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Christensen MO, Sieborg J, Nymand LK, Guttman-Yassky E, Ezzedine K, Schlapbach C, Molin S, Zhang J, Zachariae C, Thomsen SF, Thyssen JP, Egeberg A. Prevalence and clinical impact of topical corticosteroid phobia among patients with chronic hand eczema-Findings from the Danish Skin Cohort. J Am Acad Dermatol 2024:S0190-9622(24)02711-7. [PMID: 39181406 DOI: 10.1016/j.jaad.2024.07.1503] [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: 05/12/2024] [Revised: 07/11/2024] [Accepted: 07/20/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Topical corticosteroid phobia (TOPICOP) is associated with poor treatment adherence and is common among patients with skin disease. Knowledge about corticosteroid phobia and treatment adherence among patients with chronic hand eczema (CHE) is limited. OBJECTIVES To investigate patient-reported outcomes regarding topical corticosteroids (TCSs), and their impact on treatment adherence in patients with CHE. METHODS Patients with CHE from the Danish Skin Cohort answered a questionnaire including the TOPICOP scale and Medication Adherence Report Scale. Response rate was 69.2%. RESULTS Of 927 with CHE, 75.5% totally or almost agreed that TCS damage the skin, 48.9% totally or almost agreed that TCS would affect their future health and 36.3% reported some degree of fear of TCS although they were unaware of any TCS-associated risks. Most patients (77.9%) always or often stop treatment as soon as possible, whereas 54.8% always or often wait as long as possible before starting treatment. Overall, 38.8% reported that they had taken less medicine than prescribed and 54.0% had stopped treatment throughout a period. Treatment adherence decreased with increasing corticosteroid phobia (P = .004). LIMITATIONS TOPICOP has not been validated in patients with CHE. CONCLUSIONS Corticosteroid phobia is common among patients with CHE and negatively associated with treatment adherence.
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Affiliation(s)
- Maria O Christensen
- Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Johan Sieborg
- Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lea K Nymand
- Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Emma Guttman-Yassky
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Khaled Ezzedine
- Department of Dermatology, Hôpital Henri Mondor, Université Paris-Est Créteil Val de Marne, Paris, France; EA 7379 EpidermE, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Christoph Schlapbach
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sonja Molin
- Division of Dermatology, Queen's University, Kingston, Ontario, Canada
| | - Jianzhong Zhang
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Simon F Thomsen
- Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Egeberg
- Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Hoyer A, Rehbinder EM, Färdig M, Asad S, Lødrup Carlsen KC, Endre KMA, Granum B, Haugen G, Hedlin G, Monceyron Jonassen C, Katayama S, Konradsen JR, Landrø L, LeBlanc M, Mägi Olsson CA, Rudi K, Skjerven HO, Staff AC, Vettukattil R, Bradley M, Nordlund B, Söderhäll C. Filaggrin mutations in relation to skin barrier and atopic dermatitis in early infancy. Br J Dermatol 2021; 186:544-552. [PMID: 34698386 DOI: 10.1111/bjd.20831] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Loss-of-function mutations in the skin barrier gene filaggrin (FLG) increase the risk of atopic dermatitis (AD), but their role in skin barrier function, dry skin and eczema in infancy is unclear. OBJECTIVES To determine the role of FLG mutations for impaired skin barrier function, dry skin, eczema and AD at three months of age and through infancy. METHODS FLG mutations were analyzed in 1836 infants in the Scandinavian population-based PreventADALL study. Transepidermal water loss (TEWL), dry skin, eczema and AD were assessed at three, six and 12 months of age. RESULTS Filaggrin mutations were observed in 166 (9%) infants. At three months, carrying FLG mutations was not associated with impaired skin barrier function (TEWL > 11.3 g/m2 /h) or dry skin, but with eczema (OR(95%CI): 2.76 (1.81, 4.23), p < 0.001). At six months, mutation carriers had significantly higher TEWL than non-mutation carriers (mean (95%CI) 9.68 (8.69, 10.68) vs. 8.24 (7.97, 8.15), p < 0.01) and at three and six months an increased risk of dry skin on truncus (OR: 1.87 (1.25, 2.80), p = 0.002; 2.44 (1.51, 3.95), p < 0.001) or extensor limb surfaces (1.52 (1.04, 2.22), p = 0.028; 1.74 (1.17, 2.57), p = 0.005). FLG mutations were associated with eczema and AD in infancy. CONCLUSION Filaggrin mutations were not associated with impaired skin barrier function or dry skin in general at three months of age, but increased the risk for eczema, as well as for dry skin on truncus and extensors at three and six months.
