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Hwang A, Kechter J, Do T, Hughes A, Zhang N, Li X, Wasikowski R, Brumfiel C, Patel M, Boudreaux B, Bhullar P, Nassir S, Yousif M, DiCaudo DJ, Fox J, Gharaee-Kermani M, Xing X, Zunich S, Branch E, Kahlenberg JM, Billi AC, Plazyo O, Tsoi LC, Pittelkow MR, Gudjonsson JE, Mangold AR. Oral Baricitinib in the Treatment of Cutaneous Lichen Planus. medRxiv 2024:2024.01.09.24300946. [PMID: 38260663 PMCID: PMC10802654 DOI: 10.1101/2024.01.09.24300946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background Cutaneous lichen planus (LP) is a recalcitrant, difficult-to-treat, inflammatory skin disease characterized by pruritic, flat-topped, violaceous papules on the skin. Baricitinib is an oral Janus kinase (JAK) 1/2 inhibitor that interrupts the signaling pathway of interferon (IFN)-γ, a cytokine implicated in the pathogenesis of LP. Methods In this phase II trial, twelve patients with cutaneous LP received baricitinib 2 mg daily for 16 weeks, accompanied by in-depth spatial, single-cell, and bulk transcriptomic profiling of pre-and post-treatment samples. Results An early and sustained clinical response was seen with 83.3% of patients responsive at week 16. Our molecular data identified a unique, oligoclonal IFN-γ, CD8+, CXCL13+ cytotoxic T-cell population in LP skin and demonstrate a rapid decrease in interferon signature within 2 weeks of treatment, most prominent in the basal layer of the epidermis. Conclusion This study demonstrates the efficacy and molecular mechanisms of JAK inhibition in LP. Trial Registration Number : NCT05188521.
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2
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Shahin AB, Greene A, Reeder CB, Costello CM, Pittelkow MR, DiCaudo DJ. Paraneoplastic morphea with prominent mucin deposition. JAAD Case Rep 2023; 41:110-112. [PMID: 37920700 PMCID: PMC10618618 DOI: 10.1016/j.jdcr.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Affiliation(s)
| | - Adina Greene
- University of Arizona College of Medicine, Phoenix, Arizona
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Craig B. Reeder
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona
| | | | | | - David J. DiCaudo
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona
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Hwang AS, Hoss E, Pittelkow MR, Yang YW. Treatment of Hydroxyurea-Induced Ulcers With Timolol. JAMA Dermatol 2023; 159:1277-1279. [PMID: 37728912 DOI: 10.1001/jamadermatol.2023.2765] [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] [Indexed: 09/22/2023]
Abstract
This report evaluates the use of timolol in 2 patients with long-term hydroxyurea use and lower-extremity ulcers resistant to other treatments.
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Affiliation(s)
| | - Elika Hoss
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | | | - Yul W Yang
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
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Xie F, Morken CM, Zhang N, Pittelkow MR, Sartori Valinotti JC, Comfere NI, Meves A, Murphree DH, Mangold AR, Lehman JS. Development of the lichen planus quality of life questionnaire (LPQoL) informed by expert clinician input and patient feedback: a retrospective survey study. Arch Dermatol Res 2023; 315:1561-1569. [PMID: 36715723 DOI: 10.1007/s00403-023-02534-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/31/2023]
Abstract
Lichen planus (LP) can affect multiple body sites including skin, mucosae, scalp and nails, causing considerable impact on patients' quality of life. Currently, there are no LP patient-reported outcome measures (PROMs) that address all body sites potentially affected by LP. We developed a LP Quality of Life Questionnaire (LPQoL), informed by an expert consortium and patient survey study, to address this gap. The study was approved by our institution's Institutional Review Board. First, a 22-item LPQoL was designed with input from LP experts at our institution. The tool was then optimized by garnering input from patients recently diagnosed with LP, who were asked to complete the LPQoL, as well as the Dermatology Life Quality Index (DLQI) and a feedback form about the LPQoL. Fifty-eight of 150 patients (39% response rate) returned the questionnaire. Mean DLQI score was 4.9 ± 5.6 SD (range 0-25) and mean LPQoL score was 13.6 ± 10.4 SD (range 0-54). LPQoL score was positively correlated with DLQI score (r = 0.79; p < 0.001). Forty-nine out of 56 (88%) and 6/56 (11%) rated the LPQoL as 'very easy' or 'fairly easy' to complete, respectively. Based on participants' feedback, we increased the recall period from one week to one month and added questions on esophageal involvement. With iterative input from LP experts and patients, we developed a LPQoL to address the gap in a multi-site PROM specific to LP. This is a pilot study and there is ongoing validation studies; therefore, this measure should not be used in clinical practice or research until validated.
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Affiliation(s)
- Fangyi Xie
- Department of Dermatology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Colleen M Morken
- Department of Dermatology, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA
| | - Nan Zhang
- Department of Quantitative Health Sciences, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA
| | | | - Nneka I Comfere
- Department of Dermatology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Alexander Meves
- Department of Dermatology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
- Department of Biochemistry and Molecular Biology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Dennis H Murphree
- Department of Dermatology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
- Department of Artificial Intelligence and Informatics, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
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5
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Puri P, Pollock BD, Yousif M, Bhullar PK, Boudreaux BW, Fox LP, Rosenbach M, Pittelkow MR, Mangold AR. Association of society of dermatology hospitalist institutions with improved outcomes in Medicare beneficiaries hospitalized for skin disease. J Am Acad Dermatol 2023:S0190-9622(23)00156-1. [PMID: 36736624 DOI: 10.1016/j.jaad.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 02/04/2023]
Affiliation(s)
- Pranav Puri
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Benjamin D Pollock
- Department of Health Services Research, Mayo Clinic, Jacksonville, Florida
| | - Miranda Yousif
- University of Arizona College of Medicine, Phoenix, Arizona
| | | | | | - Lindy P Fox
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Misha Rosenbach
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona.
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6
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Morken CM, Bhullar PK, Boudreaux BW, Xie F, Zhang N, Lehman JS, Pittelkow MR, Mangold AR. Availability of a validated cutaneous lichen planus disease index: a systematic review. Int J Dermatol 2022. [DOI: 10.1111/ijd.16563] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Affiliation(s)
| | | | | | - Fangyi Xie
- Department of Dermatology Mayo Clinic Rochester MN USA
| | - Nan Zhang
- Department of Research and Biostatistics Mayo Clinic Phoenix AZ USA
| | - Julia S. Lehman
- Department of Dermatology Mayo Clinic Rochester MN USA
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester MN USA
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Hines A, Butterfield R, Boudreaux B, Bhullar P, Severson KJ, McBane RD, Davis MDP, Pittelkow MR, Mangold AR, Alavi A. Characteristics of ulcerated and non‐ulcerated necrobiosis lipoidica. Int J Dermatol 2022; 62:790-796. [PMID: 36479693 DOI: 10.1111/ijd.16529] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/30/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Necrobiosis lipoidica (NL) is complicated by ulceration in up to 35% of cases. METHODS Retrospective study of patients with NL seen at our institution between January 1, 1992, and May 25, 2021, was conducted. Ulcerated NL (UNL, n = 83) and non-ulcerated NL (NUNL, n = 233) groups were compared. RESULTS Twenty-six percent (83/316) of patients with NL experienced ulceration. UNL was significantly more likely to be painful (52% vs. 36%, P = 0.01), was more likely to have a lesion-associated cutaneous malignancy (7% vs. 0%, P < 0.001), and had a larger median size (7 vs. 5 cm, P = 0.004) compared to NUNL. Vascular studies were performed on a subset of patients and revealed transcutaneous oxygen pressure (TcPO2) < 40 mm Hg in 53% and venous insufficiency in 62% with no significant differences between UNL and NUNL groups. In patients with unilateral ulceration, mean TcPO2 values (39.7 vs. 46.6 mm Hg), regional perfusion index <0.6 (29% vs. 14%), and TcPO2 < 40 mm Hg (43% vs. 14%) were worse in the ulcerated leg compared to the non-ulcerated leg, but these differences were not statistically significant. CONCLUSIONS UNL was more likely to be painful, develop lesion-associated malignancy, and be larger in size compared to NUNL. There were no statistically significant differences in venous insufficiency, arterial Doppler/ankle brachial index, or TcPO2 values between UNL and NUNL patients, however, a significant portion of the cohort demonstrated abnormal vascular studies, particularly on TcPO2 and venous insufficiency testing.
