Autoimmune Skin Disease Research Articles

Juvenile Bullous Pemphigoid with Similarity Clinical Features to Chronic Bullous Disease of Childhood

Introduction: Autoimmune bullous disease (ABD) is a specific autoimmune skin disease characterized by subepidermal vesicles and bullae. In pediatrics, there is an autoimmune bullous disease controversy with clinical clusters of jewel on Chronic bullous disease of childhood (CBDC) but dominant IgG autoantibodies. A similar clinical presentation challenges diagnosis; thus, supporting studies on direct immunofluorescence (DIF) as a specific autoantibody factor are necessary. Case: A 10-year-old boy with clinically tense-walled blisters with or without an erythematous base is itchy all over his body, with a predominance of palmoplantar, neck, inguinal, and axillary, presented by erosions, crusts, and a partial cluster of jewels lesion with mucosal involvement. A complete blood count shows leukocytosis and eosinophilia. Hematoxylin-eosin (HE) staining revealed a subepidermal cleft with eosinophil predominance, while direct immunofluorescence (DIF) revealed IgG deposits in the basal membrana and intercellular parts of the basal stratum. Discussion: Histopathology reveals subepidermal blisters of eosinophil dominance, and direct immunofluorescence (DIF) examination reveals IgG autoantibody deposit dominance, verifying the diagnosis of juvenile bullous pemphigoid. Given that BP180 (BPAG2) is one of the autoantigens involved, there may be similarities between the histology and clinical presentation of Bullous pemphigoid (BP) and CBDC. Conclusion: Autoimmune bullous diseases are difficult to differentiate clinically, histological studies and direct immunofluorescence are necessary to make a diagnosis.

Patients with autoimmune skin diseases are at increased risk of adverse pregnancy outcomes

Increased rates of adverse pregnancy outcomes have been reported in association with rheumatologic diseases such as systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis. However, little is known about pregnancy outcomes in patients with autoimmune skin diseases. This study aimed to determine the frequency of adverse pregnancy outcomes in patients with autoimmune skin diseases. We hypothesized that similar to rheumatic diseases, the rate of adverse pregnancy outcomes in patients with autoimmune skin diseases would be higher than the general population. This is a case control study using the TriNetX US Collaborative Network, which is a database of electronic medical records of >95 million patients seen at 57 healthcare organizations in the United States. All pregnant women between the ages of 15 and 44 years who were seen at a healthcare organization between January 1, 2016 and December 31, 2021 were included. Participants with autoimmune skin disease were matched to healthy controls and controls with systemic rheumatologic conditions (systemic lupus erythematosus or rheumatoid arthritis). For both the autoimmune skin disease and healthy control groups, those with systemic rheumatologic condition or hidradenitis suppurativa were excluded. The primary outcomes were adverse pregnancy outcomes defined as spontaneous abortion, gestational hypertension, preeclampsia or eclampsia, gestational diabetes mellitus, intrauterine growth restriction, preterm premature rupture of membranes, preterm birth, and stillbirth. Patients with autoimmune skin diseases and controls were 1:1 propensity score-matched by age, race, ethnicity, comorbidities, obesity, and substance use. For each outcome, odds ratio with a 95% confidence interval was calculated. A total of 2788 patients with autoimmune skin diseases were matched to 2788 healthy controls. Patients with autoimmune skin diseases were at a higher risk of spontaneous abortions than controls (odds ratio, 1.54; 95% confidence interval, 1.36-1.75; P<.001). Compared with patients with systemic lupus erythematosus, patients with autoimmune skin diseases were at lower risk of having infants with intrauterine growth restriction (odds ratio, 0.59; 95% confidence interval, 0.4-0.87; P=.01), preterm birth (odds ratio, 0.68; 95% confidence interval, 0.47-0.98; P=.04), and stillbirth (odds ratio, 0.50; 95% confidence interval, 0.25-0.97; P=.04). The differences in adverse pregnancy outcomes between patients with autoimmune skin diseases and those with rheumatoid arthritis were not statistically significant. Patients with autoimmune skin diseases are at a higher risk of spontaneous abortions than patients without autoimmune skin diseases. When analyzed by each autoimmune skin disease, patients with cutaneous lupus erythematosus or vitiligo remained at increased risk of spontaneous abortions compared with patients without autoimmune skin diseases. Patients with autoimmune skin diseases have similar risks of adverse pregnancy outcomes as patients with rheumatoid arthritis, but lower risks than patients with systemic lupus erythematosus.

