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Yen LJ, Chen YC, Wang KC, Shih MC, Li CL, Yu SJ, Lu LY. Hydroxychloroquine exacerbates imiquimod-induced psoriasis-like dermatitis through stimulating overexpression of IL-6 in keratinocytes. Immunopharmacol Immunotoxicol 2024; 46:128-137. [PMID: 38059657 DOI: 10.1080/08923973.2023.2281283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/04/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Hydroxychloroquine (HCQ) is a US Food and Drug Administration (FDA)-approved treatment for systemic lupus erythematosus (SLE) through inhibition of antigen presentation and subsequent reduction in T cell activation. Psoriasis relapse after antimalarial therapy have been reported in up to 18% of patients with psoriasis. Here, we explored the role of HCQ on exacerbating dermatitis utilizing an imiquimod (IMQ)-induced psoriasis-like dermatitis mouse model. METHODS Thirty-six C57BL/6 female mice were divided into six groups: wild-type control, IMQ-Only, pre-treat HCQ (30 mg/kg and 60 mg/kg HCQ), and co-treat HCQ with IMQ (30 mg/kg and 60 mg/kg HCQ). Besides control, all were topically treated with IMQ for 5 days. Pharmacological effects and mechanisms of HCQ were assessed by clinical severity of dermatitis, histopathology, and flow cytometry. HaCaT cells were co-treated with both HCQ and recombinant IL-17A, followed by the detection of proinflammatory cytokine expression and gene profiles through enzyme-linked immunosorbent assay and next-generation sequencing. RESULTS In the pre-treated and co-treated HCQ groups, skin redness and scaling were significantly increased compared to the IMQ-Only group, and Th17 cell expression was also upregulated. Acanthosis and CD11b+IL23+ dendritic cell (DC) infiltration were observed in the HCQ treatment group. IL-6 overexpression was detected in both the HaCaT cells and skin from the experimental mice. Psoriasis-related genes were regulated after being co-treated with HCQ and recombinant IL-17A in HaCaT cells. CONCLUSIONS HCQ exacerbates psoriasis-like skin inflammation by increasing the expression of IL-6, stimulating DC infiltration, and promoting Th17 expression in the microenvironment of the skin. KEY MESSAGES This study provided possible mechanisms for inducing psoriasis during HCQ treatment through an animal model.
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Affiliation(s)
- Ling-Jung Yen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung City, Taiwan
- Department of Nursing, Meiho University, Pingtung City, Taiwan
| | - Ying-Chin Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung City, Taiwan
| | - Kai-Chun Wang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung City, Taiwan
- The Doctoral Program of Clinical and Experimental Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Meng-Chieh Shih
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung City, Taiwan
| | - Chia-Ling Li
- Children's Medical Center, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Sheng-Jie Yu
- Department of Medical Research, Taichung Veterans General Hospital, Taichung City, Taiwan
- Institute of Biomedical Sciences, College of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Ling-Ying Lu
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung City, Taiwan
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2
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Qu Y, Li D, Liu W, Shi D. Molecular consideration relevant to the mechanism of the comorbidity between psoriasis and systemic lupus erythematosus (Review). Exp Ther Med 2023; 26:482. [PMID: 37745036 PMCID: PMC10515117 DOI: 10.3892/etm.2023.12181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/03/2023] [Indexed: 09/26/2023] Open
Abstract
Systemic lupus erythematosus (SLE), a common autoimmune disease with a global incidence and newly diagnosed population estimated at 5.14 (range, 1.4-15.13) per 100,000 person-years and 0.40 million people annually, respectively, affects multiple tissues and organs; for example, skin, blood system, heart and kidneys. Accumulating data has also demonstrated that psoriasis (PS) can be a systemic inflammatory disease, which can affect organs other than the skin and occur alongside other autoimmune diseases, such as inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis and SLE. The current explanations for the possible comorbidity of PS and SLE include: i) The two diseases share susceptible gene loci; ii) they share a common IL-23/T helper 17 (Th17) axis inflammatory pathway; and iii) the immunopathogenesis of the two conditions is a consequence of the interactions between IL-17 cytokines with effector Th17 cells, T regulatory cells, as well as B cells. In addition, the therapeutic efficacy of IL-17 or TNF-α inhibitors has been demonstrated in PS, and has also become evident in SLE. However, the mechanisms have not been investigated. To the best of our knowledge, there remains a lack of substantial studies on the correlation between PS and SLE. In the present review, the literature, with regards to the epidemiology, genetic predisposition, inflammatory mechanisms and treatment of the patients with both PS and SLE, has been reviewed. Further investigations into the molecular pathogenic mechanism may provide drug targets that could benefit the patients with concomitant PS and SLE.