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Affiliation(s)
| | | | | | | | | | - Robert D. McBane
- Division of Vascular Medicine of Cardiovascular Diseases Mayo Clinic Rochester MN USA
| | | | | | | | - Afsaneh Alavi
- Department of Dermatology Mayo Clinic Rochester MN USA
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8
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Puri P, Patel MH, Brumfiel CM, Pittelkow MR, Mangold AR. Consolidation of US dermatology practices. Int J Dermatol 2022; 61:e490-e491. [PMID: 34859886 DOI: 10.1111/ijd.16017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/27/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Pranav Puri
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Meera H Patel
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
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9
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Murphree DH, Puri P, Shamim H, Bezalel SA, Drage LA, Wang M, Pittelkow MR, Carter RE, Davis MDP, Bridges AG, Mangold AR, Yiannias JA, Tollefson MM, Lehman JS, Meves A, Otley CC, Sokumbi O, Hall MR, Comfere N. Deep learning for dermatologists: Part I. Fundamental concepts. J Am Acad Dermatol 2022; 87:1343-1351. [PMID: 32434009 PMCID: PMC7669702 DOI: 10.1016/j.jaad.2020.05.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/16/2020] [Accepted: 05/12/2020] [Indexed: 12/31/2022]
Abstract
Artificial intelligence is generating substantial interest in the field of medicine. One form of artificial intelligence, deep learning, has led to rapid advances in automated image analysis. In 2017, an algorithm demonstrated the ability to diagnose certain skin cancers from clinical photographs with the accuracy of an expert dermatologist. Subsequently, deep learning has been applied to a range of dermatology applications. Although experts will never be replaced by artificial intelligence, it will certainly affect the specialty of dermatology. In this first article of a 2-part series, the basic concepts of deep learning will be reviewed with the goal of laying the groundwork for effective communication between clinicians and technical colleagues. In part 2 of the series, the clinical applications of deep learning in dermatology will be reviewed and limitations and opportunities will be considered.
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Affiliation(s)
- Dennis H Murphree
- Department of Health Sciences Research, Division of Digital Health Sciences, Mayo Clinic, Rochester, Minnesota; Mayo Clinic Office of Artificial Intelligence in Dermatology.
| | - Pranav Puri
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Huma Shamim
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Spencer A Bezalel
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Lisa A Drage
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Michael Wang
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Mark R Pittelkow
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Rickey E Carter
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - Mark D P Davis
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Alina G Bridges
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Aaron R Mangold
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | | | - Megha M Tollefson
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Julia S Lehman
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Alexander Meves
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Clark C Otley
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Olayemi Sokumbi
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Jacksonville, Florida; Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida
| | - Matthew R Hall
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Jacksonville, Florida
| | - Nneka Comfere
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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10
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Puri P, Comfere N, Drage LA, Shamim H, Bezalel SA, Pittelkow MR, Davis MDP, Wang M, Mangold AR, Tollefson MM, Lehman JS, Meves A, Yiannias JA, Otley CC, Carter RE, Sokumbi O, Hall MR, Bridges AG, Murphree DH. Deep learning for dermatologists: Part II. Current applications. J Am Acad Dermatol 2022; 87:1352-1360. [PMID: 32428608 PMCID: PMC7669658 DOI: 10.1016/j.jaad.2020.05.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 01/14/2023]
Abstract
Because of a convergence of the availability of large data sets, graphics-specific computer hardware, and important theoretical advancements, artificial intelligence has recently contributed to dramatic progress in medicine. One type of artificial intelligence known as deep learning has been particularly impactful for medical image analysis. Deep learning applications have shown promising results in dermatology and other specialties, including radiology, cardiology, and ophthalmology. The modern clinician will benefit from an understanding of the basic features of deep learning to effectively use new applications and to better gauge their utility and limitations. In this second article of a 2-part series, we review the existing and emerging clinical applications of deep learning in dermatology and discuss future opportunities and limitations. Part 1 of this series offered an introduction to the basic concepts of deep learning to facilitate effective communication between clinicians and technical experts.
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Affiliation(s)
- Pranav Puri
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona; Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota
| | - Nneka Comfere
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
| | - Lisa A Drage
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Huma Shamim
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Spencer A Bezalel
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Mark R Pittelkow
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Mark D P Davis
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Michael Wang
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Aaron R Mangold
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Megha M Tollefson
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Julia S Lehman
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Alexander Meves
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | | | - Clark C Otley
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Rickey E Carter
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - Olayemi Sokumbi
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Jacksonville, Florida; Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida
| | - Matthew R Hall
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Jacksonville, Florida
| | - Alina G Bridges
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Dennis H Murphree
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Health Sciences Research, Division of Digital Health Sciences, Mayo Clinic, Rochester, Minnesota
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Boudreaux BW, Pincelli TP, Bhullar PK, Patel MH, Brumfiel CM, Li X, Heckman MG, Pittelkow MR, Mangold AR, Sluzevich JC. Secukinumab for the treatment of adult-onset pityriasis rubra pilaris: a single-arm clinical trial with transcriptomic analysis. Br J Dermatol 2022; 187:650-658. [PMID: 35701384 DOI: 10.1111/bjd.21708] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/04/2022] [Accepted: 06/11/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The pathogenesis of pityriasis rubra pilaris (PRP) is not completely understood, but interleukin (IL)-17 has been shown to play a critical role. There are no reliable immunomodulatory agents to treat PRP. We conducted an open-label, single-arm clinical trial of secukinumab, a monoclonal antibody that inhibits IL-17A, for the treatment of PRP. OBJECTIVES To evaluate the clinical efficacy of secukinumab and define the transcriptomic landscape of PRP and its response to IL-17A blockade. METHODS Twelve patients with PRP were recruited for an open-label trial of secukinumab. Patients received a 24-week course of secukinumab. The primary endpoint was a ≥ 75% reduction in Psoriasis Area and Severity Index (PASI 75) from baseline to week 28. Secondary endpoints included PASI 90, change in Physician's Global Assessment (PGA), and change in Dermatology Life Quality Index (DLQI). RNA sequencing was performed on lesional and nonlesional skin biopsies obtained at baseline and week 2. Sample groups were compared to identify differential gene expression and pathway enrichment. This trial was registered with ClinicalTrials.gov: 'Cosentyx (secukinumab) for the treatment of adult onset pityriasis rubra pilaris' - NCT03342573. RESULTS At week 28, six of 11 patients (55%) achieved PASI 75, and three patients (27%) achieved PASI 90. PGA (P = 0.008) and DLQI scores (P = 0.010) showed significant improvement with treatment. No serious treatment-related adverse events were encountered. Treatment with secukinumab normalized transcriptional differences between lesional and nonlesional skin. Transcriptomic data from nonresponsive patients suggest that overactivity of innate immune pathways may be driving resistance to secukinumab. CONCLUSIONS Secukinumab appears to be an effective treatment for PRP and warrants further investigation. PRP is a transcriptionally heterogeneous disease, reflecting its variable response to therapy. Agents targeting other IL-17 isoforms and innate immune mediators should be considered for future clinical trials. What is already known about this topic? The pathogenesis of pityriasis rubra pilaris is incompletely understood. Successful treatment has been reported with a variety of immunomodulatory agents, but disease is often refractory to therapy. Interleukin (IL)-17 is thought to drive keratinocyte proliferation and vascular dysfunction in this disease. A previous trial demonstrated efficacy of the anti-IL-17A drug ixekizumab for pityriasis rubra pilaris. What does this study add? Herein we describe the findings of a clinical trial of secukinumab, an anti-IL-17A monoclonal antibody, for the treatment of pityriasis rubra pilaris. Secukinumab was effective in treating pityriasis rubra pilaris. Our transcriptomic data give new insight into the expressional changes that occur in response to secukinumab and suggest mechanisms of treatment resistance.
