Intralesional corticosteroids (ICs) are widely used in dermatology to treat various cutaneous conditions. A rare yet catastrophic complication, steroid injection-induced vision loss (SIIVL) remains underrecognized with more attention directed towards vision loss caused by hyaluronic acid fillers. This review examines reports of vision loss caused by intralesional steroid injections in the treatment of dermatologic disorders on the face and scalp.
Allison R. Loiselle, Raj Chovatiya, Isabelle J. Thibau
et al.
Abstract Introduction Despite advances in atopic dermatitis (AD) treatments, many patients face challenges obtaining medications. This study aimed to determine the frequency and causes of insurance coverage delays and denials for AD prescriptions and characterize the associated wait times and extent to which patients understand what to do when faced with a coverage issue. Methods This was a cross-sectional, observational study in which adult U.S. residents (aged 18+ years) with AD or caregivers of pediatric U.S. patients with AD (aged 0–17 years) completed an online survey (3 June–16 July 2021). Results Respondents (N = 978) were primarily adults with AD (81.8%), female (67.7%), and white (70.2%). There were 645 insurance delays or denials for AD prescriptions, with 48.1% (470/978) of respondents experiencing at least one delay/denial in the past year. Most delays/denials were for topical steroids (39.2%, 253/645), the most highly used prescription treatment class (83.9%, 821/978). However, the highest rate of delay/denials was for biologics, of which 43.6% (109/250) of all prescriptions faced a delay or denial. Denials were caused primarily by step therapy (27.6%) and delays by prior authorization (55.1%). Only 56.0% of respondents said they would know what to do if they faced an issue with AD prescription coverage. Conclusions Patients with AD frequently experience insurance-related barriers to obtaining recommended therapies, and many do not know how to respond when these barriers arise. Strategies to improve timely therapeutic access are needed.
The terminology used to describe reflectance confocal microscopy (RCM) findings in both melanocytic and nonmelanocytic lesions has been standardized in English. We convened a panel of Spanish-speaking RCM experts and used the Delphi method to seek consensus on which Spanish terms best describe RCM findings in this setting. The experts agreed on 52 terms: 28 for melanocytic lesions and 24 for nonmelanocytic lesions. The resulting terminology will facilitate homogenization, leading to a better understanding of structures, more standardized descriptions in clinical registries, and easier interpretation of clinical reports exchanged between dermatologists. Resumen: La terminología usada para describir los diferentes hallazgos en la microscopía confocal de reflectancia (MCR), tanto en lesiones melanocíticas, como en no melanocíticas se ha consensuado en inglés. En el presente trabajo, se proponen los términos en español que mejor interpretan estos conceptos ya descritos para la MCR, mediante el consenso de expertos de distintas nacionalidades de habla hispana y utilizando el método DELPHI para el acuerdo final. Se obtuvieron 52 términos en total, de los cuales 28 fueron para lesiones melanocíticas y 24 para lesiones no melanocíticas. El uso de la nomenclatura propuesta permitirá una homogeneización y mejor entendimiento de las estructuras; una descripción más estandarizada en los registros clínicos y una mejor interpretación de estos informes por otros dermatólogos.
Summary: Fibroblasts can be chemically induced to pluripotent stem cells (CiPSCs) through an extraembryonic endoderm (XEN)-like state or directly converted into other differentiated cell lineages. However, the mechanisms underlying chemically induced cell-fate reprogramming remain unclear. Here, a transcriptome-based screen of biologically active compounds uncovered that CDK8 inhibition was essential to enable chemically induced reprogramming from fibroblasts into XEN-like cells, then CiPSCs. RNA-sequencing analysis showed that CDK8 inhibition downregulated proinflammatory pathways that suppress chemical reprogramming and facilitated the induction of a multi-lineage priming state, indicating the establishment of plasticity in fibroblasts. CDK8 inhibition also resulted in a chromatin accessibility profile like that under initial chemical reprogramming. Moreover, CDK8 inhibition greatly promoted reprogramming of mouse fibroblasts into hepatocyte-like cells and induction of human fibroblasts into adipocytes. These collective findings thus highlight CDK8 as a general molecular barrier in multiple cell reprogramming processes, and as a common target for inducing plasticity and cell fate conversion.
Sophia Papaioannou, Jia-Xiang See, Mingeum Jeong
et al.