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Affiliation(s)
- A Hoyer
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - E M Rehbinder
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Dermatology and Venerology, Oslo University Hospital, Oslo, Norway
| | - M Färdig
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - S Asad
- Dermatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - K C Lødrup Carlsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - K M A Endre
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Dermatology and Venerology, Oslo University Hospital, Oslo, Norway
| | - B Granum
- Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - G Haugen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - G Hedlin
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - C Monceyron Jonassen
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway.,Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - S Katayama
- Folkhälsan Research Center, Helsinki, Finland.,Department of Biosciences and Nutrition, Karolinska Institute, Huddinge, Sweden.,Stem Cells and Metabolism Research Program, University of Helsinki, Helsinki, Finland
| | - J R Konradsen
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - L Landrø
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Dermatology and Venerology, Oslo University Hospital, Oslo, Norway
| | - M LeBlanc
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - C A Mägi Olsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - K Rudi
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | - H O Skjerven
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - A C Staff
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - R Vettukattil
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - M Bradley
- Dermatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - B Nordlund
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - C Söderhäll
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Augustin M, Wilsmann-Theis D, Körber A, Kerscher M, Itschert G, Dippel M, Staubach P. Diagnosis and treatment of xerosis cutis - a position paper. J Dtsch Dermatol Ges 2020; 17 Suppl 7:3-33. [PMID: 31738016 DOI: 10.1111/ddg.13906] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND RATIONALE Xerosis cutis (also referred to as xeroderma, dry skin, asteatosis) affects more than 10 million individuals in Germany. It is among the most common dermatological diagnoses and a cardinal symptom of many dermatological, internal and neurological diseases. Even though it has been established that basic skin care plays a significant role in the management of patients with xerosis cutis, there are as yet no evidence-based algorithms for diagnosis and treatment. OBJECTIVE The present position paper provides physicians across all specialties with a practical, symptom-based approach to the prevention, diagnosis and treatment of xerosis cutis. METHODS Within a structured decision-making process, a panel of experienced dermatologists first defined questions relevant to everyday clinical practice, which were then addressed by a systematic review of the literature. Based on the evidence available as well as expert consensus, diagnostic and treatment algorithms were subsequently developed and agreed upon. RESULTS Xerosis cutis is generally diagnosed on clinical grounds. Possible trigger factors must be avoided, and comorbidities should be adequately and specifically treated. Suitable skin care products should be chosen with a view to improving skin hydration and restoring its barrier function. They should therefore contain both rehydrating and lipid-replenishing components. The "drier" the skin appears, the greater the lipid content should be (preferably using water-in-oil formulations). The choice of ingredients is based on a patient's individual symptoms, such as scaling (e.g., urea), fissures/rhagades (e.g., urea or dexpanthenol), erythema (e.g., licochalcone A) and pruritus (e.g., polidocanol). Other factors to be considered include the site affected and patient age. Ingredients or rather combinations thereof for which there is good clinical evidence should be preferentially used. The best evidence by far is available for urea, whose efficacy in the treatment of xerosis is further enhanced by combining it with other natural moisturizing components and ceramides. The "xerosimeter" is a tool developed in an effort to facilitate patient management and for training purposes. It not only includes practical tools for diagnosis and follow-up but also a classification of ingredients and a structured treatment algorithm. CONCLUSION The structured symptom- and evidence-based approach proposed herein contains a road map for diagnosis and treatment of xerosis cutis. It aims to raise awareness in terms of prevention and early treatment of this condition and may thus improve quality of life and prevent potential sequelae.
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Affiliation(s)
- Matthias Augustin
- Hamburg-Eppendorf University Medical Center, Institute for Healthcare Research in Dermatology and Nursing (IVDP), Martinistr. 52, 20246, Hamburg, Germany
| | - Dagmar Wilsmann-Theis
- Department of Dermatology and Allergology, University Medical Center, Friedrich Wilhelm University, Sigmund Freud Str. 25, 53105, Bonn, Germany
| | - Andreas Körber
- Office-based Dermatologist, Rüttenscheider Str. 143, 45130, Essen, Germany
| | - Martina Kerscher
- University of Hamburg, Division of Cosmetic Sciences, Papendamm 21, 20146, Hamburg, Germany
| | - Götz Itschert
- Office-based Dermatologist, Am Rathaus 2a, 25421, Pinneberg, Germany
| | - Michaela Dippel
- MD medscript & consult, Am Kuhtriftberg 21, 67098, Bad Dürkheim, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
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Identification of differentially expressed microRNAs in the skin of experimentally sensitized naturally affected atopic beagles by next-generation sequencing. Immunogenetics 2020; 72:241-250. [PMID: 32219493 DOI: 10.1007/s00251-020-01162-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/11/2020] [Indexed: 12/18/2022]
Abstract
Canine atopic dermatitis (AD) is a very common inflammatory skin disease, but limited data are available on the genetic characterization (somatic mutations, microarrays, and genome-wide association study (GWAS)) of skin lesions in affected dogs. microRNAs are good biomarkers in inflammatory and neoplastic diseases in people. The aim of this study was to evaluate microRNA expression in the skin of atopic beagles, before and after exposure to Dermatophagoides farinae. Four atopic and four unrelated age-matched healthy beagle dogs were enrolled. Total RNA was extracted from flash-frozen skin biopsies of healthy and atopic dogs. For the atopic dogs, skin biopsies were taken from non-lesional (day 0) and lesional skin (day 28 of weekly environmental challenge with Dermatophagoides farinae). Small RNA libraries were constructed and sequenced. The microRNA sequences were aligned to CanFam3.1 genome. Differential expressed microRNAs were selected on the basis of fold-change and statistical significance (fold-change ≥ 1.5 and p ≤ 0.05 as thresholds. A total of 277 microRNAs were sequenced. One hundred and twenty-one differentially regulated microRNAs were identified between non-lesional and healthy skin. Among these, two were increased amount and 119 were decreased amount. A total of 45 differentially regulated microRNAs between lesional and healthy skin were identified, 44 were decreased amount and one was increased amount. Finally, only two increased amount microRNAs were present in lesional skin when compared with that of non-lesional skin. This is the first study in which dysregulation of microRNAs has been associated with lesional and non-lesional canine AD. Larger studies are needed to understand the role of microRNA in canine AD.