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Affiliation(s)
| | | | - Puneet K Bhullar
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Meera H Patel
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | | | - Xing Li
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ, USA
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12
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Besch-Stokes J, Bhullar P, Puri P, Boudreaux B, Costello C, Rule W, Rosenthal A, DiCaudo DJ, Pittelkow MR, Mangold A. 32888 Primary cutaneous B-cell lymphoma treated with systemic rituximab. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Lai J, Basford JR, Pittelkow MR. Levels of secretory leukocyte protease inhibitor expression in acute wounds. J Wound Care 2022; 31:S15-S19. [PMID: 35797252 DOI: 10.12968/jowc.2022.31.sup7.s15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Even with our best practices, we are frequently unable to prevent slow and stalled wound healing-particularly in people with impaired circulation and conditions such as diabetes. As a result, greater insight into the nature of wound healing and alternative treatment approaches is needed. An avenue that may be of particular promise is increasing understanding of the role of secretory leukocyte protease inhibitor (SLPI) as there is evidence that it enhances wound healing, its expression increases in response to inflammation and infection, and it exhibits anti-protease, anti-inflammatory, antiviral antibacterial and antifungal activities. METHOD The response of SLPI levels to wounding and skin injury was assessed by taking punch skin biopsies from healthy volunteers and assessing the levels of SLPI at the site of injury at the time of wounding (baseline) as well as one, two, three, four, seven, nine and 12 weeks later. RESULTS A total of 35 volunteers took part in the study. Significant elevations were found: levels of SLPI were greatly increased, 12 times that at baseline, and remained elevated at three weeks despite re-epithelialisation having occurred. CONCLUSION These findings not only suggest that levels of SLPI rise rapidly following wounding, but that these elevations are sustained, and continue to increase even when re-epithelialisation has occurred. These results suggest that the role and potential benefits of this protease inhibitor deserve further exploration.
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Affiliation(s)
- Jengyu Lai
- Department of Dermatology, Mayo Clinic College of Medicine, Rochester, MN, US.,International University of the Health Sciences, St Kitts, West Indies
| | - Jeffrey R Basford
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, MN, US
| | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic College of Medicine, Rochester, MN, US
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14
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Besch-Stokes J, Brumfiel CM, Patel MH, Harvey J, Montoya J, Severson KJ, Cumsky H, Buras M, Fagoaga JEG, Costello CM, Pittelkow MR, Mangold AR. Skin Cancer Knowledge, Attitudes and Sun Protection Practices in the Hispanic Population: A Cross-Sectional Survey. J Racial Ethn Health Disparities 2022; 10:1293-1303. [PMID: 35486349 DOI: 10.1007/s40615-022-01314-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022]
Abstract
Hispanics are more likely to be diagnosed with skin cancer at a later stage and experience worse overall survival than Whites. The objective of this cross-sectional study was to assess the skin cancer knowledge, attitudes, perceived risk, and sun protection practices among an underserved population in the Phoenix area. We recruited participants from the greater Phoenix area to undergo skin examination and complete a questionnaire. 208 participants were included. The majority were Hispanic (64.9%). Of this Hispanic group, most were from Mexico (87.9%). The Hispanic cohort had an overall mean skin cancer knowledge score of 3.68/6, the lowest of any other racial/ethnic group, but had the highest desire to learn more about skin cancer (64.6%, "strongly agree"). They were the most concerned about developing skin cancer (50.4%, "very concerned") but had relatively lower rates of sun protection practices (7.9% "always use" sunscreen, 22.0% "always use" sun-protective clothing). Limitations of this study include a small sample size, lack of validation for the skin cancer knowledge score, lack of season as a covariate in the multivariate analysis, lack of follow-up, and lack of robust skin cancer risk assessment. In conclusion, despite poorer skin cancer knowledge and sun protection practices, the Hispanic population had the highest concern for developing skin cancer and desire to learn more about skin cancer. Targeted and culturally relevant skin cancer and sun protection education for this group is needed.
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Affiliation(s)
| | | | - Meera H Patel
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Jamison Harvey
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Jordan Montoya
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | | | - Helen Cumsky
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Matthew Buras
- Division of Biostatistics, Department of Health Science Research, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | | | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA.
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15
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Johnson E, Patel MH, Brumfiel CM, Severson KJ, Bhullar P, Boudreaux B, Butterfield RJ, DiCaudo DJ, Nelson SA, Pittelkow MR, Mangold AR. Histopathologic Features of Necrobiosis Lipoidica. J Cutan Pathol 2022; 49:692-700. [DOI: 10.1111/cup.14238] [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: 05/17/2021] [Revised: 03/17/2022] [Accepted: 03/26/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Emma Johnson
- Department of Dermatology Mayo Clinic Rochester USA
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16
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Brumfiel CM, Patel MH, Severson KJ, Zhang N, Li X, Quillen JK, Zunich SM, Branch EL, Nelson SA, Pittelkow MR, Mangold AR. Ruxolitinib cream in the treatment of cutaneous lichen planus: A prospective, open-label study. J Invest Dermatol 2022; 142:2109-2116.e4. [DOI: 10.1016/j.jid.2022.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 02/08/2023]
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17
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Puri P, Rajkumar SV, Shah ND, Pittelkow MR, Mangold AR. Bexarotene: A Case Study of Medicare Part D's Specialty Drug Shortcomings. Mayo Clin Proc 2021; 96:2519-2522. [PMID: 34531065 DOI: 10.1016/j.mayocp.2021.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Pranav Puri
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ
| | | | - Nilay D Shah
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
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18
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Brumfiel CM, Patel MH, Puri P, Besch-Stokes J, Lester S, Rule WG, Khera N, Sluzevich JC, DiCaudo DJ, Comfere N, Bennani NN, Rosenthal AC, Pittelkow MR, Mangold AR. How to Sequence Therapies in Mycosis Fungoides. Curr Treat Options Oncol 2021; 22:101. [PMID: 34570278 DOI: 10.1007/s11864-021-00899-0] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 12/11/2022]
Abstract
OPINION STATEMENT Choice of therapy in mycosis fungoides is based on both patient- and lymphoma-specific factors, such as disease characteristics, comorbidities, symptoms and effect on quality of life, potential associated toxicities of therapy, response and tolerance to prior lines of therapy, and convenience and practicality. Generally, we sequence therapies from least toxic, targeted, nonimmunosuppressive to more toxic, immunosuppressive and from single agent to multiple agents, as necessary. If more toxic, immunosuppressive agents are required to alleviate disease burden or symptoms, we generally use them just long enough to control the disease, then transition to a maintenance regimen with less toxic, less immunosuppressive agents.