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Affiliation(s)
- Yuying Qu
- Department of Dermatology, College of Clinical Medicine, Jining Medical University, Jining, Shandong 272067, P.R. China
| | - Dongmei Li
- Department of Microbiology and Immunology, Georgetown University Medical Center, Washington, DC 20057, USA
| | - Weida Liu
- Department of Medical Mycology, Chinese Academy of Medical Sciences Institute of Dermatology, Nanjing, Jiangsu 272002, P.R. China
| | - Dongmei Shi
- Department of Dermatology, Jining No. 1 People's Hospital, Jining, Shandong 272011, P.R. China
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3
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Ryoo YW, Yun JM, Kim HW, Kim SA. Early-Onset Generalized Pustular Psoriasis of Pregnancy Following Hydroxychloroquine Use. Ann Dermatol 2023; 35:S43-S47. [PMID: 37853863 PMCID: PMC10608382 DOI: 10.5021/ad.21.062] [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: 03/23/2021] [Revised: 05/31/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2023] Open
Abstract
Generalized pustular psoriasis of pregnancy (GPPP), characterized by widespread sterile pustules and erythematous patches with systemic symptoms such as fever, is a rare form of pustular psoriasis. GPPP typically occurs in the third trimester of pregnancy and can be triggered by various factors such as infections, hypocalcemia, and drugs including N-butyl-scopolammonium bromide. We report a rare case of new-onset GPPP in a 33-year-old multigravida female at 17 weeks' gestation, which occurred earlier than usual, after taking hydroxychloroquine for 3 weeks to treat systemic lupus erythematosus. She stopped her medications and was treated with systemic corticosteroid, but without improvement. Her medication was changed to systemic cyclosporine; her skin lesions improved, which completely resolved after delivery. This is the first case of GPPP developed following hydroxychloroquine use for systemic lupus erythematosus, which occurred earlier than usual and completely resolved after delivery. This case demonstrates that hydroxychloroquine can induce GPPP before the third trimester of pregnancy.
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Affiliation(s)
- Young-Wook Ryoo
- Department of Dermatology, Keimyung University School of Medicine, Daegu, Korea
| | - Ji-Min Yun
- Department of Dermatology, Keimyung University School of Medicine, Daegu, Korea
| | - Hyun-Wook Kim
- Department of Dermatology, Keimyung University School of Medicine, Daegu, Korea
| | - Sung-Ae Kim
- Department of Dermatology, Keimyung University School of Medicine, Daegu, Korea.
