1
|
Bellinato F, Gisondi P, Dattola A, Richetta AG, Costanzo A, Valenti M, De Simone C, Marzano AV, Zussino M, Pezzolo E, Nacca M, Pellacani G, Girolomoni G. Spesolimab in patients with flare of generalized pustular psoriasis: A multicentre case-series. J Eur Acad Dermatol Venereol 2024; 38:e437-e439. [PMID: 38084869 DOI: 10.1111/jdv.19678] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/17/2023] [Indexed: 04/26/2024]
Affiliation(s)
- F Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - P Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - A Dattola
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - A G Richetta
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - A Costanzo
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
- Dermatology Unit, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - M Valenti
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
- Dermatology Unit, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - C De Simone
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - M Zussino
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - E Pezzolo
- Dermatology Unit, Ospedale San Bortolo, Vicenza, Italy
| | - M Nacca
- A.O.R.N. Sant'Anna e San Sebastiano Caserta, Caserta, Italy
| | - G Pellacani
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - G Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| |
Collapse
|
2
|
Gargiulo L, Ibba L, Piscazzi F, Amoruso F, Balato A, Barei F, Bertello M, Burroni AG, Caccavale S, Ferrucci SM, Foti C, Gaiani FM, Girolomoni G, Malagoli P, Marzano AV, Maurelli M, Napolitano M, Nettis E, Ortoncelli M, Patruno C, Pezzolo E, Ribero S, Romita P, Rossi MT, Zaza I, Costanzo A, Narcisi A. Upadacitinib improves symptoms of concomitant allergic rhinitis or allergic asthma in patients with severe atopic dermatitis: A 16-week multicentre retrospective study. J Eur Acad Dermatol Venereol 2024. [PMID: 38329235 DOI: 10.1111/jdv.19862] [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] [Received: 10/10/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024]
Affiliation(s)
- L Gargiulo
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - L Ibba
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - F Piscazzi
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - F Amoruso
- Dermatology Unit, Azienda Ospedaliera di Cosenza, Cosenza, Italy
| | - A Balato
- Dermatology Unit, University of Campania L, Naples, Italy
| | - F Barei
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Bertello
- Department of Biomedical Science and Human Oncology, Second Dermatologic Clinic, University of Turin, Turin, Italy
| | - A G Burroni
- Section of Dermatology, Department of Health Sciences (Di.S.Sal), IRCCS - San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy
| | - S Caccavale
- Dermatology Unit, University of Campania L, Naples, Italy
| | - S M Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Foti
- Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - F M Gaiani
- Department of Dermatology, Dermatology Unit Azienda Ospedaliera San Donato Milanese, Milan, Italy
| | - G Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - P Malagoli
- Department of Dermatology, Dermatology Unit Azienda Ospedaliera San Donato Milanese, Milan, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - M Napolitano
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - E Nettis
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | - M Ortoncelli
- Department of Biomedical Science and Human Oncology, Second Dermatologic Clinic, University of Turin, Turin, Italy
| | - C Patruno
- Section of Dermatology, Health Sciences Department, Magna Graecia University, Catanzaro, Italy
| | - E Pezzolo
- Department of Dermatology, San Bortolo Hospital, Vicenza, Italy
- A Study Centre of the Italian Group for the Epidemiologic Research in Dermatology (GISED), Bergamo, Italy
| | - S Ribero
- Department of Biomedical Science and Human Oncology, Second Dermatologic Clinic, University of Turin, Turin, Italy
| | - P Romita
- Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - M T Rossi
- Dermatology Department, University of Brescia, Brescia, Italy
| | - I Zaza
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | - A Costanzo
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - A Narcisi
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| |
Collapse
|
3
|
Avallone G, Roccuzzo G, Pileri A, Agostinelli C, Maronese CA, Aquino C, Tavoletti G, Onida F, Fava P, Ribero S, Marzano AV, Berti E, Quaglino P, Alberti-Violetti S. Clinicopathological definition, management and prognostic value of mogamulizumab-associated rash and other cutaneous events: A systematic review. J Eur Acad Dermatol Venereol 2024. [PMID: 38279614 DOI: 10.1111/jdv.19801] [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] [Received: 05/15/2023] [Accepted: 12/06/2023] [Indexed: 01/28/2024]
Abstract
Mogamulizumab is a first-in-class IgG1k monoclonal antibody that selectively targets the chemokine receptor type 4. The drug has received Food and Drug administration authorisation for mycosis fungoides and Sézary syndrome following failure of at least one previous course of systemic therapy and now is available in Europe. One of the most common treatment-related side effects observed has been the mogamulizumab-associated rash (MAR), which affects up to a quarter of patients and is the most frequent adverse event leading to drug discontinuation. The aim of this study is to perform a systematic review of the literature on patients diagnosed with MAR and other mogamulizumab-related cutaneous events to describe the clinical and histological characteristics, the management in clinical practice and to assess whether these events have prognostic implications. In total, 2073 records were initially identified through a literature search, 843 of which were duplicates. After screening for eligibility and inclusion criteria, 49 articles reporting mogamulizumab-associated cutaneous events were included. Totally, 1516 patients were retrieved, with a slight male prevalence as for the available data (639 males and 570 females, i.e. 52.9% vs. 47.1%). Regarding the reported clinicopathological findings of the cutaneous reactions, the five most common patterns were spongiotic/psoriasiform dermatitis (22%), eruptions characterized by the presence of papules and/or plaques (16.1%), cutaneous granulomatosis (11.4%), morbilliform or erythrodermic dermatitis (9.4%) and photodermatitis (7.1%). Our results highlight how the majority of the reported cutaneous adverse events on mogamulizumab are of mild-to-moderate entity and generally manageable in clinical practice, though prompt recognition is essential and case-by-case assessment should be recommended. Future research will need to focus on the MAR prognostic implications and to identify genomic and molecular markers for a more rapid and accurate diagnosis.
Collapse
Affiliation(s)
- G Avallone
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - G Roccuzzo
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - A Pileri
- Dermatology Unit, IRCCS of Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - C Agostinelli
- Hematopathology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - C A Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - C Aquino
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - G Tavoletti
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - F Onida
- Hematology-BMT Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - P Fava
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - S Ribero
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - E Berti
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Inter-Hospital Pathology Division, IRCCS MultiMedica, Milan, Italy
| | - P Quaglino
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - S Alberti-Violetti
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
4
|
Gargiulo L, Ibba L, Malagoli P, Amoruso F, Argenziano G, Balato A, Bardazzi F, Burlando M, Carrera CG, Damiani G, Dapavo P, Dini V, Fabbrocini G, Franchi C, Gaiani FM, Girolomoni G, Guarneri C, Lasagni C, Loconsole F, Marzano AV, Maurelli M, Megna M, Orsini D, Sampogna F, Travaglini M, Valenti M, Costanzo A, Narcisi A. A risankizumab super responder profile identified by long-term real-life observation-IL PSO (ITALIAN LANDSCAPE PSORIASIS). J Eur Acad Dermatol Venereol 2024; 38:e113-e116. [PMID: 37611277 DOI: 10.1111/jdv.19464] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/18/2023] [Indexed: 08/25/2023]
Affiliation(s)
- L Gargiulo
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - L Ibba
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - P Malagoli
- Department of Dermatology, Dermatology Unit, Azienda Ospedaliera San Donato Milanese, Milan, Italy
| | - F Amoruso
- Dermatology Unit, Azienda Ospedaliera di Cosenza, Cosenza, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
| | - A Balato
- Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
| | - F Bardazzi
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola Malpighi, Bologna, Italy
| | - M Burlando
- Department of Dermatology, Dipartimento di Scienze della Salute (DISSAL), University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - C G Carrera
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Damiani
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
- Clinical Dermatology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - P Dapavo
- Department of Biomedical Science and Human Oncology, Second Dermatologic Clinic, University of Turin, Turin, Italy
| | - V Dini
- Dermatology Unit, Department of Clinical and Experimental Medicine Ospedale Santa Chiara, Pisa, Italy
| | - G Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - C Franchi
- Clinical Dermatology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - F M Gaiani
- Department of Dermatology, Dermatology Unit, Azienda Ospedaliera San Donato Milanese, Milan, Italy
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - C Guarneri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Dermatology, University of Messina, AOU Policlinico G. Martino, Messina, Italy
| | - C Lasagni
- Dermatological Clinic, Department of Specialized Medicine, University of Modena, Modena, Italy
| | - F Loconsole
- Department of Dermatology, University of Bari, Bari, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - M Maurelli
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - M Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - D Orsini
- UOC Clinical Dermatology - Dermatological Institute S. Gallicano, IRCCS, Rome, Italy
| | - F Sampogna
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata (IDI) IRCCS, Rome, Italy
| | - M Travaglini
- U.O.S.D. Dermatologica - Centro per la Cura Della Psoriasi, Brindisi, Italy
| | - M Valenti
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - A Costanzo
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - A Narcisi
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| |
Collapse
|
5
|
Tavoletti G, Avallone G, Conforti C, Roccuzzo G, Maronese CA, Mattioli MA, Quaglino P, Zalaudek I, Marzano AV, Ribero S, Alberti-Violetti S. Topical ruxolitinib: A new treatment for vitiligo. J Eur Acad Dermatol Venereol 2023; 37:2222-2230. [PMID: 37147856 DOI: 10.1111/jdv.19162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/24/2023] [Indexed: 05/07/2023]
Abstract
Vitiligo is a chronic autoimmune skin disorder whose diagnosis is often psychologically upsetting. The efficacy of the available therapies, including topical corticosteroids and topical calcineurin inhibitors, has historically been limited and the management of vitiligo is still challenging. As vitiligo is a chronic disease limited to the skin, topical rather than systemic therapies may be preferable (especially among patients with localised lesions) to avoid the long-term side-effects of the latter. A topical formulation of ruxolitinib, a selective JAK1/2 inhibitor, has recently been approved in the United States for the treatment of non-segmental vitiligo in patients aged >12 years based on data from the phase III TRuE-V1 and TRuE-V2 clinical trials. The aim of this review is to describe the current evidence concerning the efficacy and safety of topical ruxolitinib in the treatment of vitiligo, and discuss issues regarding its use in younger children and pregnant or breastfeeding women, as well as the duration and durability of treatment. The promising results obtained so far suggest that 1.5% ruxolitinib cream is an effective means of treating vitiligo.
Collapse
Affiliation(s)
- G Tavoletti
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - G Avallone
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - C Conforti
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - G Roccuzzo
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - C A Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - M A Mattioli
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - P Quaglino
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - S Ribero
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - S Alberti-Violetti
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
6
|
Chiricozzi A, Ferrucci SM, Di Nardo L, Gori N, Balato A, Ortoncelli M, Maurelli M, Galluzzo M, Munera Campos M, Seremet T, Caldarola G, De Simone C, Ippoliti E, Torres T, Gkalpakiotis S, Conrad C, Carrascosa JM, Bianchi L, Argenziano G, Ribero S, Girolomoni G, Marzano AV, Peris K. Current treatment goals are achieved by the majority of patients with atopic dermatitis treated with tralokinumab: results from a multicentric, multinational, retrospective, cohort study. Expert Opin Biol Ther 2023; 23:1307-1315. [PMID: 38108300 DOI: 10.1080/14712598.2023.2292627] [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: 09/25/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Tralokinumab is a human monoclonal antibody targeting interleukin-13 that is approved for the treatment of moderate-severe atopic dermatitis. Studies analyzing the efficacy and safety of tralokinumab in a real-world setting are scarce. RESEARCH DESIGN AND METHODS A European, multicentric, real-world, retrospective cohort study was defined to assess the effectiveness and safeness profile of tralokinumab, investigating the achievement of pre-specified treatment goals; and to detect potential differences in terms of effectiveness and safeness across some selected patient subcohorts. RESULTS A total of 194 adult patients were included in this study. A significant improvement in physician-assessed disease severity was detected at each follow-up visit as compared with baseline and similar trend was observed for patient-reported outcomes and quality of life. No meaningful difference in effectiveness was found when considering patient age (<65 versus ≥65 years), neither dissecting patient cohort in dupilumab-naive vs dupilumab-treated subjects. Among tralokinumab-treated patients, 88% achieved at least one currently identified real-world therapeutic goal at week 16. CONCLUSIONS This retrospective multicenter study confirmed the effectiveness and safeness of tralokinumab throughout 32 weeks of observation, showing the achievement of therapeutic goals identified in both trial and real-world settings in a large proportion of tralokinumab-treated patients.