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Affiliation(s)
- Caitlin M Brumfiel
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Meera H Patel
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Pranav Puri
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Jake Besch-Stokes
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Scott Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - William G Rule
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Nandita Khera
- Division of Hematology Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - David J DiCaudo
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Nneka Comfere
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - N Nora Bennani
- Division of Hematology Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA.
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19
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Besch-Stokes JG, Patel MH, Brumfiel CM, Costello CM, Rule W, Rosenthal A, Pittelkow MR, DiCaudo DJ, Mangold AR. Cutaneous B cell pseudolymphoma treated with rituximab and methotrexate. Dermatol Online J 2021; 27. [PMID: 34755980 DOI: 10.5070/d327955138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 11/08/2022] Open
Abstract
Cutaneous B cell pseudolymphoma (CBPL), or cutaneous lymphoid hyperplasia, is the most common pseudolymphoma. It typically responds well to local treatment and follows a benign course. Herein, we describe the unique case of a patient with CBPL that was refractory to a variety of treatments, with subsequent response to rituximab followed by methotrexate. This case explores the complex interplay of T and B lymphocytes, and the potential role of perifollicular T cells in treatment resistant CBPL. Further, it describes the additive therapeutic effect of rituximab and methotrexate to target both B cell and T cell populations in CBPL, a strategy already employed in a number of other conditions.
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20
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Mangold AR, Patel MH, Brumfiel CM, Severson KJ, Butterfield RJ, Zhang N, Nelson SA, DiCaudo DJ, Pittelkow MR, Sekulic A. 26941 The prognostic value of inositol polyphosphate 5-phosphatase in cutaneous squamous cell carcinoma in a random sampling representative of the general population. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Sluzevich JC, Patel MH, Pincelli TP, Brumfiel CM, Pittelkow MR, Mangold A. 25240 Cosentyx (secukinumab) for the treatment of adult onset pityriasis rubra pilaris: A single arm, open-label exploratory study. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Mangold AR, Brumfiel CM, Patel MH, Severson KJ, Zhang N, Pittelkow MR. 25713 Ruxolitinib cream in the treatment of cutaneous lichen planus. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Puri P, Yiannias JA, Mangold AR, Swanson DL, Pittelkow MR. The policy dimensions, regulatory landscape, and market characteristics of teledermatology in the United States. JAAD Int 2021; 1:202-207. [PMID: 34409341 PMCID: PMC8362249 DOI: 10.1016/j.jdin.2020.09.004] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 12/21/2022] Open
Abstract
The COVID-19 pandemic has spurred healthcare systems across the world to rapidly redesign their models of care delivery. As such, this pandemic has accelerated the adoption of teledermatology in the United States. However, it remains unknown whether this momentum will be maintained after the pandemic. The future of teledermatology in the United States will be significantly influenced by a complex set of policy, legal, and regulatory frameworks. An understanding of these frameworks will help dermatologists more effectively adopt and implement teledermatology platforms. In this article, we review the current state of teledermatology in the United States, including policy dimensions, the regulatory landscape, market characteristics, and future directions.
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Affiliation(s)
- Pranav Puri
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
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24
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Puri P, Wiggins M, Yousif M, Pollock BD, Fox LP, Rosenbach M, Pittelkow MR, Mangold AR. Evaluating the potential cost savings from inpatient dermatology consultations. J Eur Acad Dermatol Venereol 2021; 35:e936-e938. [PMID: 34374133 DOI: 10.1111/jdv.17595] [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: 07/15/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
- P Puri
- Mayo Clinic, Scottsdale, AZ, USA
| | | | - M Yousif
- University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | - L P Fox
- University of California San Francisco, San Francisco, CA, USA
| | - M Rosenbach
- University of Pennsylvania, Philadelphia, PA, USA
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25
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Prudencio M, Garcia-Moreno H, Jansen-West KR, Al-Shaikh RH, Gendron TF, Heckman MG, Spiegel MR, Carlomagno Y, Daughrity LM, Song Y, Dunmore JA, Byron N, Oskarsson B, Nicholson KA, Staff NP, Gorcenco S, Puschmann A, Lemos J, Januário C, LeDoux MS, Friedman JH, Polke J, Labrum R, Shakkottai V, McLoughlin HS, Paulson HL, Konno T, Onodera O, Ikeuchi T, Tada M, Kakita A, Fryer JD, Karremo C, Gomes I, Caviness JN, Pittelkow MR, Aasly J, Pfeiffer RF, Veerappan V, Eggenberger ER, Freeman WD, Huang JF, Uitti RJ, Wierenga KJ, Marin Collazo IV, Tipton PW, van Gerpen JA, van Blitterswijk M, Bu G, Wszolek ZK, Giunti P, Petrucelli L. Toward allele-specific targeting therapy and pharmacodynamic marker for spinocerebellar ataxia type 3. Sci Transl Med 2021; 12:12/566/eabb7086. [PMID: 33087504 DOI: 10.1126/scitranslmed.abb7086] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022]
Abstract
Spinocerebellar ataxia type 3 (SCA3), caused by a CAG repeat expansion in the ataxin-3 gene (ATXN3), is characterized by neuronal polyglutamine (polyQ) ATXN3 protein aggregates. Although there is no cure for SCA3, gene-silencing approaches to reduce toxic polyQ ATXN3 showed promise in preclinical models. However, a major limitation in translating putative treatments for this rare disease to the clinic is the lack of pharmacodynamic markers for use in clinical trials. Here, we developed an immunoassay that readily detects polyQ ATXN3 proteins in human biological fluids and discriminates patients with SCA3 from healthy controls and individuals with other ataxias. We show that polyQ ATXN3 serves as a marker of target engagement in human fibroblasts, which may bode well for its use in clinical trials. Last, we identified a single-nucleotide polymorphism that strongly associates with the expanded allele, thus providing an exciting drug target to abrogate detrimental events initiated by mutant ATXN3. Gene-silencing strategies for several repeat diseases are well under way, and our results are expected to improve clinical trial preparedness for SCA3 therapies.
