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Ferrucci SM, Angileri L, Marzano AV, Berti E, Tavecchio S. Topical tacrolimus during systemic therapy for severe atopic dermatitis in the clinical practice. Eur Rev Med Pharmacol Sci 2022; 26:2518-2523. [PMID: 35442467 DOI: 10.26355/eurrev_202204_28489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the role of tacrolimus ointment in the management of patients on dupilumab therapy for severe atopic dermatitis, in a real-life setting. PATIENTS AND METHODS Consecutive patients with severe AD treated with dupilumab were enrolled. Topical treatment was associated according to the clinical practice. Eczema Area and Severity Index (EASI), itching and sleep Numerical Rating Scale (NRS) and Dermatologic quality of Life (DLQI) were recorded at baseline and after 4, 16 and 52 weeks of treatment with dupilumab. RESULTS Overall, 342 patients were enrolled, and 307 were evaluable. Tacrolimus was used by 6.5% (n=20) of patients at baseline, 11%, 13.5%, and 11.3% after 1, 4 and 12 months, respectively; the mean time to introduce tacrolimus after initiation of dupilumab was 8.3 ± 0.3 months. Low EASI score (<7; mild disease) after 1 month of systemic therapy was more frequent in patients who applied tacrolimus at baseline than in patients who did not (72.2% vs. 55.8%, p=0.027). Female sex, low DLQI scores, low age at dupilumab initiation, and non-generalized AD were correlated with an increased probability to start tacrolimus at any time during the study. CONCLUSIONS Data suggested that early treatment of localized areas with tacrolimus improves systemic treatment efficacy.
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Affiliation(s)
- S M Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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2
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Nettis E, Ferrucci SM, Pellacani G, Di Leo E, Argenziano G, Foti C, Rongioletti F, Patruno C, Ortoncelli M, Macchia L, Tavecchio S, Bonzano L, Di Bona D, Calabrese G, Fabbrocini G. Dupilumab in atopic dermatitis: predictors of treatment outcome and time to response. J Eur Acad Dermatol Venereol 2021; 35:e896-e898. [PMID: 34310749 DOI: 10.1111/jdv.17541] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/14/2021] [Accepted: 07/16/2021] [Indexed: 01/09/2023]
Affiliation(s)
- E Nettis
- Allergist and Dermatologist, Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - S M Ferrucci
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - G Pellacani
- Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - E Di Leo
- Section of Allergy and Clinical Immunology, Unit of Internal Medicine, 'F. Miulli' Hospital, Acquaviva delle Fonti, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania, Naples, Italy
| | - C Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Bari, Italy
| | - F Rongioletti
- Dermatology Clinic, University Vita Salute S. Raffaele, Milan, Italy
| | - C Patruno
- Unit of Dermatology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - M Ortoncelli
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - L Macchia
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - S Tavecchio
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - L Bonzano
- Dermatology Unit, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - D Di Bona
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - G Calabrese
- Dermatology Unit, University of Campania, Naples, Italy
| | - G Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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3
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Nettis E, Fabbrocini G, Ortoncelli M, Pellacani G, Argenziano G, Di Leo E, Patruno C, Stingeni L, Foti C, Rongioletti F, Macchia L, Tavecchio S, Napolitano M, Ribero S, Bonzano L, Calabrese G, Di Bona D, Nisticò SP, Hansel K, Romita P, Piras V, Carbonara M, Detoraki A, Ferrucci SM. Long-term effectiveness of dupilumab up to 52 weeks in atopic dermatitis in 253 adult patients. Br J Dermatol 2020; 184:561-563. [PMID: 32998177 DOI: 10.1111/bjd.19577] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | | | - E Di Leo
- Unit of Internal Medicine-"F. Miulli" Hospital, Acquaviva delle Fonti
| | - C Patruno
- University Magna Graecia of Catanzaro
| | | | - C Foti
- Unit of Dermatology, University of Bari
| | | | | | - S Tavecchio
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico.,Università degli Studi di Milano
| | | | | | | | | | | | | | | | - P Romita
- Unit of Dermatology, University of Bari
| | | | | | - A Detoraki
- Azienda Ospedaliera Universitaria Federico II
| | - S M Ferrucci
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
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Ferrucci SM, Tavecchio S, Favale EM, Angileri L, Riva D, Romagnuolo M, Beretta AE, Marzano AV. Effects of lockdown on health of patients with severe atopic dermatitis treated with dupilumab. J Eur Acad Dermatol Venereol 2020; 35:e17-e18. [PMID: 32978835 PMCID: PMC7537508 DOI: 10.1111/jdv.16955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- S M Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Tavecchio
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - E M Favale
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - L Angileri
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - D Riva
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - M Romagnuolo
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - A E Beretta
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
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5
