another disease. In this review, several connective tissue diseases and related diseases are discussed from the viewpoint of their coexistence with psoriasis.
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Dursun R, Durmaz K, Oltulu P, Ataseven A. Demodex positive discoid lupus erythematosus: Is it a separate entity or an overlap syndrome? Dermatol Ther 2020; 33:e13394. [PMID: 32275797 DOI: 10.1111/dth.13394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 12/30/2022]
Abstract
Discoid lupus erythematosus (DLE) is a chronic inflammatory erythematous skin disease that can be triggered by several factors. Rosacea is another skin disease that causes facial redness and tenderness. Demodex mites have been reported in rosacea and DLE patients commonly in the literature. These two diseases can be seen concomitant, mimic each other clinically and share common possible etiologic factors. To assess demodex mite infestation in both clinical and histopathological findings in DLE patients. We retrospectively evaluated the files of 42 patients with DLE who had been diagnosed DLE based on clinical and histopathological findings between August 2018 and August 2019. Demodex positivity was detected 50% of patients (n = 21). Neutrophile percentages in the dermal and perivascular area were higher in the demodex positive patients (4.43%) than in the Demodex negative patients (2.19%). The intensity of demodex mites correlated positively with dermal neutrophile percentages. ANA was negative in 29 patients (69%) and positive in 13 patients (31%). Anti-dsDNA was negative in serology and follicular plugging was positive in histopathology in all 42 patients (100%). This was a retrospective study. DLE and rosacea share common features in etiopathogenesis and clinical presentation. Inflammation and exacerbations caused by the demodex mites may increase the clinical severity of DLE. Although the position of demodex mites in DLE etiopathogenesis is not known exactly, the presence of high demodex in DLE patients has been determined. Standard skin surface biopsy can be a routine procedure for the evaluation of DLE patients in daily clinical practice.
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Affiliation(s)
- Recep Dursun
- Meram Medicine Faculty, Department of Dermatology, Necmettin Erbakan University, Konya, Turkey
| | - Koray Durmaz
- Meram Medicine Faculty, Department of Dermatology, Necmettin Erbakan University, Konya, Turkey
| | - Pembe Oltulu
- Meram Medicine Faculty, Department of Pathology, Necmettin Erbakan University, Konya, Turkey
| | - Arzu Ataseven
- Meram Medicine Faculty, Department of Dermatology, Necmettin Erbakan University, Konya, Turkey
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20
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Rakhshan A, Toossi P, Amani M, Dadkhahfar S, Hamidi AB. Different distribution patterns of plasmacytoid dendritic cells in discoid lupus erythematosus and lichen planopilaris demonstrated by CD123 immunostaining. An Bras Dermatol 2020; 95:307-313. [PMID: 32299739 PMCID: PMC7253924 DOI: 10.1016/j.abd.2019.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 11/10/2019] [Indexed: 02/07/2023] Open
Abstract
Background Clinical and histological features may overlap between lichen planopilaris-associated and discoid lupus erythematosus-associated scarring alopecia. Objectives The aim of this study was to demonstrate the cutaneous infiltration of plasmacytoid dendritic cells and to compare their distribution pattern in discoid lupus erythematosus and lichen planopilaris. Methods Twenty-four cases of discoid lupus erythematosus and 30 cases of lichen planopilaris were examined for immunostaining of the CD123 marker. The percentage and distribution pattern of plasmacytoid dendritic cells and the presence of the plasmacytoid dendritic cells clusters were evaluted in the samples. Results The number of plasmacytoid dendritic cells was higher in the discoid lupus erythematosus specimens. Aggregations of 10 cells or more (large cluster) were observed in half of the discoid lupus erythematosus specimens and only 2 lichen planopilaris, with 50% sensitivity and 93% specificity for differentiating discoid lupus erythematosus from lichen planopilaris. Study limitations Incidence and prevalence of discoid lupus erythematosus-associated scarring alopecia in the scalp are low, so the samples size of our study was small. Conclusions We suggest that a plasmacytoid dendritic cells cluster of 10 cells or more is highly specific for distinguishing discoid lupus erythematosus from lichen planopilaris. It also appears that CD123 immunolabeling is valuable in both active and late stages of the disease.
