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Vellaichamy G, Kohli I, Zubair R, Yin C, Braunberger T, Nahhas AF, Nicholson C, Mohammad TF, Isedeh P, Lyons AB, Nartker N, Al-Jamal M, Matsui M, Karaman-Jurukovska N, Zhou L, Lim HW, Mi QS, Hamzavi IH. An in vivo model of postinflammatory hyperpigmentation and erythema: clinical, colorimetric and molecular characteristics. Br J Dermatol 2021; 186:508-519. [PMID: 34625951 DOI: 10.1111/bjd.20804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Postinflammatory hyperpigmentation (PIH) is a common, acquired pigmentary disorder of the skin associated with significant quality-of-life impairment, especially in individuals with skin of colour. Current treatment for PIH is limited, largely due to a poor understanding of disease pathogenesis and the lack of a representative disease model. OBJECTIVES This study is intended to further develop, update and validate our previously designed in vivo model of acne-induced PIH/postinflammatory erythema (PIE) using different concentrations of trichloroacetic acid (TCA), a medium-depth chemical peel. METHODS Twenty-nine patients with skin types II-VI and clinician-confirmed presence of two or more truncal acne pustules and PIH/PIE were included. On the basis of Investigator's Global Assessment (IGA), clinical polarized photography (CPP), colorimetry and Skindex, we experimentally determined an optimum TCA concentration and assessed our model's ability to exhibit a dose-response relationship between degree of inciting insult and severity of resulting pigmentation. We also performed differential microRNA profiling and pathway analysis to explore the potential of microRNAs as molecular adjuncts to our model. RESULTS Application of TCA 30% produced lesions indistinguishable from acne-induced PIH and PIE lesions on the basis of colorimetry data without causing epidermal necrosis. Application of progressively increasing TCA doses from 20% to 30% resulted in concentration-dependent increases in CPP, IGA and colorimetry scores at all timepoints during the study. miRNA-31 and miRNA-23b may play a role in PIH pathogenesis, although further validation is required. CONCLUSIONS Our TCA-based in vivo model, using TCA concentrations between 20% and 30% with an optimum of 30%, enables the quantitative assessment of the pigmentary response to varying degrees of cutaneous inflammation in a fashion that mirrors natural acne-induced PIH and PIE.
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Affiliation(s)
- G Vellaichamy
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - I Kohli
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - R Zubair
- Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - C Yin
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | - T Braunberger
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - A F Nahhas
- Department of Dermatology, Beaumont Hospital, Farmington Hills, MI, USA
| | - C Nicholson
- Department of Dermatology, Wayne State University, Dearborn, MI, USA
| | - T F Mohammad
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - P Isedeh
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - A B Lyons
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - N Nartker
- Department of Dermatology, Wayne State University, Dearborn, MI, USA
| | - M Al-Jamal
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - M Matsui
- Department of Dermatology and Division of Environmental Sciences, School of Public Health, Columbia University, New York, NY, USA
| | | | - L Zhou
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | - H W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Q-S Mi
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | - I H Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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Lyons AB, Narla S, Kohli I, Zubair R, Nahhas AF, Braunberger TL, Joseph MK, Nicholson CL, Jacobsen G, Hamzavi IH. Assessment of Inter-rater Reliability of Clinical Hidradenitis Suppurativa Outcome Measures Using Ultrasonography. Clin Exp Dermatol 2021; 47:319-324. [PMID: 34388853 DOI: 10.1111/ced.14889] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) staging and severity is typically based upon physical examination findings which can result in misclassification of severity based on subclinical disease activity and significant variation between healthcare providers. Ultrasound (US) is an objective tool to help evaluate subclinical disease and more accurately classify severity of disease. The objective of this study was to evaluate inter-rater reliability in HS disease severity assessment using clinical and US techniques. METHODS Twenty subjects underwent clinical evaluation of HS using clinical outcome measures including Hurley, Sartorius, HS Physician Global Assessment (HS-PGA), and Hidradenitis Suppurativa Clinical Response (HiSCR) independently by two physicians. US was subsequently performed, and clinical assessments were repeated. Intra-class correlation coefficients (ICC) were obtained to evaluate inter-rater agreement of each outcome measure before and after US. RESULTS Pre- to post-US improvement in ICC was seen with the Sartorius, HiSCR nodule and abscess count, and HiSCR draining fistula count. The scores went from having "good" rater agreement for Sartorius and HiSCR nodule and abscess count and "poor" rater agreement for HiSCR draining fistula count to "excellent" rater agreement amongst these scores. CONCLUSIONS US improved inter-rater agreement and should be used in conjunction with physical examination findings to evaluate disease severity to ensure uniform staging.
