1
|
Jung HJ, Heo WI, Park KY, Lee MK, Ahn JY, Park MY, Seo SJ. The Role of Collagen VI α6 Chain Gene in Atopic Dermatitis. Ann Dermatol 2022; 34:46-54. [PMID: 35221595 PMCID: PMC8831303 DOI: 10.5021/ad.2022.34.1.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/19/2021] [Accepted: 09/08/2021] [Indexed: 11/08/2022] Open
Abstract
Background Objective Methods Results Conclusion
Collapse
Affiliation(s)
- Hye Jung Jung
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Won Il Heo
- Department of Dermatology, Chung-Ang University Hospital, Seoul, Korea
| | - Kui Young Park
- Department of Dermatology, Chung-Ang University Hospital, Seoul, Korea
| | - Mi-Kyung Lee
- Department of Dermatology, Chung-Ang University Hospital, Seoul, Korea
| | - Ji Young Ahn
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Mi Youn Park
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University Hospital, Seoul, Korea
| |
Collapse
|
2
|
Assessment of serum concentrations of matrix metalloproteinase 1, matrix metalloproteinase 2 and tissue inhibitors of metalloproteinases 1 in atopic dermatitis in correlation with disease severity and epidermal barrier parameters. Postepy Dermatol Alergol 2021; 38:773-779. [PMID: 34849123 PMCID: PMC8610038 DOI: 10.5114/ada.2021.110043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/25/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Matrix metalloproteinases (MMPs) are a group of proteolytic enzymes, conditioning the integrity of skin cells, however, their role in the inflammatory process of atopic dermatitis (AD) and the direct effect on the epidermal barrier parameters remain unexplained. Aim To assess MMP-1, MMP-2, tissue inhibitors of metalloproteinases (TIMP)-1 concentrations in blood serum in the context of transepidermal water loss (TEWL) and stratum corneum hydration in AD. Moreover, serum levels of MMPs and TIMP-1 were analysed in relation to the Eczema Area and Severity Index (EASI). Material and methods Forty-three AD patients and 22 control group subjects have been investigated. Serum concentrations of MMP-1, MMP-2, and TIMP-1 have been evaluated with ELISA. TEWL and stratum corneum hydration have been assessed with a TM300 Tewameter and a CM825 Corneometer. Skin lesions in patients with AD have been evaluated with the Eczema Area and Severity Index. Results MMP-1 and MMP-2 serum concentrations were significantly higher in the AD group. The results of TIMP-1 serum concentration were similar for both groups. The correlation between the serum concentration and the EASI was demonstrated only for MMP-2 for patients with severe and moderate AD. Patients with AD and TIMP-1 serum concentration greater than MMP-1 presented lower TEWL and higher epidermal hydration. Conclusions The results of this study warrant further investigation. The predominance of TIMP-1 over MMP-1 in blood serum can potentially limit TEWL and maintain the proper water content of the epidermis. Future work is necessary to establish how reliable the role of MMP-2 concentration is as an indicator of the severity of AD.