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Affiliation(s)
- Azadeh Rakhshan
- Department of Pathology, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parviz Toossi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Shohada-e Tajrish Hospital, Tehran, Iran
| | - Maliheh Amani
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Shohada-e Tajrish Hospital, Tehran, Iran.
| | - Sahar Dadkhahfar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Shohada-e Tajrish Hospital, Tehran, Iran
| | - Arash Bagheri Hamidi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Shohada-e Tajrish Hospital, Tehran, Iran
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21
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Wang L, Wang YJ, Hao D, Wen X, Du D, He G, Jiang X. The Theranostics Role of Mast Cells in the Pathophysiology of Rosacea. Front Med (Lausanne) 2020; 6:324. [PMID: 32047752 PMCID: PMC6997331 DOI: 10.3389/fmed.2019.00324] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/18/2019] [Indexed: 02/05/2023] Open
Abstract
Rosacea is a chronic inflammatory cutaneous disorder that adversely affects patient's health and quality of life due to the complex course and the need for repeated treatment. The exact molecular mechanisms of rosacea are unclear. Mast cells are innate immune cells that can be found in virtually all tissues. Recently, increasing evidence has indicated that mast cells have important effects on the pathogenesis of rosacea. In this review article, we describe recent advances of skin mast cells in the development of rosacea. These studies suggested that mast cells can be an important immune cell that connected innate immunity, nerves, and blood vessels in the development of rosacea. Moreover, we review the inhibition of mast cells for the potential treatment of rosacea.
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Affiliation(s)
- Lian Wang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Yu-Jia Wang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China.,State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Dan Hao
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Wen
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Dan Du
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Gu He
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China.,State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Xian Jiang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
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22
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Chen SJT, Tse JY, Harms PW, Hristov AC, Chan MP. Utility of
CD
123 immunohistochemistry in differentiating lupus erythematosus from cutaneous T cell lymphoma. Histopathology 2019; 74:908-916. [DOI: 10.1111/his.13817] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 12/30/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Stephanie J T Chen
- Department of Pathology University of Michigan Ann Arbor MI USA
- Department of Pathology University of Iowa Iowa City IA USA
| | - Julie Y Tse
- Department of Pathology Tufts Medical Center Boston MA USA
| | - Paul W Harms
- Department of Pathology University of Michigan Ann Arbor MI USA
- Department of Dermatology University of Michigan Ann Arbor MI USA
| | - Alexandra C Hristov
- Department of Pathology University of Michigan Ann Arbor MI USA
- Department of Dermatology University of Michigan Ann Arbor MI USA
| | - May P Chan
- Department of Pathology University of Michigan Ann Arbor MI USA
- Department of Dermatology University of Michigan Ann Arbor MI USA
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23
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Chasset F, Richez C, Martin T, Belot A, Korganow AS, Arnaud L. Rare diseases that mimic Systemic Lupus Erythematosus (Lupus mimickers). Joint Bone Spine 2018; 86:165-171. [PMID: 30837156 DOI: 10.1016/j.jbspin.2018.10.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2018] [Indexed: 12/13/2022]
Abstract
Several conditions have clinical and laboratory features that can mimic those present in Systemic Lupus Erythematosus (SLE). Some of these "SLE mimickers" are very common, such as rosacea which can be mistaken for the butterfly rash, while others such as Kikuchi disease, type-1 interferonopathies, Castleman's disease, prolidase deficiency, angioimmunoblastic T-cell lymphoma, Evans' syndrome in the context of primary immune deficiencies and the autoimmune lymphoproliferative syndrome are exceptionally uncommon. A proper diagnosis of SLE must therefore be based upon a complete medical history as well as on the adequate constellation of clinical or laboratory findings. While there is no single test that determines whether a patient has lupus or not, the search for auto-antibodies towards nuclear antigens is a key step in the diagnosis strategy, keeping in mind that ANAs are not specific for SLE. In case of persistent doubt, patients should be referred to reference centers with experience in the management of the disease.
