Simvastatin Prevents and Reverses Depigmentation in a Mouse Model of Vitiligo

Vitiligo is a common autoimmune disease of the skin that results in disfiguring white spots. There are no Food and Drug Administration (FDA)-approved treatments, and current treatments are time-consuming, expensive, and of low efficacy. We sought to identify new treatments for vitiligo, and first considered repurposed medications because of the availability of safety data and expedited regulatory approval. We previously reported that the IFN-γ-induced chemokine CXCL10 is expressed in lesional skin from vitiligo patients, and that it is critical for the progression and maintenance of depigmentation in our mouse model of vitiligo. We hypothesized that targeting IFN-γ signaling might be an effective new treatment strategy. Activation of signal transducer and activator of transcription 1 (STAT1) is required for IFN-γ signaling and recent studies revealed that simvastatin, an FDA-approved cholesterol-lowering medication, inhibited STAT1 activation in vitro. Therefore, we hypothesized that simvastatin may be an effective treatment for vitiligo. We found that simvastatin both prevented and reversed depigmentation in our mouse model of vitiligo, and reduced the number of infiltrating autoreactive CD8+ T cells in the skin. Treatment of melanocyte-specific, CD8+ T cells in vitro decreased proliferation and IFN-γ production, suggesting additional effects of simvastatin directly on T cells. Based on these data, simvastatin may be a safe, targeted treatment option for patients with vitiligo. © 2015 The Society for Investigative Dermatology

Current Insights in Cutaneous Lupus Erythematosus Immunopathogenesis

Cutaneous Lupus Erythematosus (CLE) is a clinically diverse group of autoimmune skin diseases with shared histological features of interface dermatitis and autoantibodies deposited at the dermal-epidermal junction. Various genetic and environmental triggers of CLE promote infiltration of T cells, B cells, neutrophils, antigen presenting cells, and NK cells into lesional skin. In this mini-review, we will discuss the clinical features of CLE, insights into CLE immunopathogenesis, and novel treatment approaches

Striae gravidarum: Associated factors

Background: Striae gravidarum (SG) is the most common change in connective tissue of pregnant women and may cause cosmetic concerns. Objectives: To determine the frequency of SG in Iranian pregnant women and its possible associations with the characteristics of themselves and their newborns. Methods: One hundred and eighteen primigravid pregnant women were included in this prospective observational study at their first prenatal visit, among them 114 completed the study and gave birth. Results: One hundred (87.7) of 114 women developed SG with a mean Davey's score of 4.04±2.47. The mean gestational age at which SG first appeared was 27.57±5.38 weeks. Family history of SG in mother, baseline and delivery body mass index, greatest abdominal and hip girths, newborn weight, height and head circumference were significantly associated with the presence of SG. All of these factors were also correlated with Davey's score. Conclusion: Genetic and physical risk factors may be involved in the development of SG in primigravid women. © 2007 The Authors Journal compilation © 2007 European Academy of Dermatology and Venereology

Upcoming treatments for morphea

Morphea (localized scleroderma) is a rare autoimmune connective tissue disease with variable clinical presentations, with an annual incidence of 0.4-2.7 cases per 100,000. Morphea occurs most frequently in children aged 2-14 years, and the disease exhibits a female predominance. Insights into morphea pathogenesis are often extrapolated from studies of systemic sclerosis due to their similar skin histopathologic features; however, clinically they are two distinct diseases as evidenced by different demographics, clinical features, disease course and prognosis. An interplay between genetic factors, epigenetic modifications, immune and vascular dysfunction, along with environmental hits are considered as the main contributors to morphea pathogenesis. In this review, we describe potential new therapies for morphea based on both preclinical evidence and ongoing clinical trials. We focus on different classes of therapeutics, including antifibrotic, anti-inflammatory, cellular and gene therapy, and antisenolytic approaches, and how these target different aspects of disease pathogenesis

Suction blistering the lesional skin of vitiligo patients reveals useful biomarkers of disease activity

BACKGROUND: Vitiligo is an autoimmune disease of the skin with limited treatment options; there is an urgent need to identify and validate biomarkers of disease activity to support vitiligo clinical studies. OBJECTIVE: To investigate potential biomarkers of disease activity directly in the skin of vitiligo subjects and healthy subjects. METHODS: Patient skin was sampled via a modified suction-blister technique, allowing for minimally invasive, objective assessment of cytokines and T-cell infiltrates in the interstitial skin fluid. Potential biomarkers were first defined and later validated in separate study groups. RESULTS: In screening and validation, CD8+ T-cell number and C-X-C motif chemokine ligand (CXCL) 9 protein concentration were significantly elevated in active lesional compared to nonlesional skin. CXCL9 protein concentration achieved greater sensitivity and specificity by receiver operating characteristic analysis. Suction blistering also allowed for phenotyping of the T-cell infiltrate, which overwhelmingly expresses C-X-C motif chemokine receptor 3. LIMITATIONS: A small number of patients were enrolled for the study, and only a single patient was used to define the treatment response. CONCLUSION: Measuring CXCL9 directly in the skin might be effective in clinical trials as an early marker of treatment response. Additionally, use of the modified suction-blister technique supports investigation of inflammatory skin diseases using powerful tools like flow cytometry and protein quantification

Understanding the Impact of Teledermatology on No-Show Rates and Healthcare Accessibility: A Retrospective Chart Review

At the onset of the COVID-19 pandemic, emergency legislation expanding coverage of telehealth service 38 swept across the nation to allow for continued access to medical care despite strict shelter-in-place guidelines. In the wake of this, telehealth usage has increased dramatically. Dermatology, in particular, is uniquely amenable to virtual visits and teledermatology has the potential to become a permanent platform from which we provide specialty care. As telehealth expands, additional data is needed on the impact of telehealth on health equity. Missed appointments, or no-shows, are a measure of health disparity, with low-income, Medicaid, and minority patients traditionally having the highest no-show rates. Given the ability of teledermatology to theoretically improve patient convenience and eliminate potential barriers to care, we sought to investigate the impact of telehealth on no-show rates and patient access at a large academic medical center

Response to the influence of teledermatology on health care access and equity

To the Editor: We thank Hadeler and his co-authors for their support of our research and for providing additional context regarding telemedicine\u27s impact on health care access and equity.Although we found that teledermatology services performed during the COVID-19 pandemic benefitted minority and Medicaid patients, Hadeler et al highlight previous survey-based studies from 2011 and 2013 to 2016 that demonstrated these patients were the least likely to utilize telemedicine. We believe there are 2 key factors that likely contributed to the increased appointment attendance among minority and Medicaid patients found in our study reflecting the rapidly evolving landscape of telemedicine. These factors are also notable, as they have implications for future access to telemedicine