RESUMEN
Summary: Background. Biomarkers of disease activity/severity and criteria of autoimmune chronic spontaneous urticaria (CSU) are still a matter of debate. Objective. To investigate possible correlations between clinical and biological markers and their associations with: 1) disease activity, 2) resistance to H1-antihistamines, 3) autoimmunity and 4) autologous serum skin test (ASST) in patients with CSU. To also analyze biological parameter modifications in patients with CSU treated with omalizumab. Materials and methods. Disease activity, H1-antihistamines response and presence of concomitant autoimmune disease were prospectively recorded in 95 patients with CSU. For 60 of them, ASST was performed. Broad biological analysis were performed. Results. C-reactive protein (CRP) serum levels were higher in H1-antihistamines unresponders (p less-than 0.0001) and in more active diseases (p = 0.033). D-dimer plasma levels were higher in H1-antihistamines unresponders (p = 0.008) and in patients with autoimmune status (concomitant autoimmune disease and/or with autoantibodies) (p = 0.016). Total immunoglobuline E (IgE) serum level was lower in patients with positive ASST. Blood basophil counts were lower in patients with CSU and especially in H1-antihistamines unresponders (p = 0.023), in patients with more active disease (p = 0.023), with positive ASST (p = 0.001), and with autoimmune status (p = 0.057). Conversely, under omalizumab, a decrease of CRP (p = 0.0038) and D-dimer serum/plasma levels (p = 0.0002) and an increase of blood basophil counts (p = 0.0023) and total IgE serum levels (p = 0.0007) were observed. Conclusions. This study brings additional evidences of interest to investigate IgE, D-dimer serum/plasma levels and basophil blood counts in patients with CSU as they could be correlated to disease activity, response to treatment and/or autoimmunity.
Asunto(s)
Enfermedades Autoinmunes , Proteína C-Reactiva/inmunología , Urticaria Crónica/inmunología , Urticaria/sangre , Urticaria/inmunología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antiidiotipos , Autoinmunidad , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Enfermedad Crónica , Femenino , Antagonistas de los Receptores Histamínicos/uso terapéutico , Humanos , Inmunoglobulina E/sangre , Masculino , Persona de Mediana Edad , Omalizumab/uso terapéutico , Resultado del Tratamiento , Urticaria/tratamiento farmacológico , Adulto JovenRESUMEN
BACKGROUND: Vitiligo is a chronic inflammatory skin disorder characterized by the loss of melanocytes. While a T helper cell (Th)1/cytotoxic T cell (Tc)1-skewed immune response is now well demonstrated in vitiligo, recent data suggest that the T-cell component could be more complex, involving different combinatorial T-cell subsets. OBJECTIVES: To analyse the phenotype and function of circulating CD4+ and CD8+ memory T-cell subsets in patients with stable and active vitiligo, in comparison with patients with psoriasis and healthy controls. METHODS: This is a monocentric, prospective, descriptive and exploratory study. Multiparametric flow cytometry analyses were performed to evaluate the surface expression of homing and T-cell-subset markers together with intracellular cytokine production in peripheral blood mononuclear cells from 60 patients with vitiligo, 25 patients with psoriasis and 28 healthy donors. RESULTS: Vitiligo peripheral blood circulating effector and central memory T cells expressed similar proportions of skin-homing markers. Decrease in the frequencies of circulating CD4+ and CD8+ Th1/Tc1, Th17/Tc17, and Th1/Th17 or Tc1/Tc17 effector memory T-cell subsets were observed in patients with vitiligo compared with healthy donors. Similar observations were made in psoriasis. In contrast, vitiligo circulating T cells showed a similar capacity for proinflammatory cytokine production compared with those in psoriasis and healthy controls. CONCLUSIONS: The decreased frequencies of circulating Th1/Tc1, Th17/Tc17 and Th1/Th17-Tc1/Tc17 cells suggest a possible migration of these T-cell subsets into the skin of patients with vitiligo. These could be targeted to prevent flares of the disease. What is already known about this topic? Vitiligo is a chronic inflammatory skin disorder associated with the loss of melanocytes. Vitiligo is characterized by a T helper cell (Th)1/cytotoxic T cell (Tc)1-skewed immune response in the skin. What does this study add? A thorough analysis of the phenotype and function of circulating memory T cells suggests the migration of Th1/Tc1, Th17/Tc17 and Th1/Th17-Tc1/Tc17 cell subsets in the skin. What is the translational message? A better understanding of the different immune T-cell subsets involved in vitiligo could lead to better therapeutic options. Linked Comment: Matos. Br J Dermatol 2020; 183:803.