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Affiliation(s)
- François Chasset
- Service de dermatologie et d'allergologie, hôpital Tenon, AP-HP, 75020, Paris, France
| | - Christophe Richez
- Immunoconcept, CNRS-UMR 5164, université de Bordeaux, 146, rue Léo-Saignat, 33076, Bordeaux, France; Centre hospitalier universitaire de Bordeaux, FHU ACRONIM, place Amélie-Raba-Léon, 33076, Bordeaux, France; Centre national de référence des maladies autoimmunes et systémiques rares Est Sud-Ouest (RESO)-LUPUS, 67000 Strasbourg, France
| | - Thierry Martin
- Centre national de référence des maladies autoimmunes et systémiques rares Est Sud-Ouest (RESO)-LUPUS, 67000 Strasbourg, France; Service d'immunologie clinique nouvel hôpital civil, 1, place de l'hôpital 67091 Strasbourg cedex, France
| | - Alexandre Belot
- Service de nephrologie, rhumatologie et dermatologie pédiatriques, hôpital Femme Mère-Enfant, hospices civils de Lyon, Lyon, France; Université de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France; Inserm U1111, 69007 Lyon, France; Filière des maladies autoimmunes et autoinflammatoires rares (FAI2R), 69677 Lyon, France
| | - Anne-Sophie Korganow
- Centre national de référence des maladies autoimmunes et systémiques rares Est Sud-Ouest (RESO)-LUPUS, 67000 Strasbourg, France; Service d'immunologie clinique nouvel hôpital civil, 1, place de l'hôpital 67091 Strasbourg cedex, France
| | - Laurent Arnaud
- Centre national de référence des maladies autoimmunes et systémiques rares Est Sud-Ouest (RESO)-LUPUS, 67000 Strasbourg, France; Service de rhumatologie, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France; Université de Strasbourg, Inserm UMR-S 1109, 67000 Strasbourg, France.
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24
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Wang ML, Chan MP. Comparative Analysis of Chilblain Lupus Erythematosus and Idiopathic Perniosis: Histopathologic Features and Immunohistochemistry for CD123 and CD30. Am J Dermatopathol 2018; 40:265-271. [DOI: 10.1097/dad.0000000000000945] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Abstract
Erythematotelangiectatic rosacea is the most prevalent rosacea subtype. Multiple dermatologic conditions may mimic erythematotelangiectatic rosacea. The authors review a comprehensive approach to evaluating subjects with a suspected diagnosis of erythematotelangiectatic rosacea and discuss findings that may warrant further investigation. Differential diagnoses can be narrowed based on the presence of characteristics such as transient erythema, nontransient erythema, and telangiectasias. A thorough history and physical examination are critical in ruling out conditions such as dermatomyositis, lupus erythematosus, atopic dermatitis, and seborrheic dermatitis.
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Affiliation(s)
- Mohammed D Saleem
- University of Florida College of Medicine, PO Box 100277, Gainesville, FL 32610-0277, USA.
| | - Jonathan K Wilkin
- University of Florida College of Medicine, PO Box 100277, Gainesville, FL 32610-0277, USA
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26
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Chang YS, Huang YC. Role of Demodex mite infestation in rosacea: A systematic review and meta-analysis. J Am Acad Dermatol 2017; 77:441-447.e6. [PMID: 28711190 DOI: 10.1016/j.jaad.2017.03.040] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/21/2017] [Accepted: 03/26/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The reported prevalence and degrees of Demodex mite infestation in rosacea vary widely. OBJECTIVE We sought to conduct an evidence-based meta-analysis of the prevalence and degrees of Demodex mite infestation in patients with rosacea. METHODS Systematic literature review and meta-analysis were conducted. Odds ratios for prevalence of infestation and standardized mean difference (SMD) for Demodex density in patients with rosacea were pooled. Subgroup analysis for type of rosacea, control group, and sampling and examination methods were also performed. RESULTS Twenty-three case-control studies included 1513 patients with rosacea. Compared with the control patients, patients with rosacea were more likely to be infested by Demodex mites [odds ratio, 9.039; 95% confidence interval (CI), 4.827-16.925] and had significantly higher Demodex density (SMD, 1.617; 95% CI, 1.090-2.145). Both erythematotelangiectatic rosacea (SMD, 2.686; 95% CI, 1.256-4.116) and papulopustular rosacea (SMD, 2.804; 95% CI, 1.464-4.145) had significantly higher Demodex density than did healthy control patients. LIMITATIONS Interstudy variability was high, and a causal relationship could not be established by case-control studies. CONCLUSIONS Patients with rosacea had significantly higher prevalence and degrees of Demodex mite infestation than did control patients. Demodex mites may play a role in both erythematotelangiectatic rosacea and papulopustular rosacea.
