1
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Chernyshov PV, Finlay AY, Tomas-Aragones L, Steinhoff M, Manolache L, Pustisek N, Dessinioti C, Svensson A, Marron SE, Bewley A, Salavastru C, Dréno B, Suru A, Koumaki D, Linder D, Evers AWM, Abeni D, Augustin M, Salek SS, Nassif A, Bettoli V, Szepietowski JС, Zouboulis CC. Quality of life measurement in rosacea. Position statement of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa. J Eur Acad Dermatol Venereol 2023; 37:954-964. [PMID: 36744752 DOI: 10.1111/jdv.18918] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/16/2023] [Indexed: 02/07/2023]
Abstract
The European Academy of Dermatology and Venereology (EADV) Task Forces (TFs) on Quality of Life (QoL) and Patient-Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa (ARHS) do not recommend the use of any generic instrument as a single method of Health Related (HR) QoL assessment in rosacea, except when comparing quimp (quality of life impairment) in rosacea patients with that in other non-dermatologic skin diseases and/or healthy controls. The EADV TFs on QoL and Patient-Oriented Outcomes and ARHS recommend the use of the dermatology-specific HRQoL instrument the Dermatology Life Quality Index (DLQI) and the rosacea-specific HRQoL instrument RosaQoL in rosacea patients. The DLQI minimal clinically important difference may be used as a marker of clinical efficacy of the treatment and DLQI score banding of 0 or 1 corresponding to no effect on patients' HRQoL could be an important treatment goal. This information may be added to consensuses and guidelines for rosacea.
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Affiliation(s)
- P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - A Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - L Tomas-Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
| | - M Steinhoff
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar.,Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar.,Medical School, Qatar University, Doha, Qatar.,School of Medicine, Weill Cornell University, New York, New York, USA
| | - L Manolache
- Dermatology, Dali Medical, Bucharest, Romania
| | - N Pustisek
- Children's Hospital Zagreb, Zagreb, Croatia
| | - C Dessinioti
- Department of Dermatology, Andreas Syggros Hospital, University of Athens, Athens, Greece
| | - A Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - S E Marron
- Department of Dermatology, Royo Villanova Hospital, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | - A Bewley
- Whipps Cross University Hospital, London, UK.,The Royal London Hospital, London, UK
| | - C Salavastru
- Department of Paediatric Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - B Dréno
- INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, Nantes Université, Univ Angers, Nantes, France
| | - A Suru
- Department of Paediatric Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - D Koumaki
- Department of Dermatology and Venereology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - D Linder
- University Clinic for Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - A W M Evers
- Institute of Psychology, Health, Medical, and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | - D Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S S Salek
- School of Life & Medical Sciences, University of Hertfordshire, Hatfield, UK
| | | | - V Bettoli
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - J С Szepietowski
- Department of Dermatology, Wroclaw Medical University, Wroclaw, Poland
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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2
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Steinhoff M, Al-Marri F, Al Chalabi R, Gieler U, Buddenkotte J. Recalcitrant erythrodermic ichthyosis with atopic dermatitis successfully treated with Dupilumab in combination with Guselkumab. Skin Health Dis 2022; 2:e87. [PMID: 35665208 PMCID: PMC9060106 DOI: 10.1002/ski2.87] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/30/2021] [Accepted: 12/13/2021] [Indexed: 11/18/2022]
Abstract
Background Autosomal recessive congenital ichthyosis refers to a group of rare inherited disorders of keratinization and defective epidermal barrier resulting in varying clinical presentations and severities ranging from harlequin ichthyosis to congenital ichthyosiform erythroderma (CIE). Secondary atopic dermatitis (AD) can aggravate the disease state for CIE patients leading to recalcitrant CIE/AD with potentially unfavourable side effects and low tolerability. Aims Here, we report about a 38‐year‐old male patient with severe CIE as well as AD over the last 30 years. Materials and Methods The patients suffered from severe inflammation, pruritus and recurrent infections for decades without disease control and intolerable adverse events of previous therapies. Results Dupilumab (targeting IL‐4Ra, 300 mg q2w) partially controlled pruritus, but only the combination of Dupilumab with Guselkumab (anti‐IL23p19) controlled both CIE and AD with markedly reduced inflammation, itch and recurrent infections. Guselkumab alone was not sufficient to treat the severe CIE/AD. Discussion Further studies are required to assess the efficacy and safety of targeted therapies like Dupilumab/Guselkumab combination therapy in severe CIE/AD.
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Affiliation(s)
- M Steinhoff
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar.,Translational Research Institute, Academic Health System Hamad Medical Corporation Doha Qatar.,Weill Cornell Medicine-Qatar Doha Qatar.,Qatar University, Medical School Doha Qatar.,Weill Cornell Medicine New York New York USA
| | - F Al-Marri
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar.,Translational Research Institute, Academic Health System Hamad Medical Corporation Doha Qatar
| | - R Al Chalabi
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar
| | - U Gieler
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar
| | - J Buddenkotte
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar.,Translational Research Institute, Academic Health System Hamad Medical Corporation Doha Qatar
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3
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Talas J, Mielcarek K, Wu J, Brunner M, Steinhoff M, Zouboulis CC. [Cutaneous leishmaniasis in Germany-still a travel-related disease]. Hautarzt 2021; 73:146-151. [PMID: 34459942 DOI: 10.1007/s00105-021-04890-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 12/01/2022]
Abstract
Cutaneous leishmaniasis is an infectious disease caused by several Leishmania species. It is transmitted to humans by the bite of the infected female phlebotomus sandfly. Today, more than 1 billion people in leishmaniasis endemic areas are at risk of infection. More than 1.5 million new cases of cutaneous leishmaniasis occur every year. On the basis of two cases, we show that cutaneous leishmaniasis is still an imported tropical disease in Germany. However, due to the increasing intercontinental travel, cases may increase. Therefore, cutaneous leishmaniasis should be considered in the differential diagnosis in patients with nonhealing wounds, ulcers, papules or nodules and the corresponding travel history.
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Affiliation(s)
- Joud Talas
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Auenweg 38, 06847, Dessau, Deutschland
| | - Katarzyna Mielcarek
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Berlin, Deutschland
| | - Jim Wu
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Auenweg 38, 06847, Dessau, Deutschland
| | - Martina Brunner
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Auenweg 38, 06847, Dessau, Deutschland
| | - Matthias Steinhoff
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Berlin, Deutschland
| | - Christos C Zouboulis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Auenweg 38, 06847, Dessau, Deutschland. .,Klinik und Poliklinik für Dermatologie, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Berlin, Deutschland.
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4
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Papanikolaou M, Onoufriadis A, Mellerio JE, Nattkemper LA, Yosipovitch G, Steinhoff M, McGrath JA. Prevalence, pathophysiology and management of itch in epidermolysis bullosa. Br J Dermatol 2020; 184:816-825. [PMID: 32810291 DOI: 10.1111/bjd.19496] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2020] [Indexed: 12/18/2022]
Abstract
Epidermolysis bullosa (EB) is a highly diverse group of inherited skin disorders, resulting from mutations in genes encoding proteins of the dermoepidermal junction. Itch (pruritus) is one of the most common symptoms across all EB subtypes. It occurs in blistered or wounded sites, or manifests as a generalized phenomenon, thereby affecting both intact skin and healing wounds. The mechanism of pruritus in EB is unclear. It is likely that skin inflammation secondary to barrier disruption, wound healing cascades and dysregulated activation of epidermal sensory nerve endings are all involved in its pathophysiology on the molecular and cellular level. Understanding these mechanisms in depth is crucial in developing optimized treatments for people with EB and improving quality of life. This review summarizes current evidence on the prevalence, mechanisms and management of itch in EB.