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Affiliation(s)
- Mercedes Prudencio
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA.,Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
| | - Hector Garcia-Moreno
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Ataxia Centre, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London WC1N 3BG, UK
| | | | | | - Tania F Gendron
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA.,Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Matthew R Spiegel
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Yari Carlomagno
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA.,Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
| | | | - Yuping Song
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Judith A Dunmore
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Natalie Byron
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Björn Oskarsson
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Katharine A Nicholson
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital (MGH), Boston, MA 02114, USA
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Sorina Gorcenco
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Neurology, Lund 22185, Sweden
| | - Andreas Puschmann
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Neurology, Lund 22185, Sweden
| | - João Lemos
- Coimbra University Hospital Centre, Coimbra University, Coimbra 3000-075, Portugal
| | - Cristina Januário
- Coimbra University Hospital Centre, Coimbra University, Coimbra 3000-075, Portugal
| | - Mark S LeDoux
- University of Memphis and Veracity Neuroscience LLC, Memphis, TN 38152, USA
| | - Joseph H Friedman
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - James Polke
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Ataxia Centre, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London WC1N 3BG, UK
| | - Robin Labrum
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Ataxia Centre, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London WC1N 3BG, UK
| | - Vikram Shakkottai
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Henry L Paulson
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Takuya Konno
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Mari Tada
- Department of Pathology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Akiyoshi Kakita
- Department of Pathology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - John D Fryer
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA.,Department of Neuroscience, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Christin Karremo
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Neurology, Lund 22185, Sweden
| | - Inês Gomes
- Coimbra University Hospital Centre, Coimbra University, Coimbra 3000-075, Portugal
| | - John N Caviness
- Department of Neurology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Jan Aasly
- Norwegian University of Science and Technology, 7006 Trondheim, Norway
| | - Ronald F Pfeiffer
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Venka Veerappan
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | | | | | | | - Ryan J Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Klaas J Wierenga
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Philip W Tipton
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Marka van Blitterswijk
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA.,Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
| | - Guojun Bu
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA.,Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
| | | | - Paola Giunti
- Ataxia Centre, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK. .,Ataxia Centre, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London WC1N 3BG, UK
| | - Leonard Petrucelli
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA. .,Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
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26
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Harvey JA, Severson KJ, Brumfiel CM, Patel MH, Butterfield RJ, Nelson SA, Sekulic A, Pittelkow MR, Mangold AR. Necrobiosis lipoidica-associated cutaneous malignancy. J Am Acad Dermatol 2021; 86:1428-1429. [PMID: 34153393 DOI: 10.1016/j.jaad.2021.06.848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/07/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Meera H Patel
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | | | | | | | | | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona.
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27
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Brumfiel CM, Patel MH, DiCaudo DJ, Rosenthal AC, Pittelkow MR, Mangold AR. Recurrence of primary cutaneous CD30-positive lymphoproliferative disorder following COVID-19 vaccination. Leuk Lymphoma 2021; 62:2554-2555. [PMID: 33974494 DOI: 10.1080/10428194.2021.1924371] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Meera H Patel
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, USA
| | - David J DiCaudo
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, USA
| | | | | | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, USA
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28
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Besch-Stokes JG, Costello CM, Severson KJ, Bhullar P, Montoya J, Butterfield RJ, DiCaudo DJ, Comfere N, Sluzevich J, Rule W, Craig FE, Rosenthal A, Pittelkow MR, Mangold AR. Primary cutaneous CD4 + small/medium T-cell lymphoproliferative disorder: Diagnosis and management. J Am Acad Dermatol 2021; 86:1167-1169. [PMID: 33915243 DOI: 10.1016/j.jaad.2021.04.067] [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: 06/08/2020] [Revised: 02/26/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | - Collin M Costello
- Department of Dermatology, Mayo Clinic, Scottsdale AZ Mayo Clinic, Scottsdale, Arizona
| | - Kevin J Severson
- Department of Dermatology, Mayo Clinic, Scottsdale AZ Mayo Clinic, Scottsdale, Arizona
| | - Puneet Bhullar
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Jordan Montoya
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Richard J Butterfield
- Division of Biostatistics, Department of Health Science Research, Mayo Clinic, Scottsdale, Arizona
| | - David J DiCaudo
- Department of Dermatology, Mayo Clinic, Scottsdale AZ Mayo Clinic, Scottsdale, Arizona
| | - Nneka Comfere
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jason Sluzevich
- Department of Dermatology, Mayo Clinic, Jacksonville, Florida
| | - William Rule
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Fiona E Craig
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, Arizona
| | | | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic, Scottsdale AZ Mayo Clinic, Scottsdale, Arizona
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale AZ Mayo Clinic, Scottsdale, Arizona.
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29
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Severson KJ, Costello CM, Brumfiel CM, Patel MH, Butterfield RJ, Nelson SA, Pittelkow MR, Mangold AR. Clinical and morphological features of necrobiosis lipoidica. J Am Acad Dermatol 2021; 86:1133-1135. [PMID: 33878403 DOI: 10.1016/j.jaad.2021.04.034] [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: 09/17/2020] [Revised: 03/13/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Kevin J Severson
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | | | - Meera H Patel
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Steven A Nelson
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona.
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30
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Breen ID, Brumfiel CM, Patel MH, Butterfield RJ, VanderPluym JH, Griffing L, Pittelkow MR, Mangold AR. Evaluation of the Safety of Calcitonin Gene-Related Peptide Antagonists for Migraine Treatment Among Adults With Raynaud Phenomenon. JAMA Netw Open 2021; 4:e217934. [PMID: 33871613 PMCID: PMC8056280 DOI: 10.1001/jamanetworkopen.2021.7934] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Calcitonin gene-related peptide (CGRP) antagonists have demonstrated tremendous promise in migraine management. However, these medications decrease reflex vasodilatory response, which may lead to exacerbation of microvascular disease in susceptible patients, such as patients with Raynaud phenomenon (RP). OBJECTIVE To investigate the microvascular complications of CGRP antagonists in patients with underlying RP. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was performed from May 18, 2018, to September 15, 2020, in Mayo Clinic Health System patients with Raynaud phenomenon while undergoing CGRP antagonist therapy to treat migraine. Inclusion criteria were age older than 18 years, history of migraine, past or current treatment with CGRP antagonists, and diagnosis of primary or secondary RP. EXPOSURE Treatment with CGRP antagonists. MAIN OUTCOMES AND MEASURES The main outcome measure was microvascular complications (eg, worsening RP, digital ulcerations, and gangrenous necrosis) after initiation of treatment with a CGRP antagonist. Patient demographic and clinical characteristics were compared between those who experienced complications and those who did not. RESULTS A total of 169 patients (163 [96.4%] female; 151 [89.3%] non-Hispanic White; mean [SD] age, 46 [13] years) were identified. Of the 169 patients, 9 (5.3%) exhibited microvascular complications, ranging from worsening RP to gangrene and autonecrosis that required distal digit amputation. Comparative analysis did not find statistically significant differences in demographic or clinical characteristics between the 2 cohorts. All 9 patients with complications were female (mean [SD] age, 40 [12] years). Five of the 9 patients (55.6%) had previously diagnosed RP; in 3 the RP was primary, and 2 it was secondary to scleroderma. The other 4 patients (44.4%) were newly diagnosed with RP. Eight of the 9 patients (88.9%) had chronic migraine; 4 had migraine with aura, and 5 had migraine without aura. The CGRP antagonist agents temporally associated with the microvascular complications included galcanezumab (in 3 patients), erenumab (in 5 patients), and fremanezumab (in 1 patient). CONCLUSIONS AND RELEVANCE The results of this study indicate that microvascular complications of CGRP antagonist use in patients with underlying RP are uncommon. The incidence of serious adverse events, although rare, warrant caution when considering the use of these agents in patients with RP.
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Affiliation(s)
- Ilana D. Breen
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale
| | | | - Meera H. Patel
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale
| | | | | | - Leroy Griffing
- Department of Rheumatology, Mayo Clinic Arizona, Phoenix
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Severson KJ, Patel MH, Brumfiel CM, Breen I, Butterfield RJ, Nelson SA, Sekulic A, Pittelkow MR, Mangold AR. Comorbidities and diabetic complications in patients with necrobiosis lipoidica. J Am Acad Dermatol 2021; 86:891-894. [PMID: 33722550 DOI: 10.1016/j.jaad.2021.03.026] [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: 11/17/2020] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Kevin J Severson
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Meera H Patel
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Ilana Breen
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | | | - Steven A Nelson
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, Arizona.
