RESUMEN
Cytophagic histiocytic panniculitis (CHP) is associated with a number of systemic conditions and is characterized by the presence of benign phagocytic histiocytes ("bean bag cells"), including phagocytosed erythrocytes, leukocytes, and platelets. We describe a case of a 72-year-old female who presented with a papular eruption that clinically mimicked pityriasis lichenoides et varioliformis acuta (PLEVA). Given that her skin biopsy had multiple features concerning PLEVA, this diagnosis was classified as a superficial pityriasis lichenoides-like variant of CHP. The histopathologic presence of cytophagic histiocytosis prompted workup for a systemic malignancy, leading to a diagnosis of underlying acute monocytic leukemia of myeloid lineage.
Asunto(s)
Paniculitis , Humanos , Femenino , Anciano , Paniculitis/patología , Paniculitis/diagnóstico , Histiocitos/patología , Leucemia Mieloide Aguda/patología , Leucemia Mieloide Aguda/diagnóstico , Leucemia Monocítica Aguda/patología , Leucemia Monocítica Aguda/diagnóstico , Diagnóstico Diferencial , Diferenciación Celular , Monocitos/patologíaRESUMEN
Chronic ultraviolet (UV) radiation exposure is the greatest risk factor for cutaneous squamous cell carcinoma (cSCC) development, and compromised immunity accelerates this risk. Having previously identified that epidermal Langerhans cells (LC) facilitate the expansion of UV-induced mutant keratinocytes (KC), we sought to more fully elucidate the immune pathways critical to cutaneous carcinogenesis and to identify potential targets of intervention. Herein, we reveal that chronic UV induces and LC enhance a local immune shift toward RORγt+ interleukin (IL)-22/IL-17A-producing cells that occurs in the presence or absence of T cells while identifying a distinct RORγt+ Sca-1+ CD103+ ICOS+ CD2+/- CCR6+ intracellular CD3+ cutaneous innate lymphoid cell type-3 (ILC3) population (uvILC3) that is associated with UV-induced mutant KC growth. We further show that mutant KC clone size is markedly reduced in the absence of RORγt+ lymphocytes or IL-22, both observed in association with expanding KC clones, and find that topical application of a RORγ/γt inhibitor during chronic UV exposure reduces local expression of IL-22 and IL-17A while markedly limiting mutant p53 KC clonal expansion. We implicate upstream Toll-like receptor signaling in driving this immune response to chronic UV exposure, as MyD88/Trif double-deficient mice also show substantially reduced p53 island number and size. These data elucidate key immune components of chronic UV-induced cutaneous carcinogenesis that might represent targets for skin cancer prevention.
Asunto(s)
Interleucinas/metabolismo , Queratinocitos/patología , Linfocitos/patología , Miembro 3 del Grupo F de la Subfamilia 1 de Receptores Nucleares/metabolismo , Neoplasias Cutáneas/patología , Piel/patología , Rayos Ultravioleta/efectos adversos , Animales , Carcinogénesis/metabolismo , Carcinogénesis/patología , Carcinogénesis/efectos de la radiación , Células Cultivadas , Inmunidad Innata/inmunología , Interleucinas/genética , Queratinocitos/metabolismo , Queratinocitos/efectos de la radiación , Células de Langerhans/inmunología , Células de Langerhans/metabolismo , Células de Langerhans/patología , Células de Langerhans/efectos de la radiación , Linfocitos/inmunología , Linfocitos/metabolismo , Linfocitos/efectos de la radiación , Ratones , Mutación , Miembro 3 del Grupo F de la Subfamilia 1 de Receptores Nucleares/genética , Piel/metabolismo , Piel/efectos de la radiación , Neoplasias Cutáneas/etiología , Neoplasias Cutáneas/metabolismo , Interleucina-22RESUMEN
BACKGROUND: Malignant melanoma in-situ, lentigo maligna (MMIS-LM) can be successfully treated with several different surgical techniques; however, the literature is inconsistent in defining them. OBJECTIVE: To comprehensively define and describe the national guideline recommended surgical techniques used to treat MMIS-LM to help clarify and standardize this terminology to ensure compliance with the guidelines. METHODS: A targeted literature review was performed from 1990 to 2022 focusing on articles that discussed the national guideline recommended surgical techniques of wide local excision, Mohs micrographic surgery (MMS), modified Mohs surgery, and staged excision/Slow-Mohs for MMIS-LM, as well as the related methods of tissue processing. National Comprehensive Cancer Network and American Academy of Dermatology guidelines were reviewed to identify how the techniques need to be employed to be compliant with guideline recommendations. RESULTS: We describe the various surgical and tissue processing techniques and discuss advantages and disadvantages of each. LIMITATIONS: This paper was styled as a narrative review defining and clarifying terminology and technique and does not investigate these topics more broadly. CONCLUSION: Understanding the methodology and terminology for these surgical procedures and tissue processing methods is critical so that both general dermatologists and surgeons can employ these techniques effectively for optimal patient care.