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Affiliation(s)
- Yin-Shuo Chang
- Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yu-Chen Huang
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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27
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Abstract
The terms 'lichenoid' and 'interface' dermatitis are often used interchangeably to describe an inflammatory pattern characterized histologically by damage to the basal keratinocytes in the epidermis. The mechanism of cell damage of such cells is now best understood as apoptosis, or programmed cell death. This inflammatory pattern of dermatoses, is also accompanied frequently by a band of lymphocytes and histiocytes in the superficial dermis, that often obscures the dermal-epidermal junction, hence the term 'lichenoid'. A discussion of the more common lichenoid/interface dermatitides encountered in the routine clinical practice encompasses the following entities: lichen planus, lupus erythematosus, dermatomyositis, erythema multiforme, graft versus host disease, fixed drug reactions, and multiple others.
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Affiliation(s)
- Alejandro A Gru
- Department of Pathology & Dermatology, University of Virginia, Charlottesville, VA, Unitee States.
| | - Andrea L Salavaggione
- Department of Radiation Oncology, The Ohio State University, Columbus, OH, United States
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28
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29
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Kolivras A, Thompson C. Primary scalp alopecia: new histopathological tools, new concepts and a practical guide to diagnosis. J Cutan Pathol 2016; 44:53-69. [PMID: 27682637 DOI: 10.1111/cup.12822] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 06/05/2016] [Accepted: 09/20/2016] [Indexed: 12/13/2022]
Abstract
The diagnosis of primary scalp alopecia remains one of the most challenging fields in dermatopathology. In this review, we would like to connect the established classification of primary alopecia into scarring (cicatricial) and non-scarring (non-cicatricial) with current concepts. We introduce a simplified pathway for the diagnosis of the most common causes of alopecia, including a discussion of tissue processing techniques and use of immunohistochemistry.
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Affiliation(s)
- Athanassios Kolivras
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Curtis Thompson
- Department of Biomedical Engineering, Oregon Health Sciences University, Portland, OR, USA.,Department of Pathology, Oregon Health Sciences University, Portland, OR, USA.,Department of Dermatology, Oregon Health Sciences University, Portland, OR, USA
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30
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Holmes AD, Steinhoff M. Integrative concepts of rosacea pathophysiology, clinical presentation and new therapeutics. Exp Dermatol 2016; 26:659-667. [DOI: 10.1111/exd.13143] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 12/13/2022]
Affiliation(s)
| | - Martin Steinhoff
- Department of Dermatology; UCD Charles Institute for Translational Dermatology; University College Dublin; Dublin Ireland
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31
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Woo YR, Lim JH, Cho DH, Park HJ. Rosacea: Molecular Mechanisms and Management of a Chronic Cutaneous Inflammatory Condition. Int J Mol Sci 2016; 17:ijms17091562. [PMID: 27649161 PMCID: PMC5037831 DOI: 10.3390/ijms17091562] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/23/2016] [Accepted: 09/07/2016] [Indexed: 01/21/2023] Open
Abstract
Rosacea is a chronic cutaneous inflammatory disease that affects the facial skin. Clinically, rosacea can be categorized into papulopustular, erythematotelangiectatic, ocular, and phymatous rosacea. However, the phenotypic presentations of rosacea are more heterogeneous. Although the pathophysiology of rosacea remains to be elucidated, immunologic alterations and neurovascular dysregulation are thought to have important roles in initiating and strengthening the clinical manifestations of rosacea. In this article, we present the possible molecular mechanisms of rosacea based on recent laboratory and clinical studies. We describe the genetic predisposition for rosacea along with its associated diseases, triggering factors, and suggested management options in detail based on the underlying molecular biology. Understanding the molecular pathomechanisms of rosacea will likely aid toward better comprehending its complex pathogenesis.