Summary: Liver sinusoidal endothelial cells (LSECs) rapidly clear lipopolysaccharide (LPS) from the bloodstream and establish intimate contact with immune cells. However, their role in regulating liver inflammation remains poorly understood. We show that LSECs modify their chemokine expression profile driven by LPS or interferon-γ (IFN-γ), resulting in the production of the myeloid- or lymphoid-attracting chemokines CCL2 and CXCL10, respectively, which accumulate in the serum of LPS-challenged animals. Natural killer (NK) cell exposure to LSECs in vitro primes NK cells for higher production of IFN-γ in response to interleukin-12 (IL-12) and IL-18. In livers of LPS-injected mice, NK cells are the major producers of this cytokine. In turn, LSECs require exposure to IFN-γ for CXCL10 expression, and endothelial-specific Cxcl10 gene deletion curtails NK cell accumulation in the inflamed livers. Thus, LSECs respond to both LPS and immune-derived signals and fuel a positive feedback loop of immune cell attraction and activation in the inflamed liver tissue.
Carmela Giancotta, Nicole Colantoni, Lucia Pacillo
et al.
Inborn errors of immunity associated with atopy (IEIs-A) are a group of inherited monogenic disorders that occur with immune dysregulation and frequent skin involvement. Several pathways are involved in the pathogenesis of these conditions, including immune system defects, alterations of skin barrier and metabolism perturbations. Current technological improvements and the higher accessibility to genetic testing, recently allowed the identification of novel molecular pathways involved in IEIs-A, also informing on potential tailored therapeutic strategies. Compared to other systemic therapy for skin diseases, biologics have the less toxic and the best tolerated profile in the setting of immune dysregulation. Here, we review IEIs-A with skin involvement focusing on the tailored therapeutic approach according to their pathogenetic mechanism.
NLRP3 inflammasome activates IL-1β and IL-18. In recent years, a large number of in vitro and in vivo studies showed elevations in expression levels of NLRP3 inflammasome, IL-1β and IL-18 in psoriasis. The involvement of NLRP3 inflammasome in the pathogenesis of psoriasis may be related to the activation of NF-κB, P2X7, S1PR1 and miRNA155. Blocking NLRP3 inflammasome may affect AMPK and SIRT1 molecules as well as T cell signaling pathways in psoriasis models. Here we review the association of NLRP3 and psoriasis, the possible mechanisms by which NLRP3 regulates the progress of psoriasis and the changes in inflammatory pathway after blockade of NLRP3.
Sudhir U. K. Nayak, Shukriti D Shenoi, S Smitha Prabhu
et al.
Koebner phenomenon (KP) or isomorphic phenomenon often helps in diagnosis of certain conditions and often reflects disease activity. Although commonly reported with psoriasis, vitiligo, and lichen planus, KP has been occasional reported with other conditions. Bullous pemphigoid has a rare association with this and we report a case with scratching being the inciting factor. A 50-year-old female with no comorbidities presented with itchy fluid-filled lesions all over the body for 15 days. Examination showed generalized distribution of bullae and vesicles with linear bulla on the forearms. Histopathology and immunofluorescence studies were conclusive of bullous pemphigoid. KP has been reported in general due to mechanical trauma, therapy, dermatoses, or reactions. KP in bullous pemphigoid is rarely reported and it is mentioned in the category IV of Boyd and Nelder classification. The linear nature of bulla in our patient was suggestive of scratching being the inciting factor for KP, which has not been reported to the best of our knowledge.
Danielle R Davari, Elizabeth L Nieman, Diana B McShane, Dean S Morrell Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC, USACorrespondence: Dean S MorrellDepartment of Dermatology, University of North Carolina School of Medicine, 410 Market Street Suite 400, Chapel Hill, NC 27516, USATel +1 984 974 3900Fax +1 984 974 3692Email morrell@med.unc.eduAbstract: Atopic dermatitis (AD) is a common disease of childhood, and infantile AD may manifest from birth to 2 years. Guidelines for the management of infantile AD are lacking, and our aim is to provide a comprehensive review of best practices and possible interventions. We will focus on topical therapy, since the use of systemic immunomodulating agents in infantile AD is rarely advised. Topical agents include emollients, topical corticosteroids (TCS), topical calcineurin inhibitors (TCIs), and phosphodiesterase 4 (PDE-4) inhibitors. We will also provide a brief overview of promising emerging therapies currently under investigation in the pediatric population.Keywords: eczema, pediatric, infants, treatment
Janković Slavenka, Ražnatović-Đurović Milena, Ćirković Anđa
et al.