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Magrone T, Russo MA, Jirillo E. Impact of Heavy Metals on Host Cells: Special Focus on Nickel-Mediated Pathologies and Novel Interventional Approaches. Endocr Metab Immune Disord Drug Targets 2019; 20:1041-1058. [PMID: 31782370 DOI: 10.2174/1871530319666191129120253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/13/2019] [Accepted: 05/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Heavy metals [arsenic, aluminium, cadmium, chromium, cobalt, lead, nickel (Ni), palladium and titanium] are environmental contaminants able to impact with host human cells, thus, leading to severe damage. OBJECTIVE In this review, the detrimental effects of several heavy metals on human organs will be discussed and special emphasis will be placed on Ni. In particular, Ni is able to interact with Toll-like receptor-4 on immune and non-immune cells, thus, triggering the cascade of pro-inflammatory cytokines. Then, inflammatory and allergic reactions mediated by Ni will be illustrated within different organs, even including the central nervous system, airways and the gastrointestinal system. DISCUSSION Different therapeutic strategies have been adopted to mitigate Ni-induced inflammatoryallergic reactions. In this context, the ability of polyphenols to counteract the inflammatory pathway induced by Ni on peripheral blood leukocytes from Ni-sensitized patients will be outlined. In particular, polyphenols are able to decrease serum levels of interleukin (IL)-17, while increasing levels of IL- 10. These data suggest that the equilibrium between T regulatory cells and T helper 17 cells is recovered with IL-10 acting as an anti-inflammatory cytokine. In the same context, polyphenols reduced elevated serum levels of nitric oxide, thus, expressing their anti-oxidant potential. Finally, the carcinogenic potential of heavy metals, even including Ni, will be highlighted. CONCLUSION Heavy metals, particularly Ni, are spread in the environment. Nutritional approaches seem to represent a novel option in the treatment of Ni-induced damage and, among them, polyphenols should be taken into consideration for their anti-oxidant and anti-inflammatory activities.
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Affiliation(s)
- Thea Magrone
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, School of Medicine, University of Bari, Bari, Italy
| | - Matteo A Russo
- MEBIC Consortium, San Raffaele Open University of Rome and IRCCS San Raffaele Pisana of Rome, Rome, Italy
| | - Emilio Jirillo
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, School of Medicine, University of Bari, Bari, Italy
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Thyssen J, Halling‐Sønderby A, Wu J, Egeberg A. Pain severity and use of analgesic medication in adults with atopic dermatitis: a cross‐sectional study. Br J Dermatol 2019; 182:1430-1436. [DOI: 10.1111/bjd.18557] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2019] [Indexed: 12/01/2022]
Affiliation(s)
- J.P. Thyssen
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS) Herlev and Gentofte Hospital Hellerup Denmark
| | - A.‐S. Halling‐Sønderby
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS) Herlev and Gentofte Hospital Hellerup Denmark
| | - J.J. Wu
- Dermatology Research and Education Foundation Irvine CA U.S.A
| | - A. Egeberg
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS) Herlev and Gentofte Hospital Hellerup Denmark
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7
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Augustin M, Wilsmann-Theis D, Körber A, Kerscher M, Itschert G, Dippel M, Staubach P. Positionspapier: Diagnostik und Therapie der Xerosis cutis. J Dtsch Dermatol Ges 2018; 16 Suppl 4:3-35. [DOI: 10.1111/ddg.13580] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Matthias Augustin
- Universitätsklinikum Hamburg-Eppendorf; Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Martinistr. 52 20246 Hamburg
| | - Dagmar Wilsmann-Theis
- Klinik und Poliklinik für Dermatologie und Allergologie der Rheinischen-Friedrich-Wilhelms Universität Bonn; Sigmund-Freud-Str. 25 53105 Bonn
| | | | - Martina Kerscher
- Universität Hamburg; Fachbereich Kosmetikwissenschaft; Papendamm 21 20146 Hamburg
| | | | - Michaela Dippel
- MD medscript & consult; Am Kuhtriftberg 21 67098 Bad Dürkheim
| | - Petra Staubach
- Hautklinik und Poliklinik der Universitätsmedizin; Johannes Gutenberg-Universität; Langenbeckstr. 1 55131 Mainz
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8
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Mahler V. Umweltassoziierte dermatologische Erkrankungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:605-617. [DOI: 10.1007/s00103-017-2543-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Larsen KR, Johansen JD, Reibel J, Zachariae C, Rosing K, Pedersen AML. Filaggrin gene mutations and the distribution of filaggrin in oral mucosa of patients with oral lichen planus and healthy controls. J Eur Acad Dermatol Venereol 2017; 31:887-893. [PMID: 28000306 DOI: 10.1111/jdv.14098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 12/02/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Lichen planus (LP) is a chronic inflammatory disease of unknown aetiology affecting the skin and oral mucosa. Oral lichenoid lesions (OLLs), like oral contact reactions, may resemble oral lichen planus (OLP) both clinically and histopathologically. As OLP and OLL are hyperkeratotic diseases and filaggrin is essential to keratinization, the distribution of filaggrin may be altered in these lesions. OBJECTIVES To investigate whether patients with OLP/OLL have (i) altered distribution of filaggrin in the oral mucosa; (ii) a higher incidence of mutations in the filaggrin gene (FLG); (iii) active dermatoses, apart from cutaneous LP, than healthy controls; and (iv) patients with OLP/OLL and a defect in the FLG have more widespread oral lesions and report more symptoms than OLP/OLL patients without a concomitant defect in the FLG. METHODS Forty-nine Caucasian patients (42 women and 7 men, mean age 61.0 ± 10.3 years), with symptomatic OLP, OLL or stomatitis, and 29 matched healthy controls underwent a clinical oral and dermatological examination, oral mucosal biopsy and filaggrin genotyping (testing for R2447X, R501X, 2282del4). Smear tests for Candida spp. were performed in all patients to exclude oral candidiasis. Immunohistochemistry were performed using poly- and monoclonal filaggrin antibodies. RESULTS The immunoreactivity for filaggrin was significantly more intense in the oral mucosa in the patients with OLP/OLL compared with healthy controls (P = 0.000025). No difference was noted in the incidence of defects in the FLG and active dermatoses between patients and healthy controls. No difference was noted in extension and number of symptoms reported by patients with OLP/OLL with or without a concomitant defect in the FLG. CONCLUSION OLP/OLL is associated with an altered distribution of filaggrin in the oral mucosa independently of defects in the FLG. Patients with OLP/OLL did not display more active dermatoses other than cutaneous LP when compared to healthy controls.