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Breen ID, Brumfiel CM, Patel MH, Rosenthal AC, Rule WG, DiCaudo DJ, Craig FE, Pittelkow MR, Mangold AR. Mogamulizumab-induced interface dermatitis drug rash treated successfully with methotrexate and extracorporeal photopheresis in a patient with Sézary syndrome. JAAD Case Rep 2021; 9:24-27. [PMID: 33604439 PMCID: PMC7873348 DOI: 10.1016/j.jdcr.2020.12.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ilana D. Breen
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | | | | | | | | | - David J. DiCaudo
- Mayo Clinic Arizona, Dermatology, Scottsdale, Arizona
- Mayo Clinic Arizona, Laboratory Medicine and Pathology, Phoenix, Arizona
| | - Fiona E. Craig
- Mayo Clinic Arizona, Laboratory Medicine and Pathology, Phoenix, Arizona
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Severson KJ, Cumsky HJL, Brumfiel CM, Janeczek MC, Ginos BF, Kosiorek HE, Besch-Stokes J, Patel MH, Rule WG, DiCaudo DJ, Rosenthal AC, Pittelkow MR, Mangold AR. Blue light photodynamic therapy with 5-aminolevulinic acid in refractory mycosis fungoides: A prospective, open-label study. J Am Acad Dermatol 2021; 85:969-971. [PMID: 33493572 DOI: 10.1016/j.jaad.2021.01.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Kevin J Severson
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Helen J L Cumsky
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona
| | | | | | - Brenda F Ginos
- Department of Health Sciences Research, Mayo Clinic Arizona, Phoenix, Arizona
| | - Heidi E Kosiorek
- Department of Health Sciences Research, Mayo Clinic Arizona, Phoenix, Arizona
| | | | - Meera H Patel
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona
| | - William G Rule
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - David J DiCaudo
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Allison C Rosenthal
- Division Hematology-Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona
| | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona.
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34
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Besch-Stokes J, Costello CM, Bhullar P, Maly C, DiCaudo DJ, Comfere N, Rule WG, Craig FE, Rosenthal A, Pittelkow MR, Mangold AR. 15591 CD4+ small/medium T-cell lymphoproliferative disorder: A Mayo Enterprise experience. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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35
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Ederaine SA, Costello CM, Maly C, Severson K, Ochoa SA, Pittelkow MR, Sekulic A, Mangold AR. 15348 Cutaneous squamous cell carcinoma in nonwhite individuals: A single-institution case-control study. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
This cohort study describes recent trends in use and payment rates and in overall expenditure for skin cancer procedures in the Medicare Part B population in the United States.
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Affiliation(s)
- Pranav Puri
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Sujith Baliga
- Department of Radiation Oncology, The Ohio State University, Columbus
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Eggermont AMM, Bellomo D, Arias-Mejias SM, Quattrocchi E, Sominidi-Damodaran S, Bridges AG, Lehman JS, Hieken TJ, Jakub JW, Murphree DH, Pittelkow MR, Sluzevich JC, Cappel MA, Bagaria SP, Perniciaro C, Tjien-Fooh FJ, Rentroia-Pacheco B, Wever R, van Vliet MH, Dwarkasing J, Meves A. Identification of stage I/IIA melanoma patients at high risk for disease relapse using a clinicopathologic and gene expression model. Eur J Cancer 2020; 140:11-18. [PMID: 33032086 PMCID: PMC7655519 DOI: 10.1016/j.ejca.2020.08.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/09/2020] [Accepted: 08/16/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Patients with stage I/IIA cutaneous melanoma (CM) are currently not eligible for adjuvant therapies despite uncertainty in relapse risk. Here, we studied the ability of a recently developed model which combines clinicopathologic and gene expression variables (CP-GEP) to identify stage I/IIA melanoma patients who have a high risk for disease relapse. PATIENTS AND METHODS Archival specimens from a cohort of 837 consecutive primary CMs were used for assessing the prognostic performance of CP-GEP. The CP-GEP model combines Breslow thickness and patient age, with the expression of eight genes in the primary tumour. Our specific patient group, represented by 580 stage I/IIA patients, was stratified based on their risk of relapse: CP-GEP High Risk and CP-GEP Low Risk. The main clinical end-point of this study was five-year relapse-free survival (RFS). RESULTS Within the stage I/IIA melanoma group, CP-GEP identified a high-risk patient group (47% of total stage I/IIA patients) which had a considerably worse five-year RFS than the low-risk patient group; 74% (95% confidence interval [CI]: 67%-80%) versus 89% (95% CI: 84%-93%); hazard ratio [HR] = 2.98 (95% CI: 1.78-4.98); P < 0.0001. Of patients in the high-risk group, those who relapsed were most likely to do so within the first 3 years. CONCLUSION The CP-GEP model can be used to identify stage I/IIA patients who have a high risk for disease relapse. These patients may benefit from adjuvant therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Mark A Cappel
- Mayo Clinic, Jacksonville, FL, USA; Gulf Coast Dermatopathology Laboratory, Tampa, FL, USA
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Puri P, Comfere N, Pittelkow MR, Bezalel SA, Murphree DH. COVID-19: An opportunity to build dermatology's digital future. Dermatol Ther 2020; 33:e14149. [PMID: 32767453 PMCID: PMC7435563 DOI: 10.1111/dth.14149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 01/11/2023]
Affiliation(s)
- Pranav Puri
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA.,Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota, USA
| | - Nneka Comfere
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota, USA.,Mayo Clinic, Department of Dermatology, Rochester, Minnesota, USA
| | - Mark R Pittelkow
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota, USA.,Depatment of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Spencer A Bezalel
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota, USA.,Mayo Clinic, Department of Dermatology, Rochester, Minnesota, USA
| | - Dennis H Murphree
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota, USA.,Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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39
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Snider S, Costello CM, Ederaine S, Besch-Stokes J, Severson KJ, DiCaudo DJ, Pittelkow MR, Mangold AR. A case of pediatric lymphomatoid papulosis treated with photodynamic therapy and narrowband ultraviolet B. Pediatr Dermatol 2020; 37:881-883. [PMID: 32618378 DOI: 10.1111/pde.14244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/07/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Abstract
We report a case of a 13-year-old boy with extensive lymphomatoid papulosis (LyP) involving his elbows, forearms, proximal thighs, and right hip, with treatment-resistant nodules on his right forearm. He was treated with full-body narrowband ultraviolet B and targeted photodynamic therapy (PDT) with 20% aminolevulinic acid (ALA). After two months, there was complete resolution of the right forearm nodules. Due to its minimal toxicity, PDT offers unique advantages and may be considered for pediatric LyP patients with symptomatic, localized disease resistant to conventional treatments.