Collapse
|
3
|
Karpec D, Rudys R, Leonaviciene L, Mackiewicz Z, Bradunaite R, Kirdaite G, Venalis A. The safety and efficacy of light emitting diodes-based ultraviolet A1 phototherapy in bleomycin-induced scleroderma in mice. Adv Med Sci 2018; 63:152-159. [PMID: 29120857 DOI: 10.1016/j.advms.2017.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 08/01/2017] [Accepted: 09/26/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE To define the efficacy and safety of narrowband ultraviolet A1 (UVA1) for the treatment of dermal fibrosis in bleomycin-induced mouse model of scleroderma. MATERIALS AND METHODS 42 DBA/2 strain mice were included in the study: healthy mice and mice with established scleroderma, treated with high or medium dose of UVA1. Non-treated groups served as control. The equipment emitting 365±5nm UVA1 radiation was used in the study. The average cumulative doses were 1200J/cm2 for high and 600J/cm2 for medium dose course. Histological analysis was performed for the evaluation of the dermal thickness and mast cells density. The expressions of p53 and Ki-67 proteins were assessed by immunohistochemical analyses. RESULTS Skin thickness of mice with scleroderma, treated with high and medium dose of UVA1, were lower (272.9±113.2μm and 394±125.9μm, respectively) in comparison to the dermal thickness of non-treated animals (599±55.7μm). The dermal mast cells count in mice with scleroderma was reduced after high and medium dose treatment to 11±1.7 and 13±2.2, respectively, as compared to that in non-treated mice (23±3.0). No significant upregulation of p53 nor Ki-67 proteins was observed in the skin of healthy mice and mice with scleroderma after high- and medium-dose of UVA1. CONCLUSIONS The results of this study indicate that 365nm UVA1 with the cumulative doses of 1200J/cm2 and 600J/cm2 is safe and effective for the dermal fibrosis treatment.
Collapse
|
4
|
Karpec D, Rudys R, Leonaviciene L, Mackiewicz Z, Bradunaite R, Kirdaite G, Venalis A. The impact of high-dose narrowband ultraviolet A1 on dermal thickness, collagen and matrix-metalloproteinases in animal model of scleroderma. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2017; 173:448-455. [PMID: 28667931 DOI: 10.1016/j.jphotobiol.2017.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/13/2017] [Accepted: 06/20/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The main purpose of the present study was to define the impact of high-dose of 365±5nm ultraviolet A1 (UVA1) on dermal fibrosis in the pre-established, bleomycin-induced mouse model of scleroderma. METHODS DBA/2 strain mice with the pre-established, bleomycin-induced scleroderma were irradiated with cumulative UVA1 dose of 1200J/cm2 and in parallel were challenged with prolonged administration of bleomycin. Non-treated groups served as the control. Light source emitting a narrow band UVA1 light of 365±5nm and 21mW/cm2 power density was used in the study. Histological analysis was performed for the evaluation of dermal thickness. The expressions of matrix-metalloproteinase-1 (MMP-1), matrix-metalloproteinase-3 (MMP-3), collagen types I and III were evaluated by immunohistochemical analyses. The Mann - Whitney U test was used for statistical analysis. RESULTS Dermal thickness in mice injected with bleomycin during all the experiment (8weeks) and irradiated with UVA1 for the last 5weeks was significantly lower than that in mice challenged only with bleomycin for 8weeks (253.96±31.83μm and 497.43±57.83μm, respectively; P=0.002). The dermal thickness after phototherapy was lower as compared with the pre-existing fibrotic changes observed after 3weeks of bleomycin injections (253.96±31.83μm and 443.87±41.76μm, respectively; P=0.002). High-dose of UVA1 induced the 5.8- and 5.2-fold increase in MMP-1 and MMP-3 expressions, respectively, and the 1.2- and 1.4-fold decrease in collagen type I and collagen type III expressions in the pre-established, bleomycin-induced scleroderma model as compared to that in the control non-irradiated mice (P=0.002). CONCLUSIONS Our study has demonstrated that a cumulative 365±5nm UVA1 radiation dosage of 1200J/cm2 not only prevents the progression of dermal fibrosis, but also induces a regression of pre-existing fibrotic changes.
Collapse
Affiliation(s)
- Diana Karpec
- State Research Institute Centre for Innovative Medicine, Santariskiu St. 5, LT-08406 Vilnius, Lithuania; Vilnius University, Faculty of Medicine, Center of Rheumatology, Santariskiu St. 2, LT-08661 Vilnius, Lithuania.
| | - Romualdas Rudys
- State Research Institute Centre for Innovative Medicine, Santariskiu St. 5, LT-08406 Vilnius, Lithuania.
| | - Laima Leonaviciene
- State Research Institute Centre for Innovative Medicine, Santariskiu St. 5, LT-08406 Vilnius, Lithuania.