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Affiliation(s)
- A B Lyons
- Multicultural Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - S Narla
- Department of Dermatology, St. Lukes Hospital, Easton, PA, USA
| | - I Kohli
- Multicultural Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Department of Physics & Astronomy, Wayne State University, Detroit, MI, USA
| | - R Zubair
- Department of Dermatology, Broward Hospital, Ft. Lauderdale, FL, USA
| | - A F Nahhas
- Department of Dermatology, Beaumont Health-Farmington Hills, Farmington Hills, MI, USA
| | - T L Braunberger
- Multicultural Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - M K Joseph
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - C L Nicholson
- Department of Dermatology, Wayne State University, Detroit, MI, USA
| | - G Jacobsen
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA
| | - I H Hamzavi
- Multicultural Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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Narla S, Azzam M, Townsend S, Vellaichamy G, Marzano AV, Alavi A, Lowes MA, Hamzavi IH. Identifying key components and therapeutic targets of the immune system in hidradenitis suppurativa with an emphasis on neutrophils. Br J Dermatol 2021; 184:1004-1013. [PMID: 32893875 DOI: 10.1111/bjd.19538] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/05/2020] [Accepted: 08/29/2020] [Indexed: 12/13/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent and debilitating skin disease of the hair follicle unit that typically develops after puberty. The disorder is characterized by comedones, painful inflammatory nodules, abscesses, dermal tunnels and scarring, with a predilection for intertriginous areas of the body (axillae, inguinal and anogenital regions). Recruitment of neutrophils to HS lesion sites may play an essential role in the development of the painful inflammatory nodules and abscesses that characterize the disease. This is a review of the major mediators involved in the recruitment of neutrophils to sites of active inflammation, including bacterial components (endotoxins, exotoxins, capsule fragments, etc.), the complement pathway anaphylatoxins C3a and C5a, tumour necrosis factor-alpha, interleukin (IL)-17, IL-8 (CXCL8), IL-36, IL-1, lipocalin-2, leukotriene B4, platelet-activating factor, kallikreins, matrix metalloproteinases, and myeloperoxidase inhibitors. Pharmacological manipulation of the various pathways involved in the process of neutrophil recruitment and activation could allow for successful control and stabilization of HS lesions and the remission of active, severe flares.
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Affiliation(s)
- S Narla
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - M Azzam
- University of Nevada School of Medicine, Reno, NV, USA
| | - S Townsend
- Wayne State School of Medicine, Detroit, MI, USA
| | | | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - A Alavi
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - M A Lowes
- The Rockefeller University, New York, NY, USA
| | - I H Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
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Lyons AB, Peacock A, McKenzie SA, Jacobsen G, Naik HB, Shi VY, Hamzavi IH, Hsiao JL. Retrospective cohort study of pregnancy outcomes in hidradenitis suppurativa. Br J Dermatol 2020; 183:945-947. [PMID: 32333790 PMCID: PMC8174655 DOI: 10.1111/bjd.19155] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A B Lyons
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - A Peacock
- Department of Internal Medicine, St Mary Mercy Hospital, Livonia, MI, USA
| | - S A McKenzie
- Department of Dermatology, University of California Los Angeles, Los Angeles, CA, USA
| | - G Jacobsen
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - H B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - V Y Shi
- Department of Dermatology, University of Arizona, Tucson, AZ, USA
| | - I H Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - J L Hsiao
- Department of Dermatology, University of California Los Angeles, Los Angeles, CA, USA
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Mahmoud BH, Hexsel CL, Hamzavi IH. An update on new and emerging options for the treatment of vitiligo. Skin Therapy Lett 2008; 13:1-6. [PMID: 18373041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Vitiligo is an acquired leukoderma that results from the loss of epidermal melanocytes, and is characterized by macules and patches of depigmented skin. With a relatively high rate of prevalence, vitiligo occurs in localized, generalized, or segmental patterns; it can run a rapidly progressive course or remain stationary. The pathogenesis of vitiligo is not yet fully understood, but the autoimmune hypothesis is the most commonly accepted one, based on which, many treatment modalities have been described. Although many therapeutic options exist and new modalities are still emerging, treatment challenges persist, as not all patients respond to available therapies. Variables that affect the choice of treatment include the extent, distribution, and progression rate of the lesions. Another challenge is the lack of a standardized scoring system, which hampers the production of level 1a evidence studies for the treatment of this condition.
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Affiliation(s)
- B H Mahmoud
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
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