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Lopes Almeida Gomes L, Werth AJ, Thomas P, Werth VP. The impact of hormones in autoimmune cutaneous diseases. J DERMATOL TREAT 2024; 35:2312241. [PMID: 38317519 DOI: 10.1080/09546634.2024.2312241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Dermatomyositis, systemic and cutaneous lupus erythematosus have a significantly higher prevalence in women than men, emphasizing the relevance of exploring the relationship between sex hormones and autoimmune skin diseases. This review analyzes the interplay between sex hormones and these two skin diseases. MATERIALS AND METHODS We performed an extensive literature search using the PubMed database from July to August 2023. Search terms included 'contraceptives', 'pregnancy', 'hormone replacement', 'tamoxifen', and 'aromatase inhibitors'. RESULTS AND DISCUSSION This comprehensive literature review shows that there remains considerable debate regarding the use of hormonal contraceptives and hormonal replacement therapy in individuals with autoimmune skin conditions. Nonetheless, it is well established that their use is contraindicated in patients with antiphospholipid syndrome or when antiphospholipid antibodies are positive. Individuals experiencing disease flares and uncontrolled symptoms should also avoid these interventions. Pregnancy planning should be timed to coincide with well-managed disease states to minimize obstetric and neonatal complications. Hormonal breast cancer treatment requires close skin monitoring. CONCLUSION Pregnancy, menopause, contraceptive use, hormone replacement therapy, and breast cancer treatment drugs result in substantial shifts in hormone levels. Additionally, hormone levels are altered by aromatase inhibitors and anti-estrogen medications. These fluctuations can modulate mechanisms influencing autoimmune skin abnormalities.
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Affiliation(s)
- Lais Lopes Almeida Gomes
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adrienne J Werth
- Department of Urogynecology, Hartford Healthcare, Hartford, CT, USA
| | - Preethi Thomas
- Department of Rheumatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria P Werth
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Xie L, Lopes Almeida Gomes L, Stone CJ, Faden DF, Werth VP. An update on clinical trials for cutaneous lupus erythematosus. J Dermatol 2024. [PMID: 38491743 DOI: 10.1111/1346-8138.17161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 03/18/2024]
Abstract
Cutaneous lupus erythematosus (CLE) comprises dermatologic manifestations that may occur independently or with systemic lupus erythematosus (SLE). Despite advancements in refining CLE classification, establishing precise subtype criteria remains challenging due to overlapping presentations and difficulty in distinguishing morphology. Current treatments encompass preventive measures, topical therapies, and systemic approaches. Hydroxychloroquine and glucocorticoids are the sole US Food and Drug Administration (FDA)-approved medications for CLE, with numerous off-label treatments available. However, these treatments are often not covered by insurance, imposing a significant financial burden on patients. The exclusion of most CLE patients, particularly those without concurrent SLE, from trials designed for SLE has resulted in a lack of targeted treatments for CLE. To develop effective CLE treatments, validated outcome measures for tracking patient responsiveness are essential. The Cutaneous Lupus Erythematosus Disease Area and Severity Index is widely utilized for its reliability, validity, and ability to differentiate between skin activity and damage. In contrast, the FDA mandates the use of the Investigator's Global Assessment, a five-point Likert scale related to lesion characteristics, for skin-related therapeutic trials. It requires the disease to resolve or almost completely resolve to demonstrate improvement, which can be difficult when there is residual erythema or incomplete clearance that is meaningfully improved from a patient perspective. Various classes of skin lupus medications target diverse pathways, allowing tailored treatment based on the patient's lupus inflammatory profile, resulting in improved outcomes. Promising targeted therapeutic drugs include anifrolumab (anti-type 1 interferon), deucravacitinib (allosteric tyrosine kinase 2 inhibitor), litifilimab (plasmacytoid dendritic cell-directed therapy), iberdomide (cereblon-targeting ligand), and belimumab (B-cell directed therapy). Despite the significant impact of CLE on quality of life, therapeutic options remain inadequate. While promising treatments for cutaneous lupus are emerging, it is crucial to underscore the urgency for skin-focused treatment outcomes and the implementation of validated measures to assess therapeutic effectiveness in clinical trials.
