Justyna Szczęch

Increased interleukin (IL)-17 serum levels in patients with hidradenitis suppurativa: Implications for treatment with anti-IL-17 agents

Background Biologics seem to offer a promising nonsurgical approach in hidradenitis suppurativa (HS), especially in disease with highly pronounced inflammation. Recent studies revealed increased expression of a broad range of cytokines in lesional HS skin, including interleukin (IL)‐17. Objective This study was undertaken to determine IL‐17 serum levels in this group of patients. Methods Our study was conducted on a group of 86 patients between 16 and 72 years of age with HS. A total of 86 matched healthy volunteers constituted the control group. Enzyme‐linked immunosorbent assay kits were used to quantify IL‐17 serum concentration. Results The mean IL‐17 serum level of patients with HS was 3.68 ± 2.08 pg/mL, which was significantly elevated (P < .0001) compared with that found in healthy volunteers (2.5 ± 1.11 pg/mL). Moreover, there was a tendency toward higher serum concentrations of IL‐17 in patients with more advanced disease (P = .005). Disease duration; patient sex, age, and body mass index; and smoking habits were not determining factors for IL‐17 serum concentration. Limitations Hospital‐based study population was a limitation, as was a lack of posttreatment assessment. Conclusion In light of our findings and literature on increased expression of IL‐17 in HS lesions, evaluating the clinical effectiveness of using anti‐IL‐17 agents in the treatment of patients with HS is justified.

Treatment of cutaneous lupus erythematosus: current practice variations.

The treatment of cutaneous lupus erythematous (CLE) remains a challenge. Most of the therapeutic options used in CLE have not been tested in randomized controlled studies and to date no agent has been approved. Therefore, CLE treatment is mostly based on personal experience. To better characterize therapeutic habits among physicians treating CLE patients, a questionnaire-based study about various aspects of topical and systemic treatment for CLE has been performed. The questionnaire was distributed among CLE experts, mostly from Japan, the USA, and Europe. A total of 82 completed questionnaires were assessed. High-potent and potent corticosteroids as well as calcineurin inhibitors were the most often recommended topical treatment for all CLE subtypes. The most relevant factors for initiation of systemic therapy were severity of skin lesions, concomitant involvement of internal organs, CLE subtype and lack of response to topical therapies. Corticosteroids and antimalarials were considered as the most suitable and effective systemic drugs for CLE patients. However, significant differences were observed between various CLE subtypes and between different countries regarding the assessment of various topical and systemic treatment options. In conclusion, great variability of obtained answers underlines the need of development of CLE treatment guidelines suitable for different disease subtypes.

Clinical characteristics of cutaneous lupus erythematosus

Introduction Lupus erythematosus (LE) shows a wide variety of clinical manifestations, skin involvement being one of the most important. Aim To analyze the clinical presentation of cutaneous variants of lupus erythematosus in terms of skin lesion spectrum and extracutaneous involvement. Material and methods A total of 64 patients with cutaneous LE (CLE) were included. The study was based on the “Core Set Questionnaire” developed by the European Society of Cutaneous Lupus Erythematosus (EUSCLE). Clinical severity of skin lesions was evaluated with the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). All results were subjected to statistical analysis. Results Fifteen (23.4%) patients had an acute CLE (ACLE), 26 (40.6%) subacute CLE (SCLE) and 21 (32.8%) chronic CLE (CCLE). Two (3.2%) individuals only demonstrated urticarial vasculitis as a cutaneous manifestation of LE and these patients were excluded. Patients with ACLE were characterized by the earliest onset of the disease (mean age of 31.9 ±15.0 years; p < 0.001). On average, 4.8 ±1.8 criteria of systemic LE were found in the ACLE group compared to 2.7 ±1.3 criteria in SCLE and 2.5 ±1.5 criteria in CCLE (p < 0.001). The highest activity of skin lesions according to CLASI was found in the SCLE group (p = 0.002). On the other hand, the most severe skin damage was observed in CCLE (p < 0.01). Conclusions Each variant of CLE differs significantly from the others in respect of various aspects of clinical manifestations. Due to a number of different variants of LE skin lesions, a unified classification of CLE still remains a challenge.

Prevalence and Relevance of Pruritus in Pregnancy

Pregnant women are at greater risk to suffer from chronic pruritus, but data on this symptom in this group is very limited. The aim of this study was to investigate the prevalence, clinical characteristics, and the importance of pruritus in pregnant women. A total of 292 consecutive pregnant women at the 33.0 ± 6.1 weeks of gestation (WoG) were recruited into this prospective, cross-sectional study. All patients underwent thorough anamnesis and detailed physical examination with the special emphasis on pruritus. Pruritus was assessed according to Visual Analogue Scale (VAS). Quality of life was measured with the Dermatology Life Quality Index (DLQI). The point prevalence of pruritus was 20.2% (n = 59), while pruritus prevalence during the entire pregnancy was 38.0% (n = 111). Pruritus started on average at the 27.2 ± 7.6 WoG; it was significantly more common among women in third trimester. The mean VAS was 4.8 (±2.4) points. The DLQI scoring significantly correlated with VAS (r = 0.52, p < 0.001). Based on the results of our study about one-third of women suffer from pruritus during pregnancy. Many of them find it a very distressing and disturbing symptom.