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4
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Gan TS, Ghazali NI, Voo SYM, Low DE, Tang JJ, Kiing JW, Muniandy P, Tey KE, Wong KW, Mohamad N, Tan WC, Selvarajah L, Ramalingam R, Ng FY, Lee CS, Raja T, Abdul Rahim NS, Tang MM, Robinson S. Clinical characteristics, management, and quality of life of psoriasis patients with coexistent lupus erythematosus: Data from the Malaysian Psoriasis Registry. Int J Rheum Dis 2023; 26:327-336. [PMID: 36382593 DOI: 10.1111/1756-185x.14492] [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: 06/13/2022] [Revised: 10/08/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the clinical characteristics, management and quality of life of psoriasis patients with and without coexistent lupus erythematosus (LE). METHODS This retrospective cross-sectional study uses data from the Malaysian Psoriasis Registry (MPR) from January 2007 to December 2018. RESULTS Of 21 735 psoriasis patients, 34 (0.16%) had coexistent LE. The male to female ratio among psoriasis patients with coexistent LE was 1:5.8 versus 1.3:1 in patients with psoriasis but without LE. Nearly 70% presented with LE preceding psoriasis. Psoriasis patients with LE had an earlier age of psoriasis onset (27.56 ± 11.51 versus 33.31 ± 16.94 years, P = 0.006), a higher rate of psoriatic arthropathy (26.5% versus 13.0%, P = 0.02), and a significantly greater impairment of quality of life (Dermatology Quality of Life Index >10; 57.6% versus 40.3%, P = 0.04) compared with psoriasis patients without LE. The majority (87.5%) had systemic LE. The incidences of lupus nephritis (72.7% versus 40%) and hematological abnormalities (50% versus 20%) were higher among patients with LE preceding psoriasis compared with those with psoriasis preceding LE. Antinuclear antibody and double-stranded DNA were positive in 59.4% and 28.1% of psoriasis patients with LE, respectively. Hydroxychloroquine triggered the onset of psoriasis in 7 (24.1%) patients. Patients with LE were more likely to receive systemic treatment for psoriasis compared with those without LE (30.3% versus 14.2%, P = 0.008). CONCLUSIONS Psoriasis patients with coexistent LE were uncommon, displayed a female preponderance, were more likely to have joint involvement, and had greater quality of life impairment than those without LE. LE preceded psoriasis in most of these patients, and systemic LE was the most common subtype.
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Affiliation(s)
- Teck Sheng Gan
- Department of Dermatology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | | | | | - Dyoi-E Low
- Department of Dermatology, Hospital Serdang, Kajang, Malaysia
| | - Jyh Jong Tang
- Department of Dermatology, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia
| | - Jiu Wen Kiing
- Department of Dermatology, Hospital Umum Sarawak, Kuching, Malaysia
| | - Pubalan Muniandy
- Department of Dermatology, Hospital Umum Sarawak, Kuching, Malaysia
| | - Kwee Eng Tey
- Department of Dermatology, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Kit Wan Wong
- Department of Dermatology, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Norazura Mohamad
- Department of Dermatology, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Wooi Chiang Tan
- Department of Dermatology, Hospital Pulau Pinang, Georgetown, Malaysia
| | - Latha Selvarajah
- Department of Dermatology, Hospital Sultan Ismail, Johor Bharu, Malaysia
| | | | - Fei Yin Ng
- Department of Dermatology, Hospital Tengku Ampuan Rahimah, Klang, Malaysia
| | - Choon Sian Lee
- Department of Dermatology, Hospital Melaka, Melaka, Malaysia
| | - Teeba Raja
- Department of Dermatology, Hospital Selayang, Batu Caves, Malaysia
| | | | - Min Moon Tang
- Department of Dermatology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Suganthy Robinson
- Department of Dermatology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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5
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Tang SC, Lu CT, Ko JL, Lin CH, Hsiao YP. Hydroxychloroquine repairs burn damage through the Wnt/β-catenin pathway. Chem Biol Interact 2023; 370:110309. [PMID: 36535310 DOI: 10.1016/j.cbi.2022.110309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/22/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Sheau-Chung Tang
- Department of Nursing, National Taichung University of Science and Technology, Taichung, 40640, Taiwan
| | - Chun-Te Lu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jiunn-Liang Ko
- Department of Medical Oncology and Chest Medicine, Chung Shan Medical University Hospital, Taichung, 402, Taiwan; Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Hui Lin
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Ping Hsiao
- Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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6
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Karaalioğlu B, Yıldırım F, Mutlu MY, Akkuzu G, Özgür DS, Bes C. A case of palmoplantar pustular psoriasis induced by hydroxychloroquine in a patient with systemic lupus erythematosus. Int J Rheum Dis 2022; 25:1200-1202. [PMID: 35922392 DOI: 10.1111/1756-185x.14392] [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: 03/02/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 10/16/2022]
Abstract
Palmoplantar pustular psoriasis (PPP) is a rare clinical form of psoriasis. It is usually seen on the palms and soles, and affects patients' quality of life. In most cases, topical or systemic treatments are not sufficiently effective, so management of PPP is generally difficult. Hydroxychloroquine (HQ) is an antimalarial drug that is widely used in many autoimmune rheumatic diseases, mainly in systemic lupus erythematosus (SLE). Several reports describe the induction and exacerbation of psoriasis by HQ. Within this report, we aimed to put emphasis on considering possible drug effects by presenting a case of PPP, induced by HQ.
