Assuntos
Alopecia , Gamopatia Monoclonal de Significância Indeterminada , Mieloma Múltiplo , Mieloma Múltiplo Latente , Humanos , Gamopatia Monoclonal de Significância Indeterminada/epidemiologia , Gamopatia Monoclonal de Significância Indeterminada/diagnóstico , Gamopatia Monoclonal de Significância Indeterminada/complicações , Alopecia/epidemiologia , Alopecia/diagnóstico , Mieloma Múltiplo/epidemiologia , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/complicações , Feminino , Masculino , Mieloma Múltiplo Latente/diagnóstico , Mieloma Múltiplo Latente/epidemiologia , Pessoa de Meia-Idade , Idoso , Estudos de Coortes , Adulto , Programas de Rastreamento/métodosRESUMO
BACKGROUND: Alopecia areata (AA) is a chronic, nonscarring hair-loss disorder associated with significant quality-of-life impairment and limited treatment options. AA has been recently linked to atopy and shown to exhibit both Th1- and Th2-driven inflammation. However, a comprehensive molecular and cellular characterization across blood and scalp compartments in both atopic and nonatopic patients is lacking. METHODS: Lesional and nonlesional scalp biopsies obtained from AA patients with (n = 16) or without (n = 20) atopic history, and 17 demographically matched healthy controls were analyzed with RNA-seq, RT-PCR, and immunohistochemistry. Flow cytometry was also performed on peripheral blood mononuclear cells (PBMCs) from a subset of patients. Differential expression was defined using |fold-change| > 1.5 and false-discovery rate <0.05. RESULTS: AA scalp exhibited robust upregulation of Th1- (IFNG, CXCL9, CXCL10, CXCL11) and Th2-related products (CCL26, CCR4, IL10, IL13, TSLP, TNFRSF4/OX40) and shared downregulation of hair keratins, regardless of atopic background, with variable Th17/Th22 modulation. AA patients with atopy exhibited greater inflammatory tone and Th2-skewing (IL10, IL13, IL33, CCR4, CCL26). Disease severity correlated significantly with immune and hair keratin biomarkers and with perifollicular cellular infiltrates. Cutaneous OX40/OX40L upregulation was paralleled by increases in circulating OX40+ and OX40L+ leukocytes, regardless of atopic background. CONCLUSION: Our results suggest some atopy-associated immune differences in AA and highlight the OX40 axis as a potential novel therapeutic target that may broadly benefit AA patients.
RESUMO
Alopecia areata (AA) is nonscarring hair loss characterized by Th1 and concomitant Th2 skewing, particularly in atopic patients. Despite novel developments for adult AA, safe and effective treatments for pediatric patients remain limited. Dupilumab, with a well-studied safety profile, may have therapeutic potential for atopic pediatric AA. To evaluate the ability of dupilumab to regrow hair in pediatric AA patients. We conducted a single-center, retrospective, observational study to evaluate hair regrowth [using Severity of Alopecia Tool (SALT)] with dupilumab in 20 children with both AD and AA (age range 5-16 years, mean 10.8 years; baseline SALT range 3-100, mean 54.4). Patient demographics, atopic history, IgE and SALT scores were collected at 12wk follow-up visits, up to > 72wks, to evaluate hair regrowth. Spearman correlations with clinical data were performed. Patients showed clinical improvement over the follow-up period (range 24 to > 72wks, mean 67.6wks) with significant mean(± SD) reduction in SALT at 48wks versus baseline [20.4(± 35.1) vs 54.4(± 37.6), respectively; p < 0.01] and continued improvement up to > 72wks [2.2(± 4.9), p < 0.01]. Baseline SALT positively correlated with disease duration (r = 0.54, p < 0.01), and negatively correlated with improvement in SALT at weeks 24, 36, and 48 (|r|≥ 0.65, p < 0.01 for all comparisons). Baseline IgE positively correlated with improvement in SALT at week 36 (r > 0.60, p < 0.05). Dupilumab was well-tolerated, with no new safety concerns. These real-world data support the utility of dupilumab to safely treat pediatric AA patients, corroborating the role of Th2 skewing in children with AA and associated atopy, warranting larger clinical trials.