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Affiliation(s)
- M Papanikolaou
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - A Onoufriadis
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - J E Mellerio
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - L A Nattkemper
- Dr Phillip Frost Department of Dermatology & Cutaneous Surgery and Miami Itch Centre, University of Miami Miller School of Medicine, Miami, FL, USA
| | - G Yosipovitch
- Dr Phillip Frost Department of Dermatology & Cutaneous Surgery and Miami Itch Centre, University of Miami Miller School of Medicine, Miami, FL, USA
| | - M Steinhoff
- Department of Dermatology, Hamad Medical Corporation, Weill Cornell Medicine-Qatar, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Weill Cornell Medicine-Qatar, Doha, Qatar.,Weill Cornell Medicine, New York, NY, USA
| | - J A McGrath
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
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5
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Husein‐ElAhmed H, Gieler U, Steinhoff M. Evidence supporting the enhanced efficacy of pentavalent antimonials with adjuvant therapy for cutaneous leishmaniasis: a systematic review and meta‐analysis. J Eur Acad Dermatol Venereol 2020; 34:2216-2228. [DOI: 10.1111/jdv.16333] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 02/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- H. Husein‐ElAhmed
- Department of Dermatology and Venereology Hospital de Baza Granada Spain
- Translational Research Institute Academic Health System Medical School Hamad Medical Corporation Doha Qatar
| | - U. Gieler
- Translational Research Institute Academic Health System Medical School Hamad Medical Corporation Doha Qatar
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar
| | - M. Steinhoff
- Translational Research Institute Academic Health System Medical School Hamad Medical Corporation Doha Qatar
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar
- College of Medicine Weill Cornell Medicine‐Qatar Doha Qatar
- Medical School Qatar University Doha Qatar
- College of Medicine Weill Cornell University New York NY USA
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6
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Schaller M, Almeida L, Bewley A, Cribier B, Del Rosso J, Dlova N, Gallo R, Granstein R, Kautz G, Mannis M, Micali G, Oon H, Rajagopalan M, Steinhoff M, Tanghetti E, Thiboutot D, Troielli P, Webster G, Zierhut M, Zuuren E, Tan J. 专家组为医生提供治疗酒渣鼻的新建议. Br J Dermatol 2020. [DOI: 10.1111/bjd.19005] [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: 11/26/2022]
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7
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Schaller M, Almeida L, Bewley A, Cribier B, Del Rosso J, Dlova N, Gallo R, Granstein R, Kautz G, Mannis M, Micali G, Oon H, Rajagopalan M, Steinhoff M, Tanghetti E, Thiboutot D, Troielli P, Webster G, Zierhut M, Zuuren E, Tan J. Panel provides new recommendations and advice for doctors on rosacea. Br J Dermatol 2020. [DOI: 10.1111/bjd.18994] [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: 11/29/2022]
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8
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Schaller M, Almeida LMC, Bewley A, Cribier B, Del Rosso J, Dlova NC, Gallo RL, Granstein RD, Kautz G, Mannis MJ, Micali G, Oon HH, Rajagopalan M, Steinhoff M, Tanghetti E, Thiboutot D, Troielli P, Webster G, Zierhut M, van Zuuren EJ, Tan J. Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel. Br J Dermatol 2019; 182:1269-1276. [PMID: 31392722 PMCID: PMC7317217 DOI: 10.1111/bjd.18420] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 01/02/2023]
Abstract
Background A transition from a subtyping to a phenotyping approach in rosacea is underway, allowing individual patient management according to presenting features instead of categorization by predefined subtypes. The ROSacea COnsensus (ROSCO) 2017 recommendations further support this transition and align with guidance from other working groups. Objectives To update and extend previous global ROSCO recommendations in line with the latest research and continue supporting uptake of the phenotype approach in rosacea through clinical tool development. Methods Nineteen dermatologists and two ophthalmologists used a modified Delphi approach to reach consensus on statements pertaining to critical aspects of rosacea diagnosis, classification and management. Voting was electronic and blinded. Results Delphi statements on which the panel achieved consensus of ≥ 75% voting ‘Agree’ or ‘Strongly agree’ are presented. The panel recommends discussing disease burden with patients during consultations, using four questions to assist conversations. The primary treatment objective should be achievement of complete clearance, owing to previously established clinical benefits for patients. Cutaneous and ocular features are defined. Treatments have been reassessed in line with recent evidence and the prior treatment algorithm updated. Combination therapy is recommended to benefit patients with multiple features. Ongoing monitoring and dialogue should take place between physician and patients, covering defined factors to maximize outcomes. A prototype clinical tool (Rosacea Tracker) and patient case studies have been developed from consensus statements. Conclusions The current survey updates previous recommendations as a basis for local guideline development and provides clinical tools to facilitate a phenotype approach in practice and improve rosacea patient management. What's already known about this topic? A transition to a phenotype approach in rosacea is underway and is being recommended by multiple working groups. New research has become available since the previous ROSCO consensus, necessitating an update and extension of recommendations.
What does this study add? We offer updated global recommendations for clinical practice that account for recent research, to continue supporting the transition to a phenotype approach in rosacea. We present prototype clinical tools to facilitate use of the phenotype approach in practice and improve management of patients with rosacea.
Linked Comment: Elewski. Br J Dermatol 2020; 182:1090–1091. Plain language summary available online
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Affiliation(s)
- M Schaller
- Department of Dermatology, Universitatsklinikum Tubingen, Tubingen, Baden-Württemberg, Germany
| | - L M C Almeida
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - A Bewley
- Department of Dermatology, Barts Health (Royal London and Whipps Cross University Hospitals), London, U.K
| | - B Cribier
- Department of Dermatology, Hopitaux Universitaires de Strasbourg, Strasbourg, Alsace, France
| | - J Del Rosso
- JDR Dermatology Research and Thomas Dermatology, Las Vegas, NV, U.S.A
| | - N C Dlova
- Department of Dermatology, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - R L Gallo
- Department of Dermatology, University of California San Diego, La Jolla, CA, U.S.A
| | - R D Granstein
- Department of Dermatology, Weill Cornell Medical College, New York, NY, U.S.A
| | - G Kautz
- Haut- und Laserklinik, Konz, Germany
| | - M J Mannis
- Department of Ophthalmology & Vision Science, University of California Davis, Davis, CA, U.S.A
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - H H Oon
- National Skin Centre, Singapore
| | - M Rajagopalan
- Apollo Hospitals Enterprise, Chennai, Tamil Nadu, India
| | - M Steinhoff
- Department of Dermatology and Venereology and Translational Research Institute, Weill Cornell Medicine-Qatar, Hamad Medical Corporation, Qatar University, Doha, Qatar.,Department of Dermatology, Weill Cornell University, New York, NY, U.S.A
| | - E Tanghetti
- Center for Dermatology and Laser Surgery, Sacramento, CA, U.S.A
| | - D Thiboutot
- Department of Dermatology, Pennsylvania State University College of Medicine, Hershey, PA, U.S.A
| | - P Troielli
- Faculty of Dermatology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - G Webster
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - M Zierhut
- Centre for Ophthalmology, University Tübingen, Tübingen, Germany
| | - E J van Zuuren
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Tan
- Windsor Clinical Research Inc and Department of Medicine, University of Western Ontario, Windsor, ON, Canada
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9
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Husein‐ElAhmed H, Gieler U, Steinhoff M. Lichen planus: a comprehensive evidence‐based analysis of medical treatment. J Eur Acad Dermatol Venereol 2019; 33:1847-1862. [DOI: 10.1111/jdv.15771] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/21/2019] [Indexed: 12/15/2022]
Affiliation(s)
- H. Husein‐ElAhmed
- Department of Dermatology and Venereology Hospital de Baza Granada Spain
- Translational Research Institute Academic Health System Medical School Hamad Medical Corporation Doha Qatar
| | - U. Gieler
- Translational Research Institute Academic Health System Medical School Hamad Medical Corporation Doha Qatar
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar
| | - M. Steinhoff