| | - Zygmunt Mackiewicz
- State Research Institute Centre for Innovative Medicine, Santariskiu St. 5, LT-08406 Vilnius, Lithuania.
| | - Ruta Bradunaite
- State Research Institute Centre for Innovative Medicine, Santariskiu St. 5, LT-08406 Vilnius, Lithuania.
| | - Gailute Kirdaite
- State Research Institute Centre for Innovative Medicine, Santariskiu St. 5, LT-08406 Vilnius, Lithuania.
| | - Algirdas Venalis
- State Research Institute Centre for Innovative Medicine, Santariskiu St. 5, LT-08406 Vilnius, Lithuania; Vilnius University, Faculty of Medicine, Center of Rheumatology, Santariskiu St. 2, LT-08661 Vilnius, Lithuania.
| |
Collapse
|
5
|
VOLNUKHIN VA, SAMSONOV VA. UVA-1 therapy of localized scleroderma and other diseases accompanied by skin sclerosis. VESTNIK DERMATOLOGII I VENEROLOGII 2013. [DOI: 10.25208/vdv566] [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
The study results confirm the efficacy of the UVA-1 therapy for patients with localized scleroderma, extragenital lichen sclerosus et atrophicus, sclerodermatous chronic graft-versus-host disease and scleredema adultorum. The therapy has an anti-inflammatory and anti^m^ action, arrests progression and reduces the activity of the disease process, and has a good efficacy and safety profile.
Collapse
|
6
|
Andres C, Kollmar A, Mempel M, Hein R, Ring J, Eberlein B. Successful ultraviolet A1 phototherapy in the treatment of localized scleroderma: a retrospective and prospective study. Br J Dermatol 2009; 162:445-7. [DOI: 10.1111/j.1365-2133.2009.09438.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
7
|
McGowan R, Tucker P, Joseph D, Wallace AM, Hughes I, Burrows NP, Ahmed SF. Short‐term growth and bone turnover in children undergoing occlusive steroid (‘Wet‐Wrap’) dressings for treatment of atopic eczema. J DERMATOL TREAT 2009; 14:149-52. [PMID: 14522624 DOI: 10.1080/09546630310004207] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To assess the effects of steroid wet-wrap therapy on short-term growth and bone turnover, eight prepubertal (M:F,5:3) children with a median age of 5.1years (range 3.3-8.8) were studied over a 2-week period prior to therapy and at 2-week intervals during therapy. Short-term growth was assessed by measuring lower leg length velocity (LLLV) by knemometry and bone and collagen turnover was assessed by urinary deoxypyridinoline crosslink excretion corrected for creatinine excretion (DPD). Median duration of study during occlusive dressings was 12 weeks (range 2-18). Topical beclomethasone dipropionate diluted 1:10 or 1:4 in white soft paraffin was applied under tubular (Tubifast) bandages in 7/8 children. Median LLLV before and during therapy were 0.43 mm/week (10(th),90(th) centile; 0.0,0.7) and 0.42 mm/week (10(th),90(th) centile; -0.35,1.01), respectively (not significant). Median DPD before and during therapy were 25.9 nmol/l/creatinine (10(th),90(th) centile; 20.8, 33.0) and 26.3 nmol/l/creatinine (10(th),90(th) centile; 21.7, 34.1) respectively (not significant). Non-invasive assessment of the effects of steroid wet-wrap therapy can be performed in children with eczema. These preliminary results show no substantial growth promoting or adverse effects of therapy.