Collapse
Affiliation(s)
- A Chiricozzi
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S M Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L Di Nardo
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - N Gori
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Balato
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - M Ortoncelli
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - M Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - M Galluzzo
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - M Munera Campos
- Department of Dermatology, Germans Trias i Pujol University Hospital (HUGTP), Autonomous University of Barcelona (UAB), Badalona, Spain
| | - T Seremet
- Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, Switzerland
| | - G Caldarola
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C De Simone
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - E Ippoliti
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - T Torres
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, University of Porto, Porto, Portugal
| | - S Gkalpakiotis
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - C Conrad
- Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, Switzerland
| | - J M Carrascosa
- Department of Dermatology, Germans Trias i Pujol University Hospital (HUGTP), Autonomous University of Barcelona (UAB), Badalona, Spain
| | - L Bianchi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - S Ribero
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - G Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - K Peris
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
7
|
Bortoluzzi P, Prigitano A, Sechi A, Boneschi V, Germiniasi F, Esposto MC, Romanò L, Pavan G, Matinato C, Veraldi S, Marzano AV, Grancini A. Report of terbinafine resistant Trichophyton spp. in Italy: Clinical presentations, molecular identification, antifungal susceptibility testing and mutations in the squalene epoxidase gene. Mycoses 2023. [PMID: 37139949 DOI: 10.1111/myc.13597] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 02/06/2023] [Accepted: 04/21/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Numerous reports of resistance to terbinafine in Trichophyton spp. from all over the world are arousing justified attention and concern. Point mutations in the gene that encodes the squalene epoxidase (SQLE) enzyme are responsible for these therapeutic resistances. OBJECTIVES Primary objective of the study was to describe first isolates of Trichophyton spp. resistant to terbinafine among the patients treated between September 2019 and June 2022 at the Dermatology Units of Ospedale Maggiore Policlinico and San Bortolo Hospital. Secondary objective was to study the resistance mechanism. METHODS Patients with confirmed Trichophyton spp. infection has been treated with systemic and topical terbinafine. Patients were then re-evaluated 12 weeks after the therapy. Patients with incomplete or absent response to terbinafine underwent a new skin scraping for direct mycological examination, new identification of dermatophyte species from culture and MALDI-TOF, molecular species identification, antifungal susceptibility testing and molecular analysis of SQLE gene. RESULTS We identified five patients without clinical response to treatment with terbinafine. The DNA sequencing of the ITS region identified one Trichophyton rubrum and four Trichophyton indotineae. The T. rubrum strain showed minimum inhibitory concentration (MIC) (90% growth inhibition) of 4 mg/L for terbinafine. The four T. indotineae strains showed a MICs range of 0.25-4 mg/L for terbinafine. The analysis of the SQLE gene in the T. rubrum strain showed a nucleotide substitution generating a missense mutation (L393F). The SQLE gene sequencing in the T. indotineae strains showed a nucleotide substitution generating a missense mutation (F397L) in two strains, a nucleotide substitution L393S in one strain and a nucleotide substitution F415C in another strain. CONCLUSIONS We report the first cases of terbinafine-resistant Trichophyton isolates in the Italian population. Solid antifungal management programs will be needed to promote more responsible use of antimycotics and preserve their therapeutic efficacy to control antifungal resistance.
Collapse
Affiliation(s)
- P Bortoluzzi
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Prigitano
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - A Sechi
- Dermatology Unit, San Bortolo Hospital, Vicenza, Italy
| | - V Boneschi
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F Germiniasi
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M C Esposto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - L Romanò
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - G Pavan
- Department of Microbiology, San Bortolo Hospital, Vicenza, Italy
| | - C Matinato
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - S Veraldi
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
- Dermatology Unit, San Bortolo Hospital, Vicenza, Italy
- Department of Microbiology, San Bortolo Hospital, Vicenza, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
- Dermatology Unit, San Bortolo Hospital, Vicenza, Italy
- Department of Microbiology, San Bortolo Hospital, Vicenza, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - A Grancini
- Laboratorio Analisi - Laboratorio di Batteriologia, Parassitologia e Micologia, Fondazione IRCCS O. Maggiore Policlinico, Milan, Italy
| |
Collapse
|
8
|
Avallone G, Cavallo F, Astrua C, Caldarola G, Conforti C, De Simone C, di Meo N, di Stefani A, Genovese G, Maronese CA, Marzano AV, Parente R, Quaglino P, Roccuzzo G, Tassone F, Zalaudek I, Senetta R, Ribero S. Cutaneous adverse reaction following SARS-CoV-2 vaccine booster dose: a real-life multicentre experience. J Eur Acad Dermatol Venereol 2022; 36:e876-e879. [PMID: 35771093 PMCID: PMC9349823 DOI: 10.1111/jdv.18386] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G Avallone
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - F Cavallo
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - C Astrua
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - G Caldarola
- UOC Dermatologia , Dipartimento di scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A.Gemelli" , IRCCS, Roma
| | - C Conforti
- Dermatology Clinic, Maggiore Hospital, Trieste, Italy
| | - C De Simone
- UOC Dermatologia , Dipartimento di scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A.Gemelli" , IRCCS, Roma.,Sezione di Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del S.Cuore, Roma
| | - N di Meo
- Dermatology Clinic, Maggiore Hospital, Trieste, Italy
| | - A di Stefani
- UOC Dermatologia , Dipartimento di scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A.Gemelli" , IRCCS, Roma
| | - G Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - C A Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - R Parente
- Department of Pathology, Humanitas-Gradenigo Hospital, Corso Regina Margherita 8, 10153, Turin, Italy
| | - P Quaglino
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - G Roccuzzo
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - F Tassone
- UOC Dermatologia , Dipartimento di scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A.Gemelli" , IRCCS, Roma
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital, Trieste, Italy
| | - R Senetta
- Department of Oncology, Pathology Unit, University of Turin, Turin, Italy
| | - S Ribero
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| |
Collapse
|
9
|
Borradori L, Van Beek N, Feliciani C, Tedbirt B, Antiga E, Bergman R, Böckle BC, Caproni M, Caux F, Chandran NS, Cianchini G, Daneshpazhooh M, De D, Didona D, Di Zenzo GM, Dmochowski M, Drenovska K, Ehrchen J, Goebeler M, Groves R, Günther C, Horvath B, Hertl M, Hofmann S, Ioannides D, Itzlinger-Monshi B, Jedličková J, Kowalewski C, Kridin K, Lim YL, Marinovic B, Marzano AV, Mascaro JM, Meijer JM, Murrell D, Patsatsi K, Pincelli C, Prost C, Rappersberger K, Sárdy M, Setterfield J, Shahid M, Sprecher E, Tasanen K, Uzun S, Vassileva S, Vestergaard K, Vorobyev A, Vujic I, Wang G, Wozniak K, Yayli S, Zambruno G, Zillikens D, Schmidt E, Joly P. Updated S2 K guidelines for the management of bullous pemphigoid initiated by the European Academy of Dermatology and Venereology (EADV). J Eur Acad Dermatol Venereol 2022; 36:1689-1704. [PMID: 35766904 DOI: 10.1111/jdv.18220] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disease of the skin and mucous membranes. This disease typically affects the elderly and presents with itch and localized or, most frequently, generalized bullous lesions. A subset of patients only develops excoriations, prurigo-like lesions, and eczematous and/or urticarial erythematous lesions. The disease, which is significantly associated with neurological disorders, has high morbidity and severely impacts the quality of life. OBJECTIVES AND METHODOLOGY The Autoimmune blistering diseases Task Force of the European Academy of Dermatology and Venereology sought to update the guidelines for the management of BP based on new clinical information, and new evidence on diagnostic tools and interventions. The recommendations are either evidence-based or rely on expert opinion. The degree of consent among all task force members was included. RESULTS Treatment depends on the severity of BP and patients' comorbidities. High-potency topical corticosteroids are recommended as the mainstay of treatment whenever possible. Oral prednisone at a dose of 0.5 mg/kg/day is a recommended alternative. In case of contraindications or resistance to corticosteroids, immunosuppressive therapies, such as methotrexate, azathioprine, mycophenolate mofetil or mycophenolate acid, may be recommended. The use of doxycycline and dapsone is controversial. They may be recommended, in particular, in patients with contraindications to oral corticosteroids. B-cell-depleting therapy and intravenous immunoglobulins may be considered in treatment-resistant cases. Omalizumab and dupilumab have recently shown promising results. The final version of the guideline was consented to by several patient organizations. CONCLUSIONS The guidelines for the management of BP were updated. They summarize evidence- and expert-based recommendations useful in clinical practice.
Collapse
Affiliation(s)
- L Borradori
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - N Van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - C Feliciani
- Dermatology Unit, Department of Medicine and Surgery, University Hospital, University of Parma, Italy
| | - B Tedbirt
- Department of Dermatology, Rouen University Hospital, Referral Center for Autoimmune Bullous Diseases, Referral Center for Autoimmune Bullous Diseases, Rouen University Hospital, INSERM U1234, Normandie University, Rouen, France
| | - E Antiga
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - R Bergman
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - B C Böckle
- Department of Dermatology, Venereology & Allergology, Innsbruck Medical University, Innsbruck, Austria
| | - M Caproni
- Department of Health Sciences, Section of Dermatology, AUSL Toscana Centro, Rare Diseases Unit, European Reference Network-Skin Member, University of Florence, Italy
| | - F Caux
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases, Groupe Hospitalier Paris Seine-Saint-Denis, AP-HP and University Paris 13, Bobigny, France
| | - N S Chandran
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - G Cianchini
- Department of Dermatology, Ospedale Classificato Cristo Re, Rome, Italy
| | - M Daneshpazhooh
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - D De
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D Didona
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - G M Di Zenzo
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - M Dmochowski
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - K Drenovska
- Department of Dermatology, Medical University of Sofia, Sofia, Bulgaria
| | - J Ehrchen
- Department of Dermatology, University of Münster, Münster, Germany
| | - M Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - R Groves
- St. John's Institute of Dermatology, Viapath Analytics LLP, St. Thomas' Hospital, London, UK.,Division of Genetics and Molecular Medicine, King's College London, Guy's Hospital, London, UK
| | - C Günther
- Department of Dermatology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - B Horvath
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M Hertl
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - S Hofmann
- Department of Dermatology, Allergy and Dermatosurgery, Helios University Hospital Wuppertal, University Witten, Herdecke, Germany
| | - D Ioannides
- 1st Department of Dermatology-Venereology, Hospital of Skin and Venereal Diseases, Aristotle University Medical School, Thessaloniki, Greece
| | - B Itzlinger-Monshi
- Department of Dermatology, Venereology and Allergy, Clinical Center Landstrasse, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria.,Medical Faculty, The Sigmund Freud Private University, Vienna, Austria
| | - J Jedličková
- Department of Dermatovenereology, Masaryk University, University Hospital St. Anna, Brno.,Department of Dermatovenereology, University Hospital Brno, Brno, Czech Republic
| | - C Kowalewski
- Department Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland
| | - K Kridin
- National Skin Centre, Singapore, Singapore
| | - Y L Lim
- Department of Dermatology and Venereology, School of Medicine, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia
| | - B Marinovic
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - J-M Mascaro
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - J M Meijer
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - D Murrell
- Department of Dermatology, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - K Patsatsi
- 2nd Department of Dermatology, Autoimmune Bullous Diseases Unit, Aristotle University School of Medicine, Papageorgiou General Hospital, Thessaloniki, Greece
| | - C Pincelli
- DermoLab, Institute of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - C Prost
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases, Groupe Hospitalier Paris Seine-Saint-Denis, AP-HP and University Paris 13, Bobigny, France
| | - K Rappersberger
- Department of Dermatology, Venereology and Allergy, Clinical Center Landstrasse, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria.,Medical Faculty, The Sigmund Freud Private University, Vienna, Austria.,Abteilung Dermatologie, Venerologie und Allergologie, Lehrkrankenhaus der Medizinischen Universität Wien, Austria
| | - M Sárdy
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany.,Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - J Setterfield
- Department of Oral Medicine, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Shahid
- Department of Dermatology, Medical University, Sofia, Bulgaria
| | - E Sprecher
- Division of Dermatology, Tel Aviv Sourasky Medical Center and Department of Human Molecular Genetics & Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Tasanen
- Department of Dermatology, the PEDEGO Research Unit, University of Oulu and Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - S Uzun
- Department of Dermatology and Venereology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - S Vassileva
- Department of Dermatology, Medical University, Sofia, Bulgaria
| | - K Vestergaard
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - A Vorobyev
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - I Vujic
- Department of Dermatology, Venereology and Allergy, Clinical Center Landstrasse, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria.,Medical Faculty, The Sigmund Freud Private University, Vienna, Austria
| | - G Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - K Wozniak
- National Skin Centre, Singapore, Singapore
| | - S Yayli
- Department of Dermatology, School of Medicine, Koç University, Istanbul, Turkey
| | - G Zambruno
- Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - D Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - E Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - P Joly
- Department of Dermatology, Rouen University Hospital, Referral Center for Autoimmune Bullous Diseases, Referral Center for Autoimmune Bullous Diseases, Rouen University Hospital, INSERM U1234, Normandie University, Rouen, France
| |
Collapse
|
10
|
Ferrucci SM, Angileri L, Marzano AV, Berti E, Tavecchio S. Topical tacrolimus during systemic therapy for severe atopic dermatitis in the clinical practice. Eur Rev Med Pharmacol Sci 2022; 26:2518-2523. [PMID: 35442467 DOI: 10.26355/eurrev_202204_28489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the role of tacrolimus ointment in the management of patients on dupilumab therapy for severe atopic dermatitis, in a real-life setting. PATIENTS AND METHODS Consecutive patients with severe AD treated with dupilumab were enrolled. Topical treatment was associated according to the clinical practice. Eczema Area and Severity Index (EASI), itching and sleep Numerical Rating Scale (NRS) and Dermatologic quality of Life (DLQI) were recorded at baseline and after 4, 16 and 52 weeks of treatment with dupilumab. RESULTS Overall, 342 patients were enrolled, and 307 were evaluable. Tacrolimus was used by 6.5% (n=20) of patients at baseline, 11%, 13.5%, and 11.3% after 1, 4 and 12 months, respectively; the mean time to introduce tacrolimus after initiation of dupilumab was 8.3 ± 0.3 months. Low EASI score (<7; mild disease) after 1 month of systemic therapy was more frequent in patients who applied tacrolimus at baseline than in patients who did not (72.2% vs. 55.8%, p=0.027). Female sex, low DLQI scores, low age at dupilumab initiation, and non-generalized AD were correlated with an increased probability to start tacrolimus at any time during the study. CONCLUSIONS Data suggested that early treatment of localized areas with tacrolimus improves systemic treatment efficacy.