- Translational Research Institute Academic Health System Medical School Hamad Medical Corporation Doha Qatar
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar
- College of Medicine Weill Cornell Medicine‐Qatar Doha Qatar
- Medical School Qatar University Doha Qatar
- College of Medicine Weill Cornell University New York NY USA
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10
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Ruppel E, Unger S, Sasama B, Steinhoff M, Guskii S, Nenoff P, Ludwig‐Peitsch W. Blastomycosis‐like Pyoderma. J Dtsch Dermatol Ges 2019; 17 Suppl 2:31-33. [DOI: 10.1111/ddg.13788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Elvira Ruppel
- Klinik für Dermatologie und PhlebologieVivantes Klinikum im Friedrichshain Berlin
- MVZ Hautzentrum Gropiuspassagen GmbH Berlin
| | - Sylvana Unger
- Klinik für Dermatologie und PhlebologieVivantes Klinikum im Friedrichshain Berlin
- Hautarztpraxis Dr. Dues und Dr. Manasterski Berlin
| | - Bianca Sasama
- Klinik für Dermatologie und PhlebologieVivantes Klinikum im Friedrichshain Berlin
| | | | - Silja Guskii
- Vivantes Fachbereich PathologieVivantes Klinikum Neukölln Berlin
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11
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Smith L, Gatault S, Casals-Diaz L, Métais C, Campion M, Coughlin S, Eissner G, Steinhoff M. 657 Characterisation of a novel murine model of atopic dermatitis. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.666] [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: 10/17/2022]
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12
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Tan J, Steinhoff M, Berg M, Del Rosso J, Layton A, Leyden J, Schauber J, Schaller M, Cribier B, Thiboutot D, Webster G. Shortcomings in rosacea diagnosis and classification. Br J Dermatol 2017; 176:197-199. [PMID: 28098383 DOI: 10.1111/bjd.14819] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2016] [Indexed: 02/07/2023]
Affiliation(s)
- J Tan
- Department of Medicine (Dermatology), Schulich School of Medicine and Dentistry, Western University, Windsor, ON, Canada
| | - M Steinhoff
- Department of Dermatology and Charles Institute for Translational Dermatology, University College Dublin, Dublin, Ireland
| | - M Berg
- University of Uppsala, Uppsala, Sweden
| | - J Del Rosso
- Department of Dermatology, Touro University College of Osteopathic Medicine, Henderson, NV, U.S.A
| | - A Layton
- Harrogate and District NHS Foundation Trust, Harrogate, U.K
| | - J Leyden
- School of Medicine, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - J Schauber
- Department of Dermatology, Ludwig-Maximillians University, Munich, Germany
| | - M Schaller
- Universitäts-Hautklinik, Tübingen, Germany
| | - B Cribier
- Dermatopathology, University of Strasbourg, Strasbourg, France
| | - D Thiboutot
- Milton S. Hershey Medical Center, Penn State University, Hershey, PA, U.S.A
| | - G Webster
- Thomas Jefferson University, Philadelphia, PA, U.S.A
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13
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Schaller M, Schöfer H, Homey B, Hofmann M, Gieler U, Lehmann P, Luger TA, Ruzicka T, Steinhoff M. Rosacea Management: Update on general measures and topical treatment options. J Dtsch Dermatol Ges 2017; 14 Suppl 6:17-27. [PMID: 27869379 DOI: 10.1111/ddg.13143] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 02/02/2023]
Abstract
Although there is presently no cure for rosacea, there are several recommended treatment options available to control many of the symptoms and to prevent them from getting worse. In addition to self-help measures like avoidance of trigger factors and proper skin care, rosacea management should include topical medications as one of the first-line choices for patients with erythematous and mild to severe papulopustular rosacea. Since mixed forms of characteristic rosacea symptoms are more common, medical treatment must be symptom-tailored for each individual case and will often involve a combination therapy. Approved topical agents for the major symptoms of rosacea encompass brimonidine for erythema and ivermectin, metronidazole or azelaic acid for inflammatory lesions, all of which have shown their efficacy in numerous valid, well-controlled trials. In addition, there are several other, not approved topical treatments which are possible options that require further validation in larger well-controlled studies.
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Affiliation(s)
- M Schaller
- Department of Dermatology, Tübingen University Hospital, Tübingen, Germany
| | - H Schöfer
- Department of Dermatology, Venereology, and Allergology, University Hospital, Goethe-University, Frankfurt/M, Germany
| | - B Homey
- Department of Dermatology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - M Hofmann
- Department of Dermatology and Allergology, Charité - Universitätsmedizin, Berlin, Germany
| | - U Gieler
- Clinics for Dermatology and Allergology, Justus-Liebig-University, Giessen, Germany
| | - P Lehmann
- Department of Dermatology and Allergology, HELIOS Hospital Wuppertal, Witten/Herdecke University, Germany
| | - T A Luger
- Department of Dermatology, University Hospital Münster, Germany
| | - T Ruzicka
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - M Steinhoff
- Department of Dermatology and, UCD Charles Institute for Translational Dermatology, University College Dublin, Dublin, Ireland
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Reinholz M, Ruzicka T, Steinhoff M, Schaller M, Gieler U, Schöfer H, Homey B, Lehmann P, Luger TA. Pathogenesis and clinical presentation of rosacea as a key for a symptom-oriented therapy. J Dtsch Dermatol Ges 2017; 14 Suppl 6:4-15. [PMID: 27869372 DOI: 10.1111/ddg.13139] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 12/11/2022]
Abstract
Rosacea is a common chronic inflammatory skin disorder that typically occurs in adults and affects the face. Synonyms of rosacea include "acne rosacea", "couperose" and "facial erythrosis", in German also "Kupferfinne" and "Rotfinne". The disorder is characterised by a chronic and flaring course and is caused by a genetically predisposed, multifactorial process. A higher incidence is seen in people with fair skin and a positive family history. The characteristic rosacea symptoms manifest primarily, but not exclusively centrofacially, with forehead, nose, chin and cheeks significantly affected. Based on the various main symptoms a classification of the individual clinical pictures can be performed. However, a classification often does not reflect the clinical reality, since the various symptoms commonly coexist. The present review provides an introduction on pathogenesis and clinical manifestations of rosacea and prefers a symptom-oriented therapy approach.
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Affiliation(s)
- M Reinholz
- Department of Dermatology and Allergology, Ludwig Maximilian University, Germany
| | - T Ruzicka
- Department of Dermatology and Allergology, Ludwig Maximilian University, Germany
| | - M Steinhoff
- Department of Dermatology and UCD Charles Institute for Translational Dermatology, University College Dublin, Ireland
| | - M Schaller
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - U Gieler
- Centre for Psychosomatic Medicine, Psychosomatic Dermatology, University Hospital Gießen, Germany
| | - H Schöfer
- Department of Dermatology, Venereology and Allergology, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - B Homey
- Department of Dermatology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - P Lehmann
- Centre for Dermatology, Allergology and Dermatologic Surgery, Helios Kliniken Wuppertal, Witten/Herdecke University, Germany
| | - T A Luger
- Department of Dermatology, University Hospital Münster, Germany
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15
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Schaller M, Schöfer H, Homey B, Gieler U, Lehmann P, Luger TA, Ruzicka T, Steinhoff M. State of the art: systemic rosacea management. J Dtsch Dermatol Ges 2017; 14 Suppl 6:29-37. [PMID: 27869374 DOI: 10.1111/ddg.13141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 12/30/2022]
Abstract
Based on numerous trials, oral tetracyclines and most commonly their second-generation derivative doxycycline have become the main pillar in systemic rosacea treatment. However, the only preparation that has been approved so far in this setting is 40 mg doxycycline in an anti-inflammatory dosage and with a modified release formulation. With the introduction of this once-daily, non-antibiotic dosing of doxycycline, oral therapy is more commonly prescribed as first-line treatment in moderate to severe papulopustular rosacea. In addition, topical and oral strategies are often used in combination due to the more substantial improvements compared to monotherapy. Although several other non-approved oral agents like macrolides, isotretinoin, and carvedilol have been evaluated for systemic treatment and showed promising results, yet the experience with these drugs in rosacea is limited, and thus they should be reserved for special situations.