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Affiliation(s)
- K R Larsen
- Department of Odontology, Oral Pathology and Oral Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - J D Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Gentofte University Hospital, Hellerup, Denmark
| | - J Reibel
- Department of Odontology, Oral Pathology and Oral Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - C Zachariae
- Department of Dermatology and Allergy, Gentofte University Hospital, Hellerup, Denmark
| | - K Rosing
- Department of Odontology, Faculty of Health and Medical Sciences, Community Dentistry, University of Copenhagen, Copenhagen N, Denmark
| | - A M L Pedersen
- Department of Odontology, Oral Pathology and Oral Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
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11
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Heede NG, Thyssen JP, Thuesen BH, Linneberg A, Szecsi PB, Stender S, Johansen JD. Health-related quality of life in adult dermatitis patients stratified by filaggrin genotype. Contact Dermatitis 2016; 76:167-177. [DOI: 10.1111/cod.12731] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/18/2016] [Accepted: 10/19/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Nina G. Heede
- Department of Dermatology and Allergy, The National Allergy Research Centre; Copenhagen University Hospital Herlev-Gentofte; 2900 Hellerup Denmark
| | - Jacob P. Thyssen
- Department of Dermatology and Allergy, The National Allergy Research Centre; Copenhagen University Hospital Herlev-Gentofte; 2900 Hellerup Denmark
| | - Betina H. Thuesen
- Research Centre for Prevention and Health, the Capital Region of Denmark; 2600 Copenhagen Denmark
| | - Allan Linneberg
- Research Centre for Prevention and Health, the Capital Region of Denmark; 2600 Copenhagen Denmark
- Department of Clinical Experimental Research; Rigshospitalet; Glostrup Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine; University of Copenhagen; 2200 Copenhagen Denmark
| | - Pal B. Szecsi
- Department of Clinical Biochemistry; Copenhagen University Hospital Herlev-Gentofte; 2900 Hellerup Denmark
| | - Steen Stender
- Department of Clinical Biochemistry; Copenhagen University Hospital Herlev-Gentofte; 2900 Hellerup Denmark
| | - Jeanne D. Johansen
- Department of Dermatology and Allergy, The National Allergy Research Centre; Copenhagen University Hospital Herlev-Gentofte; 2900 Hellerup Denmark
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Dang N, Ma X, Meng X, An L, Pang S. Dysregulated function of normal human epidermal keratinocytes in the absence of filaggrin. Mol Med Rep 2016; 14:2566-72. [PMID: 27485743 PMCID: PMC4991742 DOI: 10.3892/mmr.2016.5539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 06/21/2016] [Indexed: 11/30/2022] Open
Abstract
The aim of the present study was to investigate the impact of filaggrin knockdown on the function of normal human epidermal keratinocytes (NHEKs). Filaggrin expression levels in NHEKs were knocked down by lentivirus (LV) encoding small hairpin RNA (shRNA), with control cells infected with nonsense shRNA or not infected. Cell migration and invasion were assayed using Transwell inserts, cell adhesion and proliferation by the Cell Counting kit-8 assay, and apoptosis and cell cycle progression by flow cytometry. shRNA efficiently suppressed expression of filaggrin protein. The LV group had significantly decreased cell migration, adhesion and proliferation, and increased apoptosis compared with the control groups (P=0.027). In addition, the proportion of cells in G1 and G2 phases were significantly increased in the LV group compared with control groups (P=0.018). The results of the present study demonstrate that filaggrin knockdown inhibits NHEK migration, adhesion and proliferation, promotes apoptosis and disturbs cell cycle progression.