Asunto(s)
Peca Melanótica de Hutchinson , Melanoma , Neoplasias Cutáneas , Humanos , Peca Melanótica de Hutchinson/patología , Adhesión a Directriz , Melanoma/patología , Neoplasias Cutáneas/patología , Cirugía de Mohs/métodos , Melanoma Cutáneo MalignoRESUMEN
The current US Food and Drug Administration (FDA) indications for baricitinib include alopecia areata, rheumatoid arthritis, and COVID-19. However, increasing evidence indicates that baricitinib is effective in treating a variety of dermatological conditions. This review article comprehensively presents the available literature on this topic and will be of interest to practitioners in the field. These disorders may be broadly classified as connective tissue diseases, eczematous dermatoses, alopecias, vascular disorders, granulomatous diseases, neutrophilic dermatoses, vitiligo, psoriasis, lichenoid disorders, and other miscellaneous disorders. Shah A, Yumeen S, Qureshi A, et al. Off-label use of baricitinib in dermatology. J Drugs Dermatol. 2023;22(8):795-801. doi:10.36849/JDD.7360.
Asunto(s)
Alopecia Areata , COVID-19 , Dermatología , Psoriasis , Humanos , Uso Fuera de lo Indicado , Tratamiento Farmacológico de COVID-19 , Psoriasis/tratamiento farmacológico , Alopecia Areata/tratamiento farmacológicoRESUMEN
Climate change and environmental health are closely linked with agriculture and food supply. The environment influences accessibility, quality, and variety of foods and drinks that are available for consumption, which in turn influences population health. A growing area of research is the role of dietary intake of nutrients and how they may influence risk for skin cancer. In recent years, our group has studied dietary nutrients, particularly those found in commonly consumed beverages, such as those containing caffeine, citrus products, and alcohol, in large prospective cohorts to evaluate how their intake may influence risk for skin cancer. Our data suggest that intake of citrus juices, when consumed around once per day or more, or around 5 to 6 times per week, may be associated with increased risk for both keratinocyte carcinomas (KC) and malignant melanoma (MM). With regards to alcohol consumption, we have found that intake of white wine may be associated with increased risk for both KC and MM, while beer and red wine have not shown such associations. Lastly, our work suggests caffeinated beverages, including coffee, tea, and cola, may be associated with decreased risk for basal cell carcinoma (BCC) and MM. While the associations between food intake and skin cancer development are complex, and remain to be further analyzed in future studies, we hope that our summary may help guide individuals to small changes they may make towards potentially reducing their risk for certain skin cancers.
Asunto(s)
Citrus , Neoplasias Cutáneas , Café/efectos adversos , Estudios Prospectivos , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/etiología , Etanol , Melanoma Cutáneo MalignoRESUMEN
As they are collectively the most common malignancies, the personal and systemic burden of skin cancers represent a significant public health concern in the United States. Ultraviolet radiation from the sun as well as from artificial sources such as tanning beds is a carcinogen well-known to increase the risk of developing skin cancer in individuals. Public health policies can help mitigate these risks. In this perspectives article, we review sunscreen and sunglasses standards, tanning bed utilization, and workplace sun protection guidelines in the US and provide focused examples for improvement from Australia and the United Kingdom where skin cancer is a well-documented public health concern. These comparative examples can inform interventions in the US that have the potential to modify exposure to risk factors associated with skin cancer.
Asunto(s)
Neoplasias Cutáneas , Rayos Ultravioleta , Humanos , Estados Unidos , Rayos Ultravioleta/efectos adversos , Neoplasias Cutáneas/etiología , Neoplasias Cutáneas/prevención & control , Protectores Solares , Políticas , Salud PúblicaRESUMEN
Cutaneous T cell lymphoma (CTCL) is a rare malignancy of skin-homing T lymphocytes. Advances in whole exome sequencing have identified a vast number of both single nucleotide variants (SNVs) and genomic copy number alterations (GCNAs) as driver mutations present in CTCL cells. These alterations cluster within several key pathways - T cell/NF-κB/JAK-STAT activation, cell cycle dysregulation/apoptosis, and DNA structural dysregulation affecting gene expression - allowing the maintenance of a population of proliferating, activated malignant T lymphocytes. While much of the clinical spectrum, genetic alterations, and oncogenic behavior of CTCL have been elucidated, little is known about the etiology that underlies CTCL malignant transformation and progression. Herein, we review the epidemiology, clinical presentation, and pathophysiology of CTCL to provide a perspective on CTCL pathogenesis. We outline a series of alterations by which mature, activated T lymphocytes are endowed with apoptosis resistance and cutaneous persistence. Subsequent genomic alterations including the loss of chromosomal structural controls further promote proliferation and constitutive T cell activation. CTCL cells are both malignant cells and highly functional T cells that can have major cutaneous and immunologic effects on the patient, including the suppression of cell-mediated immunity that facilitates malignant cell expansion. A deeper understanding of the molecular and cellular underpinnings of CTCL can help guide clinical management as well as inform prognosis and therapeutic discovery.