1,25-Dihydroxyvitamin D3 Provides Benefits in Vitiligo Based on Modulation of CD8+ T Cell Glycolysis and Function

Vitiligo is a common autoimmune skin disease caused by autoreactive CD8+ T cells. The diverse effects of 1,25-dihydroxyvitamin D₃ [1,25(OH)₂D₃] on immune cell metabolism and proliferation have made it an interesting candidate as a supporting therapeutic option in various autoimmune diseases. This study aimed to elucidate the immunomodulatory effects of 1,25(OH)₂D₃ in vitiligo. Cross-sectional relationships between serum 1,25(OH)₂D₃ levels and disease characteristics were investigated in 327 patients with vitiligo. The immunomodulatory and therapeutic effects of 1,25(OH)₂D₃ were then investigated in vivo and in vitro, respectively. We found that 1,25(OH)₂D₃ deficiency was associated with hyperactivity of CD8+ T cells in the vitiligo cohort. In addition, 1,25(OH)₂D₃ suppressed glycolysis by activating the AMP-activated protein kinase (AMPK) signaling pathway, thereby inhibiting the proliferation, cytotoxicity and aberrant activation of CD8+ T cells. Finally, the in vivo administration of 1,25(OH)₂D₃ to melanocyte-associated vitiligo (MAV) mice reduced the infiltration and function of CD8+ T cells and promoted repigmentation. In conclusion, 1,25(OH)₂D₃ may serve as an essential biomarker of the progression and severity of vitiligo. The modulation of autoreactive CD8+ T cell function and glycolysis by 1,25(OH)₂D₃ may be a novel approach for treating vitiligo.

Serum miRNA profiling identified miRNAs associated with disease severity in psoriasis.

Psoriasis vulgaris is a chronic, autoimmune skin disease involving a complex interplay of epidermal keratinocytes, dermal fibroblast and infiltrating immune cells. Differential expressions of miRNAs are observed in psoriasis and the deregulated miRNAs are sometimes associated with disease severity. This study aims to identify miRNAs altered in the serum of psoriasis patients that are associated with the Psoriasis Area and Severity Index (PASI). In order to assess miRNA levels in the serum of psoriasis patients, we selected 24 differentially expressed miRNAs in the psoriatic skin are possibly derived from the skin and immune cells, as well as five miRNAs that are enriched in other tissues. We identified 16 miRNAs that exhibited significantly (p < 0.05) altered levels in the serum of psoriasis patients compared to healthy individuals. Among these, 13 miRNAs showed similar expression pattern in the serum of psoriasis patients as also observed in the psoriatic skin tissues. Ten miRNAs showed an accuracy of greater than 75% in classifying the psoriasis patients from healthy individuals. Further analysis of differential miRNA levels between the low PASI group and the high PASI group identified three miRNAs (miR-147b, miR-3614-5p, and miR-125a-5p) with significantly altered levels between the low severity and the high severity psoriasis patients. Our systematic investigation of skin and immune cell-derived miRNAs in the serum of psoriasis patients revealed alteration in miRNA levels to be associated with disease severity, which may help in monitoring the disease progression and therapeutic response.

Rational design of a JAK1-selective siRNA inhibitor for the modulation of autoimmunity in the skin

Inhibition of Janus kinase (JAK) family enzymes is a popular strategy for treating inflammatory and autoimmune skin diseases. In the clinic, small molecule JAK inhibitors show distinct efficacy and safety profiles, likely reflecting variable selectivity for JAK subtypes. Absolute JAK subtype selectivity has not yet been achieved. Here, we rationally design small interfering RNAs (siRNAs) that offer sequence-specific gene silencing of JAK1, narrowing the spectrum of action on JAK-dependent cytokine signaling to maintain efficacy and improve safety. Our fully chemically modified siRNA supports efficient silencing of JAK1 expression in human skin explant and modulation of JAK1-dependent inflammatory signaling. A single injection into mouse skin enables five weeks of duration of effect. In a mouse model of vitiligo, local administration of the JAK1 siRNA significantly reduces skin infiltration of autoreactive CD8+ T cells and prevents epidermal depigmentation. This work establishes a path toward siRNA treatments as a new class of therapeutic modality for inflammatory and autoimmune skin diseases.