Collapse
Affiliation(s)
- R McGowan
- Department of Child Health, Royal Hospital For Sick Children, Yorkhill, Glasgow, UK
| | | | | | | | | | | | | |
Collapse
|
8
|
Traitement des acrosyndromes des connectivites par photothérapie UVA-1. Étude ouverte de 11cas. Ann Dermatol Venereol 2009; 136:323-9. [DOI: 10.1016/j.annder.2008.12.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 12/22/2008] [Indexed: 11/20/2022]
|
9
|
Lü ZR, Park D, Lee KA, Ryu JW, Bhak J, Shi L, Lee DY, Park YD, Zou F, Yang JM. Profiling the dysregulated genes of keratinocytes in atopic dermatitis patients: cDNA microarray and interactomic analyses. J Dermatol Sci 2009; 54:126-9. [PMID: 19157793 DOI: 10.1016/j.jdermsci.2008.12.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 11/15/2008] [Accepted: 12/09/2008] [Indexed: 10/21/2022]
|
10
|
Wang F, Garza LA, Cho S, Kafi R, Hammerberg C, Quan T, Hamilton T, Mayes M, Ratanatharathorn V, Voorhees JJ, Fisher GJ, Kang S. Effect of increased pigmentation on the antifibrotic response of human skin to UV-A1 phototherapy. ARCHIVES OF DERMATOLOGY 2008; 144:851-8. [PMID: 18645136 PMCID: PMC2956589 DOI: 10.1001/archderm.144.7.851] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate the efficacy, potential limitations, and biological mechanisms of UV-A1 phototherapy for skin sclerosis due to collagen deposition disorders. DESIGN Before-and-after trial of UV-A1 irradiation of sclerotic skin; in vivo biochemical analyses after UV-A1 irradiation of normal skin. SETTING Academic referral center. PARTICIPANTS Patients with morphea/scleroderma or sclerodermoid graft-vs-host disease and volunteers without skin disease. Intervention Sclerotic skin was treated with high-dose (130 J/cm(2); n = 12) or medium-dose (65 J/cm(2); n = 6) UV-A1 phototherapy 3 times per week for 14 weeks; normal skin was treated with UV-A1 irradiation at various doses and frequencies, with biopsies performed afterwards. MAIN OUTCOME MEASURES In sclerotic skin, induration was clinically assessed using a scoring scale. In normal skin, quantitative polymerase chain reaction was used to assess antifibrotic responses, defined as decreased type I and type III procollagen and increased matrix metalloproteinase levels. RESULTS In patients with sclerotic skin treated with high-dose UV-A1 irradiation, clinical scores for induration modestly decreased. To investigate what factors prevented further improvement (ie, complete clearance), normal skin with light pigmentation was exposed to UV-A1 irradiation (70-150 J/cm(2)) and was assessed for antifibrotic responses. A single high-dose exposure (110-150 J/cm(2)) elicited substantial antifibrotic responses and induced skin darkening. This skin darkening attenuated responses to subsequent UV-A1 exposures and was dose dependent. Thus, to minimize skin darkening, additional patients with sclerotic skin were treated with medium-dose UV-A1 phototherapy, which was no less effective than high-dose therapy. CONCLUSION Clinical responses of sclerotic skin to UV-A1 phototherapy were modest because of UV-A1-induced skin darkening, which is photoprotective and attenuates antifibrotic responses. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00129415.
Collapse
Affiliation(s)
- Frank Wang
- Department of Dermatology, University of Michigan Medical School, 1618 A. Alfred Taubman Healthcare Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Comte C, Picot E, Peyron JL, Dereure O, Guillot B. Les UVA-1 : propriétés et indications thérapeutiques. Ann Dermatol Venereol 2007; 134:407-15. [PMID: 17483769 DOI: 10.1016/s0151-9638(07)89204-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- C Comte
- Université Montpellier II, Service de Dermatologie, CHU Saint Eloi, Montpellier.