Collapse
Affiliation(s)
- S M Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | | | | | | | | |
Collapse
|
11
|
Romagnuolo M, Pontini P, Muratori S, Marzano AV, Moltrasio C. De novo annular pustular psoriasis following mRNA COVID-19 vaccine. J Eur Acad Dermatol Venereol 2022; 36:e603-e605. [PMID: 35349736 DOI: 10.1111/jdv.18114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Affiliation(s)
- M Romagnuolo
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - P Pontini
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Muratori
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A V Marzano
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| |
Collapse
|
12
|
Avallone G, Giordano S, Astrua C, Merli M, Senetta R, Conforti C, Ribero S, Marzano AV, Quaglino P. Reply to “The first dose of COVID‐19 vaccine may trigger pemphigus and bullous pemphigoid flares: is the second dose therefore contraindicated?” by Damiani G et al. J Eur Acad Dermatol Venereol 2022; 36:e433-e435. [DOI: 10.1111/jdv.17959] [Citation(s) in RCA: 4] [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: 10/16/2021] [Revised: 12/13/2021] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
- G Avallone
- Dermatology Clinic Department of Medical Sciences University of Turin Turin Italy
| | - S Giordano
- Dermatology Clinic Department of Medical Sciences University of Turin Turin Italy
| | - C Astrua
- Dermatology Clinic Department of Medical Sciences University of Turin Turin Italy
| | - M Merli
- Dermatology Clinic Department of Medical Sciences University of Turin Turin Italy
| | - R Senetta
- Department of Oncology, Pathology Unit University of Turin Turin Italy
| | - C Conforti
- Dermatology Clinic Maggiore Hospital Trieste Italy
| | - S Ribero
- Dermatology Clinic Department of Medical Sciences University of Turin Turin Italy
| | - AV Marzano
- Dermatology Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milan Italy
| | - P Quaglino
- Dermatology Clinic Department of Medical Sciences University of Turin Turin Italy
| |
Collapse
|
13
|
Cinotti E, Perrot JL, Bruzziches F, Tognetti L, Batsikosta A, Sorrentino E, Marzano AV, Rubegni P. Eosinophilic dermatosis after AstraZeneca COVID-19 vaccination. J Eur Acad Dermatol Venereol 2021; 36:e171-e172. [PMID: 34753210 PMCID: PMC8657533 DOI: 10.1111/jdv.17806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/12/2021] [Accepted: 11/03/2021] [Indexed: 11/27/2022]
Affiliation(s)
- E Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - J-L Perrot
- Department of Dermatology, University Hospital of St-Etienne, Saint-Etienne, France
| | - F Bruzziches
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - L Tognetti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - A Batsikosta
- Department of Human Pathology and Oncology, Pathological Anatomy Section, University of Siena, Siena, Italy
| | - E Sorrentino
- Department of Human Pathology and Oncology, Pathological Anatomy Section, University of Siena, Siena, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - P Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| |
Collapse
|
14
|
Bortoluzzi P, Ferrucci S, Galimberti D, Garavelli F, Pozzo Giuffrida F, Pizzati A, Marzano AV, Mapelli C. New insights on ocular surface disease in patients with atopic dermatitis treated with dupilumab. Br J Dermatol 2021; 186:186-187. [PMID: 34431510 DOI: 10.1111/bjd.20706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 12/18/2022]
Abstract
Our study sought to describe ocular surface alterations at baseline and after 4 months of dupilumab treatment in patients with severe AD. Our findings highlight that all 25 patients showed ocular surface alterations prior to dupilumab treatment. Dupilumab may cause the worsening of clinical or subclinical pre-existing ocular alterations belonging to the spectrum of AKC.
Collapse
Affiliation(s)
- P Bortoluzzi
- Postgraduate School of Dermatology and Venereology, Università degli Studi, Milan, Italy
| | - S Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - D Galimberti
- Department of Ophthalmology, Università degli Studi, IRCCS Foundation, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F Garavelli
- Postgraduate School of Ophthalmology, Università degli Studi, Milan, Italy
| | - F Pozzo Giuffrida
- Postgraduate School of Ophthalmology, Università degli Studi, Milan, Italy
| | - A Pizzati
- Postgraduate School of Dermatology and Venereology, Università degli Studi, Milan, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - C Mapelli
- Department of Ophthalmology, Università degli Studi, IRCCS Foundation, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
15
|
Genovese G, Maronese CA, Casazza G, Corti L, Venegoni L, Muratori S, Berti E, Fanoni D, Marzano AV. Clinical and serological predictors of relapse in pemphigus: a study of 143 patients. Clin Exp Dermatol 2021; 47:98-106. [PMID: 34288016 PMCID: PMC9290045 DOI: 10.1111/ced.14854] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pemphigus is an autoimmune bullous disease mediated by autoantibodies targeting epithelial cell-cell adhesion molecules. Predictors of relapse have not yet been clearly identified. AIMS To identify factors at diagnosis and during follow-up that could be predictors of relapse. METHODS Clinical and immunopathological data at diagnosis, clinical remission and first relapse from patients with pemphigus vulgaris or foliaceus and at least a 36-month follow-up were collected retrospectively. Based on the autoantibody profile at diagnosis, three serological patient subsets were devised: (i) anti-desmoglein (Dsg)1-positive and anti-Dsg3-negative; (iii) anti-Dsg1-negative and anti-Dsg3-positive; and (iii) anti-Dsg1-positive and anti-Dsg3-positive. RESULTS Data from 143 patients were collected. No significant differences were found between relapsers (n = 90) and nonrelapsers (n = 53) for time to remission or for anti-Dsg1 and anti-Dsg3 titres at diagnosis and remission. In the analysis of all patients, a higher risk of relapse was found for a body surface area (BSA) score of 3 compared with BSA < 3 (OR = 3.30, 95% CI 1.17-9.28; P = 0.02) and for a positive titre of either anti-Dsg1 or anti-Dsg3 autoantibodies at remission compared with both being negative (OR = 2.42, 95% CI 1.21-4.85, P = 0.01). In patients who were anti-Dsg3-positive and anti-Dsg1-negative at diagnosis, failure to achieve anti-Dsg3 negativity at clinical remission was a significant predictor of relapse (OR = 7.89, 95% CI 2.06-30.21; P < 0.01). Similarly, failure to achieve anti-Dsg1 negativity at clinical remission was a significant predictor of relapse in patients with both anti-Dsg1 and anti-Dsg3 positivity at diagnosis (OR = 5.74, 95% CI 1.15-28.61; P = 0.03), but not in those who were anti-Dsg1-positive/anti-Dsg3-negative at diagnosis (OR = 1.08, 95% CI 0.27-4.30; P = 0.91). CONCLUSION Regardless of pemphigus subtype, autoantibody titre negativity at clinical remission in patients classified based on their anti-Dsg1 and anti-Dsg3 profile at diagnosis and BSA were useful tools in predicting relapse.
Collapse
Affiliation(s)
- G Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - C A Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - G Casazza
- Department of Biomedical and Clinical Sciences 'L. Sacco', Università degli Studi di Milano, Milan, Italy
| | - L Corti
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L Venegoni
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - S Muratori
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - E Berti
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - D Fanoni
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
16
|
Görög A, Antiga E, Caproni M, Cianchini G, De D, Dmochowski M, Dolinsek J, Drenovska K, Feliciani C, Hervonen K, Lakos Jukic I, Kinyó Á, Koltai T, Korponay-Szabó I, Marzano AV, Patsatsi A, Rose C, Salmi T, Schmidt E, Setterfield J, Shahid M, Sitaru C, Uzun S, Valitutti F, Vassileva S, Yayli S, Sárdy M. S2k guidelines (consensus statement) for diagnosis and therapy of dermatitis herpetiformis initiated by the European Academy of Dermatology and Venereology (EADV). J Eur Acad Dermatol Venereol 2021; 35:1251-1277. [PMID: 34004067 DOI: 10.1111/jdv.17183] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 01/14/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Dermatitis herpetiformis (DH) is a chronic, pruritic, gluten-induced skin disorder characterized by subepidermal granular IgA deposition and a variable degree of enteropathy identical to that seen in coeliac disease. So far, there has been no European consensus about the management of DH. METHODS The guidelines were created by small subgroups of a guideline committee consisting of 26 specialists from various medical fields and one patients' representative. The members of the committee then discussed the guidelines and voted for the final version at two consensus meetings. The guidelines were developed under the support of the European Academy of Dermatology and Venereology (EADV) and in collaboration with the European Dermatology Forum (EDF). RESULTS The guidelines summarize evidence-based and expert-based recommendations (S2 level) for the management of DH (see Appendix). CONCLUSION These guidelines will improve the quality of management of DH and support dermatologists in their diagnostic and therapeutic decisions.
Collapse
Affiliation(s)
- A Görög
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - E Antiga
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - M Caproni
- Rare Diseases Unit, Section of Dermatology, Department of Health Sciences, USL Toscana Centro, European Reference Network-Skin Member, University of Florence, Florence, Italy
| | - G Cianchini
- Department of Dermatology, Cristo Re Hospital, Rome, Italy
| | - D De
- Department of Dermatology, Postgraduate Institute of Medical Education Research, Chandigarh, India
| | - M Dmochowski
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, Poznań, Poland
| | - J Dolinsek
- Gastroenterology Unit, Department of Pediatrics, University Medical Center Maribor, Maribor, Slovenia.,Medical Faculty, University of Maribor, Maribor, Slovenia
| | - K Drenovska
- Department of Dermatology and Venereology, Medical University, Sofia, Bulgaria
| | - C Feliciani
- Dermatology Unit Azienda Ospedaliero - Universitaria, Università di Parma, Parma, Italy
| | - K Hervonen
- Coeliac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - I Lakos Jukic
- Department of Dermatology and Venereology, University Hospital Center Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Á Kinyó
- Department of Dermatology, Venereology and Oncodermatology, University of Pécs Medical School, Pécs, Hungary
| | - T Koltai
- Association of European Coeliac Societies, Brussels, Belgium.,Hungarian Coeliac Society, Budapest, Hungary
| | - I Korponay-Szabó
- Coeliac Disease Centre, Heim Pál National Paediatric Institute, Budapest, Hungary.,Faculty of Medicine, Institute of Paediatrics, University of Debrecen, Debrecen, Hungary
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - A Patsatsi
- Autoimmune Bullous Diseases Unit, 2nd Dermatology Department, Aristotle University School of Medicine, Thessaloniki, Greece
| | - C Rose
- Dermatopathology Laboratory, Lübeck, Germany.,German Coeliac Disease Society e. V., Stuttgart, Germany
| | - T Salmi
- Coeliac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - E Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - J Setterfield
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Host Microbiome Interactions, Faculty of Dentistry Oral & Craniofacial Sciences, King's College London, London, UK
| | - M Shahid
- Department of Dermatology and Venereology, Medical University, Sofia, Bulgaria
| | - C Sitaru
- Department of Dermatology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,BIOSS Centre for Biological Signalling, University of Freiburg, Freiburg, Germany
| | - S Uzun
- Department of Dermatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - F Valitutti
- Pediatric Unit, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - S Vassileva
- Department of Dermatology and Venereology, Medical University, Sofia, Bulgaria
| | - S Yayli
- Department of Dermatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - M Sárdy
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary.,Department of Dermatology and Allergy, University Hospital of LMU, Munich, Germany
| |
Collapse
|
17
|
Ribero S, Ramondetta A, Fabbrocini G, Bettoli V, Potenza C, Chiricozzi A, Licciardello M, Marzano AV, Bianchi L, Rozzo G, Fania L, Marasca C, Odorici G, Mambrin A, Moltrasio C, Caposiena Caro RD, Skroza N, Quaglino P, Siliquini N, Dapavo P. Effectiveness of Secukinumab in the treatment of moderate-severe hidradenitis suppurativa: results from an Italian multicentric retrospective study in a real-life setting. J Eur Acad Dermatol Venereol 2021; 35:e441-e442. [PMID: 33594790 DOI: 10.1111/jdv.17178] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/09/2021] [Indexed: 02/06/2023]
Affiliation(s)
- S Ribero
- Dermatology Clinic, University of Turin, Turin, Italy
| | - A Ramondetta
- Dermatology Clinic, University of Turin, Turin, Italy
| | - G Fabbrocini
- Department of Clinical Medicine and Surgery, Dermatology Unit, University Federico II of Naples, Naples, Italy
| | - V Bettoli
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - C Potenza
- Dermatology Unit "Daniele Innocenzi", Department of Medical Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, Italy
| | - A Chiricozzi
- Dermatology Unit, Department of Medical Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dermatology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - L Bianchi
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - G Rozzo
- Dermatology Clinic, University of Turin, Turin, Italy
| | - L Fania
- Dermatology Department, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - C Marasca
- Department of Clinical Medicine and Surgery, Dermatology Unit, University Federico II of Naples, Naples, Italy
| | - G Odorici
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - A Mambrin
- Dermatology Unit "Daniele Innocenzi", Department of Medical Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, Italy
| | - C Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - R D Caposiena Caro
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - N Skroza
- Dermatology Unit "Daniele Innocenzi", Department of Medical Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, Italy
| | - P Quaglino
- Dermatology Clinic, University of Turin, Turin, Italy
| | - N Siliquini
- Dermatology Clinic, University of Turin, Turin, Italy
| | - P Dapavo
- Dermatology Clinic, University of Turin, Turin, Italy
| |
Collapse
|
18
|
Narla S, Azzam M, Townsend S, Vellaichamy G, Marzano AV, Alavi A, Lowes MA, Hamzavi IH. Identifying key components and therapeutic targets of the immune system in hidradenitis suppurativa with an emphasis on neutrophils. Br J Dermatol 2021; 184:1004-1013. [PMID: 32893875 DOI: 10.1111/bjd.19538] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/05/2020] [Accepted: 08/29/2020] [Indexed: 12/13/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent and debilitating skin disease of the hair follicle unit that typically develops after puberty. The disorder is characterized by comedones, painful inflammatory nodules, abscesses, dermal tunnels and scarring, with a predilection for intertriginous areas of the body (axillae, inguinal and anogenital regions). Recruitment of neutrophils to HS lesion sites may play an essential role in the development of the painful inflammatory nodules and abscesses that characterize the disease. This is a review of the major mediators involved in the recruitment of neutrophils to sites of active inflammation, including bacterial components (endotoxins, exotoxins, capsule fragments, etc.), the complement pathway anaphylatoxins C3a and C5a, tumour necrosis factor-alpha, interleukin (IL)-17, IL-8 (CXCL8), IL-36, IL-1, lipocalin-2, leukotriene B4, platelet-activating factor, kallikreins, matrix metalloproteinases, and myeloperoxidase inhibitors. Pharmacological manipulation of the various pathways involved in the process of neutrophil recruitment and activation could allow for successful control and stabilization of HS lesions and the remission of active, severe flares.