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Vitíligo , Linfocitos T CD8-positivos , Humanos , Memoria Inmunológica , Leucocitos Mononucleares , Fenotipo , Estudios Prospectivos , Subgrupos de Linfocitos T , Células TH1 , Células Th17Asunto(s)
Hipersensibilidad al Látex , Goma , Elastómeros , Guantes Protectores , Humanos , Látex , Proyectos Piloto , SulfitosAsunto(s)
Mucorales/aislamiento & purificación , Mucormicosis/diagnóstico , Antifúngicos/uso terapéutico , Resultado Fatal , Femenino , Humanos , Persona de Mediana Edad , Mucorales/citología , Mucormicosis/tratamiento farmacológico , Mucormicosis/microbiología , Mucormicosis/patología , Esporangios/citologíaAsunto(s)
Dermatitis del Pañal/diagnóstico , Úlcera Cutánea/diagnóstico , Incontinencia Urinaria/complicaciones , Administración Cutánea , Biopsia , Dermatitis del Pañal/tratamiento farmacológico , Dermatitis del Pañal/patología , Humanos , Masculino , Persona de Mediana Edad , Pomadas/administración & dosificación , Vaselina/administración & dosificación , Escroto/patología , Piel/patología , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/etiología , Resultado del TratamientoAsunto(s)
Enfermedades Cardiovasculares/complicaciones , Dermatitis Atópica/complicaciones , Calidad de Vida , Enfermedades Cutáneas Infecciosas/complicaciones , Uso de Tabaco/efectos adversos , Adulto , Dermatitis Atópica/patología , Francia , Humanos , Masculino , Factores de Riesgo , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
Atopic dermatitis is a chronic disease with an alteration of the skin barrier and an abnormal immune response. The European guidelines for treatment of atopic dermatitis in children and adults recommend basic hygiene rules including daily use of emollient. Then in the first therapeutic line, for mild or acute atopic dermatitis, the prescription of local care by topical corticosteroids or topical calcineurin inhibitors is recommended. A proactive treatment is now recommended. If the atopic dermatitis is moderate or recurrent, the use of phototherapy in addition to topical treatment is recommended. Each therapeutic step can be added to improve the lesions and reduce the burden of the disease on the patient's daily life. © 2019 Elsevier Masson SAS. All rights reserved.
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Dermatitis Atópica/tratamiento farmacológico , Fármacos Dermatológicos/uso terapéutico , Fototerapia , Administración Cutánea , Administración Tópica , Corticoesteroides/administración & dosificación , Corticoesteroides/efectos adversos , Corticoesteroides/uso terapéutico , Adulto , Inhibidores de la Calcineurina/administración & dosificación , Inhibidores de la Calcineurina/uso terapéutico , Niño , Ensayos Clínicos como Asunto , Dermatitis Atópica/radioterapia , Dermatitis Atópica/terapia , Fármacos Dermatológicos/administración & dosificación , Emolientes/administración & dosificación , Emolientes/uso terapéutico , Humanos , Higiene , Inmunosupresores/administración & dosificación , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Inhibidores de Fosfodiesterasa 4/uso terapéutico , Fototerapia/efectos adversos , Fototerapia/métodos , Guías de Práctica Clínica como Asunto , Irrigación Terapéutica , Terapia Ultravioleta/efectos adversosRESUMEN
BACKGROUND: Contact dermatitis from topical antiseptic use has been reported mostly in adults, but rare cases of chlorhexidine contact dermatitis have also been described in young children. OBJECTIVE: To evaluate contact allergic dermatitis to antiseptics in young children. METHODS: The children mostly referred for a misdiagnose (cellulitis) were patch tested with a selection of the European baseline series, an antiseptics series and the personal topical products used. RESULTS: Fourteen children (8 boys, 6 girls) received a diagnosis of contact dermatitis to antiseptics between May 2010 and December 2017. The mean age at diagnosis was 38 months (8 months to 8 years); three children only had a personal history of atopy. Chlorhexidine gluconate was positive in seven cases, and benzalkonium chloride in eight cases, and in four cases, both allergens were positive. CONCLUSION: These small case series confirm that both chlorhexidine and benzalkonium chloride are implicated in contact dermatitis from antiseptic use in the paediatric population. We emphasize the initial misdiagnose of these patients, the very young age of the children and the allergenic potential of common antiseptics in non-atopic children. We hypothesize that the systematic use of antiseptics for umbilical cord care could be responsible for the sensitization in newborns.