| | | | | | | | | |
Collapse
|
12
|
Beattie PE, Dawe RS, Ibbotson SH, Ferguson J. UVA1 phototherapy for treatment of necrobiosis lipoidica. Clin Exp Dermatol 2006; 31:235-8. [PMID: 16487100 DOI: 10.1111/j.1365-2230.2005.02059.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The primary cause of collagen degeneration in necrobiosis lipoidica (NL) is proposed to be immunologically mediated vascular disease. Ultraviolet (UV)A1 has been used successfully to treat scleroderma in which both vascular damage and collagen dysregulation also occur. We treated six patients with NL [(five women; mean age of 32 years (range 22-70) and mean disease duration of 2.9 years (range 6 months to 5 years)] with a high-output ultraviolet (UV)A1 2-kW filtered metal halide source (Dr Hönle; Dermalight ultrA 1) having an emission spectrum of 340-440 nm. All patients had NL on the shins, which had been unresponsive to potent topical corticosteroid therapy (n = 6) and had responded minimally or not at all to TL-01 UVB (n = 2), topical psoralen plus UVA (PUVA) soaking (n = 2) or oral PUVA (n = 1) therapy. Patients received a variable number of total exposures (15-51), given 3-5 times weekly. NL resolved completely in one patient; this patient had minimal improvement after the first course of 16 exposures, but after a further 13 exposures, resolution occurred 6 months later. Two subjects obtained moderate improvement in their overall disease severity after 15 and 24 exposures, while two had only minimal improvement after 15 and 51 exposures. The remaining patient had no improvement after 16 treatments. Patients with the shortest disease duration had the greatest response. UVA1 therapy may be of benefit for the treatment of NL as an adjuvant therapy to topical corticosteroids or as a second-line alternative to other phototherapies, and may have a superior outcome in a proportion of patients.
Collapse
Affiliation(s)
- P E Beattie
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
| | | | | | | |
Collapse
|
13
|
Eberlein-König B, Vogel M, Katzer K, Hein R, Köhn FM, Ring J, Abeck D. Successful UVA1 phototherapy in a patient with scleredema adultorum. J Eur Acad Dermatol Venereol 2005; 19:203-4. [PMID: 15752291 DOI: 10.1111/j.1468-3083.2005.00935.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Scleredema adultorum is a rare connective tissue disorder of unknown cause. Both bath-PUVA and cream-PUVA therapy were reported to be effective. We describe a patient with scleredema adultorum who showed a striking clinical improvement with a medium-dose UVA1 phototherapy (single dose, 50 J/cm(2); 35 treatments).
Collapse
Affiliation(s)
- B Eberlein-König
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Germany.
| | | | | | | | | | | | | |
Collapse
|
14
|
Schnopp C, Tzaneva S, Mempel M, Schulmeister K, Abeck D, Tanew A. UVA1 phototherapy for disseminated granuloma annulare. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2005; 21:68-71. [PMID: 15752123 DOI: 10.1111/j.1600-0781.2005.00145.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/PURPOSE Disseminated granuloma annulare is a benign granulomatous skin disease of unknown etiology. Recently, UVA1 (340-400 nm) phototherapy has been found effective in a small series of four patients. The purpose of this two-center study was to determine the rate and duration of clinical response to UVA1 phototherapy in a larger cohort of 20 patients with disseminated granuloma annulare. METHODS Twenty patients with long-standing, stable disease (median 42 months, 95% CI 23-105) underwent UVA1 phototherapy. Sixteen patients were treated with a high-dose regimen (median single dose 110 J/cm2, 95% CI 103-121) and four patients with a medium-dose regimen (median single dose 50 J/cm2, CI 50-50). The clinical response was graded on a 5-point scale [0 = none, 1 = poor, 2 = moderate, 3 = substantial, 4 = (near) complete]. After cessation of therapy, patients with a clinical score of 3 or 4 were followed up to evaluate the duration of clinical improvement. RESULTS At the end of treatment, five patients each had substantial improvement or (near) complete clearance. Another five patients had a moderate response, three patients were considered as poor responders and two patients as treatment failures. Out of the 10 patients with good or excellent response nine were available for follow up. Of these, two patients were still clear after 3 and 6 months, and seven patients relapsed after a median of 3 months (95% CI 1.68-6.46). CONCLUSIONS UVA1 phototherapy provided good or excellent results in half of our 20 patients with disseminated granuloma annulare. In the majority of patients with a satisfactory response, however, discontinuation of treatment was followed by early recurrence of disease.