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Affiliation(s)
- Bilgin Karaalioğlu
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Fatih Yıldırım
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Melek Yalçın Mutlu
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Gamze Akkuzu
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Duygu Sevinç Özgür
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Cemal Bes
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
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7
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Liu J, Ali K, Lou H, Wang L, Wu L. First-Trimester Impetigo Herpetiformis Leads to Stillbirth: A Case Report. Dermatol Ther (Heidelb) 2022; 12:1271-1279. [PMID: 35499740 PMCID: PMC9059450 DOI: 10.1007/s13555-022-00735-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Pustular psoriasis of pregnancy (PPP), also known as impetigo herpetiformis (IH), is a rare variant of generalized pustular psoriasis (GPP) in pregnancy. It typically occurs in the third trimester and is a life-threatening condition for both the pregnant mother and the fetus if not diagnosed and treated promptly. Drug-induced PPP has been reported in sporadic case reports. Here we present a case of first-trimester PPP occurring after applying drugs including chloroquine, which we consider a possible culprit triggering the disease. Case report A 29-year-old female was admitted to our department at 45 days gestation with sudden onset of fever and widespread erythematous pustules for 9 days. She had been on medications including hydroxychloroquine before onset. The eruptions and systemic symptoms were controlled with high-dose systemic steroids; however, she was detected to have a stillbirth, and underwent dilation and curettage of the uterine. At the latest follow-up about 2 years after her admission, she reported to have delivered a healthy baby about 1 month previously. Conclusions Chloroquine has potential to lead to PPP in the first trimester of pregnancy. Further studies are warranted to investigate the etiology and treatment of PPP to facilitate early recognition and optimal management of this relatively rare dermatosis in pregnancy.
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Affiliation(s)
- Jue Liu
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Hangzhou, China
| | - Kamran Ali
- Department of Dermatology, International Education College of Zhejiang, Chinese Medical University, Hangzhou, 310006, Zhejiang, China
| | - Haiyue Lou
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Hangzhou, China
| | - Lingling Wang
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Hangzhou, China
| | - Liming Wu
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Hangzhou, China.
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8
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Aryanian Z, Balighi K, Hatami P, Goodarzi A, Mohandesi NA, Afshar ZM. SARS-CoV-2 vaccination and practical points in psoriasis patients: a narrative review. Dermatol Ther 2022; 35:e15430. [PMID: 35261123 PMCID: PMC9111853 DOI: 10.1111/dth.15430] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 11/29/2022]
Abstract
SARS‐CoV2 vaccines were approved without long‐term monitoring due to emergent situations. This has raised some issues about timing and protocol of receiving vaccines in specific situations including patients with chronic inflammatory disorders such as psoriasis. Here, we present different aspects of SARS‐CoV‐2 infection and vaccination in psoriasis patients and aim to provide solutions to overcome the potential challenges. In brief, the benefits of vaccination outweigh the potential risk; vaccine‐triggered de novo or flares of psoriasis is uncommon. As such, all psoriasis patients, especially those receiving systemic treatments including anti tumor necrosis factor agents, are strongly recommended to get SARS‐CoV‐2 vaccines. It is recommended that new immunosuppressive/immunomodulatory therapies be initiated at least 1 week after the second SARS‐CoV‐2 vaccine dose, if possible. In addition, in severe and active forms of psoriasis, it is better to delay vaccination until stabilization of the disease.