Introduction: Atopic dermatitis (AD) is a chronic skin disease that has a significant impact on quality of life (QoL). The aim of this paper was to evaluate if gender affects some aspects of QoL in children with AD. Materials and methods: The cross-sectional study was conducted at the Clinic of Dermatology and Venereology, Clinical Center of Montenegro, between August 2017 and July 2018 and included 200 children aged 5-16 years with AD diagnosis. The severity of disease was measured by the Three Item Severity (TIS) score, while QoL was assessed with the Children's Dermatology Life Quality Index (CDLQI). Socio-demographic data on children with AD were collected by a short questionnaire. Results: The difference in overall CDLQI between boys and girls was not statistically significant. The domains that were most affected by AD were school/holidays (mean score 2.27 ± 0.65), and symptoms (mean score 2.22 ± 0.70). Swimming/ sports activities, school/holidays, teasing/bullying and sleep disturbance were more affected in girls. Overall CDLQI score and CDLQI subscale scores (except school/holidays and sleep in boys) significantly correlated with TIS. According to multivariate logistic regression analyses statistically significant differences between two genders were not found for age, AD severity, concomitant atopic disease, and family history of atopic disease. Conclusion: Although we did not find differences between the two genders in the overall health related QoL, this study confirmed the tendency for AD to have a more severe impact on girls' lives. These results may influence treatment and counselling of children affected with AD.
Context: There is still a dearth of knowledge regarding the types of dermatoses occurring in postmenopausal women. The common disorders occurring in postmenopausal women and the probable effects of hormonal fluctuations on the skin have to be considered while treating postmenopausal women. Aims: To study clinical patterns of dermatosis in menopausal women. Settings and Design: It was a cross-sectional study conducted in the dermatology department from May 2017 to June 2018 after approval from ethical committee. Materials and Methods: All postmenopausal patients having dermatoses were included in the study after taking their written consent in vernacular language. Statistical Analysis Used: All findings were analyzed using STATA (14.2). Results: The study included 150 postmenopausal women. Most of the patients belonged to the age group of 61–70 years (38.67%) with a mean age of 61.52 years. The age of menopause was most commonly achieved between 40 and 50 years (57.33%). The genital dermatoses were found in 90 (60%) subjects and included atrophic vaginitis (21, 33.33%), lichen sclerosus et atrophicus (14, 15.55%), lichen simplex chronicus (14,15.55%) and tinea cruris (10,11.11%) among others. The extragenital dermatoses were found in 96 (64%) cases and common ones were dermatophytosis (16, 16.33%), lichen planus (11, 11.22%), psoriasis (9, 9.18%) and eczema (8,8.16%). Conclusion: This study is useful in understanding the various clinical patterns of postmenopausal dermatoses and thereby help the physician, dermatologist, and gynecologist to effectively manage the conditions.
Dorota Krasowska, Lidia Rudnicka, Aleksandra Dańczak-Pazdrowska
et al.
Systemic sclerosis is an immune-mediated disease characterized by a chronic and progressive course. It often leads to multiorgan failure and patient disability, and contributes to significant reduction in the quality of life. Systemic sclerosis affects the skin, subcutaneous tissue, muscles, osteoarticular system and internal organs. The complexity and diversity of clinical presentations require an individual approach and multidisciplinary collaboration both at the stage of diagnosis and treatment. Critical factors in systemic sclerosis include early diagnosis, assessment of internal organ involvement, identification of patients at potential risk of organ complications, assessment of disease dynamics and activity, and implementation of optimal therapy. Part 1 presents current recommendations for the diagnostics and monitoring of patients with systemic sclerosis. Attention is given to classification criteria, clinical forms of systemic sclerosis, assessment of skin thickness and systemic sclerosis microangiopathy, significance of antinuclear antibodies, diagnosis of interstitial lung disease and pulmonary arterial hypertension, renal crisis and cardiac abnormalities, and evaluation of the gastrointestinal tract and osteoarticular and muscular systems.
Clinical presentation is given of eruption in the case of segmental vitiligo and nevus achromicus. Literary data was presented, issues of differential diagnostics were discussed.