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Affiliation(s)
- Yu Ri Woo
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea.
| | - Ji Hong Lim
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea.
| | - Dae Ho Cho
- Department of Life Science, Sookmyung Women's University, Seoul 04310, Korea.
| | - Hyun Jeong Park
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea.
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32
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Fening K, Parekh V, McKay K. CD123 immunohistochemistry for plasmacytoid dendritic cells is useful in the diagnosis of scarring alopecia. J Cutan Pathol 2016; 43:643-8. [DOI: 10.1111/cup.12725] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/13/2015] [Accepted: 04/27/2016] [Indexed: 01/23/2023]
Affiliation(s)
- Katherine Fening
- Division of Dermatopathology; University of Alabama at Birmingham; Birmingham AL USA
| | - Viswas Parekh
- Department of Pathology; University of Alabama at Birmingham; Birmingham AL USA
| | - Kristopher McKay
- Division of Dermatopathology; University of Alabama at Birmingham; Birmingham AL USA
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33
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Kolivras A, Thompson C. Clusters of CD123+ plasmacytoid dendritic cells help distinguish lupus alopecia from lichen planopilaris. J Am Acad Dermatol 2016; 74:1267-9. [DOI: 10.1016/j.jaad.2015.12.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/25/2015] [Accepted: 12/29/2015] [Indexed: 01/05/2023]
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34
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Antonova OV, Trofimov PN, Khairutdinov VR, Belousova IE, Samtsov AV. Modern concepts of skin dendritic cells. VESTNIK DERMATOLOGII I VENEROLOGII 2016. [DOI: 10.25208/0042-4609-2016-92-1-17-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Based on the literature review this article is about the latest data of the classification and functions of dendritic cells in healthy skin and in disease.
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35
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Dargent JL, Henne S, Pranger D, Balzarini P, Sartenaer D, Bulliard G, Rack K, Facchetti F. Tumor-forming plasmacytoid dendritic cells associated with myeloid neoplasms. Report of a peculiar case with histopathologic features masquerading as lupus erythematosus. J Cutan Pathol 2015; 43:280-6. [DOI: 10.1111/cup.12639] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 10/04/2015] [Accepted: 10/05/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Jean-Louis Dargent
- Pathology; Institut de Pathologie et de Génétique (IPG); Gosselies Belgium
| | - Stéphanie Henne
- Department of Dermatology; Grand Hôpital de Charleroi (GHDC); Loverval Belgium
| | - Delphine Pranger
- Department of Oncology; Grand Hôpital de Charleroi (GHDC); Charleroi Belgium
| | - Piera Balzarini
- Department of Molecular and Translational Medicine, Section of Pathology, School of Medicine; University of Brescia; Brescia Italy
| | - Daniel Sartenaer
- Pathology; Institut de Pathologie et de Génétique (IPG); Gosselies Belgium
| | - Geneviève Bulliard
- Laboratory of Clinical Biology; Grand Hôpital de Charleroi (GHDC); Charleroi Belgium
| | - Katrina Rack
- Pathology; Institut de Pathologie et de Génétique (IPG); Gosselies Belgium
| | - Fabio Facchetti
- Department of Molecular and Translational Medicine, Section of Pathology, School of Medicine; University of Brescia; Brescia Italy
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36
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Kim M, Kim KE, Jung HY, Jo H, Jeong SW, Lee J, Kim CH, Kim H, Cho D, Park HJ. Recombinant erythroid differentiation regulator 1 inhibits both inflammation and angiogenesis in a mouse model of rosacea. Exp Dermatol 2015; 24:680-5. [PMID: 25940661 DOI: 10.1111/exd.12745] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 12/24/2022]
Abstract