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Affiliation(s)
- Zeinab Aryanian
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.Tehran, Iran.,Department of Dermatology, Babol University of Medical Sciences, Babol, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.Tehran, Iran.,Department of Dermatology, School of Medicine Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvaneh Hatami
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasoul-e- Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.,Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah, University of Medical Sciences, Kermanshah, Iran
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9
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Skin Manifestations in Psoriatic and HS Patients in Treatment with Biologicals during the COVID-19 Pandemic. J Clin Med 2021; 10:jcm10245841. [PMID: 34945136 PMCID: PMC8703332 DOI: 10.3390/jcm10245841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/29/2021] [Accepted: 12/11/2021] [Indexed: 11/17/2022] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic, a global public health emergency, has changed dermatology practice and daily routine in just under two years. Much has been written in the literature about COVID-19-associated skin manifestations. Nevertheless, much less has been written regarding skin manifestations in patients affected by severe immune-mediated skin diseases, e.g., psoriasis and hidradenitis suppurativa, undergoing biological treatment during the COVID-19 outbreak. Thus, the aim of this article is to provide the reader with an overview of the cutaneous manifestations during the COVID-19 pandemic in this subset of patients.
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10
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Sachdeva M, Mufti A, Maliyar K, Lytvyn Y, Yeung J. Hydroxychloroquine effects on psoriasis: A systematic review and a cautionary note for COVID-19 treatment. J Am Acad Dermatol 2020; 83:579-586. [PMID: 32442699 PMCID: PMC7235574 DOI: 10.1016/j.jaad.2020.05.074] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 12/20/2022]
Abstract
Background While evidence suggests that hydroxychloroquine (HCQ) may decrease the viral load in patients with a COVID-19 infection, a number of case reports indicate adverse dermatologic effects of this potential treatment. Objective To conduct a systematic review of previously reported cases of psoriasis onset, exacerbation, or relapse after HCQ treatment. Methods Embase and MEDLINE were comprehensively searched for original studies examining adverse effects of HCQ treatment related to psoriasis. Participant demographics and details of HCQ administration and psoriasis diagnosis were extracted from 15 articles representing 18 patients. Results Women accounted for a significantly larger number of cases of psoriasis compared with men and unreported sex (14 [77.8%] vs 2 [11.1%] vs 2 [11.1%], respectively). In addition, 50% (n = 9) of the patients did not have a history of psoriasis before taking HCQ. Of the 18 patients, 9 (50.0%) experienced de novo psoriasis, 5 (27.8%) experienced exacerbation of psoriatic symptoms, and 4 (22.2%) had a relapse of psoriasis after HCQ administration. Conclusion HCQ treatment may result in induction, exacerbation, or relapse of psoriasis. Monitoring for adverse effects of HCQ treatment is necessary, and clinical trials are essential in characterizing the safety profile of HCQ use in patients with a COVID-19 infection.
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Affiliation(s)
- Muskaan Sachdeva
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Asfandyar Mufti
- Department of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Khalad Maliyar
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yuliya Lytvyn
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jensen Yeung
- Department of Dermatology, University of Toronto, Toronto, Ontario, Canada.
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11
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Kutlu Ö, Metin A. A case of exacerbation of psoriasis after oseltamivir and hydroxychloroquine in a patient with COVID-19: Will cases of psoriasis increase after COVID-19 pandemic? Dermatol Ther 2020; 33:e13383. [PMID: 32259878 PMCID: PMC7235511 DOI: 10.1111/dth.13383] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ömer Kutlu
- Department of Dermatology and Venereology, School of Medicine, Uşak University, Uşak, Turkey
| | - Ahmet Metin
- Department of Dermatology and Venereology, School of Medicine, Uşak University, Uşak, Turkey
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12
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Ullah A, Zeb H, Khakwani Z, Murphy FT. Hydroxychloroquine-induced inverse psoriasis. BMJ Case Rep 2019; 12:12/2/bcr-2018-224619. [PMID: 30824460 DOI: 10.1136/bcr-2018-224619] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 65-year-old woman presented to our rheumatology clinic with pain and swelling of multiple joints of her hands. After a thorough evaluation, she was diagnosed with rheumatoid arthritis and was started on hydroxychloroquine therapy. A week later, she presented to our clinic with an acute condition and reported that after taking hydroxychloroquine for a few days she developed multiple rashes, most prominent at skin folds around her breasts, neck, axillae and buttocks. The rashes were characteristic of inverse psoriasis. Hydroxychloroquine was discontinued and the patient was started on methotrexate therapy that resulted in resolution of her rashes in a week.