Asunto(s)
Linfoma Cutáneo de Células T , Neoplasias Cutáneas , Expresión Génica , Estudios de Asociación Genética , Humanos , Linfoma Cutáneo de Células T/genética , Linfoma Cutáneo de Células T/metabolismo , Linfoma Cutáneo de Células T/patología , Transducción de Señal , Neoplasias Cutáneas/genética , Neoplasias Cutáneas/metabolismo , Neoplasias Cutáneas/patologíaAsunto(s)
Peróxido de Benzoílo , Aprobación de Drogas , Composición de Medicamentos , United States Food and Drug Administration , Humanos , Estados Unidos , Peróxido de Benzoílo/administración & dosificación , Composición de Medicamentos/métodos , Acné Vulgar/tratamiento farmacológico , Fármacos Dermatológicos/administración & dosificación , Femenino , Satisfacción del PacienteAsunto(s)
Salud Poblacional , Rosácea , Humanos , Rosácea/diagnóstico , Rosácea/epidemiología , PrescripcionesAsunto(s)
Dermatología , Academias e Institutos , Humanos , Análisis Multivariante , Sociedades Médicas , Estados UnidosRESUMEN
OBJECTIVE: Nearly 20%-29% of patients with colorectal cancer (CRC) succumb to liver or lung metastasis and there is a dire need for novel targets to improve the survival of patients with metastasis. The long isoform of the Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1-L or CC1-L) is a key regulator of immune surveillance in primary CRC, but its role in metastasis remains largely unexplored. We have examined how CC1-L expression impacts on colon cancer liver metastasis. DESIGN: Murine MC38 transfected with CC1-L were evaluated in vitro for proliferation, migration and invasion, and for in vivo experimental liver metastasis. Using shRNA silencing or pharmacological inhibition, we delineated the role in liver metastasis of Chemokine (C-C motif) Ligand 2 (CCL2) and Signal Transducer and Activator of Transcription 3 (STAT3) downstream of CC1-L. We further assessed the clinical relevance of these findings in a cohort of patients with CRC. RESULTS: MC38-CC1-L-expressing cells exhibited significantly reduced in vivo liver metastasis and displayed decreased CCL2 chemokine secretion and reduced STAT3 activity. Down-modulation of CCL2 expression and pharmacological inhibition of STAT3 activity in MC38 cells led to reduced cell invasion capacity and decreased liver metastasis. The clinical relevance of our findings is illustrated by the fact that high CC1 expression in patients with CRC combined with some inflammation-regulated and STAT3-regulated genes correlate with improved 10-year survival. CONCLUSIONS: CC1-L regulates inflammation and STAT3 signalling and contributes to the maintenance of a less-invasive CRC metastatic phenotype of poorly differentiated carcinomas.
Asunto(s)
Antígenos CD/fisiología , Moléculas de Adhesión Celular/fisiología , Neoplasias del Colon/etiología , Neoplasias del Colon/patología , Animales , Diferenciación Celular , Neoplasias Colorrectales/patología , Femenino , Humanos , Neoplasias Hepáticas/secundario , Masculino , Ratones , Ratones Endogámicos C57BL , Persona de Mediana Edad , Isoformas de Proteínas/fisiología , Células Tumorales CultivadasAsunto(s)
Carcinoma Adenoide Quístico , Neoplasias Cutáneas , Anciano , Carcinoma Adenoide Quístico/diagnóstico , Carcinoma Adenoide Quístico/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pronóstico , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/epidemiología , Tasa de Supervivencia , Estados Unidos/epidemiologíaAsunto(s)
Carcinoma Mucoepidermoide/epidemiología , Neoplasias Cutáneas/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Carcinoma Mucoepidermoide/diagnóstico , Carcinoma Mucoepidermoide/cirugía , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Pronóstico , Factores de Riesgo , Programa de VERF/estadística & datos numéricos , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/cirugía , Adulto JovenRESUMEN
This scoping review aims to characterize the use of biologics and Janus Kinase inhibitors (JAKi) in the treatment of Hidradenitis Suppurativa (HS), which is a chronic inflammatory condition. A comprehensive literature search was conducted in PubMed/NCBI, Embase, Web of Science databases, and the Clinicaltrials.gov register. The search included interventional trials assessing the use of biologics or JAKi in HS, with no geographic or time restrictions. Secukinumab and adalimumab were identified as the only two drugs approved by the FDA for treating moderate to severe HS in adults. Several other drug classes showed promising results based on clinical studies reviewed. IL-12/23 inhibitor ustekinumab demonstrated improvements in disease severity scores and HiSCR rates in small trials. IL-17 inhibitors such as brodalumab, bimekizumab, and CJM112 showed preliminary positive responses in early-phase clinical studies and case reports. While evidence was mixed, some TNF-α inhibitors such as infliximab provided benefits according to a randomized controlled trial, though etanercept trials yielded non-significant or inconsistent findings. Larger, well-designed studies are required to further establish their efficacy and safety, but biologics and JAKis show potential as alternative treatment options for moderate to severe HS. The findings of this review contribute to the growing interest among patients and to enhancing the understanding of physician's regarding potential alternative therapeutic options for HS and provide a basis for further research in this field.