Hives but no urticaria—what could it be?

AbstractUrticaria is a common inflammatory dermatosis characterized by transient, usually intensely itching wheals mediated by mast cells. Urticarial lesions can also be mimicked by other skin diseases. Differential diagnoses of urticaria should be considered if the single urticarial skin lesion persists for more than 24 h, if hyperpigmentation, scaling, or blistering occurs, if the lesions are not itching, or if fever or arthralgias are reported. In these cases, histologic examination and thorough serologic diagnostic may help to differentiate other dermatoses, such as vasculitis, autoimmune bullous skin diseases, drug reactions, or autoinflammatory syndromes. This article summarizes common differential diagnoses of urticaria.

Stem Cells as a Therapeutic Choice in Dermatological Disorders.

Stem cells are known for their extraordinary properties, mainly their potency, self-renewal, and clonality. In recent years, we have witnessed notable advancements in the field of cell therapy. Due to its remarkable properties and versatility, this cutting-edge therapy has now become a potentially promising cure for many diseases. Stem cell-based therapies have been utilized to treat various dermatological conditions, for instance, autoimmune skin disorders, atopic dermatitis, skin aging, wound healing, scar treatment, and many others. This article aims to serve as an overview of cell-based therapy's current application in dermatology field.

229 Comparative immune profiling of four autoimmune skin diseases identifies a mixed type-I and type-II interferon response as a unique inflammatory signature in skin dermatomyositis

229 Comparative immune profiling of four autoimmune skin diseases identifies a mixed type-I and type-II interferon response as a unique inflammatory signature in skin dermatomyositis

Dermatoscopic Patterns in Vitiligo.

Vitiligo is a chronic, acquired autoimmune pigmentary skin disease, most times it can be diagnosed clinically. Dermoscopy can confirm vitiligo in a non-invasive way. It is a diagnostic technique that visualizes sub-macroscopic morphological structures which correspond with specific histological structures. It detects subtle changes in the pigment pattern, evaluates vitiligo activity, attempts of re-pigmentation, leucotrichia, and differentiates it from other hypo pigmentary disorders. Most dermatoscopic clues used to assess vitiligo activity are found at the perifollicular level in the center and edge of the lesion. Perifollicular pigmentation is present in both active lesions and treated pigmented lesions with treatment. However, perifollicular depigmentation represents poor response, in treated lesions, and poor prognosis in untreated ones. The center of the lesion has reduced and/or absent pigment network, in active and stable lesions. If on dermoscopy the center of the lesion shows islands of pigment, erythema, or telangiectasias, re-pigmentation is suggested. At the periphery of the lesion, unstable vitiligo usually shows up as a diffuse border, trichrome pattern, micro-Koebner/comet tail phenomenon, satellite lesions, or a tapioca sago pattern. In stable lesions it is more frequent to find well defined or trichromic border. Pigmented lesions commonly present sharp borders and marginal or perilesional hyperpigmentation.

Shikonin promotes ferroptosis in HaCaT cells through Nrf2 and alleviates imiquimod-induced psoriasis in mice

Psoriasis is one kind of autoimmune skin disease without efficiency cure. Shikonin (SHK) is a potential drug for psoriasis treatment. Recent study suggested that ferroptosis involved in the pathological process of psoriasis. This study proved the beneficial effect of SHK with an imiquimod (IMQ) induced psoriatic model mice, and studied the ferroptosis regulative mechanism of SHK with a HaCaT cells assay in vitro. In the study, it also found that SHK treatment significantly improved imiquimod (IMQ)-induced psoriasis symptoms in mice, attenuated the production of inflammatory cytokines, including interleukin (IL)-6, IL-17, and tumor necrosis factor-alpha (i.e., TNF-α), and strongly inhibited macrophage infiltration in inflamed psoriatic skin. SHK impacted HaCaT cells (a human keratinocyte cell line) viability by enhancing intracellular and mitochondrial ferrous and lipid peroxidation levels by regulating expression of nuclear factor erythroid 2-related factor 2 (Nrf2), heme oxygenase-1 (HO-1), nuclear receptor coactivator 4 (NCOA4) and glutathione peroxidase 4 (GPX4) which could be reversed by iron chelating agent. and in psoriatic dermatitis. However, this study found the reversing capability of low dose SHK on LPS inhibited GPX4 and Nrf2 expression, which was identity to that in psoriatic dermatitis. To conclude, SHK inhibited ferroptosis in psoriatic skin by reducing inflammation, ameliorating oxidative stress and iron accumulation. Nrf2 and GPX4 might be the two major targets of SHK in psoriatic skin lesion. Our study highly lighted the basic biological mechanism of SHK on ferroptosis regulation.