Collapse
Affiliation(s)
- C Schnopp
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany.
| | | | | | | | | | | |
Collapse
|
15
|
Breuckmann F, Gambichler T, Altmeyer P, Kreuter A. UVA/UVA1 phototherapy and PUVA photochemotherapy in connective tissue diseases and related disorders: a research based review. BMC DERMATOLOGY 2004; 4:11. [PMID: 15380024 PMCID: PMC521488 DOI: 10.1186/1471-5945-4-11] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Accepted: 09/20/2004] [Indexed: 11/10/2022]
Abstract
BACKGROUND Broad-band UVA, long-wave UVA1 and PUVA treatment have been described as an alternative/adjunct therapeutic option in a number of inflammatory and malignant skin diseases. Nevertheless, controlled studies investigating the efficacy of UVA irradiation in connective tissue diseases and related disorders are rare. METHODS Searching the PubMed database the current article systematically reviews established and innovative therapeutic approaches of broad-band UVA irradiation, UVA1 phototherapy and PUVA photochemotherapy in a variety of different connective tissue disorders. RESULTS Potential pathways include immunomodulation of inflammation, induction of collagenases and initiation of apoptosis. Even though holding the risk of carcinogenesis, photoaging or UV-induced exacerbation, UVA phototherapy seems to exhibit a tolerable risk/benefit ratio at least in systemic sclerosis, localized scleroderma, extragenital lichen sclerosus et atrophicus, sclerodermoid graft-versus-host disease, lupus erythematosus and a number of sclerotic rarities. CONCLUSIONS Based on the data retrieved from the literature, therapeutic UVA exposure seems to be effective in connective tissue diseases and related disorders. However, more controlled investigations are needed in order to establish a clear-cut catalogue of indications.
Collapse
Affiliation(s)
- Frank Breuckmann
- Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Thilo Gambichler
- Dermatology Out-Patient Clinic, Oldchurch Hospital, Romford RM7 OBE, Greater London, UK
| | - Peter Altmeyer
- Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Alexander Kreuter
- Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany
| |
Collapse
|
16
|
Kyllönen H, Remitz A, Mandelin JM, Elg P, Reitamo S. Effects of 1-year intermittent treatment with topical tacrolimus monotherapy on skin collagen synthesis in patients with atopic dermatitis. Br J Dermatol 2004; 150:1174-81. [PMID: 15214906 DOI: 10.1111/j.1365-2133.2004.06017.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Topical corticosteroids decrease collagen synthesis during short-term treatment and can induce skin atrophy when applied over the long term. In contrast, short-term tacrolimus ointment therapy does not affect collagen synthesis. OBJECTIVES Our aim was to evaluate the long-term effects of 0.1% tacrolimus ointment on collagen synthesis and on skin thickness in adults with moderate to severe atopic dermatitis (AD) and to compare the findings with the effects of conventional steroid-based therapy. METHODS Fifty-six patients with AD were treated with 0.1% tacrolimus ointment in a 1-year, open-label, prospective clinical trial. Thirty-six patients with AD applied conventional steroid-based therapy and 27 healthy subjects were recruited as controls. The primary endpoint was the change in levels of procollagen propeptides I and III measured by radioimmunoassay between baseline and month 12. Additional endpoints included the change in skin thickness measured by ultrasound between baseline and month 12. RESULTS Procollagen propeptide baseline values were significantly lower in the group to be treated with tacrolimus ointment than in healthy controls. One-year treatment with tacrolimus ointment was associated with an increase in collagen synthesis; the median increase in combined procollagen propeptide levels was 272 micro g L-1 (+ 140.9%, P < 0.001) and was accompanied by a significant increase in skin thickness. In three patients with visible skin atrophy, this condition ameliorated. Corticosteroid-based therapy had no significant effect on collagen synthesis; the median increase in combined procollagen propeptide levels was 11 micro g L-1 (+ 3.9%). A significant reduction in skin thickness was demonstrated. CONCLUSIONS Long-term tacrolimus ointment therapy in patients with AD is nonatrophogenic and reverses corticosteroid-induced skin atrophy.
