Targeting the Cutaneous Microbiota in Atopic Dermatitis by Coal Tar via AHR-Dependent Induction of Antimicrobial Peptides.

Skin colonization by Staphylococcus aureus and its relative abundance is associated with atopic dermatitis (AD) disease severity and treatment response. Low levels of antimicrobial peptides in AD skin may be related to the microbial dysbiosis. Therapeutic targeting of the skin microbiome and antimicrobial peptide expression can, therefore, restore skin homeostasis and combat AD. In this study, we analyzed the cutaneous microbiome composition in 7 patients with AD and 10 healthy volunteers upon topical coal tar or vehicle treatment. We implemented and validated a Staphylococcus-specific single-locus sequence typing approach combined with classic 16S ribosomal RNA marker gene sequencing to study the bacterial composition. During coal tar treatment, Staphylococcus abundance decreased, and Propionibacterium abundance increased, suggesting a shift of the microbiota composition toward that of healthy controls. We, furthermore, identified a hitherto unknown therapeutic mode of action of coal tar, namely the induction of keratinocyte-derived antimicrobial peptides via activation of the aryl hydrocarbon receptor. Restoring antimicrobial peptide levels in AD skin via aryl hydrocarbon receptor-dependent transcription regulation can be beneficial by creating a (anti)microbial milieu that is less prone to infection and inflammation. This underscores the importance of coal tar in the therapeutic aryl hydrocarbon receptor armamentarium and highlights the aryl hydrocarbon receptor as a target for drug development.

[The aryl hydrocarbon receptor as the target structure for new drugs in psoriasis and atopic dermatitis]. / Aryl-Hydrocarbon-Rezeptor als Zielstruktur für neue Medikamente bei Psoriasis und atopischer Dermatitis.

Coal tar therapy was used for centuries to treat skin disorders characterised by inflammation and skin barrier damage. It has been shown that the aryl hydrocarbon receptor (AhR) is the key target structure for these pharmacological effects of coal tar. Since coal tar has been used less and less because of the carcinogenicity of many ingredients of coal tar, other ligands of AhR were studied. Tapinarof is such a ligand and proved to be a promising new drug to treat psoriasis and atopic dermatitis. Since many endogenous and exogenous ligands of AhR are known, it may be that this "tar-smart" product is a first example of a new drug family with which dermatologists can treat skin disorders that are characterized by inflammation and skin barrier damage.

Oxidative damage to nucleic acids and benzo(a)pyrene-7,8-diol-9,10-epoxide-DNA adducts and chromosomal aberration in children with psoriasis repeatedly exposed to crude coal tar ointment and UV radiation.

The paper presents a prospective cohort study. Observed group was formed of children with plaque psoriasis (n=19) treated by Goeckerman therapy (GT). The study describes adverse (side) effects associated with application of GT (combined exposure of 3% crude coal tar ointment and UV radiation). After GT we found significantly increased markers of oxidative stress (8-hydroxy-2'-deoxyguanosine, 8-hydroxyguanosine, and 8-hydroxyguanine), significantly increased levels of benzo[a]pyrene-7,8-diol-9,10-epoxide (BPDE) DNA adducts (BPDE-DNA), and significantly increased levels of total number of chromosomal aberrations in peripheral lymphocytes. We found significant relationship between (1) time of UV exposure and total number of aberrated cells and (2) daily topical application of 3% crude coal tar ointment (% of body surface) and level of BPDE-DNA adducts. The findings indicated increased hazard of oxidative stress and genotoxic effects related to the treatment. However, it must be noted that the oxidized guanine species and BPDE-DNA adducts also reflect individual variations in metabolic enzyme activity (different extent of bioactivation of benzo[a]pyrene to BPDE) and overall efficiency of DNA/RNA repair system. The study confirmed good effectiveness of the GT (significantly decreased PASI score).

Novel stain-free lecithinized coal tar formulation for psoriasis.