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Affiliation(s)
- Ningning Dang
- Department of Dermatology, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Xiaoli Ma
- Central Laboratory, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Xianguang Meng
- Department of Dermatology, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Liguo An
- College of Life Science, Shandong Normal University, Jinan, Shandong 250014, P.R. China
| | - Shuguang Pang
- Department of Endocrinology, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
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Timmerman JG, Heederik D, Spee T, van Rooy FG, Krop EJM, Koppelman GH, Rustemeyer T, Smit LAM. Contact dermatitis in the construction industry: the role of filaggrin loss-of-function mutations. Br J Dermatol 2015; 174:348-55. [PMID: 26451970 DOI: 10.1111/bjd.14215] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND A high prevalence of contact dermatitis (CD) and respiratory symptoms has been observed in the construction industry, probably due to widespread exposure to irritants and allergens. It is unknown whether carriers of loss-of-function mutations in the gene encoding filaggrin (FLG), a known risk gene for eczema and asthma, are at increased risk. OBJECTIVES To investigate associations of FLG mutations with CD and respiratory symptoms in Dutch construction workers. METHODS A questionnaire including items on dermal and respiratory symptoms such as wheeze, shortness of breath and asthma was administered to construction workers. Total and specific serum IgE was analysed by enzyme immunoassays. Four FLG loss-of-function mutations were genotyped. CD was diagnosed by a team of a dermatologist and a clinical occupational medicine specialist using photographs of the subjects' hands and self-reported questionnaire data. RESULTS Of the 506 participating workers, 6·3% carried at least one FLG mutation. Mild CD was diagnosed by the specialists in 34·0%, and severe CD in an additional 24·3%. CD was considered work related in 282 of 295 subjects (95·6%). Carriers of FLG variants had an increased risk of CD compared with subjects carrying wild-type alleles [mild CD: odds ratio (OR) 5·71, 95% confidence interval (CI) 1·63-20·06; severe CD: OR 8·26, 95% CI 2·32-29·39]. FLG variants and the presence of CD were not associated with respiratory symptoms and atopy. CONCLUSIONS Contact dermatitis prevalence in construction workers is high. FLG loss-of-function mutations increase the risk of CD even further. FLG mutations were not associated with respiratory symptoms or atopy.
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Affiliation(s)
- J G Timmerman
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - D Heederik
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - T Spee
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands.,Arbouw Research and Development, Harderwijk, the Netherlands
| | - F G van Rooy
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands.,Arbo Unie Expert Centre for Chemical Risk Management, Haarlem, the Netherlands
| | - E J M Krop
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - G H Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital and GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - T Rustemeyer
- Department of Dermatology, VU University Medical Centre, Amsterdam, the Netherlands
| | - L A M Smit
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
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14
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Brans R, John S. Clinical patterns and associated factors in patients with hand eczema of primarily occupational origin. J Eur Acad Dermatol Venereol 2015; 30:798-805. [DOI: 10.1111/jdv.13515] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/02/2015] [Indexed: 11/30/2022]
Affiliation(s)
- R. Brans
- Department of Dermatology, Environmental Medicine and Health Theory; University of Osnabrück; Osnabrück Germany
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück and Trauma Hospital Hamburg; Osnabrück/Hamburg Germany
- Lower Saxonian Institute of Occupational Dermatology; University of Osnabrück and University Medical Center Göttingen; Osnabrück/Göttingen Germany
| | - S.M. John
- Department of Dermatology, Environmental Medicine and Health Theory; University of Osnabrück; Osnabrück Germany
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück and Trauma Hospital Hamburg; Osnabrück/Hamburg Germany
- Lower Saxonian Institute of Occupational Dermatology; University of Osnabrück and University Medical Center Göttingen; Osnabrück/Göttingen Germany
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15
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Diepgen TL, Andersen KE, Chosidow O, Coenraads PJ, Elsner P, English J, Fartasch M, Gimenez-Arnau A, Nixon R, Sasseville D, Agner T. Guidelines for diagnosis, prevention and treatment of hand eczema. J Dtsch Dermatol Ges 2015; 13:e1-22. [PMID: 25763418 DOI: 10.1111/ddg.12510_1] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The guidelines aim to provide advice on the management of hand eczema (HE), using an evidence- and consensus-based approach. The guidelines consider a systematic Cochrane review on interventions for HE, which is based on a systematic search of the published literature (including hand-searching). In addition to the evidence- and consensus-based recommendation on the treatment of HE, the guidelines cover mainly consensus-based diagnostic aspects and preventive measures (primary and secondary prevention). Treatment recommendations include non-pharmacological interventions, topical, physical and systemic treatments. Topical corticosteroids are recommended as first line treatment in the management of HE, however continuous long-term treatment beyond six weeks only when necessary and under careful me-dical supervision. Alitretinoin is recommended as a second line treatment (relative to topical corticosteroids) for patients with severe chronic HE. Randomized control trials (RCT) are missing for other used systemic treatments and comparison of systemic drugs in “head-to-head” RCTs are needed.The guidelines development group is a working group of the European Society of Contact Dermatitis (ESCD) and has carefully tried to reconcile opposite views, define current optimal practice and provide specific recommendations, and meetings have been chaired by a professional moderator of the AWMF (Arbeitsgemeinschaft der Wis-senschaftlichen Medizinischen Fachgesellschaften; Association of the Scientific Medi-cal Societies in Germany).No financial support was given by any medical company. The guidelines are expected to be valid until December 2017 at the latest.