Carcinoma en cuirasse as an initial manifestation of inflammatory breast cancer

Carcinoma en cuirasse is an uncommon clinical manifestation of metastatic cutaneous carcinoma characterized by diffuse sclerodermoid induration of the skin. The name was given in the first description by Velpeau in 1838 based on its resemblance to the steel breastplate of cuirassier (cavalry soldier) [1]. Other terms for this distinctive morphological variant of cutaneous metastasis include armoured cancer, Panzerkrebs, scirrhous carcinoma and Acarcine eburnee [2, 3]. Usually carcinoma en cuirasse occurs in patients with local tumour relapse after mastectomy, albeit in some subjects it develops as a presenting feature of primary breast cancer (BC) [4]. Rarely, this form of cutaneous metastasis was associated with other adenocarcinomas (e.g. carcinoma of the lung, kidney or gastrointestinal tract) [5].

Disease severity and prophylactic measures in patients with cutaneous lupus erythematosus: results of a worldwide questionnaire-based study

Introduction Due to a wide array of dermatologic manifestations, assessment of disease severity in cutaneous lupus erythematosus (CLE) remains challenging. Given a need for some standardization in this field, we conducted a worldwide questionnaire-based study among physicians experienced in CLE management. Aim We asked about CLE assessment, their prophylactic measures advised to patients, and treatment recommendations. Material and methods A total of 83 completed questionnaires were received. Participating physicians recommended assessing disease severity at each patient’s visit (39.1%), monthly (4.9%) or at least every third month (17.3%). Almost half of the responding physicians (47.0%) waited 2–3 months before identifying a specific treatment option as not effective. Results The vast part of the participants informed their patients about of the risks of sun exposure and advised adequate preventive measures. Smoking was less frequently a matter of discussion between physicians and their patients. Recommendations for the timing of CLE severity assessment likely depends on disease severity and the type of therapeutic intervention. Conclusions Proper patient education about effective prophylactic measures should be included during routine CLE patient consultations.

Trigger factors of cutaneous lupus erythematosus: a review of current literature.

It is currently believed that autoimmune conditions are triggered and aggravated by a variety of environmental factors such as cigarette smoking, infections, ultraviolet light or chemicals, as well as certain medications and vaccines in genetically susceptible individuals. Recent scientific data have suggested a relevant role of these factors not only in systemic lupus erythematosus, but also in cutaneous lupus erythematosus (CLE). A variety of environmental factors have been proposed as initiators and exacerbators of this disease. In this review we focused on those with the most convincing evidence, emphasizing the role of drugs in CLE. Using a combined search strategy of the MEDLINE and CINAHL databases the following trigger factors and/or exacerbators of CLE have been identified and described: drugs, smoking, neoplasms, ultraviolet radiation and radiotherapy. In order to give a practical insight we emphasized the role of drugs from various groups and classes in CLE. We also aimed to present a short clinical profile of patients with lesions induced by various drug classes.

Biologics for Itch: IL-4/IL-13, IL-31, IL-17, and IL-23 Antagonists

Purpose of ReviewThe purpose of this review is to provide the current knowledge on antipruritic properties of IL-4/IL-13, IL-31, IL-17, and IL-23 antagonists in selected chronic skin conditions.Recent FindingsSince pruritus is regarded as one of the most bothersome and unpleasant symptoms accompanying numerous inflammatory skin disorders, efforts are ongoing in the development of new treatment strategies capable of reducing its intensity thus improving the patients’ quality of life. Recent discoveries in targeted therapies and studies on pruritus have established that blockade of certain cytokines and/or pathways not only reduces the severity of skin involvement, but also shows a potent antipruritic activity.SummaryConsidering a favorable safety profile of biologic drugs, their antipruritic properties are very promising and give a new hope for clinicians and the patients suffering from a number of itchy dermatoses. These recent findings clearly show that certain cytokines and their receptors may represent potential targets for innovative antipruritic drugs. Newer insights into the underlying pathogenesis of itch and identification of novel molecular pathways will undoubtedly promote the progress in the field of pruritus management.

Erythema gyratum repens associated with cryptogenic organizing pneumonia

A 54-year-old male was admitted due to peculiar figurate erythemas mainly located on the lower legs. The patient had an 18-month history of cryptogenic organizing pneumonia complicated by pulmonary hypertension. Cryptogenic organizing pneumonia was diagnosed based on chest X-ray, computed tomography (showing dispersed stromal fibrosis with bronchiectasis [Figure 1] and mediastinal lymph node enlargement) and lung biopsy.