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Antiinfecciosos Locales/efectos adversos , Compuestos de Benzalconio/efectos adversos , Clorhexidina/análogos & derivados , Dermatitis Alérgica por Contacto/etiología , Niño , Preescolar , Clorhexidina/efectos adversos , Femenino , Humanos , Lactante , Masculino , Pruebas del ParcheAsunto(s)
Alopecia Areata/tratamiento farmacológico , Anticuerpos Monoclonales/uso terapéutico , Dermatitis Atópica/tratamiento farmacológico , Adulto , Alopecia Areata/complicaciones , Alopecia Areata/inmunología , Anticuerpos Monoclonales/farmacología , Anticuerpos Monoclonales Humanizados , Dermatitis Atópica/complicaciones , Dermatitis Atópica/inmunología , Esquema de Medicación , Humanos , Inyecciones Subcutáneas , Subunidad alfa del Receptor de Interleucina-4/antagonistas & inhibidores , Subunidad alfa del Receptor de Interleucina-4/inmunología , Masculino , Resultado del TratamientoAsunto(s)
Adalimumab/administración & dosificación , Fármacos Dermatológicos/efectos adversos , Hidradenitis Supurativa/tratamiento farmacológico , Infliximab/efectos adversos , Psoriasis/inducido químicamente , Adalimumab/efectos adversos , Adulto , Femenino , Humanos , Masculino , Recurrencia , Estudios Retrospectivos , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresRESUMEN
BACKGROUND: Plasmacytoid dendritic cells (pDCs) are a subset of dendritic cells specialized in the production of type I interferon (IFN-α/ß) and involved in various cutaneous inflammatory and autoimmune disorders, such as cutaneous lupus erythematosus (CLE) and vitiligo. Heat shock proteins (HSPs) are molecular chaperones essential for maintaining cellular functions, but they can act as a danger signal during inflammation. OBJECTIVES: To decipher the role of HSP70 in the production of IFN-α by pDCs in CLE and vitiligo. METHODS: Expression of HSP70 and CD123+ pDCs was analysed by immunohistochemistry or immunofluorescence in CLE and vitiligo skin samples. Flow cytometry was performed to analyse expression of HSP70 receptors, activation markers on pDCs and DNA uptake by pDCs in the presence of HSP70. The impact of HSP70 on DNA-induced IFN-α secretion by pDCs was evaluated by enzyme-linked immunosorbent assay (ELISA). The effect of IFN-α on chemokine (C-X-C motif) ligand 9 (CXCL9)/10 gene and protein expression by keratinocytes was determined by real-time polymerase chain reaction and ELISA. RESULTS: Infiltration of pDCs in CLE and progressive vitiligo was primarily located in the epidermis, close to keratinocytes expressing HSP70. In vitro experiments revealed that the pDCs expressing HSP70 receptor Lox-1 (lectin-like oxidized low-density lipoprotein-receptor-1) were able to aggregate HSP70. Exogenous HSP70 induced activation of pDCs and increased the uptake of exogenous DNA. Furthermore, HSP70 potentiated DNA-induced IFN-α production by pDCs. Finally, IFN-α induced expression of CXCL9 and CXCL10 by keratinocytes. CONCLUSIONS: These data demonstrate that interaction between HSP70 and pDCs in CLE and vitiligo is a prerequisite for the enhancement of IFN-α production, and could be an interesting target.