Collapse
Affiliation(s)
- S Narla
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - M Azzam
- University of Nevada School of Medicine, Reno, NV, USA
| | - S Townsend
- Wayne State School of Medicine, Detroit, MI, USA
| | | | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - A Alavi
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - M A Lowes
- The Rockefeller University, New York, NY, USA
| | - I H Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| |
Collapse
|
19
|
Ferrucci SM, Tavecchio S, Favale EM, Angileri L, Riva D, Romagnuolo M, Beretta AE, Marzano AV. Effects of lockdown on health of patients with severe atopic dermatitis treated with dupilumab. J Eur Acad Dermatol Venereol 2020; 35:e17-e18. [PMID: 32978835 PMCID: PMC7537508 DOI: 10.1111/jdv.16955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- S M Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Tavecchio
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - E M Favale
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - L Angileri
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - D Riva
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - M Romagnuolo
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - A E Beretta
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
20
|
Talamonti M, Galluzzo M, Chiricozzi A, Quaglino P, Fabbrocini G, Gisondi P, Marzano AV, Potenza C, Conti A, Parodi A, Belloni Fortina A, Bardazzi F, Argenziano G, Rongioletti F, Stingeni L, Micali G, Loconsole F, Venturini M, Bongiorno MR, Feliciani C, Rubegni P, Amerio P, Fargnoli MC, Pigatto P, Savoia P, Nisticò SP, Giustini S, Carugno A, Cannavò SP, Rech G, Prignano F, Offidani A, Lombardo M, Zalaudek I, Bianchi L, Peris K. Management of biological therapies for chronic plaque psoriasis during COVID-19 emergency in Italy. J Eur Acad Dermatol Venereol 2020; 34:e770-e772. [PMID: 32735716 PMCID: PMC7436412 DOI: 10.1111/jdv.16841] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 01/07/2023]
Affiliation(s)
- M Talamonti
- Dermatology Department, University of Rome 'Tor Vergata', Rome, Italy
| | - M Galluzzo
- Dermatology Department, University of Rome 'Tor Vergata', Rome, Italy
| | - A Chiricozzi
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Quaglino
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - G Fabbrocini
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - P Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - C Potenza
- Department of Medico-Surgical Sciences and Biotechnologies, Dermatology Unit 'Daniele Innocenzi' Sapienza University of Rome - Polo Pontino, Rome, Italy
| | - A Conti
- Dermatologic Unit, Department of Specialized Medicine, AOU Policlinico di Modena, Modena, Italy
| | - A Parodi
- Ospedale-Policlinico San Martino IRCCS Genova, Clinica Dermatologica DiSSal Università di Genova, Genova, Italy
| | - A Belloni Fortina
- Dermatology Unit - Department of Medicine DIMED, University of Padova, Padova, Italy
| | - F Bardazzi
- Dermatology Division, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - F Rongioletti
- Section of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - L Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - F Loconsole
- Department of Biomedical Science and Human Oncology, Unit of Dermatology, University of Bari, Bari, Italy
| | - M Venturini
- Department of Dermatology, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - M R Bongiorno
- Section of Dermatology, Department of Health Promotion, Maternal-Infant, Internal Medicine and Specialization, University of Palermo, Palermo, Italy
| | - C Feliciani
- Department of Medicine and Surgery, Section of Dermatology, University of Parma, Parma, Italy
| | - P Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Italy
| | - P Amerio
- Department of Medicine and Aging Science, Dermatologic Clinic, G. D'Annunzio University, Chieti, Italy
| | - M C Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - P Pigatto
- Department of Biomedical, Surgical and Dental Sciences, Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, University of Milan, Milan, Italy
| | - P Savoia
- Department of Health Science, Dermatologic Clinic, University of Eastern Piedmont, Novara, Italy
| | - S P Nisticò
- Dermatology Unit, Department of Health Sciences, Università Magna Graecia, Catanzaro, Italy
| | - S Giustini
- Department of Dermatology, Sapienza' University of Rome, Rome, Italy
| | - A Carugno
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - S P Cannavò
- Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - G Rech
- Division of Dermatology, Santa Chiara Hospital, Trento, Italy
| | - F Prignano
- Dermatology Clinic, Department of Health Sciences, University of Florence, Florence, Italy
| | - A Offidani
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy
| | - M Lombardo
- Unit of Dermatological Diseases, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - I Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - L Bianchi
- Dermatology Department, University of Rome 'Tor Vergata', Rome, Italy
| | - K Peris
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | | |
Collapse
|
21
|
Naik HB, Alhusayen R, Frew J, Guilbault S, Ingram JR, Lowes MA, Marzano AV, Paul M, Villumsen B, Yannuzzi CA. Global Hidradenitis Suppurativa COVID-19 Registry: a registry to inform data-driven management practices. Br J Dermatol 2020; 183:780-781. [PMID: 32597495 PMCID: PMC7361290 DOI: 10.1111/bjd.19345] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 12/19/2022]
Affiliation(s)
- H B Naik
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - R Alhusayen
- Sunnybrook Research Institute, Dermatology Division, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - J Frew
- Department of Dermatology, Liverpool Hospital, University of New South Wales, Sydney, NSW, Australia
| | | | - J R Ingram
- Department of Dermatology & Academic Wound Healing, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - M A Lowes
- The Rockefeller University, New York, NY, USA
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - M Paul
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - B Villumsen
- Patientforeningen HS Danmark, Copenhagen, Denmark
| | | |
Collapse
|
22
|
Benzecry V, Pravettoni V, Segatto G, Marzano AV, Ferrucci S. Type 2 Inflammation: Atopic Dermatitis, Asthma, and Hypereosinophilia Successfully Treated With Dupilumab. J Investig Allergol Clin Immunol 2020; 31:261-263. [PMID: 32732182 DOI: 10.18176/jiaci.0614] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- V Benzecry
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.,UOC Dermatologia, Fondazione IRCCS Ca´ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Pravettoni
- UO Medicina Generale, Immunologia e Allergologia, Fondazione IRCCS Ca´ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Segatto
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.,UO Medicina Generale, Immunologia e Allergologia, Fondazione IRCCS Ca´ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A V Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.,UOC Dermatologia, Fondazione IRCCS Ca´ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Ferrucci
- UOC Dermatologia, Fondazione IRCCS Ca´ Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
23
|
Romagnuolo M, Angileri L, Tavecchio S, Marzano AV, Ferrucci S. Safety and efficacy of dupilumab in a patient with severe atopic dermatitis and HIV infection, with 15 months of follow-up. Clin Exp Dermatol 2020; 45:762-763. [PMID: 32379943 DOI: 10.1111/ced.14278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 11/28/2022]
Affiliation(s)
- M Romagnuolo
- Dermatology Unit, Department of Pathophysiology and Transplantation, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L Angileri
- Dermatology Unit, Department of Pathophysiology and Transplantation, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Tavecchio
- Dermatology Unit, Department of Pathophysiology and Transplantation, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A V Marzano
- Dermatology Unit, Department of Pathophysiology and Transplantation, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Ferrucci
- Dermatology Unit, Department of Pathophysiology and Transplantation, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
24
|
Marzano AV, Genovese G, Casazza G, Moltrasio C, Dapavo P, Micali G, Sirna R, Gisondi P, Patrizi A, Dini V, Bianchini D, Bianchi L, Fania L, Prignano F, Offidani A, Atzori L, Bettoli V, Cannavò SP, Venturini M, Bongiorno MR, Costanzo A, Fabbrocini G, Peris K. Evidence for a 'window of opportunity' in hidradenitis suppurativa treated with adalimumab: a retrospective, real-life multicentre cohort study. Br J Dermatol 2020; 184:133-140. [PMID: 32119111 DOI: 10.1111/bjd.18983] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The anti-tumour necrosis factor (TNF)-α adalimumab is the only licenced biologic for moderate-to-severe hidradenitis suppurativa (HS). No predictors of response have been identified so far. OBJECTIVES To identify clinical parameters predicting response to adalimumab and confirm its efficacy/safety. METHODS The data of 389 patients with HS treated with adalimumab in 21 Italian centres were reviewed. Sex, age at onset/diagnosis/baseline, body mass index, smoking, phenotype, previous treatments, concomitant antibiotics and 'therapeutic delay', defined as the time from HS onset to adalimumab initiation, were assessed. Response to adalimumab and its impact on quality of life (QoL) were evaluated using the Hidradenitis Suppurativa Clinical Response (HiSCR) and the Dermatology Life Quality Index (DLQI) or the Visual Analogue Scale for pain (VAS pain), respectively. Logistic regression analysis was performed. RESULTS The therapeutic delay correlated to lack of response to adalimumab at week 16 [odds ratio (OR) 1·92 for therapeutic delay > 10 years; 95% confidence interval (CI) 1·28-2·89; P = 0·0016). HiSCR was achieved in 43·7% and 53·9% patients at week 16 and 52, respectively. Significant reductions in both DLQI and VAS pain were found between week 16 vs. baseline (P < 0·0001 for both) and week 52 vs. baseline (P < 0·0001 for both). Previous immunosuppressants inversely correlated to HiSCR at week 52 (OR = 1·74, 95% CI 1·04-2·91, P = 0·0342). CONCLUSIONS Inverse correlation between therapeutic delay and clinical response was found, supporting early adalimumab use and providing evidence for a 'window of opportunity' in HS treatment. Adalimumab efficacy and safety were confirmed, along with patients' QoL improvement. Immunosuppressants could negatively influence the response to adalimumab inducing a switch to non-TNF-α-driven pathways.