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16
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Heede NG, Thyssen JP, Thuesen BH, Linneberg A, Johansen JD. Anatomical patterns of dermatitis in adult filaggrin mutation carriers. J Am Acad Dermatol 2015; 72:440-8. [DOI: 10.1016/j.jaad.2015.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/12/2014] [Accepted: 01/05/2015] [Indexed: 01/28/2023]
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17
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Armengot-Carbo M, Hernández-Martín Á, Torrelo A. The Role of Filaggrin in the Skin Barrier and Disease Development. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2014.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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18
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Jungersted JM, Høgh JK, Hellgren LI, Wilkinson S, Jemec GBE, Agner T. Hand eczema and stratum corneum ceramides. Clin Exp Dermatol 2014; 40:243-6. [DOI: 10.1111/ced.12502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2014] [Indexed: 01/26/2023]
Affiliation(s)
- J. M. Jungersted
- Department of Dermatology; Roskilde Hospital; Roskilde Denmark
- Department of Dermatology; Bispebjerg Hospital; Copenhagen Denmark
| | - J. K. Høgh
- Center of Biological Sequence Analysis; Technical University of Denmark; Kongens Lyngby Denmark
| | - L. I. Hellgren
- Center of Biological Sequence Analysis; Technical University of Denmark; Kongens Lyngby Denmark
| | - S. Wilkinson
- Medical Toxicology Centre; Institute for Cellular Medicine; Newcastle University; Newcastle upon Tyne UK
| | - G. B. E. Jemec
- Department of Dermatology; Roskilde Hospital; Roskilde Denmark
| | - T. Agner
- Department of Dermatology; Bispebjerg Hospital; Copenhagen Denmark
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19
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Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease with specific genetic and immunological mechanisms. The rapid development of new techniques in molecular biology had ushered in new discoveries on the role of cytokines, chemokines, and immune cells in the pathogenesis of AD. New polymorphisms of AD are continually being reported in different populations. The physical and immunological barrier of normal intact skin is an important part of the innate immune system that protects the host against microbials and allergens that are associated with AD. Defects in the filaggrin gene FLG may play a role in facilitating exposure to allergens and microbial pathogens, which may induce Th2 polarization. Meanwhile, Th22 cells also play roles in skin barrier impairment through IL-22, and AD is often considered to be a Th2/Th22-dominant allergic disease. Mast cells and eosinophils are also involved in the inflammation via Th2 cytokines. Release of pruritogenic substances by mast cells induces scratching that further disrupts the skin barrier. Th1 and Th17 cells are mainly involved in chronic phase of AD. Keratinocytes also produce proinflammatory cytokines such as thymic stromal lymphopoietin (TSLP), which can further affect Th cells balance. The immunological characteristics of AD may differ for various endotypes and phenotypes. Due to the heterogeneity of the disease, and the redundancies of these mechanisms, our knowledge of the pathophysiology of the disease is still incomplete, which is reflected by the absence of a cure for the disease.
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Affiliation(s)
- Zhanglei Mu
- Department of Dermatology, Peking University People's Hospital, No11, Xizhimen South Street, Beijing, 100044, China
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20
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Armengot-Carbo M, Hernández-Martín Á, Torrelo A. The role of filaggrin in the skin barrier and disease development. ACTAS DERMO-SIFILIOGRAFICAS 2014; 106:86-95. [PMID: 24674607 DOI: 10.1016/j.ad.2013.10.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 08/17/2013] [Accepted: 10/13/2013] [Indexed: 12/30/2022] Open
Abstract
Filaggrin is a structural protein that is fundamental in the development and maintenance of the skin barrier. The function of filaggrin and its involvement in various cutaneous and extracutaneous disorders has been the subject of considerable research in recent years. Mutations in FLG, the gene that encodes filaggrin, have been shown to cause ichthyosis vulgaris, increase the risk of atopic dermatitis and other atopic diseases, and exacerbate certain conditions. The present article reviews the current knowledge on the role of filaggrin in the skin barrier, FLG mutations, and the consequences of filaggrin deficiency.
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Affiliation(s)
- M Armengot-Carbo
- Servicio de Dermatología, Hospital Infantil Niño Jesús, Madrid, España.
| | | | - A Torrelo
- Servicio de Dermatología, Hospital Infantil Niño Jesús, Madrid, España
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21
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Fölster-Holst R, Dähnhardt-Pfeiffer S, Dähnhardt D, Proksch E. The role of skin barrier function in atopic dermatitis: an update. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.12.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Carlsen BC, Meldgaard M, Johansen JD, Thyssen JP, Menné T, Szecsi PB, Stender S. Filaggrin compound heterozygous patients carry mutations intransposition. Exp Dermatol 2013; 22:572-5. [DOI: 10.1111/exd.12199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2013] [Indexed: 12/23/2022]
Affiliation(s)
- Berit C. Carlsen
- Department of Dermato-Allergology; National Allergy Research Centre; Copenhagen University Hospital Gentofte; Hellerup; Denmark
| | - Michael Meldgaard
- Department of Clinical Biochemistry; Copenhagen University Hospital Gentofte; Hellerup; Denmark
| | - Jeanne D. Johansen
- Department of Dermato-Allergology; National Allergy Research Centre; Copenhagen University Hospital Gentofte; Hellerup; Denmark
| | - Jacob P. Thyssen
- Department of Dermato-Allergology; National Allergy Research Centre; Copenhagen University Hospital Gentofte; Hellerup; Denmark
| | - Torkil Menné
- Department of Dermato-Allergology; National Allergy Research Centre; Copenhagen University Hospital Gentofte; Hellerup; Denmark
| | - Pal B. Szecsi
- Department of Clinical Biochemistry; Copenhagen University Hospital Gentofte; Hellerup; Denmark
| | - Steen Stender
- Department of Clinical Biochemistry; Copenhagen University Hospital Gentofte; Hellerup; Denmark
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23