BACKGROUND: Coal tar has been a very popular traditional treatment for various types of psoriasis for over a century. It is the first-line treatment for scalp, hand, and foot psoriasis. However, the application of coal tar on hair invariably causes staining, which results in a high degree of patient non-compliance, especially in patients with non-black hair. Thus, the treatment of scalp psoriasis with a topical coal tar formulation requires that special concern be paid to product esthetics. OBJECTIVE: This study aimed to evaluate the hair-staining characteristics of a novel lecithinized coal tar (LCT) formulation on different types of mammalian hair. METHODS: Samples of hair from different mammals, including human, sheep, rabbit, and goat, were repeatedly exposed to the LCT formulation over 14 days. The color of hair samples treated with LCT was compared with that of untreated control hair samples. RESULTS: The study revealed the distinct non-staining potential of the LCT formulation. CONCLUSIONS: This LCT formulation lacks the propensity to stain hair and thus has excellent potential to be exploited in the treatment of scalp psoriasis.

Early specific free radical-related cytotoxicity of gas phase cigarette smoke and its paradoxical temporary inhibition by tar: An electron paramagnetic resonance study with the spin trap DEPMPO.

Electron paramagnetic resonance (EPR) spin trapping studies demonstrated aqueous tar particulate matter (TPM) and gas phase cigarette smoke (GPCS) to behave as different sources of free radicals in cigarette smoke (CS) but their cytotoxic implications have been only assessed in CS due to its relevance to the natural smoking process. Using a sensitive spin trapping detection with 5-(diethoxyphosphoryl)-5-methyl-1-pyrroline-N-oxide (DEPMPO), this study compared the respective roles of CS- and GPCS-derived free radicals on smoke-induced cytotoxicity and lipid peroxidation of filtered and unfiltered, machine-smoked experimental and reference cigarettes yielding a wide range of TPM yields. In buffer bubbled with CS the DEPMPO/superoxide spin adduct was the major detected nitroxide. Use of appropriate control experiments with nitric oxide radical (NO*) or carbonyl sulfide, and a computer analysis of spin adduct diastereoisomery showed that the hydroxyl radical (HO*) adduct of DEPMPO seen in GPCS-bubbled was rather related to metal-catalyzed nucleophilic synthesis than to direct HO* trapping. Unexpectedly a protective effect of TPM on murine 3T3 fibroblasts was observed in early (<3h) free radical-, GPCS-induced cell death, and carbon filtering decreased free radical formation, toxicity and lipid peroxidation in three cell lines (including human epithelial lung cells) challenged with GPCS. These results highlight an acute, free radical-dependent, harmful mechanism specific to the GPCS phase, possibly involving NO* chemistry, whose physical or chemical control may be of great interest with the aim of reducing the toxicity of smoke.

Regulation of cutaneous drug-metabolizing enzymes and cytoprotective gene expression by topical drugs in human skin in vivo.

