Altered skin microbiome, inflammation, and JAK/STAT signaling in Southeast Asian ichthyosis patients

BACKGROUND

Congenital ichthyosis (CI) is a collective group of rare hereditary skin disorders. Patients present with epidermal scaling, fissuring, chronic inflammation, and increased susceptibility to infections. Recently, there is increased interest in the skin microbiome; therefore, we hypothesized that CI patients likely exhibit an abnormal profile of epidermal microbes because of their various underlying skin barrier defects. Among recruited individuals of Southeast Asian ethnicity, we performed skin meta-genomics (i.e., whole-exome sequencing to capture the entire multi-kingdom profile, including fungi, protists, archaea, bacteria, and viruses), comparing 36 CI patients (representing seven subtypes) with that of 15 CI age-and gender-matched controls who had no family history of CI.

RESULTS

This case-control study revealed 20 novel and 31 recurrent pathogenic variants. Microbiome meta-analysis showed distinct microbial populations, decreases in commensal microbiota, and higher colonization by pathogenic species associated with CI; these were correlated with increased production of inflammatory cytokines and Th17- and JAK/STAT-signaling pathways in peripheral blood mononuclear cells. In the wounds of CI patients, we identified specific changes in microbiota and alterations in inflammatory pathways, which are likely responsible for impaired wound healing.

CONCLUSIONS

Together, this research enhances our understanding of the microbiological, immunological, and molecular properties of CI and should provide critical information for improving therapeutic management of CI patients.

The collagen market and knowledge, attitudes, and practices of Brazilian consumers regarding collagen ingestion

Collagen is considered a nutraceutical, and its consumption has been expanding due to the increased life expectancy, rising per capita income, and increased consumer awareness of health care. This study aimed to evaluate consumers' perceptions, knowledge, attitudes, and practices about the consumption of collagen-based products by using an online questionnaire and to correlate them with socio-economic data. A market survey (pharmacy stores and online) was also conducted to evaluate the available products. In total, 275 participants answered the survey, 73.3% from the Southeast region, mostly female (84.0%). Most participants reported three months as the period of collagen intake (31.6%), and the consumption period was associated with the perception of the health benefits (p < 0.001). Furthermore, the participants' knowledge and perceptions regarding collagen intake are frequently associated with dermatological and orthopedic changes. Collagen-based products supplementation is a growing market with a broad target audience (genders, age groups, and socio-economic levels). The commercial presentation of collagen has been diversified over the years, and powder collagen is the most consumed (52.7%) and cheapest compared with capsules, pills, or gummies. The results of the present study demonstrate that most consumers of this type of supplement associate its benefits with aesthetic care such as skin, hair, and nails, although the scientific literature has shown its effects in treating osteoarticular diseases, for example. Undoubtedly, the correct dose prescription, treatment time, and choice of product presentation must be analyzed carefully, as they significantly impact treatment results.

Ambient temperature exposure and risk of outpatient visits for dermatologic diseases in Xinxiang, China: a time-series analysis

The effect of ambient temperature on dermatologic diseases has received widespread attention. Previous studies have shown that ambient temperature might affect specific dermatologic diseases, but results were inconsistent. This study aims to assess the short-term effect of ambient temperature on outpatient visits due to dermatologic diseases (DMs) in Xinxiang, China. Daily DMs outpatient visits, mean temperature, mean relative humidity, and air pollution data of Xinxiang were retrieved from January 1, 2015, to December 31, 2018. A distributed lag nonlinear model (DLNM) was applied to analyze the effect of ambient temperature on DMs outpatients. We controlled several potential confounding factors such as the long-term trend, public holiday, day of the week, humidity, and air pollutants (NO₂, PM_2.5). Finally, two more stratification analysis was conducted by age and gender. A total of 164,270 outpatients of DMs were enrolled during our study, and the daily mean visits were 113. The estimated effect of temperature on DMs was nonlinear. Heat temperature would exacerbate outpatients of dermatologic diseases. With a reference median temperature (17 °C), the effect of temperature on DMs was most pronounced at lag0-14; exposure to heat (32 °C, 99th) was associated with 1.565 (95% CI: 1.266-1.934) increased risk of outpatients for DMs. Stratification analysis showed that citizens of young ages were susceptive to heat; both genders had a similar relationship between temperature and DMs risk. This study highlights that ambient temperature was associated with DMs outpatients; heat temperature might aggravate DMs risk. The health hazards of heat temperature required more attention, and more effective prevention measurements should be designed and implemented to curb global warming.