Collapse
Affiliation(s)
- A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - G Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - G Casazza
- Dipartimento di Scienze Biomediche e Cliniche 'L. Sacco', Università degli Studi di Milano, Milan, Italy
| | - C Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - P Dapavo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - R Sirna
- Dermatology Unit, Department of Surgery, Misericordia Hospital, Grosseto, Italy
| | - P Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - A Patrizi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - V Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - D Bianchini
- Dermatologic Clinic, Department of Internal Medicine and Medical Specialties, 'La Sapienza' University, Rome, Italy
| | - L Bianchi
- Department of Dermatology, University of Rome 'Tor Vergata', Rome, Italy
| | - L Fania
- First Dermatology Clinic and Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - F Prignano
- Department Health Science Section of Dermatology, University of Florence, Florence, Italy
| | - A Offidani
- Dermatological Clinic Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy
| | - L Atzori
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - V Bettoli
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - S P Cannavò
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
| | - M Venturini
- Department of Dermatology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - M R Bongiorno
- Section of Dermatology, Department of Health Promotion, Maternal-Infant, Internal Medicine and Specialization, University of Palermo, Palermo, Italy
| | - A Costanzo
- Dermatology Unit, IRCCS Humanitas Clinical and Research Center, Rozzano (Milan), Italy
| | - G Fabbrocini
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - K Peris
- Institute of Dermatology, Università Cattolica - Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| |
Collapse
|
25
|
Asero R, Marzano AV, Ferrucci S, Lorini M, Carbonelli V, Cugno M. Co-occurrence of IgE and IgG autoantibodies in patients with chronic spontaneous urticaria. Clin Exp Immunol 2020; 200:242-249. [PMID: 32115683 DOI: 10.1111/cei.13428] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/04/2020] [Accepted: 02/26/2020] [Indexed: 01/13/2023] Open
Abstract
Chronic spontaneous urticaria (CSU) pathogenesis shows a complex and still unclear interplay between immunoglobulin (Ig)G- and IgE-mediated autoimmunity, leading to mast cell and basophil degranulation and wheal formation. The objective of this study was to evaluate at the same time IgE- and IgG-reactivity to well recognized and recently reported autoantigens in CSU patients, and to assess the effects of such reactivity on response to the anti-IgE monoclonal antibody omalizumab. Twenty CSU patients underwent omalizumab treatment. Urticaria activity score 7 (UAS7) was recorded at baseline and at different drug administration time-points for categorizing early-, late- or non-responders. At baseline, sera from the 20 patients and from 20 controls were tested for IgE and IgG autoantibodies to high- and low-affinity IgE receptors (FcεRI and FcεRII), tissue factor (TF) and thyroglobulin (TG) by immunoenzymatic methods. Antibody levels were compared with those of controls and analysed according to response. Eighteen patients were omalizumab responders (11 early and seven late), while two were non-responders. More than 50% of patients had contemporary IgE and IgG to at least to one of the four different autoantigens. Late responders showed higher levels of both anti-TF IgE and IgG than early responders (P = 0·011 and P = 0·035, respectively). Twenty-five per cent of patients had levels of anti-FcεRI IgE, exceeding the upper normal limit, suggesting that it could be a novel auto-allergen in CSU. In CSU, there is an autoimmune milieu characterized by the co-existence of IgE and IgG autoantibodies to the same antigen/allergen, particularly in late responders to omalizumab, possibly explaining the slower response.
Collapse
Affiliation(s)
- R Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - A V Marzano
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - S Ferrucci
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Lorini
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - V Carbonelli
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - M Cugno
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.,Medicina Interna, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
26
|
Marzano AV, Chiricozzi A, Giovanardi G, Argenziano G, Bettoli V, Bianchi L, Dapavo P, Dini V, Fabbrocini G, Micali G, Offidani AM, Potenza C, Prignano F, Gualberti G, Saragaglia V, Rongioletti F. Creation of a severity index for hidradenitis suppurativa that includes a validated quality-of-life measure: the HIDRAscore. J Eur Acad Dermatol Venereol 2020; 34:1815-1821. [PMID: 32119143 PMCID: PMC7607398 DOI: 10.1111/jdv.16328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/11/2020] [Indexed: 01/19/2023]
Abstract
Background Hidradenitis suppurativa (HS) is a chronic, debilitating disease with a considerable effect on patient quality of life. Its clinical severity can be measured using different scoring systems; however, few of them include patient‐centred parameters. Objective To create a new scoring system for HS that includes a quality‐of‐life instrument, the HIDRAdisk. Methods This post hoc analysis was carried out within the framework of a multicentre, longitudinal, epidemiologic study conducted over 9 months on quality‐of‐life aspects of HS. The new severity score was created using as reference a question from the Subject Satisfaction Questionnaire (SSQ) concerning the severity of HS as evaluated by the patient. Associated variables were selected using univariable and multivariable logistic regression models. The discriminant capabilities of the final model and of the final score were evaluated by the area under the receiver operating characteristic curve and the Hosmer–Lemeshow test. Results The study population included 308 patients with HS of any severity grade. According to the results of the regression models, the variables associated with the reference SSQ measure were number of inflammatory nodules, abscesses and draining fistulas; the HIDRAdisk score; and the number of subumbilical lesions. The HIDRAscore is obtained by the sum of the scores associated with the number of these parameters. Possible scores range from 0 to 10. Conclusion The HIDRAscore is a new scoring system for HS severity which, in addition to the clinical evaluation by the physician, includes a validated patient‐reported outcome measure, the HIDRAdisk.
Collapse
Affiliation(s)
- A V Marzano
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - A Chiricozzi
- Institute of Dermatology, Catholic University - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Giovanardi
- Institute of Dermatology, Catholic University - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania, Naples, Italy
| | - V Bettoli
- Dermatology Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera, University of Ferrara, Ferrara, Italy
| | - L Bianchi
- Department of Dermatology, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - P Dapavo
- Dermatologia, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - V Dini
- U.O. Dermatologia, Università di Pisa, Pisa, Italy
| | - G Fabbrocini
- U.O.C. di Dermatologia, Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - G Micali
- Dermatology Clinic, P.O.G. Rodolico, A.O.U. Policlinico, Vittorio Emanuele, Catania, Italy
| | - A M Offidani
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - C Potenza
- Dermatology Operational Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and medicine, Sapienza University of Rome - Polo Pontino- Latina, Italy
| | - F Prignano
- Clinica Dermatologica, ASF Dipartimento di Chirurgia e Medicina Translazionale, Università di Firenze, Ospedale Piero Palagi, Florence, Italy
| | | | | | - F Rongioletti
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| |
Collapse
|
27
|
Genovese G, Caorsi R, Moltrasio C, Marzano AV. Successful treatment of co-existent SAPHO syndrome and hidradenitis suppurativa with adalimumab and methotrexate. J Eur Acad Dermatol Venereol 2020; 33 Suppl 6:40-41. [PMID: 31535768 DOI: 10.1111/jdv.15849] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/24/2019] [Indexed: 12/24/2022]
Abstract
SAPHO syndrome, namely Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis, is a rare autoinflammatory chronic disease presenting with non-infectious inflammatory osteitis, sterile joint inflammation and skin manifestations, including palmoplantar pustulosis and severe acne. The case of a 15-year-old boy affected by SAPHO syndrome and hidradenitis suppurativa (HS) is presented and discussed. Coexistence of these two diseases may represent a therapeutic challenge and this case confirms literature data reporting the efficacy of the combination of methotrexate and adalimumab in SAPHO complicated by HS.
Collapse
Affiliation(s)
- G Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - R Caorsi
- Centro per le malattie autoinfiammatorie ed immunodeficienze, Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - C Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
28
|
Fanoni D, Venegoni L, Vergani B, Tavecchio S, Cattaneo A, Leone BE, Berti E, Marzano AV. Evidence for a role of autoinflammation in early-phase psoriasis. Clin Exp Immunol 2019; 198:283-291. [PMID: 31509228 DOI: 10.1111/cei.13370] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 09/02/2019] [Indexed: 12/19/2022] Open
Abstract
Psoriasis is a common, inflammatory immune-mediated skin disease mainly presenting with plaques whose pathogenesis is based on the central role of the interleukin (IL)-23/IL-17 axis. However, the mechanisms acting in papular lesions of early-phase psoriasis are not fully understood. The aim of this study was to assess the involvement of autoinflammation, a state of sterile inflammation mainly driven by IL-1 over-production that has been recently hypothesized to act in the early phase of disease. Lesional skin of 10 patients with recent onset, untreated psoriasis has been investigated for expression of IL-1β, IL-17, IL-23 and other cytokines involved in the disease in comparison with normal skin of 10 healthy controls using a protein array method. Immunohistochemical phenotyping of inflammatory infiltrate and co-localization experiments with immunofluorescence confocal microscopy were conducted. IL-1β was significantly more expressed in psoriasis than in normal skin (P < 0·0001). The chemokine IL-8 was also over-expressed in psoriasis (P = 0·03) while IL-12, IL-17, IL-23, tumour necrosis factor-α and interferon-γ were only slightly more expressed in psoriasis than in normal skin, without reaching statistical significance. The inflammatory infiltrate consisted mainly of neutrophils with a relevant number of macrophages and dendritic cells and only scattered, predominantly T helper 1 lymphocytes. IL-1β co-localized mainly with CD66b, a neutrophil marker, suggesting that neutrophils were the major source of this cytokine. IL-1β over-expression in combination with low expression of cytokines that are predominant in late-phase plaque psoriasis may support the role of autoinflammation in early-phase disease, possibly paving the way to randomized trials with IL-1 antagonists.
Collapse
Affiliation(s)
- D Fanoni
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - L Venegoni
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - B Vergani
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - S Tavecchio
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - A Cattaneo
- UOC Dermatologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - B E Leone
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - E Berti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.,UOC Dermatologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A V Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.,UOC Dermatologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
29
|
Marzano AV, Genovese G, Casazza G, Fierro MT, Dapavo P, Crimi N, Ferrucci S, Pepe P, Liberati S, Pigatto PD, Offidani A, Martina E, Girolomoni G, Rovaris M, Foti C, Stingeni L, Cristaudo A, Canonica GW, Nettis E, Asero R. Predictors of response to omalizumab and relapse in chronic spontaneous urticaria: a study of 470 patients. J Eur Acad Dermatol Venereol 2018; 33:918-924. [PMID: 30451325 DOI: 10.1111/jdv.15350] [Citation(s) in RCA: 64] [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] [Received: 08/02/2018] [Revised: 10/18/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is defined as spontaneous occurrence of wheals and/or angioedema for ≥6 weeks. Omalizumab is a monoclonal anti-IgE antibody effective in refractory CSU, but its mechanism of action and markers predictive of response remain not completely defined. OBJECTIVES To correlate baseline levels of two proposed biomarkers, total IgE (bIgE) and d-dimer (bd-dimer), and clinical parameters to omalizumab response and to relapses after drug withdrawal. METHODS In this retrospective Italian multicentre study, clinical data were collected in 470 CSU patients, and bIgE and bd-dimer were measured in 340 and 342 patients, respectively. Disease activity was determined by Urticaria Activity Score 7 (UAS7) at week 1 and 12 after omalizumab starting. Relapses were evaluated during a 2- and 3-month interval after a first and a second course of treatment, respectively. RESULTS bIgE correlated to a good response to omalizumab since levels were significantly higher in responders than non-responders (P = 0.0002). Conversely, bd-dimer did not correlate to response. There was no correlation between both bIgE and d-dimer and either first or second relapse. Disease duration was significantly longer in patients who experienced either first or second relapse (P < 0.0001 and P = 0.0105, respectively), while baseline UAS7 correlated only to first relapse (P = 0.0023). CONCLUSIONS Our study confirms bIgE as a reliable biomarker predicting response to omalizumab in CSU, while it does not support the usefulness of bd-dimer unlike previous findings. CSU duration before omalizumab and baseline UAS7 may be clinical markers of relapse risk.
Collapse
Affiliation(s)
- A V Marzano
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - G Genovese
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - G Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - M T Fierro
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - P Dapavo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - N Crimi
- Department of Clinical and Experimental Medicine-Respiratory Medicine & Allergy, University of Catania, Catania, Italy
| | - S Ferrucci
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P Pepe
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - S Liberati
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - P D Pigatto
- Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Orthopaedic Institute, University of Milan, Milan, Italy
| | - A Offidani
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - E Martina
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - G Girolomoni
- Department of Medicine, Section of Dermatology, University of Verona, Verona, Italy
| | - M Rovaris
- Department of Medicine, Section of Dermatology, University of Verona, Verona, Italy
| | - C Foti
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - L Stingeni
- Section of Clinical, Allergological and Venereological Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - A Cristaudo
- Service of Occupational and Environmental Allergic Dermatology, San Gallicano Dermatology Institute for Research and Care, Rome, Italy
| | - G W Canonica
- Department of Internal Medicine, Respiratory Disease Clinic, IRCCS Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
| | - E Nettis
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | - R Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Milan, Italy
| |
Collapse
|
30
|
Garcovich S, De Simone C, Giovanardi G, Robustelli E, Marzano AV, Peris K. Post-bariatric surgery hidradenitis suppurativa: a new patient subset associated with malabsorption and micronutritional deficiencies. Clin Exp Dermatol 2018; 44:283-289. [PMID: 30144136 DOI: 10.1111/ced.13732] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Bariatric surgery (BS) represents the most effective treatment for morbid obesity and its related complications, potentially ameliorating chronic comorbid inflammatory skin conditions, such as psoriasis and hidradenitis suppurativa (HS). Weight-loss interventions are strongly encouraged in patients with HS, but the resulting effect on the course of the disease has been poorly reported. AIM To describe the effect of BS-associated weight-loss on the course of HS. METHODS This was a retrospective, descriptive study of a hospital-based patient cohort with HS in order to investigate the relationship between exposure to a BS procedure and the HS disease course. Clinical characteristics and BS-related outcomes were retrospectively analysed by chart review for identified cases. Laboratory parameters for selected micronutrients (levels of vitamin A, D and B12, plus zinc and iron) were re-evaluated at a follow-up visit in each post-BS case. Typical patients with HS from the general cohort served as controls for the comparison of vitamin D and zinc serum levels. RESULTS Of 178 patients with HS, 12 patients with incident HS who had undergone a BS procedure were identified. A subset of patients (n = 10) developed initial signs and symptoms of cutaneous suppuration after experiencing weight loss related to malabsorptive bariatric procedures. Post-BS patients with HS presented multiple micronutritional deficiencies and insufficient responses to standard, first-line antibiotic treatments. Of the micronutrients we selected for analysis, zinc was found to be at significantly lower serum levels in post-BS patients with HS compared with typical patients with HS. CONCLUSIONS Post-BS HS may represent a new patient subset, requiring customized clinical management.