The erythroid differentiation regulator 1 (Erdr1), which is a novel and highly conserved factor, was recently reported to be negatively regulated by IL-18 and to play a crucial role as an antimetastatic factor. IL-18 is a proinflammatory cytokine that functions as an angiogenic mediator in inflammation. Rosacea is a chronic inflammatory skin disorder that is characterized by abnormal inflammation and vascular hyperactivity of the facial skin. To determine whether Erdr1 contributes to the regulation of the chronic inflammatory process in the development of rosacea, an immunohistochemical analysis was performed in healthy donors and patients with rosacea. In this study, we showed that Erdr1 was downregulated, whereas IL-18 was upregulated, in patients with rosacea, which led us to question the role of Erdr1 in this disorder. Moreover, a rosacea-like BALB/c mouse model was used to determine the role of Erdr1 in rosacea in vivo. LL-37 injection induced typical rosacea features, including erythema, telangiectasia and inflammation. Treatment with recombinant Erdr1 (rErdr1) resulted in a significant reduction of erythema, inflammatory cell infiltration (including CD4(+) and CD8(+) T cells), and microvessel density with vascular endothelial growth factor (VEGF). Taken together, our findings suggest that rErdr1 may be involved in attenuating the inflammation and angiogenesis associated with the pathogenesis of rosacea. Thus, these results provide new insight into the mechanism involved in this condition and indicate that rErdr1 could be a potential target for therapeutic intervention of rosacea.
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Affiliation(s)
- Miri Kim
- Department of Dermatology, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Eun Kim
- Department of Life Science, Sookmyung Women's University, Seoul, Korea
| | - Haw Young Jung
- Department of Dermatology, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hyunmu Jo
- Department of Dermatology, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Seo-Won Jeong
- Department of Dermatology, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | | | - Chang Han Kim
- Biotech. Team, Cent'l Res. Inst. Ilyang Pharm. Co., Ltd., Gyeonggi-do, Korea
| | - Heejong Kim
- Biotech. Team, Cent'l Res. Inst. Ilyang Pharm. Co., Ltd., Gyeonggi-do, Korea
| | - Daeho Cho
- Department of Life Science, Sookmyung Women's University, Seoul, Korea
| | - Hyun Jeong Park
- Department of Dermatology, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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37
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Buhl T, Sulk M, Nowak P, Buddenkotte J, McDonald I, Aubert J, Carlavan I, Déret S, Reiniche P, Rivier M, Voegel JJ, Steinhoff M. Molecular and Morphological Characterization of Inflammatory Infiltrate in Rosacea Reveals Activation of Th1/Th17 Pathways. J Invest Dermatol 2015; 135:2198-2208. [PMID: 25848978 DOI: 10.1038/jid.2015.141] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/11/2015] [Accepted: 03/18/2015] [Indexed: 02/07/2023]
Abstract
Rosacea is a common chronic inflammatory skin disease of unknown etiology. Our knowledge about an involvement of the adaptive immune system is very limited. We performed detailed transcriptome analysis, quantitative real-time reverse-transcriptase-PCR, and quantitative immunohistochemistry on facial biopsies of rosacea patients, classified according to their clinical subtype. As controls, we used samples from patients with facial lupus erythematosus and healthy controls. Our study shows significant activation of the immune system in all subtypes of rosacea, characterizing erythematotelangiectatic rosacea (ETR) already as a disease with significant influx of proinflammatory cells. The T-cell response is dominated by Th1/Th17-polarized immune cells, as demonstrated by significant upregulation of IFN-γ or IL-17, for example. Chemokine expression patterns support a Th1/Th17 polarization profile of the T-cell response. Macrophages and mast cells are increased in all three subtypes of rosacea, whereas neutrophils reach a maximum in papulopustular rosacea. Our studies also provide evidence for the activation of plasma cells with significant antibody production already in ETR, followed by a crescendo pattern toward phymatous rosacea. In sum, Th1/Th17 polarized inflammation and macrophage infiltration are an underestimated hallmark in all subtypes of rosacea. Therapies directly targeting the Th1/Th17 pathway are promising candidates in the future treatment of this skin disease.