BACKGROUND: Individuality in the expression and regulation of hepatic drug-metabolizing enzymes (DMEs) and cytoprotective (CP) genes is an important determinant of treatment response. There is increasing evidence that many DMEs and CP genes are also expressed in human skin. Responses to topical drugs used to treat common skin diseases, such as psoriasis, are unpredictable and may potentially be rationalized, at least in part, by interindividual differences in cutaneous DME and CP gene expression. OBJECTIVES: We investigated whether three topical drugs [coal tar, all-trans retinoic acid (atRA) and clobetasol 17-propionate] used in routine clinical practice modulated the expression of a variety of DME and CP genes [cytochrome P450s, glutathione S-transferases (GSTs) and drug transporters] in healthy human skin in vivo. METHODS: Healthy adult volunteers (n = 30) were invited to participate in the study. Each subject was randomly allocated to receive two of the three study chemicals and one control site application. Crude coal tar (n = 13), atRA (n = 14) or clobetasol 17-propionate (n = 10) was applied under occlusion to photoprotected buttock skin for 96 h. A vehicle control (white soft paraffin) was also applied under the same conditions at an adjacent site in all subjects. Full-thickness punch biopsies (4-mm diameter) were then taken from treated and control sites. Total RNA was extracted and reverse transcribed into cDNA, which was used as a template in subsequent real-time polymerase chain reaction analysis, where fluorescent output was directly proportional to input cDNA concentration. Triplicate measurements of skin mRNA expression were made from each sample, and the arithmetic mean values taken. After logarithmic transformation, the paired t-test was used to compare values between treated and control skin. RESULTS: Cytochrome P450s CYP1A1, CYP1A2, CYP1B1, CYP2C18, quinone reductase (NQO-1), GSTP1, gamma-glutamyl cysteine synthetase (gamma-GCS), glutathione peroxidase-1 (GPx-1), cyclooxygenase-2 (COX-2) and haem oxygenase-1 (HO-1) were induced by coal tar; CYP26, NADPH P450 reductase (CPR), GSTP1 and HO-1 by atRA; and CYP3A5 by clobetasol 17-propionate. In contrast, CYP1A1 and CYP1A2 expression was suppressed by atRA, and gamma-GCS and MRP1 by clobetasol 17-propionate. Marked interindividual variation in gene regulation by topical drugs was seen for the majority of genes examined. CONCLUSIONS: These data demonstrate that topical drugs can modulate DME gene expression in human skin in vivo and indicate that variation in the expression and regulation of these genes may be a determinant of individuality in response to topical therapies for common skin diseases.

The topical treatment of psoriasis.

According to the patients, improvement of efficacy, long-term safety and improvement of compliance are needed. The topical treatment has been innovated during the last decade. Most important are the introduction of two new classes of treatments: topical vitamin D(3) analogues and the retinoid tazarotene. To what extent, however, have we achieved developments which are in line with the needs as expressed by the patients? Improved efficacy has been realized by successful combinations of topical treatments. In particular, the combinations of dithranol, vitamin D(3) and tazarotene with a topical corticosteroid proved to be very effective with a reduced profile of side-effects. The efficacy of vitamin D(3) analogues and tazarotene is such that the efficacy of a potent corticosteroid (betamethasone-17-valerate) is approached; calcipotriol even showed an efficacy which is at least as good as this corticosteroid. The long-term safety of new compounds has been evaluated for at least 12 months in large studies. Remarkably for corticosteroids such information is available for only 12 weeks. However, intermittent applications of a topical corticosteroid in combination with another topical treatment provide an effective and safe long-term control of psoriasis. Compliance is a conditio sine qua non for an effective topical treatment. Important progress has been made to increase compliance. Short-contact dithranol has been popularized as an ambulatory treatment which is a highly effective approach as a care instruction programme. Formulations which are better from a cosmetical point of view have been developed for various topical treatments. Reduction of the frequency of applications proved to be possible for most treatments. Once daily applications for corticosteroids, vitamin D(3) analogues and retinoids have been developed, and intermittent applications, a few times per week, are possible for corticosteroids, which proved to be very effective with a reduced profile of side-effects, and are also developed for dithranol.

Coal tar: past, present and future.

Crude coal tar has been used in the treatment of dermatoses for many decades. In the last few years its use has been limited to skin diseases such as psoriasis and chronic dermatitis. Newer topical modalities for psoriasis are being used increasingly for treatment, but have failed to replace crude coal tar as a first-line treatment of psoriasis. We review the pharmacology, chemistry and use of crude coal in order to reappraise its role as a therapeutic agent in dermatology.

Effects of topical preparations on the erythemogenicity of UVB: implications for psoriasis phototherapy.

BACKGROUND: Topical preparations are sometimes applied before phototherapy without consideration of their potential to block UVB. OBJECTIVE: Our purpose was to examine the ability of topical preparations to block UVB. METHODS: Volunteers pretreated with mineral oil, a clear liquid emollient, 5% crude coal tar, 6% salicylic acid ointment, emollient creams, and petrolatum underwent minimal erythema dose testing. Transmission of UVB through a clear film coated with the preparations was measured. RESULTS: Tars and salicylic acid blocked UVB. Thick application of petrolatum and emollient creams can reduce transmission of UVB. Mineral oil and a clear liquid emollient did not significantly affect transmission or erythemogenicity of UVB. CONCLUSION: Clear liquid emollient and mineral oil can be used before phototherapy. If not removed before phototherapy, preparations containing tar or salicylic acid, or thickly applied petrolatum or emollients, can block UVB and presumably reduce its efficacy in the treatment of psoriasis.