Collapse
Affiliation(s)
- S Garcovich
- Institute of Dermatology, F. Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C De Simone
- Institute of Dermatology, F. Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Giovanardi
- Institute of Dermatology, F. Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Robustelli
- IRCCS Cà Granda Foundation, Dermatology Unit, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - A V Marzano
- IRCCS Cà Granda Foundation, Dermatology Unit, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - K Peris
- Institute of Dermatology, F. Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
31
|
Genovese G, Muratori S, Berti E, Marzano AV. Bullous erythroderma: novel association of pityriasis rubra pilaris with bullous pemphigoid. Clin Exp Dermatol 2018; 44:73-75. [PMID: 30129048 DOI: 10.1111/ced.13718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 11/29/2022]
Affiliation(s)
- G Genovese
- Dermatology Unit, Department of Physiopathology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - S Muratori
- Dermatology Unit, Department of Physiopathology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - E Berti
- Dermatology Unit, Department of Physiopathology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - A V Marzano
- Dermatology Unit, Department of Physiopathology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| |
Collapse
|
32
|
Verdelli A, Coi A, Marzano AV, Antiga E, Cozzani E, Quaglino P, La Placa M, Benucci M, De Simone C, Papini M, Parodi A, Bianchi F, Caproni M. Autoantibody profile and clinical patterns in 619 Italian patients with cutaneous lupus erythematosus. J Eur Acad Dermatol Venereol 2018; 33:742-752. [PMID: 29924416 DOI: 10.1111/jdv.15147] [Citation(s) in RCA: 14] [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] [Received: 02/01/2018] [Accepted: 05/30/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Anti-nuclear antibodies (ANA), anti-extractable nuclear antigens (ENA) and anti-dsDNA antibodies are often associated with cutaneous lupus erythematosus (CLE), with variable frequency depending on skin subtype. However, specific data based on large case-series on the pathogenetic, diagnostic and prognostic meaning of such autoantibodies are still lacking. OBJECTIVE To characterize the correlations between CLE subtypes as well as LE-non-specific skin lesions and their autoantibody pattern. METHODS Epidemiological, clinical and immunopathological data of 619 Italian patients with CLE and LE-non-specific skin lesions were analysed. Differences in age, sex, clinical features and autoantibody profile were evaluated in each LE subgroup. RESULTS Anti-nuclear antibodies (P < 0.0001), anti-dsDNA (P < 0.0001), ENA (P = 0.001), anti-Sm (P = 0.001), anti-RNP (P = 0.004) and anti-histone (P = 0.005) antibodies were associated with SLE. A strong association between ANA (P < 0.0001) and anti-dsDNA (P < 0.0001) and female gender was also found: positive ANA and positive anti-dsDNA had a higher prevalence among females. Chronic CLE resulted to be negatively associated with ENA (OR = 0.51, P < 0.0001), anti-Ro/SSA (OR = 0.49, P < 0.0001) and anti-dsDNA (OR = 0.37, P < 0.0001). Intermittent CLE resulted to be negatively associated with ENA (OR = 0.50, P = 0.007) and ANA (OR = 0.61, P = 0.025). Subacute CLE resulted to be associated with ENA (OR = 5.19, P < 0.0001), anti-Ro/SSA (OR = 3.83, P < 0.0001), anti-Smith (OR = 2.95, P = 0.004) and anti-RNP (OR = 3.18, P = 0.007). Acute CLE resulted to be strongly associated with anti-dsDNA (OR = 6.0, P < 0.0001) and ANA (OR = 18.1, P < 0.0001). LE-non-specific skin lesions resulted to be significantly associated with systemic involvement. Livedo reticularis was significantly associated with ENA (P = 0.007) and anti-Ro/SSA (P = 0.036). Palpable purpura and periungual telangiectasia were significantly associated with ANA. CONCLUSION According to our findings, some well-known associations between CLE subtypes and autoantibody profile were confirmed; moreover, specific association between autoantibodies and LE-non-specific skin lesions was highlighted. A strict association between anti-ENA and anti-Ro/SSA antibodies and livedo reticularis, ANA and palpable purpura, and ANA and periungual telangiectasia was evidenced.
Collapse
Affiliation(s)
- A Verdelli
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
| | - A Coi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - A V Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, UOC Dermatologia, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - E Antiga
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
| | - E Cozzani
- IRCCS-AOU San Martino-IST, Dissal, Section of Dermatology, University of Genoa, Genoa, Italy
| | - P Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - M La Placa
- Dermology Division, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - M Benucci
- Rheumatology Unit, S. Giovanni di Dio Hospital, Florence, Italy
| | - C De Simone
- Dermatology Department, Policlinico Universitario 'A. Gemelli', Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Papini
- Department of Surgical and Biomedical Sciences, Dermatologic Clinic of Terni, University of Perugia, Perugia, Italy
| | - A Parodi
- IRCCS-AOU San Martino-IST, Dissal, Section of Dermatology, University of Genoa, Genoa, Italy
| | - F Bianchi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - M Caproni
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
| |
Collapse
|
33
|
Cugno M, Genovese G, Ferrucci S, Casazza G, Asero R, Marzano AV. IgE and D-dimer baseline levels are higher in responders than nonresponders to omalizumab in chronic spontaneous urticaria. Br J Dermatol 2018; 179:776-777. [PMID: 29582427 DOI: 10.1111/bjd.16593] [Citation(s) in RCA: 12] [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] [Indexed: 12/01/2022]
Affiliation(s)
- M Cugno
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.,Medicina Interna, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Genovese
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.,UOC Dermatologia, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Ferrucci
- UOC Dermatologia, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Casazza
- Department of Biomedical and Clinical Sciences Luigi Sacco, Università degli Studi di Milano, Milan, Italy
| | - R Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - A V Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.,UOC Dermatologia, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
34
|
Schmidt T, Hoch M, Lotfi Jad SS, Solimani F, Di Zenzo G, Marzano AV, Goebeler M, Cozzani E, Kern JS, Sitaru C, Lakoš Jukić I, Sárdy M, Uzun S, Jedlickova H, Gläser R, Kaneda M, Eming R, Göpel G, Ishii N, Greene B, Hashimoto T, Hertl M. Serological diagnostics in the detection of IgG autoantibodies against human collagen VII in epidermolysis bullosa acquisita: a multicentre analysis. Br J Dermatol 2017; 177:1683-1692. [PMID: 28703393 DOI: 10.1111/bjd.15800] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epidermolysis bullosa acquisita (EBA) is a rare, potentially devastating autoimmune disease of the skin. IgG autoantibodies directed against type VII collagen (Col7), the major component of anchoring fibrils, induce skin fragility leading to cutaneous and mucocutaneous blister formation, which is mostly of a scarring phenotype. Thus, powerful and reproducible diagnostic assays are critical to establish the diagnosis of EBA early to avoid irreversible sequelae. OBJECTIVES The present international, retrospective multicentre study included a large cohort of patients with EBA and evaluated the diagnostic power of four different diagnostic assays for the detection of anti-Col7 IgG autoantibodies. METHODS Overall, 95 EBA sera and 200 control sera consisting of 100 bullous pemphigoid sera, 50 pemphigus vulgaris sera and 50 sera of healthy controls were tested for anti-Col7 IgG autoantibodies using indirect immunofluorescence (IIF), two commercial enzyme-linked immunosorbent assay (ELISA) systems and Western blot (WB) analysis. EBA sera were taken from patients with positive direct immunofluorescence and IgG reactivity in at least one of the immunoserological assays (IIF, ELISA, WB). RESULTS A Col7-NC1/NC2 ELISA (MBL, Nagoya, Japan) showed the highest sensitivity (97·9%), followed by a Col7-NC1 ELISA (Euroimmun, Lübeck, Germany) (89·5%), WB with Col7-NC1 (85·3%), and IIF on saline-split human skin (74·7%). The specificities of both ELISA systems were comparable (NC1 98·7%, NC1/NC2 99·3%). Furthermore, WB was more sensitive than IIF, which was more specific. CONCLUSIONS The two commercially available ELISA systems allow for a highly sensitive and specific diagnosis of EBA. The sensitivity of the Col7-NC1/NC2 ELISA is significantly higher compared with the ELISA based on the Col7-NC1 domain only.
Collapse
Affiliation(s)
- T Schmidt
- Department of Dermatology and Allergology, Philipps-University, Marburg, D-35043, Germany
| | - M Hoch
- Department of Dermatology and Allergology, Philipps-University, Marburg, D-35043, Germany
| | - S S Lotfi Jad
- Department of Dermatology and Allergology, Philipps-University, Marburg, D-35043, Germany
| | - F Solimani
- Department of Dermatology and Allergology, Philipps-University, Marburg, D-35043, Germany
| | - G Di Zenzo
- Istituto Dermopatico dell'Immacolata, Rome, Italy
| | - A V Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano - Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - M Goebeler
- Department of Dermatology, Venereology and Allergology, Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - E Cozzani
- Dermatology, IRCCS AOU San Martino Di.S.Sal., Genoa, Italy
| | - J S Kern
- Department of Dermatology, Medical Center, University of Freiburg, Freiburg, Germany
| | - C Sitaru
- Department of Dermatology, Medical Center, University of Freiburg, Freiburg, Germany
| | - I Lakoš Jukić
- Department of Dermatovenerology, University of Zagreb, Zagreb, Croatia
| | - M Sárdy
- München, Department of Dermatology and Allergology, Ludwig Maximilians University Munich, Munich, Germany
| | - S Uzun
- Department of Dermatology and Venereology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - H Jedlickova
- Department of Dermatovenereology, St. Anna University Hospital, Masaryk University, Brno, Czech Republic
| | - R Gläser
- Department of Dermatology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - M Kaneda
- Medical and Biological Laboratories, Co. Ltd, Nagoya, Japan
| | - R Eming
- Department of Dermatology and Allergology, Philipps-University, Marburg, D-35043, Germany
| | - G Göpel
- Department of Dermatology and Allergology, Philipps-University, Marburg, D-35043, Germany
| | - N Ishii
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - B Greene
- Institute of Biometry and Statistics, Philipps-University Marburg, D-35043, Marburg, Germany
| | - T Hashimoto
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - M Hertl
- Department of Dermatology and Allergology, Philipps-University, Marburg, D-35043, Germany
| |
Collapse
|
35
|
Cugno M, Tedeschi A, Frossi B, Bossi F, Marzano AV, Asero R. Detection of Low-Molecular-Weight Mast Cell-Activating Factors in Serum From Patients With Chronic Spontaneous Urticaria. J Investig Allergol Clin Immunol 2017; 26:310-313. [PMID: 27763857 DOI: 10.18176/jiaci.0051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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
BACKGROUND AND OBJECTIVES Functionally active autoantibodies to IgE and to the high-affinity IgE receptor (FcεRI) can be detected in serum in about 40% of patients with chronic spontaneous urticaria (CSU). Recent studies showed that serum from patients with CSU can induce activation of mast cells, irrespective of whether they carry high-affinity IgE receptors. To evaluate mast cell activation induced by factors in the serum of CSU patients with a molecular weight lower than that of autoantibodies. METHODS Eight CSU patients and 5 healthy controls were evaluated. Whole serum and serum fractionated at 100, 50, and 30 kDa were used to stimulate in vitro LAD2 mast cells. The enzymatic activity of β-hexosaminidase was evaluated in supernatants and cell pellets as a measure of mast cell degranulation. RESULTS Mean (SEM) release of mast cell β-hexosaminidase induced by whole serum from CSU patients was higher than that induced by serum from the healthy controls (14.4 [2.7%] vs 5.1 [2.4%]; P=.027). In addition, serum fractions below 100 kDa and below 50 kDa from CSU patients induced mast cell degranulation that was significantly higher than that induced by the corresponding fractions in sera from healthy controls (10.2% [1.4%] vs 3.8% [1.9%] [P=.024] and 10.1% [1.2%] vs 3.9% [1.7%] [P=.012], respectively). In 4 CSU patients, we evaluated serum fractions <30 kDa, which retained their capacity to activate mast cells (11.0% [0.7%]). CONCLUSIONS This study shows that sera from CSU patients may contain low-molecular-weight mast cell-activating factors other than autoantibodies. These factors could be an additional mechanism contributing to the pathogenesis of CSU.