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Affiliation(s)
- Asad Ullah
- Department of Internal Medicine, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania, USA
| | - Hassan Zeb
- Department of Internal Medicine, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania, USA
| | - Zeeshan Khakwani
- Department of Internal Medicine, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania, USA
| | - Frederick T Murphy
- Altoona Arthritis and Osteoporosis Center/Altoona Center for Clinical Research, Ducansville, Pennsylvania, USA
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13
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Abstract
Background Psoriasis is a common disorder of the skin, immune system, and joints that is influenced by genetic and environmental factors. It can be aggravated or induced by drugs. Objectives To identify the major drugs implicated in inducing or exacerbating psoriasis and to discuss their characteristics. Methods We performed a PubMed literature search for reviews and case reports on drugs that exacerbate or induce psoriasis. Articles were screened by title and abstract and then examined for their findings and references. Results Drugs most often reported to exacerbate or induce psoriasis were β-blockers, lithium, synthetic antimalarials, nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, interferons, tetracyclines, tumor necrosis factor-α inhibitors, and steroid withdrawal. Conclusions Characterizing drugs that induce or exacerbate psoriasis by latency and type of psoriatic eruption can help guide clinical reasoning. Although a relatively uncommon occurrence, psoriatic lesions can be caused by drugs, allowing astute physicians to recognize and change their management plans accordingly.
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Affiliation(s)
- Julie Hong
- Mount Sinai School of Medicine, New York, New York
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14
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Prieto-Barrios M, Castellanos-González M, Velasco-Tamariz V, Burillo-Martínez S, Morales-Raya C, Ortiz-Romero P, Rivera-Diaz R. Two poles of the Th 17-cell-mediated disease spectrum: Analysis of a case series of 21 patients with concomitant lupus erythematosus and psoriasis. J Eur Acad Dermatol Venereol 2016; 31:e233-e236. [DOI: 10.1111/jdv.13986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M. Prieto-Barrios
- Department of Dermatology; Hospital Universitario 12 de Octubre; Madrid Spain
| | | | - V. Velasco-Tamariz
- Department of Dermatology; Hospital Universitario 12 de Octubre; Madrid Spain
| | - S. Burillo-Martínez
- Department of Dermatology; Hospital Universitario 12 de Octubre; Madrid Spain
| | - C. Morales-Raya
- Department of Dermatology; Hospital Universitario 12 de Octubre; Madrid Spain
| | - P. Ortiz-Romero
- Department of Dermatology; Hospital Universitario 12 de Octubre; Madrid Spain
| | - R. Rivera-Diaz
- Department of Dermatology; Hospital Universitario 12 de Octubre; Madrid Spain
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15
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Gravani A, Gaitanis G, Zioga A, Bassukas ID. Synthetic antimalarial drugs and the triggering of psoriasis - do we need disease-specific guidelines for the management of patients with psoriasis at risk of malaria? Int J Dermatol 2013; 53:327-30. [PMID: 24320605 DOI: 10.1111/ijd.12231] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Α distinct side effect of the synthetic quinolinic antimalarial drugs, still widely used for the treatment and prophylaxis of malaria, is the induction of psoriasis in predisposed or susceptible individuals. OBJECTIVE To describe two patients that had induction and exacerbation of psoriasis due to the administration of hydroxychloroquine, to adapt pertinent literature on the pathophysiology of this side effect, to review psoriasis-triggered cases by newer, non-quinolinic antimalarials, and to propose malaria treatment and prophylaxis guidelines for psoriatic patients. PATIENTS AND METHODS Two patients, a 40-year-old female with unknown history of psoriasis and a 37-year-old primigravida with an established history of psoriasis, were treated with hydroxychloroquine for a newly diagnosed lichen planopilaris and for an exacerbation of psoriatic arthritis, respectively. PubMed was searched (last accessed 20 October 2012) employing as search strategy the keywords (psoriasis) AND (drug), where "drug" is the name of each of the newer, non-quinolinic antimalarials. RESULTS Psoriasis was controlled in both patients. The primigravida gave birth to a healthy child at 39 weeks of gestation. The literature review returned no articles that linked the newer antimalarials with psoriasis. CONCLUSION Despite the increased awareness, antimalarials-triggered psoriasis is still diagnosed. Fortunately, the current artemisinin-based antimalarial treatment can be safely offered to susceptible individuals. Additionally, prophylaxis with doxycycline or the combination atovaquone-proguanil could be a safe suggestion for malaria prophylaxis in psoriatic patients.