Retinoic acid antagonizes basal as well as coal tar and glucocorticoid-induced cytochrome P4501A1 expression in human skin.

Cytochrome P4501A1 is known to be expressed in skin and thus has been implicated in the pathogenesis of skin cancer due to certain environmental carcinogens. Retinoic acid (RA) has been used in chemoprevention of certain skin and other epithelial cancers. Therefore, we used Northern and Western analysis to determine the effect of externally applied RA on basal P4501A1 expression. RA reduced basal levels of P4501A1 mRNA and protein by 68 (n = 14, P = 0.005) and 75% (n = 7, P = 0.04) respectively. RA application also reduced basal levels of P4501A2 (another P4501A1 subfamily member) mRNA by 93% (n = 7, P = 0.001) as determined by reverse transcription-polymerase chain reaction. Interestingly, P4501A1 mRNA expression induced by coal tar or glucocorticoid (clobetasol) was reduced 46 (n = 10, P = 0.003) and 69% (n = 5, P < 0.05) respectively by RA co-application. Downregulation of basal P4501A1 expression and antagonism of coal tar mediated P4501A1 induction by RA may be a mechanism involved in chemo-prevention of skin and other epithelial cancer by RA.

The antifungal activity of a coal tar gel on Malassezia furfur in vitro.

OBJECTIVE: Seborrhoeic dermatitis is associated with Malassezia furfur, but the exact role of this lipophilic yeast is still unclear. The in vitro antifungal activity of a coal tar gel, the base of the gel and coal tar (Stantar) itself has been evaluated against 54 different M. furfur strains, isolated from patients suffering from dandruff, seborrhoeic dermatitis and pityriasis versicolor. METHODS: Minimum inhibitory concentrations (MICs) of the tested agents were measured by the agar dilution technique. RESULTS: The coal tar gel was found to be able to inhibit growth of 52 out of 54 investigated M. furfur isolates in vitro at MIC values between 625 and 10,000 micrograms/ml-corresponding to 3-5 micrograms/ml coal tar. However, the gel base also appears to be a less potent inhibitor of in vitro growth of M. furfur. In addition, it could be demonstrated that coal tar alone has an antifungal potential on M. furfur in vitro. MIC values from 250 to 5,000 micrograms/ml for coal tar were found. Presumably, both coal tar as the active ingredient and the gel base contribute to the in vitro activity of the coal tar gel against M. furfur. CONCLUSIONS: It is suggested that the effect of coal tar gel ointment in dandruff and seborrhoeic dermatitis therapy in vivo may be at least partly due to an antifungal activity of the coal tar but also of the gel base.

[State of immunobiological reactivity of experimental animals to tuberculosis and exposure to coal tar]. / Sostoianie immunobiologicheskoi reaktivnosti éksperimental'nykh zhivotnykh pri tuberkuleznoi infektsii i vozdeistvii kamennougol'noi smoly.

Among most common environmental factors microflora and xenobiotics are capable of changing immunological resistance of human and animal body. Combined action of these factors on the animals has never been studied. Guinea pig experiments showed that M. tuberculosis can significantly change immunogram of the animals exposed for a long time to coal tar. On the one hand, the effect may be negative, but on the other, in certain conditions coal tar enhanced guinea pig's resistance to M. tuberculosis.

Carcinogens show comedogenic activity: a potential animal screen for tumorigenic substances.