Collapse
Affiliation(s)
- M Cugno
- Medicina Interna, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - A Tedeschi
- SC Medicina Interna a Indirizzo Pneumologico, AO Fatebenefratelli e Oftalmico, Milano, Italy
| | - B Frossi
- Dipartmento di Scienze e Tecnologie Biomediche, Università di Udine, Udine, Italy
| | - F Bossi
- Dipartmento di Scienze Mediche, Chirurgiche e della Salute, Università di Trieste, Ospedale Universitario di Cattinara, Trieste, Italy
| | - A V Marzano
- Unità Operativa di Dermatologia, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - R Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| |
Collapse
|
36
|
Antiga E, Maglie R, Volpi W, Bianchi B, Berti E, Marzano AV, Caproni M. T helper type 1-related molecules as well as interleukin-15 are hyperexpressed in the skin lesions of patients with pyoderma gangrenosum. Clin Exp Immunol 2017; 189:383-391. [PMID: 28518224 DOI: 10.1111/cei.12989] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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] [Accepted: 05/11/2017] [Indexed: 01/03/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a rare, immune-mediated skin disease classified into the group of neutrophilic dermatoses. Although a number of studies confirmed the central role of innate immunity, only few studies have investigated the possible contributing role of acquired immunity. In particular, no reports concerning T helper type 1 (Th1) and Th2 cells are available as yet. Therefore, 15 patients with PG, five with Sweet's syndrome (SS) and nine skin specimens from healthy controls (HC) were investigated, evaluating the expression of Th1-related markers interleukin (IL)-12, interferon (IFN)-γ, C-X-C motif chemokine receptor 3 (CXCR3) and C-C motif chemokine receptor 5 (CCR5), of the Th2-related molecules IL-4, IL-5, IL-13 and CCR3, of the co-stimulatory axis CD40/CD40 ligand, of IL-15 and the natural killer (NK) cell marker CD56 in skin lesions by immunohistochemistry. Patients with PG and SS showed a higher expression of Th1 markers than HC. Conversely, IL-5- and CCR3-expressing cells were less numerous in PG skin lesions compared to SS (P = 0·0157 and < 0·0001, respectively). Both CD40 and CD40L were expressed more in PG than in SS and HC (P < 0·0001 for both). Finally, the number of IL-15+ and CD56+ cells was higher in the skin of patients with PG than in those of SS and HC (P < 0·0001 for both). Our results suggest that Th2 cells are down-regulated in PG. At the same time, over-expression of the co-stimulatory axis CD40/CD40L amplifies the impairment of the Th1/Th2 balance. Both these findings might explain the most aggressive behaviour of PG in comparison to SS. Moreover, over-expression of IL-15+ and CD56+ cells may suggest a possible role of NK cells in the pathogenesis of the disease.
Collapse
Affiliation(s)
- E Antiga
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
| | - R Maglie
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
| | - W Volpi
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
| | - B Bianchi
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
| | - E Berti
- Dermatology Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A V Marzano
- Dermatology Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Caproni
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
| |
Collapse
|
37
|
Marzano AV, Damiani G, Ceccherini I, Berti E, Gattorno M, Cugno M. Autoinflammation in pyoderma gangrenosum and its syndromic form (pyoderma gangrenosum, acne and suppurative hidradenitis). Br J Dermatol 2017; 176:1588-1598. [PMID: 27943240 DOI: 10.1111/bjd.15226] [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: 11/10/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a rare skin disease characterized clinically by ulcers with undermined borders, and histologically by neutrophil-rich infiltrates. PG may occur alone, in syndromic forms or associated with systemic diseases, such as inflammatory bowel disease and haematological or rheumatological disorders. OBJECTIVES To determine a specific genetic background related to autoinflammation for PG. METHODS We assessed autoinflammation by evaluating the cytokine profile and genes involved in classic autoinflammatory diseases in 13 patients with PG and in seven patients with the syndromic form, known as PASH (pyoderma gangrenosum, acne and suppurative hidradenitis). RESULTS In skin samples, the expression of interleukin (IL)-1β and its receptors, IL-17 and its receptor, and tumour necrosis factor-α and its receptors were significantly higher in both PG (P = 0·001) and in PASH (P < 0·001) than in controls. The chemokines IL-8; chemokine (C-X-C motif) ligand 1/2/3; chemokine (C-X-C motif) ligand 16; and RANTES (regulated on activation, normal T-cell-expressed and secreted) were also overexpressed. Cases of PG and PASH showed mutations in the autoinflammatory genes MEFV, NLRP3, NLRP12, NOD2, LPIN2 and PSTPIP1. CONCLUSIONS Overexpression of cytokines/chemokines, along with genetic changes, supports the hypothesis that PG and its syndromic form, PASH, are a spectrum of polygenic autoinflammatory conditions.
Collapse
Affiliation(s)
- A V Marzano
- IRCCS Cà Granda Foundation, Dermatology Unit, Department of Pathophysiology and Transplantation, University of Milan, Milan, 20122, Italy
| | - G Damiani
- IRCCS Cà Granda Foundation, Dermatology Unit, Department of Pathophysiology and Transplantation, University of Milan, Milan, 20122, Italy
| | | | - E Berti
- IRCCS Cà Granda Foundation, Dermatology Unit, Department of Pathophysiology and Transplantation, University of Milan, Milan, 20122, Italy
| | - M Gattorno
- Istituto Gaslini, Genetica Medica, Genoa, Italy
| | - M Cugno
- Internal Medicine, University of Milan, Milan, 20122, Italy
| |
Collapse
|
38
|
Affiliation(s)
- A V Marzano
- Dermatology Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Cà Granda Foundation, Via Pace 9, 20122, Milan, Italy.
| |
Collapse
|
39
|
Marzano AV, Borghi A, Meroni PL, Cugno M. Pyoderma gangrenosum and its syndromic forms: evidence for a link with autoinflammation. Br J Dermatol 2016; 175:882-891. [PMID: 27106250 DOI: 10.1111/bjd.14691] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2015] [Indexed: 12/13/2022]
Abstract
Pyoderma gangrenosum is a rare inflammatory neutrophilic dermatosis manifesting as painful ulcers with violaceous, undermined borders on the lower extremities. It may occur in the context of classic syndromes like PAPA (pyogenic arthritis, pyoderma gangrenosum and acne) and SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis), as well as in a recently described entity named PASH (pyoderma gangrenosum, acne and suppurative hidradenitis). Pyoderma gangrenosum has recently been included within the spectrum of autoinflammatory diseases, which are characterized by recurrent episodes of sterile inflammation, without circulating autoantibodies and autoreactive T cells. In PAPA syndrome, different mutations involving the PSTPIP1 gene, via an increased binding affinity to pyrin, induce the assembly of inflammasomes. These are molecular platforms involved in the activation of caspase 1, a protease that cleaves inactive prointerleukin (pro-IL)-1β to its active isoform IL-1β. The overproduction of IL-1β triggers the release of a number of proinflammatory cytokines and chemokines, which are responsible for the recruitment and activation of neutrophils, leading to neutrophil-mediated inflammation. In SAPHO syndrome, the activation of the PSTPIP2 inflammasome has been suggested to play a role in inducing the dysfunction of the innate immune system. Patients with PASH have recently been reported to present alterations of genes involved in well-known autoinflammatory diseases, such as PSTPIP1, MEFV, NOD2 and NLRP3. Pyoderma gangrenosum and its syndromic forms can be regarded as a single clinicopathological spectrum in the context of autoinflammation.
Collapse
Affiliation(s)
- A V Marzano
- Unità Operativa di Dermatologia, IRCCS Fondazione Cá Granda, Ospedale Maggiore Policlinico, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
| | - A Borghi
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
| | - P L Meroni
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Cattedra di Reumatologia, Istituto G. Pini, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - M Cugno
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Sezione di Medicina Interna, Università degli Studi di Milano, IRCCS Fondazione Cá Granda, Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
40
|
Affiliation(s)
- A V Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - G Damiani
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. .,Department of Dermatology, University of Trieste, Trieste, Italy.
| |
Collapse
|
41
|
Marzano AV, Frezzolini A, Caproni M, Parodi A, Fanoni D, Quaglino P, Girgenti V, La Placa M, Fabbri P, Caputo R, Berti E. Immunohistochemical Expression of Apoptotic Markers in Drug-Induced Erythema Multiforme, Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Int J Immunopathol Pharmacol 2016; 20:557-66. [PMID: 17880768 DOI: 10.1177/039463200702000313] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are considered to be severity variants of the same disease, which is almost always associated with drug intake. In contrast, erythema multiforme (EM) is a disorder regarded as only rarely caused by drugs. Keratinocyte apoptosis has been shown to play an important part in the pathogenesis of SJS and TEN, whilst its role in EM remains controversial. To determine the expression of apoptosis-associated molecules Fas, Fas ligand (FasL), Bcl-2 and Bax in the above disorders, an immunohistochemical analysis was performed. We studied both lesional skin from thirty patients having drug-induced EM and 5 cases classified within the SJS/TEN spectrum and normal skin samples. We found a keratinocyte overexpression of Fas antigen, an important molecule mediating apoptosis, not only in SJS and TEN but also in EM. Another noteworthy finding was the strong expression of Bcl-2, a protein known as blocking apoptosis, along the basal layer and in the dermal infiltrate both in SJS/TEN and in EM. Taken together, these findings suggest that Fas-dependent keratinocyte apoptosis may play a part in the pathogenesis of both SJS/TEN and EM. Fas-mediated cell death may be partially suppressed by the Bcl-2 protein.
Collapse
Affiliation(s)
- A V Marzano
- Institute of Dermatological Sciences, University of Milan, IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena of Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Rusmini M, Federici S, Caroli F, Grossi A, Baldi M, Obici L, Insalaco A, Tommasini A, Caorsi R, Gallo E, Olivieri AN, Marzano AV, Coviello D, Ravazzolo R, Martini A, Gattorno M, Ceccherini I. A Next Generation Sequencing approach to the mutational screening of patients affected with systemic autoinflammatory disorders: diagnosis improvement and interpretation of complex clinical phenotypes. Pediatr Rheumatol Online J 2015. [PMCID: PMC4596991 DOI: 10.1186/1546-0096-13-s1-o24] [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: 11/17/2022] Open
|
43
|
Papini M, Quaglino P, La Placa M, Marzano AV. A project by the SIDeMaST Immunopathology Group on cutaneous vasculitis. GIORN ITAL DERMAT V 2015; 150:165-167. [PMID: 25876144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Vasculitides are a challenge to the clinician, in terms of both diagnosis and therapy. Multiple classification systems have been implemented and the numerous classification schemes reflect the complexity of establishing a simple classification that could be functional for daily care. Although vasculitis classification has become increasingly elaborated, some areas remain ill defined. Some forms of vasculitis are still difficult to assign to a specific disease entity. Generally accepted operational criteria are available for many vasculitides, but for some entities there are no effective criteria. Moreover, diagnostic criteria for vasculitis with sufficient strength and/or confidence that can be universally accepted are not yet available. The need for diagnostic criteria validated and agreed upon is particularly relevant in the context of cutaneous vasculitis. The project of the SIDeMaST Italian Group of Immunopathology on cutaneous vasculitis is a national prospective observational study designed to develop and validate diagnostic criteria and to improve and validate classification criteria for cutaneous small vessel vasculitis also known as leukocytoclastic vasculitis (CLV). Primary objective of the study will also be that of developing the CUtaneous VAsculitis Severity Index (CUVASI). Secondary objectives of the project will be: 1) definition of the etiological agents that are most frequently associated with CLV; 2) search for possible correlations between causative agent and peculiar clinical and/or histopathological aspects; 3) evaluation of immunofluorescence pattern observed in this specific group of primitive cutaneous vasculitis in order to characterize the diagnostic sensitivity and specificity of this technique; 4) identification of a set of clinical investigations and laboratory tests to be performed for a correct CLV assessment. Actually 15 Italian dermatological clinics are contributing to the project and anticipated recruiting >100 patients with CLV. A pilot retrospective study to assess the feasibility of the project is going to be launched and if its results are positive then the prospective study will be started and it promises to be a unique opportunity to evaluate a large database on CLV in Italian population.
Collapse
Affiliation(s)
- M Papini
- Terni Dermatological Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy -
| | | | | | | |
Collapse
|
44
|
Marzano AV, Pigatto P, Cristaudo A, Ayala F, Rossi O, Senna G, Triggiani M, Asero R. Management of chronic spontaneous urticaria: practical parameters. GIORN ITAL DERMAT V 2015; 150:237-246. [PMID: 25714626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Chronic urticaria (CU) is a skin disorder characterized by transient, pruritic wheals persisting for longer than 6 weeks. According to the European Academy of Allergy and Clinical Immunology (EAACI) guidelines, CU can be categorized into two main types: chronic spontaneous urticaria (CSU), in which the wheals appear spontaneously, and inducible urticaria, that is triggered by physical agents. CSU may be due to triggering factors such as food allergens or infections, but in at least 40% of cases it is autoimmune in origin, caused by circulating autoantibodies anti-FcεR1 or anti-IgE, or autoreactive. In the present paper, re-evaluating the EAACI guidelines, we have developed a document containing some practical indications which are useful for diagnosis and management of CSU in the context of the Italian situation. Concerning CSU treatment, second generation antihistamines are the first-line treatment; these drugs can be used, as second-line treatment, at a higher than licensed dose in patients who do not respond adequately at licensed doses. The third-line treatment includes leukotriene receptor antagonists which, however, do not have a specific indication for the treatment of CSU, cyclosporine, whose use in this disease is still off-label, and omalizumab. The latter is a recombinant monoclonal IgG antibody that binds free IgE, down regulates mast cell function and induces eosinophil apoptosis. Recently, it has emerged as an effective and safe treatment for antihistamine-unresponsive CSU of both autoimmune/autoreactive and non-autoimmune/non-autoreactive, and has been officially approved for use against this disease.