Assuntos
Alopecia em Áreas , Anticorpos Monoclonais Humanizados , Cabelo , Humanos , Alopecia em Áreas/tratamento farmacológico , Alopecia em Áreas/imunologia , Criança , Adolescente , Feminino , Masculino , Estudos Retrospectivos , Anticorpos Monoclonais Humanizados/uso terapêutico , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/administração & dosagem , Pré-Escolar , Cabelo/crescimento & desenvolvimento , Cabelo/efeitos dos fármacos , Resultado do Tratamento , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/imunologia , Índice de Gravidade de Doença , Imunoglobulina E/sangue , Imunoglobulina E/imunologia , SeguimentosRESUMO
Skin barrier function (SBF) disorders are a class of pathologies that affect a significant portion of the world population. These disorders cause skin lesions with intense itch, impacting patients' physical and psychological well-being as well as their social functioning. It is in the interest of patients that their disorder be monitored closely while under treatment to evaluate the effectiveness of the ongoing therapy and any potential adverse reactions. Symptom-based assessment techniques are widely used by clinicians; however, they carry some limitations. Techniques to assess skin barrier impairment are critical for understanding the nature of the disease and for helping personalize treatment. This review recalls the anatomy of the skin barrier and describes an atomic-force microscopy approach to quantitatively monitor its disorders and their response to treatment. We review a panel of studies that show that this technique is highly relevant for SBF disorder research, and we aim to motivate its adoption into clinical settings.
Assuntos
Microscopia de Força Atômica , Humanos , Microscopia de Força Atômica/métodos , Pele/patologia , Pele/diagnóstico por imagem , Dermatopatias/patologiaAssuntos
Dermatite Atópica , Impetigo , Análise da Randomização Mendeliana , Humanos , Dermatite Atópica/genética , Dermatite Atópica/complicações , Impetigo/epidemiologia , Impetigo/diagnóstico , Polimorfismo de Nucleotídeo Único , Proteínas Filagrinas , Guanilato Ciclase , Proteínas de Membrana , Proteínas Adaptadoras de Sinalização CARDRESUMO
Contact dermatitis (CD) is a common and burdensome condition divided into irritant contact dermatitis and allergic contact dermatitis. Treatment relies on accurate diagnosis and identification of the trigger, because definitive treatment is irritant or allergen avoidance. However, avoidance is not always possible, such as when the patient is reacting to a necessary medical device, when the trigger is integral to the patient's occupation, and when avoidance is practically untenable. In these cases, treatment is particularly challenging, especially because the literature on treatments in this clinical scenario is limited. In addition, CD has a complex pathophysiology that varies according to the trigger type, leading to variable treatment efficacy. This article reviews the current literature on treatments for CD with a focus on treatments when trigger avoidance is not feasible.
Assuntos
Dermatite Alérgica de Contato , Humanos , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/tratamento farmacológico , Dermatite Alérgica de Contato/terapia , Alérgenos/imunologia , Dermatite Irritante/diagnóstico , Dermatite Irritante/terapia , Dermatite de Contato/diagnóstico , Dermatite de Contato/terapiaAssuntos
Doenças Autoimunes , Bases de Dados Factuais , Rosácea , Humanos , Rosácea/epidemiologia , Rosácea/diagnóstico , Estudos de Casos e Controles , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/imunologia , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Estados Unidos/epidemiologia , Bases de Dados Factuais/estatística & dados numéricos , Idoso , Adulto Jovem , AdolescenteAssuntos
Alopecia em Áreas , Isquemia Miocárdica , Humanos , Alopecia em Áreas/epidemiologia , Estados Unidos/epidemiologia , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Bases de Dados Factuais/estatística & dados numéricos , Idoso , Transtornos Cerebrovasculares/epidemiologia , Fatores de RiscoRESUMO
PURPOSE: Based on a potential shared pathophysiology tied to mast cell activity and neurogenic inflammation that may link pruritus and chronic cough (CC), this study, leveraging the All of Us database, examines the association between the two conditions. MATERIALS AND METHODS: A nested case-control comparison was used to examine the association, identifying cases with SNOMED codes 418363000 (pruritus) and 68154008 (CC). Matching was performed on a 1:4 ratio by age, sex, and ethnicity using the MatchIt package in R, followed by maximum likelihood method to estimate odds ratios (ORs) and 95% confidence intervals from 2x2 contingency tables. RESULTS: CC patients (n = 2,388) were more than twice as likely to be diagnosed with pruritus (OR: 2.65) and pruritus patients (n = 22,496) were more than twice as likely to be diagnosed with CC (OR: 2.57), than respective matched controls. CONCLUSIONS: These results highlight the potential bidirectional relationship between CC and pruritus, suggesting possible shared immune and neural pathways. Treatments like difelikefalin and nalbuphine that modulate these pathways, alongside P2X3 targeting agents, are emerging as potential therapeutic approaches for itch and chronic cough given the possible interconnected pathophysiology. This study's insights into the associations between pruritus and CC may pave the way for targeted therapeutic strategies that address their shared mechanisms.
Assuntos
Tosse Crônica , Prurido , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Estudos de Casos e Controles , Tosse Crônica/complicações , Bases de Dados Factuais , Prurido/complicações , Estados UnidosRESUMO
Melanoma case reports show variations in treatment by age and sex.