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Nettis E, Ferrucci SM, Ortoncelli M, Pellacani G, Foti C, Di Leo E, Patruno C, Rongioletti F, Argenziano G, Macchia L, Tavecchio S, Napolitano M, Ribero S, Bonzano L, Romita P, Di Bona D, Nisticò SP, Piras V, Calabrese G, Detoraki C, Carbonara M, Fabbrocini G. Use of Dupilumab for 543 Adult Patients with Moderate-To-Severe Atopic Dermatitis: A Multicenter, Retrospective Study. J Investig Allergol Clin Immunol 2020; 32:124-132. [PMID: 32856595 DOI: 10.18176/jiaci.0641] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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: 11/20/2022] Open
Abstract
BACKGROUND Dupilumab has been demonstrated to be an effective treatment for patients with moderate-to-severe atopic dermatitis (AD) in clinical trials. However, evidence of real-world experience with dupilumab in a broader population is limited to date. METHODS Adult patients with moderate-to-severe AD, defined as an Eczema Area Severity Index (EASI) score of 24 or higher, treated with dupilumab at ten Italian academic centers, were included in the study. Physician-reported outcome measures (EASI), patient-reported outcome measures (pruritus and sleep score, Dermatology Life Quality Index, DLQI) and serological markers [immunoglobulin (Ig) E and eosinophil count] after 16 weeks were analyzed. RESULTS We enrolled 543 patients with moderate-to-severe AD. Two patients (0.4%) discontinued treatment. The median ± interquartile percentage change from baseline to 16 weeks of treatment in the EASI score was -87.5±22.0 (p<0.001). EASI-50, EASI-75 and EASI-90 response rates were 98.1%, 81.5%, and 50.8% after 16 weeks. At 16 weeks, 93.0% of the patients had achieved a 4- point or higher improvement in DLQI from baseline. During dupilumab treatment, 12.2% of the patients developed conjunctivitis, and total IgE significantly decreased (p<0.001). Interestingly, in the multivariate logistic regression model, the risk of developing dupilumab-related conjunctivitis was associated with early AD onset [OR, 2.25; 95%CI, 1.07-4.70; p=0.03] and presence of eosinophilia [OR, 1.91; 95%CI, 1.05-3.39; p=0.03]. CONCLUSION To date, this is the broadest real-life study in AD patients treated with dupilumab. We observed significant improvements induced by dupilumab in adult patients with moderate-to-severe AD, to a greater extent than those reported in clinical trials.
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Affiliation(s)
- E Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - S M Ferrucci
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Ortoncelli
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.,Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - G Pellacani
- Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - C Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Italy
| | - E Di Leo
- Section of Allergy and Clinical Immunology, Unit of Internal Medicine - "F. Miulli" Hospital, AcquavivadelleFonti, (BA), Italy
| | - C Patruno
- Unit of Dermatology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - F Rongioletti
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania, Naples, Italy
| | - L Macchia
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - S Tavecchio
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Napolitano
- Department of Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - S Ribero
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - L Bonzano
- Allergology Service, AUSL Modena, Italy
| | - P Romita
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Italy
| | - D Di Bona
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - S P Nisticò
- Unit of Dermatology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - V Piras
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - G Calabrese
- Dermatology Unit, University of Campania, Naples, Italy
| | - C Detoraki
- Department of Internal Medicine and Clinical Pathology, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - M Carbonara
- National Institute of Statistics (ISTAT), Bari, Italy
| | - G Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Romagnuolo M, Angileri L, Tavecchio S, Marzano AV, Ferrucci S. Safety and efficacy of dupilumab in a patient with severe atopic dermatitis and HIV infection, with 15 months of follow-up. Clin Exp Dermatol 2020; 45:762-763. [PMID: 32379943 DOI: 10.1111/ced.14278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 11/28/2022]
Affiliation(s)
- M Romagnuolo
- Dermatology Unit, Department of Pathophysiology and Transplantation, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L Angileri
- Dermatology Unit, Department of Pathophysiology and Transplantation, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Tavecchio
- Dermatology Unit, Department of Pathophysiology and Transplantation, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A V Marzano
- Dermatology Unit, Department of Pathophysiology and Transplantation, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Ferrucci
- Dermatology Unit, Department of Pathophysiology and Transplantation, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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7
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Ferrucci S, Romagnuolo M, Angileri L, Berti E, Tavecchio S. Safety of dupilumab in severe atopic dermatitis and infection of Covid-19: two case reports. J Eur Acad Dermatol Venereol 2020; 34:e303-e304. [PMID: 32330323 PMCID: PMC7267596 DOI: 10.1111/jdv.16527] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 12/30/2022]
Affiliation(s)
- S Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Romagnuolo
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - L Angileri
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - E Berti
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - S Tavecchio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
