CLA+ memory T cells in atopic dermatitis

Circulating skin‐homing cutaneous lymphocyte‐associated antigen (CLA)$^{+}$ T cells constitute a small subset of human memory T cells involved in several aspects of atopic dermatitis: Staphylococcus aureus related mechanisms, the abnormal Th2 immune response, biomarkers, clinical aspects of the patients, pruritus, and the mechanism of action of targeted therapies. Superantigens, IL‐13, IL‐31, pruritus, CCL17 and early effects on dupilumab‐treated patients have in common that they are associated with the CLA$^{+}$ T cell mechanisms in atopic dermatitis patients. The function of CLA$^{+}$ T cells corresponds with the role of T cells belonging to the skin‐associated lymphoid tissue and could be a reason why they reflect different mechanisms of atopic dermatitis and many other T cell mediated skin diseases. The goal of this review is to gather all this translational information of atopic dermatitis pathology

Finasteride induced Gynecomastia: Case report and Review of the Literature

Finasteride (1 mg/day) is widely utilized by dermatologists for the treatment of androgenetic alopecia. Although enjoying a relatively good safety profile, several sex-related adverse effects have been reported with this drug. Here we report two cases of gynecomastia, one of them bilateral, caused by Propecia® prescribed for the treatment of androgenetic alopecia. Although relatively rare, physicians should be aware of this side effect and inform their patients when prescribing this medication

The impact of close surveillance on pregnancy outcome among women with a prior history of antepartum complications attributed to thrombosis: a cohort study

<p>Abstract</p> <p>Background</p> <p>There is limited evidence, so far, as to the optimal management of women with a prior obstetric history of antepartum complications attributed to thrombosis. We aimed to investigate the contribution of close antepartum surveillance on pregnancy outcome among women with prior antepartum complications attributed to thrombosis.</p> <p>Methods</p> <p>The study was conducted on all women who were delivered, conceived and delivered again between January 2000 and January 2006 at a university teaching hospital. Women included were managed in previous pregnancy at a low risk setting and had unpredicted antepartum complications occurring at a gestational age of 23 weeks or more. Antepartum complications considered were intrauterine fetal death, neonates who were small for gestational age, severe pre-eclampsia and placental abruption. All women were tested for the presence of thrombophilia after delivery. In the following pregnancy, only women found to have any thrombophilia (thrombophilic group) were treated with enoxaparin. Both the thrombophilic group and the non-thrombophilic group (tested negatively for thrombophilia) were managed and observed closely at our high-risk pregnancy clinic.</p> <p>Results</p> <p>Ninety-seven women, who conceived at least once after the diagnosis of the relevant antepartum complications, were included in this study. Forty-nine had any thrombophilia and 48 tested negatively. Composite antepartum complications (all antepartum complications considered) were reduced significantly after close antepartum surveillance in both groups. Mean birth weight and mean gestational age improved significantly and were comparable between the groups.</p> <p>Conclusion</p> <p>Close antepartum surveillance may contribute to improvement in the perinatal outcomes of women with prior antepartum complications attributed to thrombosis.</p

689 - Unmet needs of managing atopic dermatitis: where do we stand in modifying vs. suppressing disease?