КЛИНИКО-ДИАГНОСТИЧЕСКОЕ ЗНАЧЕНИЕ АНТИНУКЛЕАРНЫХ АНТИТЕЛ В ПРАКТИКЕ ПЕДИАТРА (ЧАСТЬ 3)

Antinuclear antibodies (ANA), first discovered many decades ago in patients with systemic lupus erythematosus (SLE), still remain a diagnostic criterion for this disease. However, subsequent studies have shown that the range of diseases in which ANA are detected is extremely wide and includes not only systemic rheumatic diseases, but also other autoimmune diseases (AD), including autoimmune cytopenias, autoimmune liver diseases, gastrointestinal diseases, autoimmune pathology of the thyroid gland and other endocrine glands, autoimmune skin diseases etc. The low specificity of ANA determines their relatively low diagnostic value, which increases when taking into account the luminescence pattern, indicating the presence of certain autoABs. The presence of ANA in patients with AD has a certain prognostic significance since in a number of diseases it is associated with their clinical features and the nature of the process as well as the expected response to the treatment with various drugs. Due to the fact that various AD are often combined in patients, the detection of ANA may be a reason for expanding the examination aiming to diagnose them in a timely manner. See Part 2 at N.S. Podchernyaeva, M.K. Osminina, E.V. Frolkova, M.A. Kudryashova, M.R. Gripp, N.Yu. Golovanov. Clinical and diagnostic value of antinuclear antibodies in a pediatric physician’s practice (Part 2). Pediatria n.a. G.N. Speransky. 2023; 102 (2): 78-89. DOI: 10.24110/0031-403X-2023-102-2-78-89, and Part 1 at N.S. Podchernyaeva, L.G. Khachatryan, M.K. Osminina, E.V. Frolkova, M.A. Kudryashova. Clinical diagnostic value of antinuclear antibodies in pediatric practice (part I). Pediatria n.a. G.N. Speransky. 2022; 101 (3): 185-198. - DOI: 10.24110/0031-403X-2022-101-3-185-198.

Psoriasis Skin Disease Classification based on Clinical Images

Psoriasis is an autoimmune skin disorder that causes skin plaques to develop into red and scaly patches. It affects millions of people globally. Dermatologists currently employ visual and haptic methods to determine a medical issue's severity. Intelligent medical imaging-based diagnosis systems are now a possibility because of the relatively recent development of deep learning technologies for medical image processing. These systems can help a human expert make better decisions about a patient's health. Convolutional neural networks, or CNNs, on the other hand, have achieved imaging performance levels comparable to, if not better than, those of humans. In the paper, a Dermnet dataset is used. Image preprocessing, fuzzy c-mean-based segmentation, MobileNet-based feature extraction, and a support vector machine (SVM) classification are used for skin disease classification. Dermnet's dataset was investigated for images of skin conditions using three classes Psoriasis, Dermatofibroma, and Melanoma are studied. The performance metrics such as accuracy, precision-recall, and f1-score are evaluated and compared for three classes of skin diseases. Despite working with a smaller dataset, MobileNet with Support Vector Machine outperforms ResNet in terms of accuracy (99.12%), precision (98.65%), and recall (99.66%).