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Affiliation(s)
- M Schaller
- Department of Dermatology, Tübingen University Hospital, Tübingen, Germany
| | - H Schöfer
- Department of Dermatology, Venereology, and Allergology, University Hospital, Goethe-University, Frankfurt/M, Germany
| | - B Homey
- Department of Dermatology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - U Gieler
- Clinics for Dermatology and Allergology, Justus-Liebig-University, Giessen, Germany
| | - P Lehmann
- Department of Dermatology and Allergology, HELIOS Hospital Wuppertal, Witten/Herdecke University, Germany
| | - T A Luger
- Department of Dermatology, University Hospital Münster, Germany
| | - T Ruzicka
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - M Steinhoff
- Department of Dermatology and UCD Charles Institute for Translational Dermatology, University College Dublin, Dublin, Ireland
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16
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Reinholz M, Ruzicka T, Steinhoff M, Schaller M, Gieler U, Schöfer H, Homey B, Lehmann P, Luger TA. Pathogenese und Klinik der Rosazea als Schlüssel für eine symptomorientierte Therapie. J Dtsch Dermatol Ges 2017; 14 Suppl 6:4-16. [PMID: 27869378 DOI: 10.1111/ddg.13139_g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 01/06/2023]
Abstract
Rosazea ist eine häufige chronisch-entzündliche Hauterkrankung, die typischerweise bei Erwachsenen vorkommt und das Gesicht betrifft. Synonyme der Rosazea sind Acne rosacea, Kupferfinne, Rotfinne, Couperose und Rosacea. Die Erkrankung ist durch einen chronischen und schubartigen Verlauf gekennzeichnet und wird durch ein genetisch prädisponiertes, multifaktorielles Geschehen bedingt. Ein vermehrtes Auftreten wird bei hellem Hauttyp und positiver Familienanamnese verzeichnet. Die charakteristischen Rosazea-Symptome manifestieren sich vorwiegend, aber nicht ausschließlich zentrofazial, wobei Stirn, Nase, Kinn und die Wangen maßgeblich betroffen sind. Dabei werden unterschiedliche Hauptsymptome voneinander unterschieden, anhand derer eine Klassifikation der verschiedenen klinischen Bilder vorgenommen werden kann. Eine Klassifizierung wird oftmals jedoch nicht der klinischen Realität gerecht, da die verschiedenen Symptome häufig gemeinsam auftreten. Diese Übersichtarbeit führt in die Pathogenese und Klinik der Rosazea ein und plädiert für einen symptomorientierten Therapieansatz.
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Affiliation(s)
- M Reinholz
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München
| | - T Ruzicka
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München
| | - M Steinhoff
- Department of Dermatology and UCD Charles Institute for Translational Dermatology, University College Dublin, Irland
| | - M Schaller
- Universitäts-Hautklinik, Klinikum der Universität Tübingen
| | - U Gieler
- Zentrum für Psychosomatische Medizin, Psychosomatische Dermatologie, Universitätsklinikum Gießen
| | - H Schöfer
- Klinik für Dermatologie, Venerologie und Allergologie, Johann Wolfgang Goethe-Universität, Frankfurt/Main
| | - B Homey
- Klinik für Dermatologie, Universitätsklinikum Düsseldorf
| | - P Lehmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Kliniken Wuppertal
| | - T A Luger
- Klinik für Hautkrankheiten, Allgemeine Dermatologie und Venerologie, Universitätsklinikum Münster
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Urh A, Robison K, Pivarnik K, Mathews C, Raker C, Steinhoff M, Stuckey A, DiSilvestro P, Granai C, Moore R. Indocyanine green (ICG) fluorescence directed sentinel lymph node dissection (SLND) in women with endometrial cancer. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.128] [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: 11/26/2022]
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18
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Schaller M, Almeida LMC, Bewley A, Cribier B, Dlova NC, Kautz G, Mannis M, Oon HH, Rajagopalan M, Steinhoff M, Thiboutot D, Troielli P, Webster G, Wu Y, van Zuuren E, Tan J. Rosacea treatment update: recommendations from the global ROSacea COnsensus (ROSCO) panel. Br J Dermatol 2017; 176:465-471. [PMID: 27861741 DOI: 10.1111/bjd.15173] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Rosacea is currently treated according to subtypes. As this does not adequately address the spectrum of clinical presentation (phenotypes), it has implications for patient management. The ROSacea COnsensus panel was established to address this issue. OBJECTIVES To incorporate current best treatment evidence with clinical experience from an international expert panel and establish consensus to improve outcomes for patients with rosacea. METHODS Seventeen dermatologists and three ophthalmologists reached consensus on critical aspects of rosacea treatment and management using a modified Delphi approach. The panel voted on statements using the responses 'strongly disagree', 'disagree', 'agree' or 'strongly agree'. Consensus was defined as ≥ 75% 'agree' or 'strongly agree'. All voting was electronic and blinded. RESULTS The panel agreed on phenotype-based treatments for signs and symptoms presenting in individuals with rosacea. First-line treatments were identified for individual major features of transient and persistent erythema, inflammatory papules/pustules, telangiectasia and phyma, underpinned by general skincare measures. Multiple features in an individual patient can be simultaneously treated with multiple agents. If treatment is inadequate given appropriate duration, another first-line option or the addition of another first-line agent should be considered. Maintenance treatment depends on treatment modality and patient preferences. Ophthalmological referral for all but the mildest ocular features should be considered. Lid hygiene and artificial tears in addition to medications are used to treat ocular rosacea. CONCLUSIONS Rosacea diagnosis and treatment should be based on clinical presentation. Consensus was achieved to support this approach for rosacea treatment strategies.
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Affiliation(s)
- M Schaller
- Department of Dermatology, Universitatsklinikum Tubingen, Tubingen, Baden-Württemberg, Germany
| | - L M C Almeida
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - A Bewley
- Whipps Cross University Hospital, London, U.K.,Royal London Hospital, London, U.K
| | - B Cribier
- Department of Dermatology, Hopitaux Universitaires de Strasbourg, Strasbourg, Alsace, France
| | - N C Dlova
- Department of Dermatology, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - G Kautz
- Haut- und Laserklinik, Konz, Germany
| | - M Mannis
- Department of Ophthalmology and Vision Science, University of California Davis, Davis, CA, U.S.A
| | - H H Oon
- National Skin Centre, Singapore
| | - M Rajagopalan
- Apollo Hospitals Enterprise, Chennai, Tamil Nadu, India
| | - M Steinhoff
- Department of Dermatology and UCD Charles Institute for Translational Dermatology, University College Dublin, Dublin, Ireland
| | - D Thiboutot
- Department of Dermatology, Pennsylvania State University College of Medicine, Hershey, PA, U.S.A
| | - P Troielli
- Faculty of Dermatology, Universidad de Buenos Aires, School of Medicine, Buenos Aires, Argentina
| | - G Webster
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Y Wu
- Department of Dermatology, Peking University First Hospital, Beijing, China
| | - E van Zuuren
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Tan
- Department of Medicine, University of Western Ontario, Windsor, ON, Canada
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19
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Tan J, Almeida LMC, Bewley A, Cribier B, Dlova NC, Gallo R, Kautz G, Mannis M, Oon HH, Rajagopalan M, Steinhoff M, Thiboutot D, Troielli P, Webster G, Wu Y, van Zuuren EJ, Schaller M. Updating the diagnosis, classification and assessment of rosacea: recommendations from the global ROSacea COnsensus (ROSCO) panel. Br J Dermatol 2017; 176:431-438. [PMID: 27718519 DOI: 10.1111/bjd.15122] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Rosacea is currently diagnosed by consensus-defined primary and secondary features and managed by subtype. However, individual features (phenotypes) can span multiple subtypes, which has implications for clinical practice and research. Adopting a phenotype-led approach may facilitate patient-centred management. OBJECTIVES To advance clinical practice by obtaining international consensus to establish a phenotype-led rosacea diagnosis and classification scheme with global representation. METHODS Seventeen dermatologists and three ophthalmologists used a modified Delphi approach to reach consensus on statements pertaining to critical aspects of rosacea diagnosis, classification and severity evaluation. All voting was electronic and blinded. RESULTS Consensus was achieved for transitioning to a phenotype-based approach to rosacea diagnosis and classification. The following two features were independently considered diagnostic for rosacea: (i) persistent, centrofacial erythema associated with periodic intensification; and (ii) phymatous changes. Flushing, telangiectasia, inflammatory lesions and ocular manifestations were not considered to be individually diagnostic. The panel reached agreement on dimensions for phenotype severity measures and established the importance of assessing the patient burden of rosacea. CONCLUSIONS The panel recommended an approach for diagnosis and classification of rosacea based on disease phenotype.