Effects of Patients' Expectation in Dermatology: Evidence from Experimental and Clinical Placebo Studies and Implications for Dermatologic Practice and Research

Patients' expectations towards the benefit of a treatment are key determinants of placebo responses and can affect the development and course of medical conditions and the efficacy and tolerability of active medical treatment. The mechanisms mediating these placebo and nocebo effects have been best described in the field of experimental pain and placebo analgesia. However, also in dermatology experimental and clinical studies demonstrate that various skin diseases such as inflammatory dermatoses and allergic reactions can be modulated by patients' expectations. Dermatologists should consider the important modulatory role of patients' expectations on the efficacy and tolerability of specific treatments and the key role of verbal information, patients' prior treatment experiences (associative learning), and the quality and quantity of doctor-patient communication in shaping treatment expectation. As a consequence, techniques aiming at maximizing patients' expectation effects should be implemented into daily clinical routine. By contrast, in clinical studies expectation effects should be maximally controlled and harmonized to improve the "assay sensitivity" to detect new compounds. Further translational studies, also in dermatoses that have not been investigated yet, are needed to better characterize the mechanisms underlying patients' expectation and to gain further insights into potential clinical implications of these effects in dermatologic conditions. Therefore, in this review, we provide a brief overview on the concept of expectation effects on treatment outcome in general, summarize what is already known about this topic for dermatologic diseases, and finally present the relevance of this topic in clinical dermatology.

Predictive Value of NUDT15 Variants on Neutropenia Among Han Chinese Patients with Dermatologic Diseases: A Single-Center Observational Study

Introduction

Azathioprine is a synthetic purine analogue derived from 6-mercaptopurine which acts by disrupting nucleic acid synthesis and interfering with T cell activation. It is effective in dermatology diseases related to the immune system. However, its side effects, including severe neutropenia, kept patients from using it. Mutations in thiopurine methyltransferase (TPMT) and inosine triphosphate pyrophosphohydrolase (ITPA) genes account for the major genetic polymorphism markers for azathioprine adverse risk factors in Caucasians, but not in Asians. The predictive value of the nucleoside diphosphate-linked moiety X motif 15 gene (NUDT15) has been studied in various diseases among different populations. The aim of our study was to determine the contribution of NUDT15 mutations in azathioprine-induced neutropenia in Han Chinese patients with dermatologic diseases.

Methods

The study enrolled all consecutive patients, older than 13 years old, with dermatological diseases currently treated orally with azathioprine in our clinic. Samples were also collected from patients with documented leukopenia in our prior study that examined the association between TPMT, ITPA, and neutropenia after informed reconsent. Complete blood count, differential count, and hepatic and renal function were checked regularly. The DNA samples for NUDT15 genotype were obtained from the patients.

Results

In total, we enrolled 56 patients (39 male, 17 female). The NUDT15 genotypes are mostly C/C (N = 36, 64.29%). Heterozygous variant (C/T) accounts for 30.36% (N = 17) and homozygous variant (T/T) accounts for 5.36% (N = 3). Among these patients, 15 patients (26.79%) developed neutropenia, including all three patients carry homozygous variant (T/T). The age-, sex-, and dose-adjusted risk of heterozygous variant compared to wild type is 9.383 (95% CI 1.32–66.96).

Conclusions

Pretreatment screening of NUDT15 might reduce the chance of azathioprine-induced neutropenia in Han Chinese patients with dermatologic diseases.

Therapeutic Apheresis in Hematologic, Autoimmune and Dermatologic Diseases With Immunologic Origin

The process of curing a patient by removing his illness by extracting blood is a very old one. Many years ago, phlebotomy was practiced to cure illness. Now, this old process, placed on a rational basis with therapeutic apheresis (TA), is being followed in clinical practice. Therapeutic plasma exchange (TPE) with hollow fiber modules has been used in different severe diseases for more than 40 years. Based on many years of experience with the extracorporeal circulation in end-stage renal disease, the authors herein give an overview of TA in immunological diseases, especially in hematologic, autoimmune and dermatologic diseases. Updated information on immunology and molecular biology of different immunological diseases is discussed in relation to the rationale for apheresis therapy and its place in combination with other modern therapies. With the introduction of novel and effective biologic agents, TA is indicated only in severe cases, such as in rapid progression despite immunosuppressive therapy and/or biologic agents. In mild forms of autoimmune disease, treatment with immunosuppressive therapies and/or biologic agents seems to be sufficient. The prognosis of autoimmune diseases with varying organ manifestations has improved in recent years, due in part to very aggressive therapy schemes. For the immunological diseases that can be treated with TA, the guidelines of the German Working Group of Clinical Nephrology and of the Apheresis Applications Committee of the American Society for Apheresis are cited. TA has been shown to effectively remove the autoantibodies from blood and lead to rapid clinical improvement.

Ectoparasites in small exotic mammals

Ectoparasites inhabiting the skin are responsible for significant problems in small mammals, owing to ingestion of blood, lymph, sebaceous secretions, and scavenging skin debris, as well as a hypersensitivity reaction to parasite antigen resulting in severe pruritus and subsequent self-trauma-induced lesions. In general practice, the most common diagnosis in exotic pets is an unspecified mite infestation, but other ectoparasites such as lice, fleas, insects, or even helminths may cause dermatologic diseases. If treatment with topical insecticides is planned, the small mammal should be isolated for a few hours to enable drying and spreading of the product.