Subacute Cutaneous Lupus Erythematous

Subacute Cutaneous Erythematous (SCLE) is an Auto-Immune skin disorder that cause skin sores and rashes when your immune system attacks itself. In this case report describe 39 years old female patient with SCLE. It is characterized by either ring-shaped red scaly border and also scaly red bumps in sun exposed areas associated with itching, pain and burning sensation. In this case, the patient has a multiple red colour lesions initially on the upper back region then spread to B/L UL, abdomen, chest, face and LL which is aggravating to sunlight. The patient is having a history of skin burns like lesions, tuberculomas and SJS. The diagnosis of SCLE was revealed by clinical presentation, Skin biopsy result and laboratory finding i.e. ANA Test was found to be highly positive and confirms that it is an autoimmune disease. The patient was treated with corticosteroid drug, DMARDs along with antihistaminic drugs and supportive therapy like nutritional supplements and skin lotion for external application, which led to significant improvement in the lesion formation and other symptoms. The case report highlights the careful monitoring and appropriate treatment of SCLE.

FRI210 Rare Clobetasol Induced Adrenal Insufficiency In A Patient With Chronic Psoriasis

Abstract Disclosure: H. Maldonado Rivera: None. A. Subtain: None. S. Pastori: None. J.A. Gonzalez: None. S.R. Vallepu: None. N. Shahid: None. E. Angueira: None. N. Shaaban: None. A 38-year man with PMH of severe plaque psoriasis presented to the ED with complaints of right leg weakness. Patient denied nausea, vomiting, headache, chest pain, shortness of breath, and tremors. His skin psoriasis has been affecting him since childhood but got worse at age 24. The patient has been using clobetasol creams to reduce the itchiness and scaly skin that is formed throughout his body. Patient had morning cortisol level of 2.0 mcg/dL (n &amp;gt;15 mcg/dL). Patient’s cortisol level increased to 13.6 mcg/dL in the first 30 minutes and 17.0 mcg/dL at 60 minutes of corticotropin stimulation test. Based on the result, patient is diagnosed with adrenal insufficiency due to values of cortisol being &amp;lt;18.0mcg/dL. ACTH levels measured at the start were 22.1 pg/mL (n 6-76 pg/mL). This patient’s adrenal insufficiency is potentially multifactorial. The patient may have secondary adrenal insufficiency due to chronic use of clobetasol, a medium-potency topical steroid which has been associated with adrenal insufficiency with prolonged use. This is the most probable diagnosis in the presence of stable blood pressure and in the absence of nausea, vomiting, hyponatremia, hyperkalemia, hypercalcemia, and eosinophilia. However, the patient’s lack of gaining weight and hyperpigmentation seen in the lips and tongue as well as psoriasis, autoimmune skin disease condition may predispose the patient to develop primary adrenal insufficiency. In that case, the patient would need lifelong treatment with PO steroids, especially needing stress dosing if he becomes severely ill. This patient may be developing a primary adrenal insufficiency due to a potential autoimmune adrenalitis. Currently, patient has adequate blood pressure and electrolytes, which suggest he may develop disease later and is currently not in need of fludrocortisone. Patient’s anti-adrenal antibodies, anti-21-hydroxylase antibodies were negative. Patient was started on a medium stress dose of prednisone 20 mg PO in AM and 10 mg in PM. Patient was discharged with prednisone 10 mg PO in AM and 5 mg in PM (this is the equivalent of 40mg of hydrocortisone in AM and 20mg of Hydrocortisone in PM due to moderate illness). Eventually, patient’s prednisone dose was tapered to 5 mg in AM and 2.5mg in PM. Conclusion: This is a very rare case of clobetasol, a medium potency topical steroid used to treat severe plaque psoriasis causing secondary adrenal insufficiency due to negative feedback inhibition of hypothalamus-pituitary-adrenal axis. Reference: Ohman EM, Rogers S, Meenan FO, McKenna TJ. Adrenal Suppression following Low-Dose Topical Clobetasol Propionate. Journal of the Royal Society of Medicine. 1987;80(7):422-424.doi:10.1177/014107688708000709 Presentation: Friday, June 16, 2023

Plant exosomes fused with engineered mesenchymal stem cell-derived nanovesicles for synergistic therapy of autoimmune skin disorders.