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Affiliation(s)
- J Tan
- Department of Medicine, University of Western Ontario, Windsor, ON, Canada
| | - L M C Almeida
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - A Bewley
- Whipps Cross University Hospital, London, U.K.,Royal London Hospital, London, U.K
| | - B Cribier
- Department of Dermatology, Hopitaux Universitaires de Strasbourg, Strasbourg, Alsace, France
| | - N C Dlova
- Department of Dermatology, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - R Gallo
- Department of Dermatology, University of California San Diego, La Jolla, CA, U.S.A
| | - G Kautz
- Haut- und Laserklinik, Konz, Germany
| | - M Mannis
- Department of Ophthalmology and Vision Science, University of California Davis, Davis, CA, U.S.A
| | - H H Oon
- National Skin Centre, Singapore, Singapore
| | - M Rajagopalan
- Department of Dermatology, Apollo Hospitals Enterprise, Chennai, Tamil Nadu, India
| | - M Steinhoff
- Department of Dermatology and UCD Charles Institute for Translational Dermatology, University College Dublin, Dublin, Ireland
| | - D Thiboutot
- Department of Dermatology, Pennsylvania State University College of Medicine, Hershey, PA, U.S.A
| | - P Troielli
- Faculty of Dermatology, School of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - G Webster
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Y Wu
- Department of Dermatology, Peking University First Hospital, Beijing, China
| | - E J van Zuuren
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - M Schaller
- Department of Dermatology, Universitatsklinikum Tubingen, Tubingen, Baden-Württemberg, Germany
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Schaller M, Schöfer H, Homey B, Gieler U, Lehmann P, Luger TA, Ruzicka T, Steinhoff M. Aktueller Stand der systemischen Rosazea-Therapie. J Dtsch Dermatol Ges 2016; 14 Suppl 6:29-37. [DOI: 10.1111/ddg.13141_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- M Schaller
- Universitäts-Hautklinik; Klinikum der Universität Tübingen; Deutschland
| | - H Schöfer
- Klinik für Dermatologie, Venerologie und Allergologie; Johann Wolfgang Goethe-Universität; Frankfurt/Main Deutschland
| | - B Homey
- Klinik für Dermatologie; Universitätsklinikum Düsseldorf; Deutschland
| | - U Gieler
- Zentrum für Psychosomatische Medizin, Psychosomatische Dermatologie; Universitätsklinikum Gießen; Deutschland
| | - P Lehmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie; Helios Kliniken Wuppertal, Universität Witten/Herdecke; Deutschland
| | - TA Luger
- Klinik für Hautkrankheiten, Allgemeine Dermatologie und Venerologie; Universitätsklinikum Münster; Deutschland
| | - T Ruzicka
- Klinik und Poliklinik für Dermatologie und Allergologie; Ludwig-Maximilians-Universität München
| | - M Steinhoff
- Department of Dermatology and UCD Charles Institute for Translational Dermatology; University Collge Dublin; Dublin Irland
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21
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Schaller M, Schöfer H, Homey B, Hofmann M, Gieler U, Lehmann P, Luger TA, Ruzicka T, Steinhoff M. Rosazea-Management: Update über allgemeine Maßnahmen und topische Therapieoptionen. J Dtsch Dermatol Ges 2016; 14 Suppl 6:17-28. [PMID: 27869373 DOI: 10.1111/ddg.13143_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 11/29/2022]
Abstract
Obwohl bislang für die Rosazea keine kurative Therapie besteht, können verschiedene Optionen zur Behandlung der Symptome und zur Vorbeugung von Exazerbationen empfohlen werden. Neben Selbsthilfemaßnahme wie der Vermeidung von Triggerfaktoren und einer geeigneten Hautpflege sollte das Rosazea-Management bei Patienten mit erythematöser und leichter bis schwerer papulopustulöser Rosazea die Anwendung topischer Präparate als First-Line-Therapie umfassen. Da Überlappungen der charakteristischen Rosazea-Symptome im klinischen Alltag die Regel sind, sollte die medikamentöse Therapie auf die individuellen Symptome zugeschnitten werden; auch eine Kombinationstherapie kann erforderlich sein. Zu den für die Behandlung der Hauptsymptome der Rosazea zugelassenen Wirkstoffen gehören Brimonidin gegen das Erythem sowie Ivermectin, Metronidazol oder Azelainsäure gegen entzündliche Läsionen. Ihre Wirksamkeit wurde in zahlreichen validen, gut kontrollierten Studien belegt. Darüber hinaus existieren verschiedene nicht zugelassene topische Behandlungsmöglichkeiten, deren Wirksamkeit und Sicherheit noch in größeren, kontrollierten Studien zu untersuchen ist.
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Affiliation(s)
- M Schaller
- Universitäts-Hautklinik, Klinikum der Universität Tübingen, Deutschland
| | - H Schöfer
- Klinik für Dermatologie, Venerologie und Allergologie, Johann Wolfgang Goethe-Universität, Frankfurt/Main, Deutschland
| | - B Homey
- Klinik für Dermatologie, Universitätsklinikum Düsseldorf, Deutschland
| | - M Hofmann
- Klinik für Dermatologie und Allergologie, Charité - Universitätsmedizin Berlin, Deutschland
| | - U Gieler
- Zentrum für Psychosomatische Medizin, Psychosomatische Dermatologie, Universitätsklinikum Gießen, Deutschland
| | - P Lehmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Kliniken Wuppertal, Universität Witten/Herdecke, Deutschland
| | - T A Luger
- Klinik für Hautkrankheiten, Allgemeine Dermatologie und Venerologie, Universitätsklinikum Münster, Deutschland
| | - T Ruzicka
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München
| | - M Steinhoff
- Department of Dermatology and UCD Charles Institute for Translational Dermatology, University Collge Dublin, Dublin, Irland
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Abstract
Pruritus is an unpleasant sensation that evokes the urgent desire to scratch. It is a symptom derived from many nervous system disorders that affects a large population of humans and is treated by a variety of pharmacological agents with variable access. Chronic itch is a huge unmet health problem which affect upward 20% of people worldwide. The mechanisms underlying the chronic pruritus are complex. Studies of the neurobiology, neurophysiology and cellular biology of itch have gradually been clarifying the mechanism of chronic itch both peripherally and centrally. The discussion has been focused on pruriceptive nerves and their receptors as well as the cytokines/chemokines that play major roles in itch induction. Though it is historically hypothesized that pain convey signal generated with the stimuli under high intensity, and itch transduces signal from the same nerves of pain but under low intensity, recently, with the identification of distinct itch specific sensory afferent fibers the theory has twisted the "intensity" to a existence of a complete separation of pain and itch pathways. This review helps to understand the unique properties of itch signaling pathways and their clinical importance of the itch perception and pruritic diseases.
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Affiliation(s)
- J Meng
- Department of Dermatology and UCD Charles Institute for Translational Dermatology, Dublin, Ireland.
| | - M Steinhoff
- Department of Dermatology and UCD Charles Institute for Translational Dermatology, Dublin, Ireland.
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Smith L, Moran B, Rea H, Raverdeau M, McDonald I, Mills K, Steinhoff M. 268 Expression of Interleukin-33 by resident and immune cells in the skin of patients with atopic dermatitis. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.288] [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: 10/21/2022]
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Szollosi A, McDonald I, Szabó I, Kirby B, van den Bogaard E, Schalkwijk J, Steinhoff M. 319 The role of TLR-3 in the itch-scratch cycle of nodular prurigo - new insights into innate immune mechanisms of peripheral itch sensitization. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.339] [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: 11/26/2022]
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Seto TL, Tabangin ME, Langdon G, Mangeot C, Dawodu A, Steinhoff M, Narendran V. Racial disparities in cord blood vitamin D levels and its association with small-for-gestational-age infants. J Perinatol 2016; 36:623-8. [PMID: 27101387 PMCID: PMC4973215 DOI: 10.1038/jp.2016.64] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 02/22/2016] [Accepted: 03/11/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine the relationship of race and maternal characteristics and their association with cord blood vitamin D levels and small-for-gestational-age (SGA) status. STUDY DESIGN Cord blood vitamin D levels were measured in 438 infants (276 black and 162 white). Multivariable logistic regression models were used to evaluate associations between maternal characteristics, vitamin D status and SGA. RESULTS Black race, Medicaid status, mean body mass index at delivery and lack of prenatal vitamin use were associated with vitamin D deficiency. Black infants had 3.6 greater adjusted odds (95% confidence interval (CI): 2.4, 5.6) of vitamin D deficiency when compared with white infants. Black infants with vitamin D deficiency had 2.4 greater adjusted odds (95% CI: 1.0, 5.8) of SGA. Vitamin D deficiency was not significantly associated with SGA in white infants. CONCLUSION Identification of risk factors (black race, Medicaid status, obesity and lack of prenatal vitamin use) can lead to opportunities for targeted prenatal vitamin supplementation to reduce the risk of neonatal vitamin D deficiency and SGA status.