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Bandier J, Ross-Hansen K, Carlsen BC, Menné T, Linneberg A, Stender S, Szecsi PB, Meldgaard M, Thyssen JP, Johansen JD. Carriers of filaggrin gene (FLG) mutations avoid professional exposure to irritants in adulthood. Contact Dermatitis 2013; 69:355-62. [DOI: 10.1111/cod.12097] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/11/2013] [Accepted: 03/26/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Josefine Bandier
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; Hellerup 2900 Denmark
| | - Katrine Ross-Hansen
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; Hellerup 2900 Denmark
| | - Berit C. Carlsen
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; Hellerup 2900 Denmark
| | - Torkil Menné
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; Hellerup 2900 Denmark
| | - Allan Linneberg
- Research Centre for Prevention and Health; Copenhagen University Hospital Glostrup; Glostrup Denmark
| | - Steen Stender
- Department of Clinical Biochemistry; Copenhagen University Hospital Gentofte; Hellerup 2900 Denmark
| | - Pal B. Szecsi
- Department of Clinical Biochemistry; Copenhagen University Hospital Gentofte; Hellerup 2900 Denmark
| | - Michael Meldgaard
- Department of Clinical Biochemistry; Copenhagen University Hospital Gentofte; Hellerup 2900 Denmark
| | - Jacob P. Thyssen
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; Hellerup 2900 Denmark
| | - Jeanne D. Johansen
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; Hellerup 2900 Denmark
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24
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Landeck L, Visser M, Skudlik C, Brans R, Kezic S, John SM. Clinical course of occupational irritant contact dermatitis of the hands in relation to filaggrin genotype status and atopy. Br J Dermatol 2013; 167:1302-9. [PMID: 22962861 DOI: 10.1111/bjd.12035] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Filaggrin loss-of-function mutations and atopy may alter the clinical course of irritant contact dermatitis (ICD). OBJECTIVE To investigate the clinical course of patients with occupational ICD according to loss-of-function mutations in the filaggrin gene (FLG) and atopy. METHODS In a prospective cohort study, the clinical course, use of topical corticosteroids, sick leave, recovery rate and job continuation were investigated in 459 inpatients treated for occupational ICD of the hands. Patients were genotyped for four FLG mutations, examined for atopy and followed for up to 3 years after discharge. RESULTS Our study included 327 (71·2%) atopic individuals and 132 nonatopic individuals. Overall, 68 patients showed a mutation in the FLG alleles R501X, R2447X, S3247X and 2282del4 (60 atopic and eight nonatopic). Nonatopic patients with ICD responded well to therapeutic approaches, while atopy status made subjects more resistant to therapy, resulting in lower rates of recovery and job continuation and higher use of topical corticosteroids. Carriage of FLG loss-of-function mutations in combination with atopy worsened the course. The risk of abandoning one's profession in this group was significantly increased when compared with 'pure' ICD (odds ratio 3·1) after 3 years. CONCLUSIONS Patients with atopy are a special risk population for ICD. In the presence of atopy, FLG mutations seem to be a modifier of the severity of the clinical course in ICD. Early-stage identification of this subgroup may result in additional emphasis to these patients regarding the importance of adherence to specific therapeutic interventions.
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Affiliation(s)
- L Landeck
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.
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25
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Abstract
Ichthyosis vulgaris is caused by loss-of-function mutations in the filaggrin gene (FLG) and is characterized clinically by xerosis, scaling, keratosis pilaris, palmar and plantar hyperlinearity, and a strong association with atopic disorders. According to the published studies presented in this review article, FLG mutations are observed in approximately 7·7% of Europeans and 3·0% of Asians, but appear to be infrequent in darker-skinned populations. This clinical review article provides an overview of ichthyosis vulgaris epidemiology, related disorders and pathomechanisms. Not only does ichthyosis vulgaris possess a wide clinical spectrum, recent studies suggest that carriers of FLG mutations may have a generally altered risk of developing common diseases, even beyond atopic disorders. Mechanistic studies have shown increased penetration of allergens and chemicals in filaggrin-deficient skin, and epidemiological studies have found higher levels of hand eczema, irritant contact dermatitis, nickel sensitization and serum vitamin D levels. When relevant, individuals should be informed about an increased risk of developing dermatitis when repeatedly or continuously exposed to nickel or irritants. Moreover, with our current knowledge, individuals with ichthyosis vulgaris should be protected against neonatal exposure to cats to prevent atopic dermatitis and should abstain from smoking to prevent asthma. Finally, they should be advised against excessive exposure to factors that decrease skin barrier functions and increase the risk of atopic dermatitis.
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Affiliation(s)
- J P Thyssen
- Dermatology Service, Veterans Affairs Medical Center, and Department of Dermatology, UCSF, 4150 Clement Street, San Francisco, CA 94121, USA.
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26
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Bieber T. Atopic dermatitis 2.0: from the clinical phenotype to the molecular taxonomy and stratified medicine. Allergy 2012; 67:1475-82. [PMID: 23106343 DOI: 10.1111/all.12049] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2012] [Indexed: 11/29/2022]
Abstract
Atopic dermatitis (AD) is a paradigmatic inflammatory chronic skin disease. As for other chronic skin diseases, (i) the spectrum of the clinical phenotype and severity as well as (ii) the genetic background and (iii) the underlying mechanisms strongly suggest a high degree of pathophysiological heterogeneity yet leading to a similar clinical pattern, that is, the eczematous skin lesion, but showing distinct progression patterns. This review suggests to exploit the recent knowledge about AD for a novel approach proposing a tentative first molecular taxonomy of this disease based on the genotype and endophenotype. The consequences in terms of personalized prevention and management are delineated.