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Affiliation(s)
- Sam Snider
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
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40
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Puri P, Baliga S, Pittelkow MR. Trends in Medicare utilization and reimbursement for electronic brachytherapy following 2016 billing code changes. J Am Acad Dermatol 2020; 84:1154-1155. [PMID: 32682891 DOI: 10.1016/j.jaad.2020.07.034] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Pranav Puri
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Sujith Baliga
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
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41
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Bellomo D, Arias-Mejias SM, Ramana C, Heim JB, Quattrocchi E, Sominidi-Damodaran S, Bridges AG, Lehman JS, Hieken TJ, Jakub JW, Pittelkow MR, DiCaudo DJ, Pockaj BA, Sluzevich JC, Cappel MA, Bagaria SP, Perniciaro C, Tjien-Fooh FJ, van Vliet MH, Dwarkasing J, Meves A. Model Combining Tumor Molecular and Clinicopathologic Risk Factors Predicts Sentinel Lymph Node Metastasis in Primary Cutaneous Melanoma. JCO Precis Oncol 2020; 4:319-334. [PMID: 32405608 PMCID: PMC7220172 DOI: 10.1200/po.19.00206] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose More than 80% of patients who undergo sentinel lymph node (SLN) biopsy have no nodal metastasis. Here we describe a model that combines clinicopathologic and molecular variables to identify patients with thin and intermediate thickness melanomas who may forgo the SLN biopsy procedure due to their low risk of nodal metastasis. Patients and Methods Genes with functional roles in melanoma metastasis were discovered by analysis of next generation sequencing data and case control studies. We then used PCR to quantify gene expression in diagnostic biopsy tissue across a prospectively designed archival cohort of 754 consecutive thin and intermediate thickness primary cutaneous melanomas. Outcome of interest was SLN biopsy metastasis within 90 days of melanoma diagnosis. A penalized maximum likelihood estimation algorithm was used to train logistic regression models in a repeated cross validation scheme to predict the presence of SLN metastasis from molecular, clinical and histologic variables. Results Expression of genes with roles in epithelial-to-mesenchymal transition (glia derived nexin, growth differentiation factor 15, integrin β3, interleukin 8, lysyl oxidase homolog 4, TGFβ receptor type 1 and tissue-type plasminogen activator) and melanosome function (melanoma antigen recognized by T cells 1) were associated with SLN metastasis. The predictive ability of a model that only considered clinicopathologic or gene expression variables was outperformed by a model which included molecular variables in combination with the clinicopathologic predictors Breslow thickness and patient age; AUC, 0.82; 95% CI, 0.78-0.86; SLN biopsy reduction rate of 42% at a negative predictive value of 96%. Conclusion A combined model including clinicopathologic and gene expression variables improved the identification of melanoma patients who may forgo the SLN biopsy procedure due to their low risk of nodal metastasis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mark A Cappel
- Mayo Clinic, Jacksonville, FL, USA.,Gulf Coast Dermatopathology Laboratory, Tampa, FL, USA
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42
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Yang YW, Lehrer MD, Mangold AR, Yiannias JA, Nelson SA, Pittelkow MR. Treatment of granuloma annulare and related granulomatous diseases with sulphasalazine: a series of 16 cases. J Eur Acad Dermatol Venereol 2020; 35:211-215. [PMID: 32216136 DOI: 10.1111/jdv.16356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 02/21/2020] [Accepted: 02/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Granuloma annulare (GA) and the related annular elastolytic giant cell granuloma (AEGCG) and interstitial granulomatous dermatitis (IGD) are idiopathic histiocytic inflammatory disorders, which are frequently recalcitrant to treatment. OBJECTIVES Evaluate the efficacy of sulphasalazine in treating GA, AEGCG and IGD. METHODS Sixteen patients were identified with granulomatous disease who were treated with sulphasalazine between September 2015 and September 2019. Outcomes were based on patients' and providers' subjective evaluations. RESULTS Sixteen patients were included in the study (ages 56-89, four male and twelve female). Previous treatments were attempted in fifteen patients. Clinical improvement was seen in fourteen patients (87.5%). Initial improvement was noted within a mean (SD) of 66.4 (35.1) days after starting therapy, with increasing benefits over time. Ten patients (62.5%) reported complete or near-complete clearance, three patients (18.8%) reported significant improvement, and one (6.3%) reported partial improvement. Twelve patients elected to stop or reduce therapy, resulting in relapse or worsening in five patients. CONCLUSIONS Sulphasalazine may be considered as treatment for GA and GA-related conditions.
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Affiliation(s)
- Y W Yang
- Mayo Clinic, Scottsdale, AZ, USA
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43
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Costello CM, Maly CJ, Snider S, Severson KJ, DiCaudo DJ, Rosenthal AC, Northfelt DW, Rule W, Craig FE, Pittelkow MR, Mangold AR. Immunosuppression-associated primary cutaneous plasmablastic lymphoma secondary to romidepsin. JAAD Case Rep 2019; 6:19-22. [PMID: 31909131 PMCID: PMC6938883 DOI: 10.1016/j.jdcr.2019.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Connor J. Maly
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Sam Snider
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | | | | | | | - Donald W. Northfelt
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona
| | - William Rule
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Fiona E. Craig
- Department of Pathology, Mayo Clinic, Scottsdale, Arizona
| | | | - Aaron R. Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
- Correspondence to: Aaron R. Mangold, MD, Mayo Clinic – Department of Dermatology, 13400 E Shea Blvd, Scottsdale, AZ 85259.
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44
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Costello CM, Cumsky HJL, Maly CJ, Harvey JA, Buras MR, Pallagi PJ, Gustaveson AL, Singh DP, Nelson SA, Pittelkow MR, Mangold AR. Improving Access to Care Through the Establishment of a Local, Teledermatology Network. Telemed J E Health 2019; 26:935-940. [PMID: 31613713 DOI: 10.1089/tmj.2019.0051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Access to dermatologic care is a major issue in the United States, especially within the un- and underinsured populations; technology, including teledermatology, will pay a role in improving access to care. Methods: We performed a prospective study between November 2016 and September 2017. We leveraged a partnership between Mayo Clinic and Mountain Park Health Clinic, a community clinic that primarily serves un- and underinsured populations. We implemented a mobile phone-based store and forward (SAF) teledermatology service, which integrated an external community health clinic to an existing electronic health record (EHR) using standardized data capture forms, real-time support, and simple workflows. Results: Thirty-seven patients were enrolled in the study, 65% female and 35% male with an average age of 47.9 (SD = 15.9). The ethnic breakdown was: 81.1% Hispanic, 13.5% Caucasian, and 5.4% African American. The majority, 62.2%, did not have a high school education, 45.9% were unemployed, and 51.4% were uninsured. 64.9% earned less than $25,000 for annual household income. Teledermatology consultation increased the absolute diagnostic and management concordance by 36.6% (p = 0.01, 95% CI 12.2%-61.0%) and 34.2% (p < 0.01, 95% CI 11%-57%), respectively. Primary care providers had a significant increase in mean confidence in the diagnosis and management of dermatology conditions pre and poststudy (3.60 vs. 3.70 and 3.21 vs. 3.60, respectively; p < 0.01). Ninety-six percent of the primary care providers agreed (52.0%) and strongly agreed (44.0%) that they would send another patient for teleconsultation. Conclusion: We successfully implemented a SAF teledermatology consultative service in a community health clinic outside our EHR. A similar approach can be used by other large health care organizations to provide integrated, high-quality consultation to clinics with rural, un- and underinsured populations.