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Affiliation(s)
- T L Seto
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - M E Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - G Langdon
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - C Mangeot
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - A Dawodu
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - M Steinhoff
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - V Narendran
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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27
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Akiyama T, Nagamine M, Davoodi A, Iodi Carstens M, Cevikbas F, Steinhoff M, Carstens E. Intradermal endothelin-1 excites bombesin-responsive superficial dorsal horn neurons in the mouse. J Neurophysiol 2015; 114:2528-34. [PMID: 26311187 DOI: 10.1152/jn.00723.2015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 07/21/2015] [Accepted: 08/24/2015] [Indexed: 01/21/2023] Open
Abstract
Endothelin-1 (ET-1) has been implicated in nonhistaminergic itch. Here we used electrophysiological methods to investigate whether mouse superficial dorsal horn neurons respond to intradermal (id) injection of ET-1 and whether ET-1-sensitive neurons additionally respond to other pruritic and algesic stimuli or spinal superfusion of bombesin, a homolog of gastrin-releasing peptide (GRP) that excites spinal itch-signaling neurons. Single-unit recordings were made from lumbar dorsal horn neurons in pentobarbital-anesthetized C57BL/6 mice. We searched for units that exhibited elevated firing after id injection of ET-1 (1 μg/μl). Responsive units were further tested with mechanical stimuli, bombesin (spinal superfusion, 200 μg·ml(-1)·min(-1)), heating, cooling, and additional chemicals [histamine, chloroquine, allyl isothiocyanate (AITC), capsaicin]. Of 40 ET-1-responsive units, 48% responded to brush and pinch [wide dynamic range (WDR)] and 52% to pinch only [high threshold (HT)]. Ninety-three percent responded to noxious heat, 50% to cooling, and >70% to histamine, chloroquine, AITC, and capsaicin. Fifty-seven percent responded to bombesin, suggesting that they participate in spinal itch transmission. That most ET-1-sensitive spinal neurons also responded to pruritic and algesic stimuli is consistent with previous studies of pruritogen-responsive dorsal horn neurons. We previously hypothesized that pruritogen-sensitive neurons signal itch. The observation that ET-1 activates nociceptive neurons suggests that both itch and pain signals may be generated by ET-1 to result in simultaneous sensations of itch and pain, consistent with observations that ET-1 elicits both itch- and pain-related behaviors in animals and burning itch sensations in humans.
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Affiliation(s)
- T Akiyama
- Department of Neurobiology, Physiology, and Behavior, University of California, Davis, California
| | - M Nagamine
- Department of Neurobiology, Physiology, and Behavior, University of California, Davis, California
| | - A Davoodi
- Department of Neurobiology, Physiology, and Behavior, University of California, Davis, California
| | - M Iodi Carstens
- Department of Neurobiology, Physiology, and Behavior, University of California, Davis, California
| | - F Cevikbas
- Departments of Dermatology and Surgery, University of California, San Francisco, California; and
| | - M Steinhoff
- Department of Dermatology and Charles Institute for Translational Dermatology, University College Dublin, Dublin, Ireland
| | - E Carstens
- Department of Neurobiology, Physiology, and Behavior, University of California, Davis, California;
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Kadan Y, Fiacone S, McCourt C, Raker C, Granai C, Steinhoff M, Moore R. Abstract number 12: Predictive factors for the presence of malignant transformation of pelvic endometriosis. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.04.030] [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: 11/27/2022]
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Hill E, Steinhoff M, Raker C, DiSilvestro P. Tumor microvessel density does not correlate with bevacizumab response in recurrent ovarian cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.229] [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: 11/25/2022]
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30
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Moore R, Roque D, McCourt C, Stuckey A, DiSilvestro P, Sung J, Steinhoff M, Granai C, Robison K. Isolated sentinel lymph node biopsy with conservative management in women diagnosed with vulvar cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.077] [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: 11/26/2022]
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Affiliation(s)
- L Partyka
- Department of Radiology, Rhode Island Hospital, Alpert Medical School, Brown University , Providence, Rhode Island , USA
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Steinhoff M, Kinzel M, Krahl D. Weißliche Papeln im Gesicht, Nacken und Dekolleté. J Dtsch Dermatol Ges 2012. [DOI: 10.1111/j.1610-0387.2012.07971_suppl.x] [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: 11/28/2022]
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Zhang T, Ding Y, Zhang J, Wang D, Wu J, Jiang Y, Chen L, Feng Z, McFarland J, Steinhoff M, Black S, Zhao G. Epidemiology and health utilization of influenza in <5 years-old children in Suzhou, China. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.463] [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: 11/27/2022] Open
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35
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Fowler J, Jarratt M, Moore A, Meadows K, Pollack A, Steinhoff M, Liu Y, Leoni M. Once-daily topical brimonidine tartrate gel 0·5% is a novel treatment for moderate to severe facial erythema of rosacea: results of two multicentre, randomized and vehicle-controlled studies. Br J Dermatol 2012; 166:633-41. [PMID: 22050040 DOI: 10.1111/j.1365-2133.2011.10716.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Erythema of rosacea is thought to result from abnormal cutaneous vasomotor activity. Brimonidine tartrate (BT) is a highly selective α(2) -adrenergic receptor agonist with vasoconstrictive activity. OBJECTIVE To determine the optimal concentration and dose regimen of topical BT gel for the treatment of erythema of rosacea and to evaluate its efficacy and safety. METHODS In study A, 122 subjects were randomized to receive a single application of BT 0·07%, 0·18%, 0·5% or vehicle. In study B (4-week treatment and 4-week follow-up), 269 subjects were randomized to receive BT 0·5% once daily, BT 0·18% once daily, vehicle once daily, BT 0·18% twice daily or vehicle twice daily. Evaluations included Clinician's Erythema Assessment (CEA), Patient's Self-Assessment (PSA), Chroma Meter measurements and adverse events. RESULTS In study A, a single application of topical BT gel reduced facial erythema in a dose-dependent fashion. A significant difference between BT 0·5% and vehicle in Chroma Meter redness value was observed from 30min to 12h after application. In study B, BT 0·5% once daily had a statistically superior success profile (defined as a two-grade improvement on both CEA and PSA over 12h) compared with vehicle once daily on days 1, 15 and 29 (all P<0·001). No tachyphylaxis, rebound of erythema or aggravation of other disease signs (telangiectasia, inflammatory lesions) was observed. All regimens were safe and well tolerated with similarly low incidence of adverse events. CONCLUSIONS Once-daily BT gel 0·5% is well tolerated and provides significantly greater efficacy than vehicle gel for the treatment of moderate to severe erythema of rosacea.
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Affiliation(s)
- J Fowler
- University of Louisville, Louisville, KY, USA.
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36
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Kwapiszewska G, Markart P, Marsh LM, Dahal B, Schermuly RT, Taube C, Meinhardt A, Ghofrani HA, Steinhoff M, Seeger W, Preissner KT, Weißmann N, Wygrecka M. PAR-2 depletion protects against development of pulmonary hypertension. Pneumologie 2012. [DOI: 10.1055/s-0032-1302546] [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: 10/28/2022]
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37
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DiSilvestro P, Ali S, Peter C, Spirtos N, Lucci J, Lee Y, Cohn D, Tewari K, Muller C, Steinhoff M. A Gynecologic Oncology Group phase III randomized trial of weekly cisplatin and radiation versus cisplatin and tirapazamine and radiation in stage IB2, IIA, IIIB and IVA cervical carcinoma limited to the pelvis. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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38
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Dummer R, Beyer M, Hymes K, Epping MT, Bernards R, Steinhoff M, Sterry W, Kerl H, Heath K, Ahern JD, Hardwick JS, Garcia-Vargas J, Baumann K, Rizvi S, Frankel SR, Whittaker SJ, Assaf C. Vorinostat combined with bexarotene for treatment of cutaneous T-cell lymphoma:in vitroand phase I clinical evidence supporting augmentation of retinoic acid receptor/retinoid X receptor activation by histone deacetylase inhibition. Leuk Lymphoma 2012; 53:1501-8. [DOI: 10.3109/10428194.2012.656625] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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39
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Steinhoff M, Fischer M, Paschke-Kratzin A. Comparison of extraction conditions for milk and hen's egg allergens. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2011; 28:373-83. [PMID: 21331964 DOI: 10.1080/19440049.2010.545957] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The evaluation of recovery rates by extracting milk powder and egg powder using eleven different extractants gave approximately similar results for both foods. Compared with the other extraction solutions investigated, '1% Tween 20® and 0.4% Triton X-100®' and '4% SDS' are the most suitable extractants to isolate proteins of hen's egg or milk. When comparing calculated protein recovery rates of egg and milk powder extracts, the results clearly indicated that the choice of a suitable extractant is of particular importance. Qualitative investigation of the extracts via LDS-PAGE followed by silver staining as well as immunoblotting confirmed the results of protein quantification. Hence, the immunoblots showed that the extraction agents had no negative influence on the antigenicity of the extracted allergenic proteins. In this study, variation of extraction temperature led neither to any benefit in extraction quality nor to degradation. Changing pH did not reveal any trends, but progressive protein hydrolysis under strong alkaline conditions. Evaluation of recovery rates as well as results of unspecific and specific staining of the extracts showed that an extraction time of 1 h is sufficient for an appropriate sample preparation. For investigations with and without food matrix different results were obtained. In summary, wheat starch did not influence the extraction quality within all examined materials and different extractants. In contrast, using fat powder and dry cake mix, respectively, led to different results in the extraction procedure. When fat powder and dry cake mix were used as food matrices, some protein recovery rates decreased and some increased depending on the allergen material. These results highlight the fact that the suitability of the extractant not only depends on the properties of the allergen but furthermore on the type of matrix containing the allergen.