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8
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Nettis E, Ortoncelli M, Pellacani G, Foti C, Di Leo E, Patruno C, Rongioletti F, Argenziano G, Ferrucci SM, Macchia L, Napolitano M, Ribero S, Bonzano L, Romita P, Di Bona D, Bennardo L, Piras V, Calabrese G, Tavecchio S, Detoraki C, Carbonara M, Fabbrocini G. A Multicenter Study on the Prevalence of Clinical Patterns and Clinical Phenotypes in Adult Atopic Dermatitis. J Investig Allergol Clin Immunol 2020; 30:448-450. [PMID: 32376512 DOI: 10.18176/jiaci.0519] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - M Ortoncelli
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - G Pellacani
- Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - C Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Italy
| | - E Di Leo
- Section of Allergy and Clinical Immunology, Unit of Internal Medicine-"F. Miulli" Hospital, Acquaviva delle Fonti, (BA), Italy
| | - C Patruno
- Unit of Dermatology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - F Rongioletti
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania, Naples, Italy
| | - S M Ferrucci
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - L Macchia
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - M Napolitano
- Department of Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - S Ribero
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - L Bonzano
- Allergology Service, AUSL Modena, Italy
| | - P Romita
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Italy
| | - D Di Bona
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - L Bennardo
- Unit of Dermatology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - V Piras
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - G Calabrese
- Dermatology Unit, University of Campania, Naples, Italy
| | - S Tavecchio
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - C Detoraki
- Department of Internal Medicine and Clinical Pathology, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - M Carbonara
- National Institute of Statistics (ISTAT), Bari, Italy
| | - G Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Ferrucci S, Tavecchio S, Berti E, Angileri L. Acute onset of psoriasis in a patient with atopic dermatitis treated with dupilumab. Clin Exp Dermatol 2020; 45:625-626. [PMID: 32112580 DOI: 10.1111/ced.14207] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2020] [Indexed: 01/11/2023]
Affiliation(s)
- S Ferrucci
- Dermatology Unit, Department of Pathophysiology and Transplantation, IRCCS Foundation Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Tavecchio
- Dermatology Unit, Department of Pathophysiology and Transplantation, IRCCS Foundation Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dermatology Unit, Department of Pathophysiology and Transplantation, IRCCS Foundation Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - E Berti
- Dermatology Unit, Department of Pathophysiology and Transplantation, IRCCS Foundation Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dermatology Unit, Department of Pathophysiology and Transplantation, IRCCS Foundation Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - L Angileri
- Dermatology Unit, Department of Pathophysiology and Transplantation, IRCCS Foundation Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dermatology Unit, Department of Pathophysiology and Transplantation, IRCCS Foundation Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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10
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Fanoni D, Venegoni L, Vergani B, Tavecchio S, Cattaneo A, Leone BE, Berti E, Marzano AV. Evidence for a role of autoinflammation in early-phase psoriasis. Clin Exp Immunol 2019; 198:283-291. [PMID: 31509228 DOI: 10.1111/cei.13370] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2019] [Indexed: 12/19/2022] Open
Abstract
Psoriasis is a common, inflammatory immune-mediated skin disease mainly presenting with plaques whose pathogenesis is based on the central role of the interleukin (IL)-23/IL-17 axis. However, the mechanisms acting in papular lesions of early-phase psoriasis are not fully understood. The aim of this study was to assess the involvement of autoinflammation, a state of sterile inflammation mainly driven by IL-1 over-production that has been recently hypothesized to act in the early phase of disease. Lesional skin of 10 patients with recent onset, untreated psoriasis has been investigated for expression of IL-1β, IL-17, IL-23 and other cytokines involved in the disease in comparison with normal skin of 10 healthy controls using a protein array method. Immunohistochemical phenotyping of inflammatory infiltrate and co-localization experiments with immunofluorescence confocal microscopy were conducted. IL-1β was significantly more expressed in psoriasis than in normal skin (P < 0·0001). The chemokine IL-8 was also over-expressed in psoriasis (P = 0·03) while IL-12, IL-17, IL-23, tumour necrosis factor-α and interferon-γ were only slightly more expressed in psoriasis than in normal skin, without reaching statistical significance. The inflammatory infiltrate consisted mainly of neutrophils with a relevant number of macrophages and dendritic cells and only scattered, predominantly T helper 1 lymphocytes. IL-1β co-localized mainly with CD66b, a neutrophil marker, suggesting that neutrophils were the major source of this cytokine. IL-1β over-expression in combination with low expression of cytokines that are predominant in late-phase plaque psoriasis may support the role of autoinflammation in early-phase disease, possibly paving the way to randomized trials with IL-1 antagonists.