Abstract Introduction Atopic Dermatitis (AD) is a chronic relapsing inflammatory skin condition that is evolvingly perceived as a systemic disease, particularly when severe. The therapeutic ladder for managing AD has undergone substantial expansion in the last decade as new pathways are revealed, yet 75% of patients are not satisfied with their management of AD. While patients may report symptom relief, AD often requires ongoing treatment, increased dosage, or alternating regimens. For those patients who appear to respond well over a prolonged period, it is unclear whether they will tolerate treatment cessation. Objective To evaluate the current therapeutic options available for AD from the standpoint of their disease-modifying vs. disease-suppressing capabilities. Methods A systematic review of the literature was performed using academic research databases including PubMed and Embase between 1994 and 2024. The studies extracted from the search included, but were not limited to, randomized placebo-controlled trials, systematic reviews, cross-sectional studies, observational studies, case series, case reports, and retrospective studies. Current and emerging therapies for the treatment of AD were assessed for their ability to modify underlying disease mechanisms, and/or induce disease remission. Results Although several of the drugs that are currently approved for AD target the pathogenic Th2 axis, Janus Kinase (JAK) inhibitors have the most supporting evidence for their ability to modify underlying disease mechanisms. Inhibiting distinct JAK families hinders the downstream effects of multiple cytokines involved in AD at once. In some case reports, patients treated with selective JAK-1 inhibitors for up to 6 months did not experience disease recurrence following cessation during a several-month follow-up period. Similar studies of certain biological agents have shown prolonged periods of remission after discontinuation of dupilumab, tralokinumab, and lebrikizumab. This suggests that they may also drive long-lasting cellular changes, especially when implemented in early disease. Targeting OX40 or its ligand, the OX40L, may also hold promise for modifying AD. Studies have additionally indicated that there may be a therapeutic window of opportunity for maximal treatment impact in AD. Early intervention shortly after pediatric onset of disease may lead to improved long-term control and reduced comorbidity development. Novel disease-modifying strategies are currently being investigated in clinical trials for their capacity to correct skin and gut dysbiosis, restore epidermal barrier integrity, and alter innate and adaptive immune responses. Conclusions Recent progress in drug development has greatly advanced symptom control in patients with AD. However, only a few, if any, therapeutic strategies have demonstrated long-term disease modification. There is an unmet need to study the rate of recurrence upon cessation of current AD therapies. Future research should prioritize the development of therapeutic interventions for AD that not only treat symptoms but also modify the underlying disease pathology over time

CLA+ memory T cells in atopic dermatitis: CLA+ T cells and atopic dermatitis

Circulating skin-homing cutaneous lymphocyte-associated antigen (CLA)+ T cells constitute a small subset of human memory T cells involved in several aspects of atopic dermatitis: Staphylococcus aureus related mechanisms, the abnormal Th2 immune response, biomarkers, clinical aspects of the patients, pruritus, and the mechanism of action of targeted therapies. Superantigens, IL-13, IL-31, pruritus, CCL17 and early effects on dupilumab-treated patients have in common that they are associated with the CLA+ T cell mechanisms in atopic dermatitis patients. The function of CLA+ T cells corresponds with the role of T cells belonging to the skin-associated lymphoid tissue and could be a reason why they reflect different mechanisms of atopic dermatitis and many other T cell mediated skin diseases. The goal of this review is to gather all this translational information of atopic dermatitis pathology

The erythema Q-score, an imaging biomarker for redness in skin inflammation.

Physician rating of cutaneous erythema is central to clinical dermatological assessment as well as quantification of outcome measures in clinical trials in a number of dermatologic conditions. However, issues with inter-rater reliability and variability in the setting of higher Fitzpatrick skin types make visual erythema assessment unreliable. We developed and validated a computer-assisted image-processing algorithm (EQscore) to reliably quantify erythema (across a range of skin types) in the dermatology clinical setting. Our image processing algorithm evaluated erythema based upon green light suppression differentials between affected and unaffected skin. A group of four dermatologists used a 4-point Likert scale as a human evaluation of similar erythematous patch tests. The algorithm and dermatologist scores were compared across 164 positive patch test reactions. The intra-class correlation coefficient of groups and the correlation coefficient between groups were calculated. The EQscore was validated on and independent image set of psoriasis, minimal erythema dose testing and steroid-induced blanching images. The reliability of the erythema quantification method produced an intra-class correlation coefficient of 0.84 for the algorithm and 0.67 for dermatologists. The correlation coefficient between groups was 0.85. The EQscore demonstrated high agreement with clinical scoring and superior reliability compared with clinical scoring, avoiding the pitfalls of erythema underrating in the setting of pigmentation. The EQscore is easily accessible (http://lab.rockefeller.edu/krueger/EQscore), user-friendly, and may allow dermatologists to more readily and accurately rate the severity of dermatological conditions and the response to therapeutic treatments