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Affiliation(s)
- M Steinhoff
- Institute of Food Chemistry, University of Hamburg, Grindelallee 117, D-20146, Germany
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Abstract
Pruritus (itch) is a major characteristic and one of the most debilitating symptoms in allergic and atopic diseases and the diagnostic hallmark of atopic dermatitis. Pruritus is regularly defined as an unpleasant sensation provoking the desire to scratch. Although we achieved rather good knowledge about certain inducers of itch such as neuropeptides, amines, mu-opioids, cytokines and proteases, for example, less is known about the pathophysiological specifities among the different diseases, and the therapeutic consequences which may derive thereoff. This review dissects the role of mediators, receptors and itch inhibitors on peripheral nerve endings, dorsal root ganglia, the spinal cord and the CNS leading to the amplification or - vice versa - suppression of pruritus. As the treatment of pruritus in allergic and atopic skin disease is still not satisfactory, knowing these pathways and mechanisms may lead to novel therapeutic approaches against this frequently encountered skin symptom.
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Affiliation(s)
- J Buddenkotte
- Deparment of Dermatology, Boltzmann Institute for Cell- and Immunobiology of Skin, University Hospital Münster, Münster, Germany
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Augé C, Balz-Hara D, Steinhoff M, Vergnolle N, Cenac N. Protease-activated receptor-4 (PAR 4): a role as inhibitor of visceral pain and hypersensitivity. Neurogastroenterol Motil 2009; 21:1189-e107. [PMID: 19413681 DOI: 10.1111/j.1365-2982.2009.01310.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Protease-activated receptor-4 (PAR(4)) belongs to the family of receptors activated by the proteolytic cleavage of their extracellular N-terminal domain and the subsequent binding of the newly released N-terminus. While largely expressed in the colon, the role of PAR(4) in gut functions has not been defined. We have investigated the effects of PAR(4) agonist on colonic sensations and sensory neuron signalling, and its role in visceral pain. We observed that a single administration of the PAR(4) agonist peptide (AYPGKF-NH(2)), but not the control peptide (YAPGKF-NH(2)) into the colon lumen of mice significantly reduced the visceromotor response to colorectal distension at different pressures of distension. Further, intracolonic administration of the PAR(4) agonist, but not the control peptide, was able to significantly inhibit PAR(2) agonist- and transcient receptor potential vanilloid-4 (TRPV4) agonist-induced allodynia and hyperalgesia in response to colorectal distension. Protease-activated receptor-4 was detected in sensory neurons projecting from the colon, and isolated from the dorsal root ganglia, where it co-expressed with PAR(2) and TRPV4. In total sensory neurons, PAR(4) agonist exposure inhibited free intracellular calcium mobilization induced by the pro-nociceptive agonists of PAR(2) and TRPV4. Finally, PAR(4)-deficient mice experienced increased pain behaviour in response to intracolonic administration of mustard oil, compared with wild-type littermates. These results show that PAR(4) agonists modulate colonic nociceptive response, inhibit colonic hypersensitivity and primary afferent responses to pro-nociceptive mediators. Endogenous activation of PAR(4) also plays a major role in controlling visceral pain. These results identify PAR(4) as a previously unknown modulator of visceral nociception.
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Affiliation(s)
- C Augé
- INSERM U563, Centre de Physiopathologie de Toulouse Purpan, Toulouse, France
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Eicheler W, Seitz J, Steinhoff M, Forssmann WG, Adermann K, Aumüller G. Distribution of rat hepatic steroid 5 alpha-reductase 1 as shown by immunohistochemistry. Exp Clin Endocrinol Diabetes 2009; 103:105-12. [PMID: 7553073 DOI: 10.1055/s-0029-1211337] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Peptide fragments of rat liver 5 alpha-reductase were synthesized according to the published primary sequence data. The peptide were used (i) in free form and (ii) linked to keyhole limpet hemocyanin (KLH), respectively, for immunization of rabbits. Resulting antisera showed positive reaction with the respective peptide-antigen in an ELISA. In Western blot experiments the antisera specifically recognized a 26,000 mol wt protein in extracts from female and male rat liver. All antisera, as well as isolated immunoglobulins, showed inhibition of 5 alpha-reductase activity in microsomes prepared from rat liver. Positive immunohistochemical reactions were observed in the perinuclear cytoplasm of hepatocytes. No reaction was seen in Kupffer- and connective tissue cells. Acinar heterogeneity of the immunoreaction was seen in the male rat liver with a gradient from the portal canal to the central vein. After androgen-deprivation a considerable increase in immunoreactivity was seen in male rat liver cells, indicating androgen-dependent suppression of the enzyme in male liver.