Collapse
Affiliation(s)
- A V Marzano
- Unit of Dermatology, Department of Physiopathology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy -
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Marzano AV, Balice Y, Tavecchio S, Desimine C, Colombo A, Berti E. Granulomatous vasculitis. GIORN ITAL DERMAT V 2015; 150:193-202. [PMID: 25791629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Wegener's granulomatosis and Churg-Strauss Syndrome respectively, are systemic granulomatous vasculitides affecting small- and medium-sized blood vessels. Both GPA and EGPA are included within the group of antineutrophilic cytoplasmic antibodies (ANCA)-associated vasculitides, on the basis of the detection of such autoantibodies in a significant proportion of affected patients. Two main settings of GPA, possibly overlapping each other, are recognized: a localized form, which is limited to the upper airways but is highly relapsing and refractory, and a diffuse form, which is initially more severe but then less commonly recurrent. In EGPA, a prodromic phase characterized by asthma and rhino-sinusitis is followed by an eosinophilic phase, marked by peripheral eosinophilia, and then by a vasculitic phase, in which skin lesions are a prominent feature together with peripheral neuropathy and renal involvement. Polymorphic cutaneous manifestations can occur during the course of both GPA and EGPA, and include palpable purpura, livedo reticularis, papules, nodules, vesiculo-bullae and necrotic-ulcerative lesions most commonly involving the lower extremities; pyoderma gangrenosum-like ulcers and lesions resembling erythema multiforme have been described in GPA and EGPA, respectively. Oral involvement is not uncommon in GPA and may manifest as nonspecific erosive lesions or as a hyperplastic gingivitis named strawberry gingivitis. Considering that skin involvement is common in ANCA-associated vasculitides and may also be their presenting sign, the role of dermatologist is crucial in the early diagnosis of these forms as well as of vasculitis in general.
Collapse
Affiliation(s)
- A V Marzano
- Operative Unit of Dermatology, Department of Transplantation, Medico-Surgical Physiopathology,University of Milan, Ca' Granda IRCCS Foundation, Ospedale Maggiore Policlinico, Milan, Italy -
| | | | | | | | | | | |
Collapse
|
46
|
Marzano AV, Tavecchio S, Venturini M, Sala R, Calzavara-Pinton P, Gattorno M. Urticarial vasculitis and urticarial autoinflammatory syndromes. GIORN ITAL DERMAT V 2015; 150:41-50. [PMID: 25586657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Urticaria is a frequent disorder classified as acute and chronic forms, which presents with wheals that can be associated with angioedema. Several entities may manifest with urticarial skin lesions, encompassing a heterogeneous group of conditions that have to be differentiated from ordinary urticaria. This review is focused on two of these urticarial syndromes: urticarial vasculitis (UV), which represents the most important differential diagnosis with common urticaria, and autoinflammatory diseases such as cryopyrin-associated periodic syndromes (CAPS) and Schnitzler's Syndrome, both rare multisystem forms that may masquerade as common urticaria. UV is a small-vessel vasculitis with predominant skin involvement, characterized by wheals persisting for more than 24 hours, burning rather than itching and resolving with hyperpigmentation as well as by other cutaneous manifestations including purpura, papules, vesicles, bullae and necrotic-ulcerative lesions. Histology shows a classic pattern of leukocytoclastic vasculitis, with possible presence of upper dermal edema. CAPS are classified as three distinct entities: familial cold autoinflammatory syndrome, Muckle-Wells Syndrome and chronic infantile neurological cutaneous and articular syndrome, which represent a spectrum of disorders caused by different mutations in a single gene, NLRP3 (NOD-like receptor 3). This gene encodes for cryopyrin, an inflammasome protein that activates interleukin-1β, leading to an overproduction of this pivotal proinflammatory cytokine. Histologically, urticarial lesions are generally characterized by a perivascular neutrophilic infiltrate. Unlike urticaria, neither UV nor urticarial autoinflammatory syndromes do respond to antihistamines: thus, it is important not to misdiagnose such conditions in order to give the patients specific treatments, potentially preventing serious systemic complications.
Collapse
Affiliation(s)
- A V Marzano
- Department of Medico‑Surgical and Transplantation Physiopathology, Operative Unit of Dermatology,University of Milan, Italy, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy -
| | | | | | | | | | | |
Collapse
|
47
|
Marzano AV, Fanoni D, Antiga E, Quaglino P, Caproni M, Crosti C, Meroni PL, Cugno M. Expression of cytokines, chemokines and other effector molecules in two prototypic autoinflammatory skin diseases, pyoderma gangrenosum and Sweet's syndrome. Clin Exp Immunol 2014; 178:48-56. [PMID: 24903614 DOI: 10.1111/cei.12394] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2014] [Indexed: 12/23/2022] Open
Abstract
Pyoderma gangrenosum (PG) and Sweet's syndrome (SS) are two inflammatory skin diseases presenting with painful ulcers and erythematous plaques, respectively; both disorders have a debilitating clinical behaviour and PG is potentially life-threatening. Recently, PG and SS have been included among the autoinflammatory diseases, which are characterized by recurrent episodes of sterile inflammation, without circulating autoantibodies and autoreactive T cells. However, an autoinflammatory pattern clearly supporting this inclusion has never been demonstrated. We studied 16 patients with PG, six with SS and six controls, evaluating, using a sandwich-based protein antibody array method, the expression profile of inflammatory effector molecules in PG, SS and normal skin. The expressions of interleukin (IL)-1 beta and its receptor I were significantly higher in PG (P = 0·0001 for both) and SS (P = 0·004-0·040) than in controls. In PG, chemokines such as IL-8 (P = 0·0001), chemokine (C-X-C motif) ligand (CXCL) 1/2/3 (P = 0·002), CXCL 16 (P = 0·003) and regulated upon activation normal T cell expressed and secreted (RANTES) (P = 0·005) were over-expressed. In SS, IL-8 (P = 0·018), CXCL 1/2/3 (P = 0·006) and CXCL 16 (P = 0·036) but not RANTES were over-expressed, suggesting that chemokine-mediated signals are lower than in PG. Fas/Fas ligand and CD40/CD40 ligand systems were over-expressed in PG (P = 0·0001 for Fas, P = 0·009 for Fas ligand, P = 0·012 for CD40, P = 0·0001 for CD40 ligand), contributing to tissue damage and inflammation, while their role seems to be less significant in SS. Over-expression of cytokines/chemokines and molecules amplifying the inflammatory network supports the view that PG and SS are autoinflammatory diseases. The differences in expression profile of inflammatory effectors between these two disorders may explain the stronger local aggressiveness in PG than SS.
Collapse
Affiliation(s)
- A V Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Marzano AV, Tavecchio S, Menicanti C, Crosti C. Drug-induced lupus erythematosus. GIORN ITAL DERMAT V 2014; 149:301-309. [PMID: 24819757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Drug-induced lupus erythematosus (DI-LE) is defined as an entity characterized by clinical manifestations and immunopathological serum findings similar to those of idiopathic lupus but which is temporally related to drug exposure and resolves after withdrawal of the implicated drug. Similarly to idiopathic lupus, DI-LE can be divided into systemic LE, subacute cutaneous LE (SCLE), chronic cutaneous LE (CCLE) and cutaneous LE tumidus. DI-SCLE is the most frequent variant of drug-induced cutaneous LE and presents mainly with annular-polycyclic lesions; the clinical picture is often widespread, with involvement of the lower legs that are usually spared in idiopathic SCLE. ANA and anti-Ro/SSA antibodies are typically present, whereas antihistone antibodies are uncommonly found. We have recently addressed the question whether DI-SCLE differs significantly from its idiopathic counterpart by virtue of clinical features and, based on our findings, we have suggested that the frequent occurrence of malar rash and bullous, erythema multiforme-like and vasculitic manifestations can be regarded as the hallmark of DI-SCLE. In contrast, the histology is not a useful diagnostic criterion for DI-SCLE, considering that the typical pattern of lichenoid interface dermatitis is seen only in the early stage of disease and tissue eosinophilia does not represent a differentiating histopathological feature. DI-CCLE and DI-LE tumidus, albeit possibly misdiagnosed, are rarely observed and are characterized by classic discoid lesions and erythematous-oedematous plaques on sun exposed areas, respectively. Management of DI-LE is based on the discontinuation of the offending drug; topical and/or systemic corticosteroids and other immunomodulating/immunosuppressive agents should be reserved for resistant cases.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Antinuclear/blood
- Biomarkers/blood
- Drug Therapy, Combination
- Female
- Glucocorticoids/therapeutic use
- Humans
- Immunologic Factors/blood
- Immunosuppressive Agents/therapeutic use
- Leg/pathology
- Lupus Erythematosus, Cutaneous/diagnosis
- Lupus Erythematosus, Cutaneous/drug therapy
- Lupus Erythematosus, Cutaneous/etiology
- Lupus Erythematosus, Cutaneous/immunology
- Lupus Erythematosus, Cutaneous/pathology
- Lupus Erythematosus, Discoid/etiology
- Lupus Erythematosus, Discoid/pathology
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/drug therapy
- Lupus Erythematosus, Systemic/etiology
- Lupus Erythematosus, Systemic/immunology
- Lupus Erythematosus, Systemic/pathology
- Male
- Middle Aged
- Torso/pathology
- Treatment Outcome
Collapse
Affiliation(s)
- A V Marzano
- Operative Unit of Dermatology Department of Pathophysiology and Transplantation University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy -
| | | | | | | |
Collapse
|
49
|
Tedeschi A, Marzano AV, Lorini M, Balice Y, Cugno M. Eosinophil cationic protein levels parallel coagulation activation in the blister fluid of patients with bullous pemphigoid. J Eur Acad Dermatol Venereol 2014; 29:813-7. [PMID: 24650303 DOI: 10.1111/jdv.12464] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 02/17/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP) is an autoimmune blistering disease due to autoantibodies against two hemidesmosomal antigens, namely BP180 and BP230, and characterized by coagulation activation both at cutaneous and systemic levels. Skin-infiltrating eosinophils contribute to bulla formation and, upon activation, are supposed to initiate the coagulation cascade. OBJECTIVE The aim of this study was to investigate whether the activation of eosinophils and coagulation are linked in BP. METHODS We evaluated the correlation between eosinophil cationic protein (ECP) levels and concentrations of the prothrombotic markers F1 + 2 and D-dimer in blister fluid and blood samples of 30 BP patients. Thirty healthy subjects were used as normal controls. RESULTS ECP, F1 + 2 and D-dimer plasma levels were significantly higher in BP patients than in normal subjects. A significant correlation was found between ECP plasma levels and blood eosinophil count (r = 0.54, P = 0.002). F1 + 2 plasma levels positively correlated with disease severity, expressed as the percentage of body surface area involved (r = 0.36, P = 0.048). A striking increase in ECP (288.8 ± 45.2 ng/mL), F1 + 2 (31 409.9 ± 2929.4 pmol/L) and D-dimer levels (342 798.3 ± 44 206 ng/mL) was found in blister fluid from BP patients. In blister fluid, ECP levels were significantly higher than in peripheral blood (P < 0.0001) and were positively correlated with the levels of both F1 + 2 (r = 0.4, P = 0.02) and D-dimer (r = 0.5, P = 0.0045). CONCLUSIONS ECP levels are strikingly elevated in blister fluids from BP patients and correlate with markers of coagulation activation, supporting the view that eosinophils initiate the coagulation cascade at skin level.
Collapse
Affiliation(s)
- A Tedeschi
- Unità Operativa di Allergologia e Immunologia Clinica, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | | | | |
Collapse
|
50
|
Marzano AV, Menicanti C, Crosti C, Trevisan V. Neutrophilic dermatoses and inflammatory bowel diseases. GIORN ITAL DERMAT V 2013; 148:185-196. [PMID: 23588144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Pyoderma gangrenosum (PG) and Sweet's Syndrome (SS) are inflammatory skin diseases caused by the accumulation of neutrophils in the skin and, rarely, in internal organs, which led to coining the term of neutrophilic dermatoses (ND) to define these conditions. Recently, ND have been included among the autoinflammatory diseases, which are forms due to mutations of genes regulating the innate immune responses. Both PG and SS are frequently associated with inflammatory bowel diseases (IBD), a group of chronic intestinal disorders which comprises ulcerative colitis and Crohn's disease and whose pathogenesis involves both the innate and adaptive immunity in genetically prone individuals. Patients with IBD develop PG in 1-3% of cases, while SS is rarer. PG presents with deep erythematous-to-violaceous painful ulcers with undermined borders, but bullous, pustular, and vegetative variants can also occur. SS, also known as acute febrile neutrophilic dermatosis, is characterized by the abrupt onset of fever, peripheral neutrophilia, tender erythematous skin lesions and a diffuse neutrophilic dermal infiltrate. In this review that will be focused on PG and SS, we will describe also the aseptic abscesses syndrome, a new entity within the spectrum of ND which frequently occurs in association with IBD and is characterized by deep abscesses mainly involving the spleen and skin and by polymorphic cutaneous manifestations including PG- and SS-like lesions.
Collapse
Affiliation(s)
- A V Marzano
- Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Italy.
| | | | | | | |
Collapse
|