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Affiliation(s)
- Agoritsa Gravani
- Department of Dermatology, University Hospital of Ioannina, Ioannina, Greece
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16
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Wolf R, Orion E, Ruocco E, Ruocco V. Abnormal epidermal barrier in the pathogenesis of psoriasis. Clin Dermatol 2012; 30:323-8. [PMID: 22507047 DOI: 10.1016/j.clindermatol.2011.08.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Almost 2 decades ago, Williams and Elias suggested a unifying concept for the pathogenesis of disorders of cornification, according to which the integrity of the epidermal barrier and its effective function is an important factor in the regulation of epidermal DNA synthesis. Interference with the barrier integrity or function will result in epidermal hyperplasia and may be the primary event leading to hyperproliferative skin diseases, such as psoriasis. We have analyzed alterations to several structures of the epidermal barrier that might be responsible for barrier dysfunction and thus lead to hyperproliferation of the epidermis in an attempt to repair the barrier and, as a result, might be inducers of psoriasis. There are several convincing reports indicating that inhibiting of epidermal transglutaminase may lead to epidermal hyperproliferation and that this stimulus might trigger psoriasis among genetically predisposed patients. Disturbance of epidermal barrier function caused by derangement of lipid or cholesterol or ceramide synthesis leads to increased DNA synthesis and epidermal hyperplasia and as a result might be an inducer of psoriasis. We could find little evidence to show that defective defense of the epidermis or an abnormal response of it to bacteria plays a role in the pathogenesis of psoriasis. Accumulating data indicate that there is an association of psoriasis and mutations of genes within the epidermal differentiation complex, which are crucial for the development, maturation, cornification, cross-linking, and terminal differentiation of the epidermis, called psoriasis susceptibility locus 4.
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Affiliation(s)
- Ronni Wolf
- Dermatology Unit, Kaplan Medical Center, Rehovot 76100, Israel.
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17
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Cuesta-Montero L, Belinchón I. Conectivopatías y psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:487-97. [DOI: 10.1016/j.ad.2011.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Accepted: 03/02/2011] [Indexed: 11/25/2022] Open
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18
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Connective Tissue Diseases and Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/j.adengl.2011.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Antimalarial medications have become the parenteral drugs of choice for treating the cutaneous manifestations of lupus erythematosus. The immune-modulating activity of these agents makes them useful in a variety of other dermatoses. With prudent dosage and monitoring, these agents can be used safely and effectively in the treatment and management of dermatologic disease.
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Affiliation(s)
- M J Van Beek
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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20
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Abstract
Articles included in this review reflect the recent advances made in basic research and the clinical management of psoriatic arthritis in 1999. Some of these advances are destined to modify the current approach to the disease. The problems related to nosology and epidemiology, the two still controversial aspects, are discussed first. Genetic susceptibility to psoriasis and psoriatic arthritis, and the inciting role played by some bacteria, are confirmed, and attention is focused on the role of T cells, cytokines, adhesion molecules, and angiogenetic factors in the skin and synovial membrane. New classification criteria are provided and a simplified spectrum of the disease seems to emerge from clinical studies. Modern imaging techniques enable early articular changes to be discovered, support innovative pathogenetic hypotheses, and allow new therapeutic approaches.
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Affiliation(s)
- R Scarpa
- Cattedra di Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Università Federico II, Italy.
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