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Affiliation(s)
- W Eicheler
- Philipps-University Marburg, Department of Anatomy and Cell Biology, Germany
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44
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Brandenbusch VC, Steinhoff M. [Initial manifestation of SAPHO syndrome]. ROFO-FORTSCHR RONTG 2009; 181:900-2. [PMID: 19582660 DOI: 10.1055/s-0028-1109556] [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: 10/20/2022]
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45
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Maza S, Gellrich S, Assaf C, Beyer M, Spilker L, Orawa H, Munz DL, Sterry W, Steinhoff M. Yttrium-90 ibritumomab tiuxetan radioimmunotherapy in primary cutaneous B-cell lymphomas: first results of a prospective, monocentre study. Leuk Lymphoma 2009; 49:1702-9. [DOI: 10.1080/10428190802258923] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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46
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Dummer R, Hymes K, Sterry W, Steinhoff M, Assaf C, Kerl H, Ahern J, Rizvi S, Ricker JL, Whittaker S. Vorinostat in combination with bexarotene in advanced cutaneous T-cell lymphoma: A phase I study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8572] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8572 Background: Vorinostat, a histone deacetylase inhibitor, is registered for the treatment of advanced cutaneous T-cell lymphoma (CTCL) in the US. Preclinical studies suggest that vorinostat may enhance the activity of chemotherapeutic or biological anticancer agents in a variety of cancers. This Phase I, multicenter, open-label study systematically evaluated vorinostat combined with the retinoid bexarotene in patients (pts) with advanced CTCL. Methods: Eligible pts were aged ≥18 years with stage ≥IB progressive, persistent, or recurrent CTCL refractory to ≥1 systemic therapy. Primary objective was to determine the maximum tolerated dose (MTD). Phase Ia Part I: dose escalation of vorinostat (200–400 mg/day) and bexarotene (150–300 mg/m2/day); Part II: fixed vorinostat dose (400 mg/day) with bexarotene dose escalation (150–450 mg/day). Cycles were repeated every 28 days for ≤6 cycles. Clinical activity and safety of the combination was also assessed. Results: 23 pts received ≥1 dose of study medication. Three pts in dose level (DL) 2 experienced dose-limiting toxicities (DLTs) ( Table ). No DLTs were observed in the first cycle of DL 2a and 2b. The MTD (Part I) was vorinostat 200 mg/day plus bexarotene 300 mg/m2/day. The Part II MTD was not reached as the study was discontinued early due to low enrollment; no DLTs were observed at DL 6 or 7. The most common drug-related adverse events (DRAEs) were hypothyroidism (35%), fatigue (30%), and hypertriglyceridemia (30%). No Grade 4 or 5 DRAEs were reported and 4 pts had serious DRAEs (Grade ≤3). Eighteen pts have discontinued: 5 due to AEs, 5 due to progressive disease, and 8 withdrew consent. Of 22 pts evaluable for efficacy, 4 (18%) had an objective response, and 7 (32%) derived clinical benefit (pruritis relief). Conclusions: These preliminary data suggest that the vorinostat/bexarotene combination is feasible in pts with advanced CTCL; however, the dosage of either drug must be reduced to avoid unacceptable side effects. [Table: see text] [Table: see text]
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Affiliation(s)
- R. Dummer
- Universitätsspital Zürich, Dermatologische Klinik, Zürich, Switzerland; NYU Medical Center, New York, NY; Universitätsklinikums Charité, Berlin, Germany; University Clinic of Dermatology, Graz, Austria; Merck Research Laboratories, Upper Gwynedd, PA; St John's Institute of Dermatology, London, United Kingdom
| | - K. Hymes
- Universitätsspital Zürich, Dermatologische Klinik, Zürich, Switzerland; NYU Medical Center, New York, NY; Universitätsklinikums Charité, Berlin, Germany; University Clinic of Dermatology, Graz, Austria; Merck Research Laboratories, Upper Gwynedd, PA; St John's Institute of Dermatology, London, United Kingdom
| | - W. Sterry
- Universitätsspital Zürich, Dermatologische Klinik, Zürich, Switzerland; NYU Medical Center, New York, NY; Universitätsklinikums Charité, Berlin, Germany; University Clinic of Dermatology, Graz, Austria; Merck Research Laboratories, Upper Gwynedd, PA; St John's Institute of Dermatology, London, United Kingdom
| | - M. Steinhoff
- Universitätsspital Zürich, Dermatologische Klinik, Zürich, Switzerland; NYU Medical Center, New York, NY; Universitätsklinikums Charité, Berlin, Germany; University Clinic of Dermatology, Graz, Austria; Merck Research Laboratories, Upper Gwynedd, PA; St John's Institute of Dermatology, London, United Kingdom
| | - C. Assaf
- Universitätsspital Zürich, Dermatologische Klinik, Zürich, Switzerland; NYU Medical Center, New York, NY; Universitätsklinikums Charité, Berlin, Germany; University Clinic of Dermatology, Graz, Austria; Merck Research Laboratories, Upper Gwynedd, PA; St John's Institute of Dermatology, London, United Kingdom
| | - H. Kerl
- Universitätsspital Zürich, Dermatologische Klinik, Zürich, Switzerland; NYU Medical Center, New York, NY; Universitätsklinikums Charité, Berlin, Germany; University Clinic of Dermatology, Graz, Austria; Merck Research Laboratories, Upper Gwynedd, PA; St John's Institute of Dermatology, London, United Kingdom
| | - J. Ahern
- Universitätsspital Zürich, Dermatologische Klinik, Zürich, Switzerland; NYU Medical Center, New York, NY; Universitätsklinikums Charité, Berlin, Germany; University Clinic of Dermatology, Graz, Austria; Merck Research Laboratories, Upper Gwynedd, PA; St John's Institute of Dermatology, London, United Kingdom
| | - S. Rizvi
- Universitätsspital Zürich, Dermatologische Klinik, Zürich, Switzerland; NYU Medical Center, New York, NY; Universitätsklinikums Charité, Berlin, Germany; University Clinic of Dermatology, Graz, Austria; Merck Research Laboratories, Upper Gwynedd, PA; St John's Institute of Dermatology, London, United Kingdom
| | - J. L. Ricker
- Universitätsspital Zürich, Dermatologische Klinik, Zürich, Switzerland; NYU Medical Center, New York, NY; Universitätsklinikums Charité, Berlin, Germany; University Clinic of Dermatology, Graz, Austria; Merck Research Laboratories, Upper Gwynedd, PA; St John's Institute of Dermatology, London, United Kingdom
| | - S. Whittaker
- Universitätsspital Zürich, Dermatologische Klinik, Zürich, Switzerland; NYU Medical Center, New York, NY; Universitätsklinikums Charité, Berlin, Germany; University Clinic of Dermatology, Graz, Austria; Merck Research Laboratories, Upper Gwynedd, PA; St John's Institute of Dermatology, London, United Kingdom
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Shah AS, Knoll MD, Sharma PR, Moisi JC, Kulkarni P, Lalitha MK, Steinhoff M, Thomas K. Invasive pneumococcal disease in Kanti Children's Hospital, Nepal, as observed by the South Asian Pneumococcal Alliance network. Clin Infect Dis 2009; 48 Suppl 2:S123-8. [PMID: 19191607 DOI: 10.1086/596490] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Pneumonia accounts for approximately 2 million deaths annually among children aged <5 years, with most of these deaths occurring in Africa and southern Asia. The South Asian Pneumococcal Alliance (SAPNA) network in Nepal is generating local epidemiological data to assist in the development of national and regional policies for prevention of pneumococcal and Haemophilus influenzae (Hib) disease. METHODS Children aged 2 months to 5 years with suspected invasive bacterial disease were recruited from Kanti Children Hospital, Kathmandu, Nepal. Specimens of blood, CSF, and normally sterile body fluids were cultured, and analysis of antimicrobial susceptibility patterns and serotyping of Streptococcus pneumoniae isolates were performed. CSF specimens were also tested for S. pneumoniae and Hib antigens by a latex agglutination test and an immunochromatographic test of pneumococcal antigen (NOW S. pneumoniae Antigen Test; Binax). RESULTS A total of 2528 children with suspected invasive bacterial disease were recruited, of whom 82% had pneumonia, 9.6% had meningitis, 2% had very severe disease, and 0.4% had bacteremia; the remainder received another diagnosis. Before hospitalization, 26.7% had received antibiotic treatment. Fifty children had S. pneumoniae identified as the etiological agent of invasive disease. Of 2461 blood cultures performed, 22 were positive for S. pneumoniae. Of 33 cases of S. pneumoniae meningitis, 11 were detected by CSF culture, and 21 were detected by latex agglutination and pneumococcal antigen tests. The rate of detection of S. pneumoniae in CSF was 3.6% by culture, compared with 7.8% by latex agglutination and 10% by pneumococcal antigen testing. The rate of detection of H. influenzae in CSF was 1.7% by culture and 6.5% by latex agglutination. The most common serotypes found were 1, 5, 2, and 7F, followed by 12A, 19B, and 23F. Of all the invasive isolates, 3.8% were resistant to penicillin, and 68% were resistant to trimethoprim-sulfamethoxazole. CONCLUSIONS The SAPNA network has identified Hib and pneumococci as causes of significant disease in Nepal.
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Affiliation(s)
- A S Shah
- Institute of Medicine and Kanti Children's Hospital, Kathmandu, Nepal.
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Batuwanthudawe R, Karunarathne K, Dassanayake M, de Silva S, Lalitha M, Thomas K, Steinhoff M, Abeysinghe N. Surveillance of Invasive Pneumococcal Disease in Colombo, Sri Lanka. Clin Infect Dis 2009; 48 Suppl 2:S136-40. [DOI: 10.1086/596492] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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49
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Beyer M, Steinhoff M, Anagnostopoulos I, Assaf C, Sterry W. Hepatosplenisches T-Zell-Lymphom unter Therapie mit TNF-α-inhibierenden Biologics: (k)ein Risiko für Patienten mit Psoriasis? J Dtsch Dermatol Ges 2009. [DOI: 10.1111/j.1610-0387.2008.06961_supp.x] [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: 11/29/2022]
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Kempkes C, Rattenholl A, Bocheva GS, Hoek KS, Haußer A, Dummer R, Steinhoff M. Proteinase-activated receptors 1 and 2 activate protein kinase D1 in human melanoma cells. Cell Commun Signal 2009. [PMCID: PMC4292014 DOI: 10.1186/1478-811x-7-s1-a99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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