Formation of a comedo, an impaction of horny cells in sebaceous follicles, entails a metaplastic change in the differentiation patterns of the follicular epithelium. Since metaplasia is a requisite early stage in carcinogenesis, we postulated that carcinogens might be comedogenic. The rabbit ear was used to assay the comedogenic potentialities of an array of known tumorigens. Complete carcinogens and some tumor promotors were invariably strongly comedogenic at concentrations of 1.0% and below. Comedogenic chemicals commonly found in skin care products usually required concentrations of 40% and greater to induce comedones which were small in comparison to carcinogen induced comedones. We suggest that the rabbit ear model might be an easy and reliable way to screen for carcinogenicity.

In vitro comparison of antifungal effects of a coal tar gel and a ketoconazole gel on Malassezia furfur.

Malassezia furfur seems to be a major pathogenetic factor in seborrhoeic dermatitis, a frequent human skin disease. To estimate the antifungal properties of a coal tar gel (5 mg ml-1 coal tar) which is used in the treatment of seborrhoeic dermatitis of the scalp, we compared its effects on the in vitro growth of M. furfur with those of a ketoconazole gel (20 mg ml-1 ketoconazole). None of the gels was fungicidal within incubation times up to 20 min. During a single application, both gels remain on the skin for only 5 min. Fungicidal effects are consequently unlikely to play a substantial therapeutic role. Fungistatic effects were observed with both gels. In cultures inoculated with 1 x 10(3) cells ml-1, a 1:49 152 dilution of the ketoconazole gel and a 1:768 dilution of the coal tar gel still showed inhibitory effects. At inoculum densities of 1 x 10(5) ml-1, both gels were fungistatic only in dilutions of a maximum of 1:40. Our results suggest that under clinical treatment conditions the fungistatic activities of both preparations should be comparable.

Detection of benzo[a]pyrene-diol-epoxide-DNA adducts in white blood cells of psoriatic patients treated with coal tar.

An enzyme-linked immunosorbent assay (ELISA) was used to detect BPDE-DNA adducts in white blood cells of 23 psoriatic patients undergoing clinical coal tar therapy. Ten of these patients were reanalyzed 2-5 months after the end of the coal tar treatments. The results show that the mean adduct level during the treatment period was 0.26 +/- 0.16 fmole BPDE/micrograms DNA (7.7 +/- 4.9 adducts/10(8) nucleotides), while 2-5 months later the mean adduct level had decreased significantly (P less than 0.005) to 0.11 +/- 0.08 fmole BPDE/micrograms DNA (3.3 +/- 2.4 adducts/10(8) nucleotides). No relationship could be ascertained between the level of exposure and the amount of BPDE-DNA adducts. In addition, no difference in the level of DNA adducts was found between smoking and non-smoking patients.

Pyridine and other coal tar constituents as inhibitors of potato polyphenol oxidase: a non-animal model for neurochemical studies.

Potato polyphenol oxidase activity was strongly and noncompetitively inhibited by the "Perov mixture" of coal tar components and by pyridine alone, while phenol competitively inhibited the enzyme. These two inhibitors are structural components of the parkinsonogenic neurotoxin N-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). By extension, dopamine and neuromelanin synthesis in the brain may be influenced by the inhibitory effects of such compounds upon the copper-dependent steps of tyrosine metabolism. The non-animal model used in this study may represent an alternative to the use of animal tissues in neurodegenerative disease research.

Effect of UVB plus tar therapy on serum levels of interleukin-2 receptors in patients with psoriasis.

Baseline serum levels of interleukin-2 receptor (IL2R) were measured in 65 patients with active psoriasis. IL2R levels in psoriatic patients were significantly higher than in healthy controls (582.4 +/- 289.23 u/ml vs. 369.64 +/- 111.10 u/ml; P less than 0.05), but did not differ statistically from values found in an atopic dermatitis control group (619.88 +/- 254.27 u/ml). Sex, age and severity of the disease do not affect levels of IL2R. The same IL2R levels were measured in 26 psoriatic patients receiving UVB plus tar therapy. This therapy, continued until clinical remission, lowered IL2R levels to values comparable to controls. This decrease may be due to an immunosuppressive effect of therapy.