Existing therapeutics for autoimmune diseases remain problematic due to low efficacy, severe side effects, and difficulties to reach target tissues. Herein, we design multifunctional fusion nanovesicles that can target lesions for the treatment of autoimmune skin diseases. The grapefruit-derived exosome-like nanovesicles (GEVs) with anti-inflammatory and antioxidant effects are first encapsulated with CX5461, an immunosuppressant with anti-proliferative properties to form GEV@CX5461. In order to enhance therapeutic efficiency and safety, GEV@CX5461 are then fused with CCR6+ nanovesicles derived from membranes of engineered gingiva-derived mesenchymal stem cells (GMSCs). The resulting FV@CX5461 not only maintain the bioactivity of GEVs, CX5461, and GMSC membranes but also home to inflamed tissues rich in chemokine CCL20 through the chemotaxis function of CCR6 on FVs. Moreover, FV@CX5461 reduce the secretion of inflammatory factors, calm down Th17 cell activation, and induce Treg cell infiltration. Finally, impressive therapeutic efficiency in both psoriasis and atopic dermatitis disease models is demonstrated using FV@CX5461 to reshape the unbalanced immune microenvironment. A nanotherapeutic drug delivery strategy is developed using fusion nanovesicles derived from plant and animal cells with high clinical potential.

Case Report: A successful treatment approach of rituximab and azathioprine for pemphigus vulgaris

Pemphigus Vulgaris is an uncommon autoimmune skin disorder that is characterized by persistent and blistering lesions. In approximately 50% of patients, mucous membrane erosions are the initial symptom. The primary presenting symptom is often oral mucosal erosions. Affected individuals frequently experience flaccid blisters and erosions on healthy skin and mucous membranes, and other areas of the body may also be affected. This condition is the result of autoantibodies that target desmosomal antigens. We are presenting a case of a 28-year-old male who presented to the hospital with fluid-filled lesions on his forehead and in his oral cavity. A skin biopsy was performed, and he was diagnosed with pemphigus vulgaris. Initially, he was started on a combination of steroids and azathioprine, but he did not respond to this treatment regimen. However, he was successfully treated with injection rituximab. Rituximab has been found to be an effective treatment approach towards pemphigus vulgaris. It can help prevent further complications and reduce the severity of the disease. By targeting the autoantibodies that cause the disorder, rituximab can help control the patient's symptoms and improve their quality of life. It is important to note that early diagnosis and treatment can play a critical role in the management of pemphigus vulgaris.

CXCL13 Serum Level as a Potential Biomarker in Vitiligo Patients: Correlation with Disease Activity and Severity

Background: Vitiligo is a prevalent autoimmune pigmentary skin disorder, with 0.5 - 2% of the global population prevalence. Human follicular T helper cells, dendritic follicular cells, and mesenchymal lymphoid tissue organizer cells all generate the B-cell chemokine (C-X-C motif) ligand 13 (CXCL13). Chemokine (C-X-C motif) ligand 13 and its receptor CXCR5 have been linked to the etiopathogenesis of various autoimmune and inflammatory diseases in the latest studies. Objectives: This study aimed to assess the serum CXCL13 level in vitiligo patients and its relation to the activity and severity of the disease. Methods: This case-control study involved 21 vitiligo patients and 21 age and gender-matched healthy controls. Full history taking, clinical evaluation, and assessment of the disease activity and severity were performed for all the patients. The CXCL13 serum levels were measured by enzyme-linked immunosorbent assay (ELISA). Results: The serum CXCL13 levels were significantly higher in vitiligo patients than in healthy controls (227.35 ± 125.70 and 130.58 ± 26.52 ng/L, respectively; P = 0.002). There was a significant relationship between CXCL13 and the clinical pattern of activity among patients with vitiligo; however, there was no correlation with disease activity or severity index scores. Conclusions: Although CXCL13 was greater in vitiligo patients than in healthy controls, it was unrelated to the activity or severity of the illness. This finding suggests that CXCL13 might have a role in the immunological pathogenesis of vitiligo.