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Affiliation(s)
- D Fanoni
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - L Venegoni
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - B Vergani
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - S Tavecchio
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - A Cattaneo
- UOC Dermatologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - B E Leone
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - E Berti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.,UOC Dermatologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A V Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.,UOC Dermatologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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11
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Ferrucci S, Tavecchio S, Berti E, Angileri L. Dupilumab and prurigo nodularis-like phenotype in atopic dermatitis: our experience of efficacy. J DERMATOL TREAT 2019; 32:453-454. [DOI: 10.1080/09546634.2019.1659479] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- S. Ferrucci
- Department of Pathophysiology and Transplantation, Dermatology Unit, I.R.C.C.S. Foundation Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S. Tavecchio
- Department of Pathophysiology and Transplantation, Dermatology Unit, I.R.C.C.S. Foundation Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - E. Berti
- Department of Pathophysiology and Transplantation, Dermatology Unit, I.R.C.C.S. Foundation Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Dermatology Unit, I.R.C.C.S. Foundation Cà Granda Ospedale Maggiore Policlinico, Università Degli Studi di Milano, Milan, Italy
| | - L. Angileri
- Department of Pathophysiology and Transplantation, Dermatology Unit, I.R.C.C.S. Foundation Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Dermatology Unit, I.R.C.C.S. Foundation Cà Granda Ospedale Maggiore Policlinico, Università Degli Studi di Milano, Milan, Italy
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Marzano AV, Balice Y, Tavecchio S, Desimine C, Colombo A, Berti E. Granulomatous vasculitis. GIORN ITAL DERMAT V 2015; 150:193-202. [PMID: 25791629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Wegener's granulomatosis and Churg-Strauss Syndrome respectively, are systemic granulomatous vasculitides affecting small- and medium-sized blood vessels. Both GPA and EGPA are included within the group of antineutrophilic cytoplasmic antibodies (ANCA)-associated vasculitides, on the basis of the detection of such autoantibodies in a significant proportion of affected patients. Two main settings of GPA, possibly overlapping each other, are recognized: a localized form, which is limited to the upper airways but is highly relapsing and refractory, and a diffuse form, which is initially more severe but then less commonly recurrent. In EGPA, a prodromic phase characterized by asthma and rhino-sinusitis is followed by an eosinophilic phase, marked by peripheral eosinophilia, and then by a vasculitic phase, in which skin lesions are a prominent feature together with peripheral neuropathy and renal involvement. Polymorphic cutaneous manifestations can occur during the course of both GPA and EGPA, and include palpable purpura, livedo reticularis, papules, nodules, vesiculo-bullae and necrotic-ulcerative lesions most commonly involving the lower extremities; pyoderma gangrenosum-like ulcers and lesions resembling erythema multiforme have been described in GPA and EGPA, respectively. Oral involvement is not uncommon in GPA and may manifest as nonspecific erosive lesions or as a hyperplastic gingivitis named strawberry gingivitis. Considering that skin involvement is common in ANCA-associated vasculitides and may also be their presenting sign, the role of dermatologist is crucial in the early diagnosis of these forms as well as of vasculitis in general.