Collapse
Affiliation(s)
- H Kyllönen
- Department of Dermatology, Hospital for Skin and Allergic Diseases, University of Helsinki, 00250, Finland
| | | | | | | | | |
Collapse
|
17
|
Tjioe M, Smits T, Blokx WAM, van de Kerkhof PCM, Gerritsen MJP. High-dose long wave visible light induces perinuclear vacuolization in vivo
but does not result in early photoageing and apoptosis. Exp Dermatol 2003; 12:610-4. [PMID: 14705801 DOI: 10.1034/j.1600-0625.2003.00050.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
With the advancing widespread use of photodynamic therapy, questions have arisen about the necessity to protect the adjacent healthy skin from high-dose long-wave light. The aim of the present study was to investigate the effects of high dose visible light on the skin of healthy volunteers with focus on apoptosis, DNA damage, inflammation, melanogenesis and induction of matrix metalloproteinases (MMP). Fourteen healthy volunteers were included and irradiated daily on their buttocks with 1300 kJ/m2 long wave visible light (560-780 nm) on five consecutive days with a cumulative dose of 6500 kJ/m2. In each volunteer six biopsies were taken before and 24 h after irradiation on days 1, 2, 3 and 5 and on day 8 and 12. Frozen and paraffin sections were investigated by measuring parameters for photodamage (apoptosis, p53, phosphorylated c-Jun), skin ageing (phosphorylated c-Jun, MMP-1, elastin content) melanogenesis (Melan A). Although no sunburn cells were seen, a significant increase in perinuclear vacuolization was noted (P < 0.0003) from day 5 till 7 days after the last irradiation. There was no expression of phosphorylated c-Jun, whereas the expression of p53, Melan A, MMP-1 and elastin content did not change. High-dose visible light induces a significant increase in perinuclear vacuolization, but does not result in apoptosis, photodamage or early induction of skin ageing.
Collapse
Affiliation(s)
- Milan Tjioe
- Department of Dermatology, University Medical Centre Nijmegen, The Netherlands.
| | | | | | | | | |
Collapse
|
18
|
Affiliation(s)
- Noah S Scheinfeld
- Department of Dermatology, St. Luke's-Roosevelt Hospital Center, New York, New York 10025, USA.
| | | | | | | |
Collapse
|
19
|
Karrer S, Bosserhoff AK, Weiderer P, Landthaler M, Szeimies RM. Influence of 5-aminolevulinic acid and red light on collagen metabolism of human dermal fibroblasts. J Invest Dermatol 2003; 120:325-31. [PMID: 12542540 DOI: 10.1046/j.1523-1747.2003.12037.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Patients with localized scleroderma receiving topical photodynamic therapy with 5-aminolevulinic acid show a reduction in skin tightness, suggesting that this therapy reduces skin sclerosis. To investigate potential mechanisms, the effects of 5-aminolevulinic acid and light on collagen metabolism were studied in vitro. Normal and scleroderma fibroblasts were treated with sublethal doses of 5-aminolevulinic acid and red light and transferred to three-dimensional collagen lattices. Cell supernatants were taken 6-72 h after photodynamic therapy to determine protein levels of the matrix metalloproteinases 1, 2, and 3, and of their inhibitors, tissue inhibitor of metalloproteinase 1 and 2 by enzyme-linked immunosorbent assay. Cellular mRNA expression of these proteins and of collagen type I and III was measured by quantitative real-time polymerase chain reaction. A significant, time-dependent induction of matrix metalloproteinase 1 (up to 2.4-fold after 48 h) and matrix metalloproteinase 3 (up to 4.3-fold after 48 h) protein levels was seen after 5-aminolevulinic acid-photodynamic therapy. Irradiation with ultraviolet A light, used as a positive control, showed a similar induction of matrix metalloproteinase 1 (2.3-fold after 48 h). The mRNA levels of matrix metalloproteinase 1 and matrix metalloproteinase 3 were