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Affiliation(s)
- Th. Bieber
- Department of Dermatology and Allergy; University of Bonn; Bonn; Germany
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27
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Silverberg JI, Silverberg NB. Atopic Dermatitis: Update on Pathogenesis and Comorbidities. CURRENT DERMATOLOGY REPORTS 2012. [DOI: 10.1007/s13671-012-0021-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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28
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Thyssen J. The association between filaggrin mutations, hand eczema and contact dermatitis: a clear picture is emerging. Br J Dermatol 2012. [DOI: 10.1111/bjd.12075] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- J.P. Thyssen
- Department of Dermato‐Allergology,
National Allergy Research Centre,
Copenhagen University Hospital Gentofte,
Gentofte, Denmark
E‐mail:
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29
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Carson CG, Rasmussen MA, Thyssen JP, Menné T, Bisgaard H. Clinical presentation of atopic dermatitis by filaggrin gene mutation status during the first 7 years of life in a prospective cohort study. PLoS One 2012; 7:e48678. [PMID: 23166590 PMCID: PMC3499508 DOI: 10.1371/journal.pone.0048678] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 09/28/2012] [Indexed: 12/23/2022] Open
Abstract
Background Filaggrin null mutations result in impaired skin barrier functions, increase the risk of early onset atopic dermatitis and lead to a more severe and chronic disease. We aimed to characterize the clinical presentation and course of atopic dermatitis associated with filaggrin mutations within the first 7 years of life. Method The COPSAC cohort is a prospective, clinical birth cohort study of 411 children born to mothers with a history of asthma followed during their first 7 years of life with scheduled visits every 6 months, as well as visits for acute exacerbations of dermatitis. Atopic dermatitis was defined in accordance with international guidelines and described at every visit using 35 predefined localizations and 10 different characteristics. Results A total of 170 (43%) of 397 Caucasian children developed atopic dermatitis. The R501X and/or 2282del4 filaggrin null mutations were present in 26 (15%) of children with atopic dermatitis and were primarily associated with predilection to exposed skin areas (especially the cheeks and back of the hands) and an up-regulation of both acute and chronic dermatitis. Furthermore, we found the filaggrin mutations to be associated with a higher number of unscheduled visits (3.6 vs. 2.7; p = 0.04) and more severe (moderate-severe SCORAD 44% vs. 31%; p = 0.14), and widespread dermatitis (10% vs. 6% of the body area, p<0.001) with an earlier age at onset (246 vs. 473 days, p<0.0001) compared to wild-type. Conclusion In children, filaggrin mutations seem to define a specific endotype of atopic dermatitis primarily characterized by predilection to exposed areas of the body, in particular hands and cheeks, and an up-regulation in both acute and chronic morphological markers. Secondary, this endotype is characterized by an early onset of dermatitis and a more severe course, with more generalized dermatitis resulting in more frequent medical consultations.
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Affiliation(s)
- Charlotte Giwercman Carson
- Copenhagen Prospective Studies on Asthma in Childhood; COPSAC, Health Sciences, University of Copenhagen, Copenhagen University Hospital, Gentofte, Copenhagen, Denmark
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30
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Kaae J, Menné T, Carlsen BC, Zachariae C, Thyssen JP. The hands in health and disease of individuals with filaggrin loss-of-function mutations: clinical reflections on the hand eczema phenotype. Contact Dermatitis 2012; 67:119-24. [DOI: 10.1111/j.1600-0536.2012.02130.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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31
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Meldgaard M, Szecsi PB, Carlsen BC, Thyssen JP, Johansen JD, Menné T, Stender S. A novel multiplex analysis of filaggrin polymorphisms: a universally applicable method for genotyping. Clin Chim Acta 2012; 413:1488-92. [PMID: 22705401 DOI: 10.1016/j.cca.2012.06.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 05/24/2012] [Accepted: 06/07/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND The filaggrin protein is expressed as profilaggrin mainly in stratum granulosum cells of the epidermis. The profilaggrin gene codes for 10-12 filaggrin repeats. The filaggrin protein is important for skin barrier function. Filaggrin deficiency due to functional null-polymorphisms affects 8-10% of the people in Northern Europe and is a strong risk factor for several diseases. Here, we describe a novel method for efficient, multiplexed genotyping of variations in the profilaggrin gene. METHODS Five known techniques were combined: i) allele-specific PCR, ii) PCR with tagged primers, iii) asymmetric PCR, iv) multiplex PCR, and v) hybridization of single-stranded PCR products to spectrally coded microbeads carrying tag sequences as capture probes. Asymmetry of PCR was accomplished by having the tagged and allele-specific forward primers present in limiting concentrations. Asymmetry ensured that the later PCR cycles generated only single-stranded reverse-strand products. This greatly improved the assay sensitivity and allowed for simple optimization. RESULTS The specificity of the tags was verified with single PCR in wildtype and homozygous samples. Only the PCR products with the appropriate anti-tag hybridized to the corresponding beads, demonstrating the specificity of the signal. The hybridization signal is strongly dependent on single-stranded PCR products. After 46 PCR cycles, double-stranded products are clearly present, but only the single-stranded products generated in later cycles hybridize to the beads and elicit the strong signals that allow for unambiguous genotyping. CONCLUSIONS We have tested 17,000 samples for three filaggrin polymorphisms using this method, with a call rate exceeding 99% and a reagent cost of US $ 0.75 per sample. The method is universally applicable for multiplex genotyping of e.g. hereditary hemochromatosis, lactose intolerance, or cystic fibrosis.
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Affiliation(s)
- Michael Meldgaard
- Department of Clinical Biochemistry, Gentofte Hospital, University of Copenhagen, Denmark.
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32
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Uter W. Beyond atopic eczema: filaggrin loss-of-function mutations in dry, fissured hand eczema. Br J Dermatol 2012; 166:3. [PMID: 22212054 DOI: 10.1111/j.1365-2133.2011.10679.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- W Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, D-91052 Erlangen, Germany.
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