Asunto(s)
Productos Biológicos , Hidradenitis Supurativa , Inhibidores de las Cinasas Janus , Índice de Severidad de la Enfermedad , Hidradenitis Supurativa/tratamiento farmacológico , Humanos , Inhibidores de las Cinasas Janus/uso terapéutico , Productos Biológicos/uso terapéutico , Resultado del Tratamiento , Adalimumab/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéuticoRESUMEN
Dermatologic diseases often exhibit distinct geographic patterns, underscoring the significant role of regional environmental, genetic, and sociocultural factors in driving their prevalence and manifestations. Geographic information and geospatial analysis enable researchers to investigate the spatial distribution of adverse health outcomes and their relationship with socioeconomic and environmental risk factors that are inherently geographic. Health geographers and spatial epidemiologists have developed numerous geospatial analytical tools to collect, process, visualize, and analyze geographic data. These tools help provide vital spatial context to the comprehension of the underlying dynamics behind health outcomes. By identifying areas with high rates of dermatologic disease and areas with barriers to access to quality dermatologic care, findings from studies utilizing geospatial analysis can inform the design and targeting of policy and intervention to help improve dermatologic healthcare outcomes and promote health equity. This article emphasizes the significance of geospatial data and analysis in dermatology research. We explore the common processes in data acquisition, harmonization, and geospatial analytics while conducting spatially and dermatologically relevant research. The article also highlights the practical application of geospatial analysis through instances drawn from the dermatology literature.
Asunto(s)
Dermatología , Humanos , Promoción de la SaludRESUMEN
Understanding the genetic adaptations that occurred as humans migrated out of Africa to higher latitudes helps explain on a population-wide level how UV radiation (UVR) exposure will have varying consequences and benefits in patients of different skin pigmentations. It has been hypothesized that the need for efficient vitamin D synthesis was the primary driver for the skin-lightening process that evolutionarily occurred as humans migrated to higher latitudes. This review analyzes the level of support for the hypothesis that skin lightening occurred to enable adequate vitamin D synthesis in populations that migrated to areas with less UVR. Our literature search supported the hypothesis that through natural selection and intricate genetic adaptations, humans who migrated to areas with lower levels of UVR underwent a skin-lightening process to avoid the consequences of vitamin D deficiency. Our review includes an analysis of migration patterns out of Africa and how these affected pigmentation genes that are found in certain ethnic populations can be used to better understand this critical adaptation process when counseling patients on the need for sun protection.
Asunto(s)
Adaptación Fisiológica , Pigmentación de la Piel , Rayos Ultravioleta , Vitamina D , Humanos , Migración Humana , Selección Genética , Luz Solar/efectos adversos , Rayos Ultravioleta/efectos adversos , Vitamina D/metabolismo , Deficiencia de Vitamina DRESUMEN
BACKGROUND: Acquired port-wine stains (APWS) are rare vascular malformations that share the same clinical and histological features as their congenital counterparts. Rare cases of AWPS secondary to trauma or in association with medications have been reported in the literature. PATIENTS AND METHODS: We report two cases of APWS. One case appeared at the age of 2 months, the earliest reported in the literature and continued to evolve till the age of 3 years presenting with multifocal distribution mainly affecting the lower face. The second case developed during oral isotretinoin intake and persisted after discontinuation of the treatment. RESULTS AND CONCLUSIONS: The second patient declined treatment, but the first patient had a remarkable improvement following treatment with the pulsed dye laser, which remains the standard of care for capillary malformations on the face.