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Affiliation(s)
- Lillian Xie
- Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lais Lopes Almeida Gomes
- Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Caroline J Stone
- Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniella Forman Faden
- Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Victoria P Werth
- Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Nathan NR, Lopes Almeida Gomes L, Wang-Evers M, Patel PM, Doyle A, Manstein D. Novel assessment of lip redness and microcirculation using optical coherence tomography after dermal filler injection. Lasers Surg Med 2023; 55:838-845. [PMID: 37434586 DOI: 10.1002/lsm.23705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVES Lip filler injections are one of the most popular procedures in esthetic dermatology. In this study, we used three-dimensional colorimetric photography to assess lip color and optical coherence tomography-angiography (OCT-A), a noninvasive alternative to histopathology, to evaluate microcirculation after hyaluronic acid (HA) injection. The pain of the injection procedure was also assessed. METHODS An average of 0.85cc of the total volume of HA with lidocaine was injected into the upper and lower lip of eighteen young (<30yo) and nine postmenopausal healthy women. OCT-A, two-dimensional, and three-dimensional images were acquired immediately before (visit 1) and 15 days after injection (visit 2). Custom-made software was used to analyze the imaging data to detect vessel morphology and redness changes. The Wong-Baker FACES pain rating scale (0-10) was used to score the subject procedural pain. RESULTS For young and old subjects, three-dimensional lip volume was greater than the injected volume. OCT-A images of the lips showed higher vessel density and thickness, reaching statistical significance in the younger cohort. The overall trend of increased redness assessed by three-dimensional colorimetric imaging and increased vascularity evaluated by OCT-A imaging were similar. However, the correlation was not statistically significant for standard two-dimensional digital photography. The average pain score after the first needle insertion and overall procedure were 2.9 and 3.5, respectively. CONCLUSIONS The results suggest an increased microvasculature network observed in OCT-A images in young females. The increased blood vessel density and thickness observed by OCT-A after HA lip filler injection is associated with increased lip redness and volume as assessed by colorimetric three-dimensional photography; however, more research is needed to confirm these findings. This study presents OCT-A as a novel noninvasive tool to investigate changes in lip microvascularity after HA filler injection and indicates that HA filler procedures may affect lip vascularity.
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Affiliation(s)
- Neera R Nathan
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Department of Dermatology, Lahey Health and Medical Center, Burlington, Massachusetts, USA
| | - Lais Lopes Almeida Gomes
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Michael Wang-Evers
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Payal M Patel
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Abigail Doyle
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Dieter Manstein
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, Massachusetts, USA
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Pera Calvi I, R Marques I, Cruz SA, Mesquita YLL, Padrao EMH, Souza RM, Brown A, Caçador DGV, Poppe LM, Lopes Almeida Gomes L. Safety and efficacy of topical nitric oxide-releasing berdazimer gel for molluscum contagiosum clearance: A systematic review and meta-analysis of randomized controlled trials. Pediatr Dermatol 2023; 40:1060-1063. [PMID: 37721050 DOI: 10.1111/pde.15419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/05/2023] [Indexed: 09/19/2023]
Abstract
Molluscum contagiosum (MC) is a contagious infection that, although benign, can become an aesthetic burden and lead to other opportunistic infections, secondary dermatitis, and self-isolation. Currently, several treatment options are available for MC, including the newly investigated nitric oxide-releasing berdazimer gel, leading this review to evaluate randomized controlled trials (RCT) comparing berdazimer gel with a vehicle for treating MC. The meta-analysis included three reports and four RCT involving 1854 patients, with 1106 (59.6%) randomized to receive berdazimer. Our findings suggest that berdazimer is effective in the management of MC lesions, but the increased clearance of lesions and reduction of scarring must be weighed against the potential for topical adverse effects, particularly when considering the use of this therapy in pediatric patients.
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Affiliation(s)
- Izabela Pera Calvi
- Division of Medicine, Immanuel Kant Baltic Federal University, Kaliningrad, Kaliningrad, Russia
| | - Isabela R Marques
- Division of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Sara A Cruz
- Division of Medicine, Immanuel Kant Baltic Federal University, Kaliningrad, Kaliningrad, Russia
| | | | - Eduardo M H Padrao
- Internal Medicine Division, University of Connecticut, Farmington, Connecticut, USA
| | - Rafaela M Souza
- Dermatology Division, La Paz University Hospital, Madrid, Spain
| | - Andrew Brown
- Internal Medicine Division, University of Connecticut, Farmington, Connecticut, USA
| | - Danielle G V Caçador
- Dermatology Division, Institute of Research and Medical Education (IPEMED) Faculty of Medical Sciences, São Paulo, São Paulo, Brazil
| | - Lidia M Poppe
- Dermatology Division, Praxis Dr. Poppe & Kollegen, Bad Kissingen, Bavaria, Germany
| | - Lais Lopes Almeida Gomes
- Dermatology Division, Cutaneous Biology Research Center (CBRC), Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
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Gomes LLA, Ferreira BDFM, Carmo MCLD, Silva SCMC. Retalhoplastia e fechamento por segunda intenção: opção na reconstrução da orelha e conduto auditivo externo. S&CD 2018. [DOI: 10.5935/scd1984-8773.20181021104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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