significantly increased 12 h after irradiation, whereas collagen type I mRNA was strongly decreased already 6 h following irradiation. Collagen type III, tissue inhibitor of metalloproteinase 1, and matrix metalloproteinase 2 did not change after photodynamic therapy. Addition of nontoxic concentrations of sodium azide, a singlet-oxygen quencher, significantly inhibited induction of matrix metalloproteinase 1 by 5-aminolevulinic acid and light. These data show that 5-aminolevulinic acid and light induce matrix metalloproteinase 1 and matrix metalloproteinase 3 expression in normal and scleroderma fibroblasts in a singlet oxygen-dependent way while reducing collagen type I mRNA expression. Induction of collagen-degrading enzymes together with reduction of collagen production might be responsible for the anti-sclerotic effects of 5-aminolevulinic acid-photodynamic therapy observed in vivo.
Collapse
Affiliation(s)
- Sigrid Karrer
- Department of Dermatology, University of Regensburg, Regensburg, Germany.
| | | | | | | | | |
Collapse
|
20
|
Reitamo S, Remitz A, Kyllönen H, Saarikko J. Topical noncorticosteroid immunomodulation in the treatment of atopic dermatitis. Am J Clin Dermatol 2002; 3:381-8. [PMID: 12113647 DOI: 10.2165/00128071-200203060-00002] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
At present, the first-line drugs for treating atopic dermatitis are topical corticosteroids. They are effective when used short-term; however, long-term use of the corticosteroids is associated with suppressive effects on the connective tissue, seen as skin atrophy or resistance to therapy. Currently, two topical noncorticosteroid immunomodulators tacrolimus (FK506) and pimecrolimus (SDZ ASM 981) are under development, or already on the market in some countries for atopic dermatitis. These two compounds show structural similarity. In T lymphocytes they bind to the same cellular receptor, the FK-binding protein (FKBP) or macrophilin-12. Tacrolimus shows a 3-fold greater affinity to FKBP compared with pimecrolimus. The tacrolimus/ pimecrolimus-FKBP complex further binds to calcineurin, an enzyme vital for the early activation of T cells. The consequence of calcineurin binding is a lack of activation of both T helper cell types 1 and 2. Further effects of these compounds have been suggested on other inflammatory cells, such as Langerhans cells and mast cells/basophils. In contrast to corticosteroids, no suppressive effects on connective tissue cells have been observed. Taken together, treatment of inflammation results in healing of the barrier function of the skin. This again results in reduced bioavailability of the drug, as compared with systemic use. Placebo-controlled studies have shown the efficacy of both tacrolimus (at 0.03 and 0.1%) and pimecrolimus (at 0.6 and 1%). The main adverse event in these studies has been a burning sensation and increased pruritus at the site of application. Typically, these adverse events are observed only during the first days of treatment. Long-term safety studies, of up to one year, have not revealed any new adverse events. So far, long-term use of topical noncorticosteroid compounds has not been associated with signs of immune deficiency. Although there is currently no evidence for clinically relevant, prolonged adverse effects, some of these, such as an increased risk of photocarcinogenesis, need to be monitored. There is evidence from tacrolimus studies that monotherapy results in better long-term results when compared with combination therapy with corticosteroids. Tacrolimus and pimecrolimus could replace topical corticosteroids as the first-line treatment of atopic dermatitis.
Collapse
Affiliation(s)
- Sakari Reitamo
- Department of Dermatology, Hospital for Skin and Allergic Diseases, University of Helsinki, Helsinki, Finland.
| | | | | | | |
Collapse
|