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Affiliation(s)
- A V Marzano
- Operative Unit of Dermatology, Department of Transplantation, Medico-Surgical Physiopathology,University of Milan, Ca' Granda IRCCS Foundation, Ospedale Maggiore Policlinico, Milan, Italy -
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Marzano AV, Tavecchio S, Venturini M, Sala R, Calzavara-Pinton P, Gattorno M. Urticarial vasculitis and urticarial autoinflammatory syndromes. GIORN ITAL DERMAT V 2015; 150:41-50. [PMID: 25586657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Urticaria is a frequent disorder classified as acute and chronic forms, which presents with wheals that can be associated with angioedema. Several entities may manifest with urticarial skin lesions, encompassing a heterogeneous group of conditions that have to be differentiated from ordinary urticaria. This review is focused on two of these urticarial syndromes: urticarial vasculitis (UV), which represents the most important differential diagnosis with common urticaria, and autoinflammatory diseases such as cryopyrin-associated periodic syndromes (CAPS) and Schnitzler's Syndrome, both rare multisystem forms that may masquerade as common urticaria. UV is a small-vessel vasculitis with predominant skin involvement, characterized by wheals persisting for more than 24 hours, burning rather than itching and resolving with hyperpigmentation as well as by other cutaneous manifestations including purpura, papules, vesicles, bullae and necrotic-ulcerative lesions. Histology shows a classic pattern of leukocytoclastic vasculitis, with possible presence of upper dermal edema. CAPS are classified as three distinct entities: familial cold autoinflammatory syndrome, Muckle-Wells Syndrome and chronic infantile neurological cutaneous and articular syndrome, which represent a spectrum of disorders caused by different mutations in a single gene, NLRP3 (NOD-like receptor 3). This gene encodes for cryopyrin, an inflammasome protein that activates interleukin-1β, leading to an overproduction of this pivotal proinflammatory cytokine. Histologically, urticarial lesions are generally characterized by a perivascular neutrophilic infiltrate. Unlike urticaria, neither UV nor urticarial autoinflammatory syndromes do respond to antihistamines: thus, it is important not to misdiagnose such conditions in order to give the patients specific treatments, potentially preventing serious systemic complications.
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Affiliation(s)
- A V Marzano
- Department of Medico‑Surgical and Transplantation Physiopathology, Operative Unit of Dermatology,University of Milan, Italy, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy -
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Marzano AV, Tavecchio S, Menicanti C, Crosti C. Drug-induced lupus erythematosus. GIORN ITAL DERMAT V 2014; 149:301-309. [PMID: 24819757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Drug-induced lupus erythematosus (DI-LE) is defined as an entity characterized by clinical manifestations and immunopathological serum findings similar to those of idiopathic lupus but which is temporally related to drug exposure and resolves after withdrawal of the implicated drug. Similarly to idiopathic lupus, DI-LE can be divided into systemic LE, subacute cutaneous LE (SCLE), chronic cutaneous LE (CCLE) and cutaneous LE tumidus. DI-SCLE is the most frequent variant of drug-induced cutaneous LE and presents mainly with annular-polycyclic lesions; the clinical picture is often widespread, with involvement of the lower legs that are usually spared in idiopathic SCLE. ANA and anti-Ro/SSA antibodies are typically present, whereas antihistone antibodies are uncommonly found. We have recently addressed the question whether DI-SCLE differs significantly from its idiopathic counterpart by virtue of clinical features and, based on our findings, we have suggested that the frequent occurrence of malar rash and bullous, erythema multiforme-like and vasculitic manifestations can be regarded as the hallmark of DI-SCLE. In contrast, the histology is not a useful diagnostic criterion for DI-SCLE, considering that the typical pattern of lichenoid interface dermatitis is seen only in the early stage of disease and tissue eosinophilia does not represent a differentiating histopathological feature. DI-CCLE and DI-LE tumidus, albeit possibly misdiagnosed, are rarely observed and are characterized by classic discoid lesions and erythematous-oedematous plaques on sun exposed areas, respectively. Management of DI-LE is based on the discontinuation of the offending drug; topical and/or systemic corticosteroids and other immunomodulating/immunosuppressive agents should be reserved for resistant cases.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Antinuclear/blood
- Biomarkers/blood
- Drug Therapy, Combination
- Female
- Glucocorticoids/therapeutic use
- Humans
- Immunologic Factors/blood
- Immunosuppressive Agents/therapeutic use
- Leg/pathology
- Lupus Erythematosus, Cutaneous/diagnosis
- Lupus Erythematosus, Cutaneous/drug therapy
- Lupus Erythematosus, Cutaneous/etiology
- Lupus Erythematosus, Cutaneous/immunology
- Lupus Erythematosus, Cutaneous/pathology
- Lupus Erythematosus, Discoid/etiology
- Lupus Erythematosus, Discoid/pathology
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/drug therapy
- Lupus Erythematosus, Systemic/etiology
- Lupus Erythematosus, Systemic/immunology
- Lupus Erythematosus, Systemic/pathology
- Male
- Middle Aged
- Torso/pathology
- Treatment Outcome
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Affiliation(s)
- A V Marzano
- Operative Unit of Dermatology Department of Pathophysiology and Transplantation University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy -
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Veraldi S, La Vela V, Tavecchio S. Tinea capitis versus acne keloidalis nuchae with Trichophyton violaceum superinfection. GIORN ITAL DERMAT V 2011; 146:247-248. [PMID: 21566556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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