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Affiliation(s)
| | - Helen J L Cumsky
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Connor J Maly
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA.,Georgetown School of Medicine, Washington, District of Columbia, USA
| | - Jamison A Harvey
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Matthew R Buras
- Department of Health Science Research, Mayo Clinic, Scottsdale, Arizona, USA
| | - Peter J Pallagi
- Department of Media Support, Mayo Clinic, Scottsdale, Arizona, USA
| | | | | | - Steven A Nelson
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
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45
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Besch-Stokes JG, Costello CM, Bhullar PK, Maly CJ, Rosenthal AC, DiCaudo DJ, Pittelkow MR, Mangold AR. Regression of mycosis fungoides with large-cell transformation following skin biopsy. J Eur Acad Dermatol Venereol 2019; 34:e82-e84. [PMID: 31566801 DOI: 10.1111/jdv.15976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - C M Costello
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - P K Bhullar
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - C J Maly
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - A C Rosenthal
- Department of Hematology Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - D J DiCaudo
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - M R Pittelkow
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - A R Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
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46
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Affiliation(s)
- John J Kohorst
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Christopher H Bailey
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Phoenix, Arizona
| | - Louise K Andersen
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota.,now at Department of Dermato-Venereology, Aarhus University Hospital, Aarhus C, Denmark
| | | | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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Kotwal A, Turcu AF, Sonawane V, Bahn RS, Pittelkow MR, Bridges A, Stan MN. Clinical Experience with Rituximab and Intravenous Immunoglobulin for Pretibial Myxedema: A Case Series. Thyroid 2019; 29:692-699. [PMID: 30854936 DOI: 10.1089/thy.2018.0706] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Severe pretibial myxedema (PTM) can be difficult to manage, highlighting the need to investigate newer therapies. Rituximab (RTX) and intravenous immunoglobulin (IVIg) have been tried in Graves' orbitopathy. Since PTM and orbitopathy share a similar underlying pathophysiology, this study aimed to explore these therapies for progressive PTM. Methods: The electronic database was screened for PTM patients evaluated at the Mayo Clinic, Rochester, from 2002 to 2016, and three patients who received IVIg and five who received RTX are reported. PTM pattern was classified as non-pitting edema, plaque and induration, nodular/nummular, and elephantiasis. PTM was confirmed by biopsy in six patients. Results: The patients' median age was 53.8 years, 75% were female, and all but one patient were either active or former smokers. All patients were euthyroid and had progressed despite various therapies prior to starting these agents. Six patients had a plaque and induration pattern, and two had a nodular pattern with elephantiasis. After therapy, six (75%) patients had PTM stability or improvement both subjectively and objectively (80% with RTX and 66% with IVIg). The three patients (one in the IVIg group and two in the RTX group) who had subjective improvement had a plaque pattern. One patient with elephantiasis had a transient response to IVIg and another had stability after RTX. Thyrotropin receptor antibody values and orbitopathy also improved in patients who demonstrated PTM improvement. No serious adverse events were reported, but one patient each had transient hypertension and injection-site thrombophlebitis after IVIg. Conclusions: Immunomodulation therapy was followed by PTM improvement or stability in most patients, with a slightly better response after RTX compared to IVIg. A validated response assessment instrument and larger series of patients are required to determine if the underlying disease process could be curtailed with these agents.
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Affiliation(s)
- Anupam Kotwal
- 1 Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Adina F Turcu
- 2 Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, Michigan
| | - Vikram Sonawane
- 1 Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Rebecca S Bahn
- 1 Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | | | - Alina Bridges
- 3 Department of Dermatology, Mayo Clinic, Rochester, Minnesota
- 4 Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Marius N Stan
- 1 Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
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Cumsky HJL, Maly CJ, Costello CM, Buras MR, Ranieri LM, Grover ML, Comfere NI, Nelson SA, Pittelkow MR, Mangold AR. Impact of standardized templates and skin cancer learning modules for teledermatology consultations. Int J Dermatol 2019; 58:1423-1429. [PMID: 30916785 DOI: 10.1111/ijd.14437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little research has been done in teledermatology to examine the effects of standardized templates and subject-specific learning modules. METHODS We performed a prospective study examining the effects of standardized templates and standardized cutaneous oncology learning modules on teledermatology referrals at Mayo Clinic. This data was then compared to previous teledermatology referrals before standardized templates were adopted. RESULTS A total of 42 teledermatology consultations were performed during the 4-month study period. The use of standardized templates resulted in an absolute reduction in face-to-face referrals. Teledermatology consultation increased the absolute diagnostic and management concordance by 26.2% (P = 0.02) and 33.3% (P < 0.01), respectively, and decreased the absolute diagnostic and management discordance by 19.1% (P = 0.03) and 31.0% (P < 0.01), respectively. The largest knowledge gaps were identified in cutaneous oncology. Educational intervention improved theoretical referral rates and confidence in diagnosis and management overall. CONCLUSION The implementation of standardized intake templates reduces the rate of face-to-face referrals. Teledermatology improves primary care-based dermatological care and reduces theoretical referral rates.
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Affiliation(s)
- Helen J L Cumsky
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Connor J Maly
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA.,Georgetown School of Medicine, Washington, DC, USA
| | | | - Matthew R Buras
- Department of Health Science Research, Mayo Clinic, Scottsdale, AZ, USA
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49
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Yonan YA, Cumsky HJL, Costello CM, Maly CJ, Rosenthal AC, Reeder CB, Rule WG, Pittelkow MR, Craig FE, DiCaudo DJ, Mangold AR. Syringotropic and folliculotropic mycosis fungoides with mycosis fungoides-associated vasculopathic ulcers. JAAD Case Rep 2019; 5:231-233. [PMID: 30834284 PMCID: PMC6384313 DOI: 10.1016/j.jdcr.2019.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Yousif A Yonan
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Helen J L Cumsky
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Connor J Maly
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona.,Georgetown University School of Medicine, Washington, DC
| | | | - Craig B Reeder
- Department of Hematology, Mayo Clinic, Scottsdale, Arizona
| | - William G Rule
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
| | | | - Fiona E Craig
- Department of Pathology, Mayo Clinic, Scottsdale, Arizona
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50
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Cumsky HJL, Costello CM, Zhang N, Butterfield R, Buras MR, Schmidt JE, Drenner K, Nelson SA, Ochoa SA, Baum CL, Pittelkow MR, DiCaudo DJ, Sekulic A, Mangold AR. The prognostic value of inositol polyphosphate 5-phosphatase in cutaneous squamous cell carcinoma. J Am Acad Dermatol 2019; 80:626-632.e1. [PMID: 30359624 PMCID: PMC10577667 DOI: 10.1016/j.jaad.2018.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 09/13/2018] [Accepted: 10/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Inositol polyphosphate 5-phosphatase (INPP5A) has been shown to play a role in development and progression of cutaneous squamous cell carcinoma (cSCC). The goal of the current study was to explore the prognostic value of INPP5A expression in cSCC. METHODS A total of 189 cases of actinic keratosis and SCC in 174 patients were identified; clinical and outcome data were abstracted, histopathology was rereviewed, and immunohistochemical staining and interpretation was performed for INPP5A. RESULTS The majority of tumors (89.4%) had an INPP5A score of 2 or 3. No patients had complete loss of INPP5A. Tumors with an INPP5A score of 1 were more likely to be intermediate- to high-risk tumors (Brigham and Women's Hospital stage ≥T2a 85.0% vs 23.7% [P < .0001]) characterized by a larger diameter (2.4 cm vs 1.3 cm [P = .0004]), moderate-to-poor differentiation (86.7% vs 17.6% [P < .0001]), and perineural invasion (37.5% vs 5.3%, [P < .0001]). An INPP5A score of 1 was associated with a worse 3-year survival (a rate of 42.3% [hazard ratio, 2.81, P = .0006]) and a local metastasis rate of 48.0% (hazard ratio, 4.71; P < .0001). CONCLUSIONS Low INPP5A scores are predictive of aggressive tumors and may be a useful adjunct to guide clinical management of cSCC.
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Affiliation(s)
- Helen J L Cumsky
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Nan Zhang
- Department of Health Science Research, Mayo Clinic, Scottsdale, Arizona
| | | | - Matthew R Buras
- Department of Health Science Research, Mayo Clinic, Scottsdale, Arizona
| | | | - Kevin Drenner
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | | | - Shari A Ochoa
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | | | | | | | | | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona.
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