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Affiliation(s)
- Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany; Charles Institute for Translational Dermatology, University College Dublin, Dublin, Ireland; Department of Dermatology and Surgery, University of California, San Francisco, California, USA
| | - Mathias Sulk
- Department of Dermatology and Surgery, University of California, San Francisco, California, USA; Department of Dermatology, University of Münster, Münster, Germany
| | - Pawel Nowak
- Department of Dermatology, University of Münster, Münster, Germany
| | - Jörg Buddenkotte
- Department of Dermatology, University of Münster, Münster, Germany
| | - Ian McDonald
- Charles Institute for Translational Dermatology, University College Dublin, Dublin, Ireland
| | - Jérôme Aubert
- Molecular Dermatology, Research Department, Galderma R&D, Sophia Antipolis, France
| | - Isabelle Carlavan
- Molecular Dermatology, Research Department, Galderma R&D, Sophia Antipolis, France
| | - Sophie Déret
- Molecular Dermatology, Research Department, Galderma R&D, Sophia Antipolis, France
| | - Pascale Reiniche
- Molecular Dermatology, Research Department, Galderma R&D, Sophia Antipolis, France
| | - Michel Rivier
- Molecular Dermatology, Research Department, Galderma R&D, Sophia Antipolis, France
| | - Johannes J Voegel
- Molecular Dermatology, Research Department, Galderma R&D, Sophia Antipolis, France.
| | - Martin Steinhoff
- Charles Institute for Translational Dermatology, University College Dublin, Dublin, Ireland; Department of Dermatology and Surgery, University of California, San Francisco, California, USA; Department of Dermatology, University of San Diego, USA.
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Gambichler T, Pätzholz J, Schmitz L, Lahner N, Kreuter A. FOXP3+ and CD39+ regulatory T cells in subtypes of cutaneous lupus erythematosus. J Eur Acad Dermatol Venereol 2015; 29:1972-7. [DOI: 10.1111/jdv.13123] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/02/2015] [Indexed: 11/28/2022]
Affiliation(s)
- T. Gambichler
- Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - J. Pätzholz
- Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - L. Schmitz
- Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - N. Lahner
- Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - A. Kreuter
- Department of Dermatology; Venereology; and Allergology; HELIOS St. Elisabeth Hospital; Oberhausen Germany
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Vemuri RC, Gundamaraju R, Sekaran SD, Manikam R. Major pathophysiological correlations of rosacea: a complete clinical appraisal. Int J Med Sci 2015; 12:387-96. [PMID: 26005373 PMCID: PMC4441063 DOI: 10.7150/ijms.10608] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/08/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Rosacea is a characteristic cutaneous disorder with a diverse clinical manifestations ranging from facial vascular hyper-reactivity to sebaceous gland hyperplasia. Many theories on pathophysiology of rosacea were proposed over the past decade, however the pathogenicity is poorly understood. AIM To review the evidence on different pathophysiological correlations of rosacea. METHODS A literature search was conducted for studies published between 1990 to March 2014. The inclusion criteria was pathophysiology, randomized controlled trials, controlled trials on rosacea. RESULTS Out of 5141 articles, 14 high quality studies met all the selection criteria. Of 14 articles, 5 are randomized control trials (RCTs), 2 are controlled trial, 3 comparative trials, 2 observational trials, 1 prospective and 1 diagnostic trial. The studies were categorized into two groups: the trigger factors and sub-types & symptoms. Of 7 high quality studies, 4 provided strong evidence that immune responses causing disease triggered by external/internal factors such as sunlight, food and chemical agents, 3 trials provided significant evidence of microorganisms as causative agents. The remaining trials did not provide significant evidences on pathophysiology. CONCLUSION Vasculature, chronic inflammatory responses, environmental triggers, food and chemicals ingested and microorganisms either alone or in combination are responsible for rosacea. Many promising drugs are under various phases of clinical trials and interestingly, probiotics could also possibly be used as one of the treatment option.
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Affiliation(s)
- Ravi Chandra Vemuri
- 1. Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Rohit Gundamaraju
- 1. Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Shamala Devi Sekaran
- 1. Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Rishya Manikam
- 2. Department of Trauma and Emergency, University Malaya Medical Center, 59100 Kuala Lumpur, Malaysia
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