Attenuated effects of topical vinpocetine in an imiquimod-induced mouse model of psoriasis

Psoriasis is an uncontrolled, long-lasting inflammatory dermatosis distinguished by thickened, erythematous, and flaky skin lesions. Massive amounts of inflammatory cytokines are produced when immune system imbalances are driven by genetic and environmental triggers. Vinpocetine (VNP), a man-made analogue of the compound vincamine found in the dwarf periwinkle herb, has robust anti-inflammatory, immunomodulatory, and anti-oxidative effects; alleviates the epidermal penetration of immune cells, such as eosinophils and neutrophils; and abolishes the generation of pro-inflammatory molecules. ObjectiveThis study was aimed at exploring the effects of long-term topical VNP, both alone and co-administered with clobetasol propionate, in an imiquimod-induced mouse model of psoriasiform dermatitis. MethodsThe study protocol consisted of 48 Swiss albino mice, randomly divided into six groups of eight mice each. In group I, petroleum jelly was administered daily for 8 days. In group II, imiquimod was administered topically at 62.5 mg daily for 8 days. In groups III, VI, V, and VI, 0.05% clobetasol propionate, 1% VNP, 3% VNP, and 3% VNP plus 0.05% clobetasol were administered topically for an additional 8 days after the induction, thus resulting in a total trial length of 16 days. ResultsTopical VNP at various doses alleviated the severity of imiquimod-induced psoriatic lesions—including erythema, silvery-white scaling, and thickening—and reversed the histopathological abnormalities. Moreover, imiquimod-exposed animals treated with VNP showed markedly diminished concentrations of inflammatory biomarkers, including tumour necrosis factor-α, interleukin (IL)-8, IL-17A, IL-23, IL-37, nuclear factor-kappa B (NF-κB), and transforming growth factor-β1. ConclusionThis research provides new evidence that VNP, alone and in combination with clobetasol, may serve as a potential adjuvant for long-term management of autoimmune and autoinflammatory skin diseases, particularly psoriasis, by attenuating psoriatic lesion severity, suppressing cytokine generation, and limiting NF-κB-mediated inflammation.

An integrated approach of psoriasis in the light of Siddha and Ayurveda – A clinical case report

Psoriasis is a chronic autoimmune skin disease in which there is an accelerated turnover of skin cell growth. This is one of the challenging conditions in dermatology where the treatment remains a conundrum. The symptoms get relapsed once the medicine/ treatment is withdrawn. An integrated approach of Siddha and Ayurvedic treatments renders the relapse of this condition deferred. We report an integrated approach in a 31-year-old male patient diagnosed with Psoriasis Vulgaris (PASI -18.3) and suffered for a duration of 20 years. The patient had lesions in the chest, abdomen, back of trunk, shoulder, knees, and scalp. He was treated with integrated Siddha and Ayurvedic modalities of treatment for a period of consecutive 40 days and was followed up without a treatment for a period of 1 year. No recurrence was observed after the complete resolution of lesions which occurred within 41 days of treatment. reported after three months of treatment. The importance of diet is highlighted. This study has unraveled possible effective treatments with long-lasting relief for psoriasis with an integrated approach.

Nano-encapsulated anandamide reduces inflammatory cytokines in vitro and lesion severity in a murine model of cutaneous lupus erythematosus.

Cutaneous lupus erythematosus (CLE) is a heterogeneous autoimmune skin disease which occurs independently and in conjunction with systemic lupus erythematosus. Drug development for CLE is severely lacking. Anandamide (AEA) is a primary endocannabinoid which exhibits immunomodulatory effects through mixed cannabinoid receptor agonism. We evaluated AEA as topical treatment for CLE and assessed benefits of nanoparticle encapsulation (AEA-NP) on cutaneous drug penetration, delivery and biological activity. Compared to untreated controls, AEA-NP decreased IL-6 and MCP-1 in UVB-stimulated keratinocytes (p < 0.05) in vitro. In BALB/c mice, AEA-NP displayed improved cutaneous penetration, extended release and persistence of AEA in the follicular unit extending to the base after 24 h. Utilizing the MRL-lpr lupus murine model, twice weekly treatment of lesions with topical AEA-NP for 10 weeks led to decreased clinical and histologic lesion scores compared to unencapsulated AEA and untreated controls (p < 0.05). Prophylactic application of AEA-NP to commonly involved areas on MRL-lpr mice similarly resulted in decreased clinical and histologic scores when compared to controls (p < 0.05), and reduced C3 and IBA-1 in lesional tissue (p < 0.05). The demonstrated clinical and immunomodulatory effects of treatment with AEA support its potential as therapy for CLE. This work also suggests that encapsulation of AEA improves penetration and treatment efficacy. Future studies will be conducted to assess full therapeutic potential.