Autoimmune Skin Disease Research Articles

Pemphigus Foliaceus in A Potato Donut Seller: A Case Report

Background: Pemphigus foliaceus is a condition of a rare and potentially life-threatening autoimmune blistering skin disease, thought to be caused by circulating autoantibodies against desmoglein-1 (Dsg-1), a glycoprotein with an integral role in maintaining intercellular adhesion between keratinocytes. Pemphigus foliaceus primary lesions generally manifest as erythematous papules, plaques, and erosions with the addition of scaly crusts as secondary lesions. Immunosuppressant is the mainstay therapy for pemphigus foliaceus. This case report describes the case of a female patient who worked as a potato donut seller with pemphigus foliaceus and analyzes the relationship between her disease and work.Case Presentation: A 31-year-old woman presented with a history of itchiness, redness, and burning sensation on her face, followed by the appearance of vesicles on her face, spreading to the back, arms, and legs. The patient worked as a potato donut seller and encountered numerous potential hazards. Upon further examination, the patient was diagnosed with pemphigus foliaceus. Discussion: Establishing an occupational disease requires a seven-step method, taking into account the clinical diagnosis, occupational, individual, and other exposures outside of work. In this case, neither occupational, individual, nor other environmental risk factors of pemphigus foliaceus was found. Conclusion: There are no substantial evidence that occupational exposures as a potato donut seller cause or exacerbate the patient’s diagnosis of pemphigus foliaceus. The patient’s innate genetic susceptibility remains the main factor contributing to her diagnosis.

Characterization of the serum and skin inflammatory profile in canine pemphigus foliaceus using multiplex assay and quantitative real-time polymerase chain reaction (qRT-PCR)

Canine pemphigus foliaceus (PF) is a common autoimmune skin disease characterized by autoantibodies binding to epithelial adhesion molecules resulting inflammatory response. The immune network of cytokine and chemokine abnormalities that characterize the immune response in canine PF are poorly explored. This study evaluated serum and lesional skin cytokine and chemokine profiles of dogs diagnosed with PF compared to healthy control dogs. Serum samples obtained from 11 PF dogs and 16 healthy control dogs were analyzed using commercially available canine multiplex assay for 13 biomarkers (Canine Milliplex assay). Eight lesional skin samples from seven PF dogs and five healthy site-matched samples from five healthy dogs were evaluated for 20 immune markers using quantitative real-time PCR. Immunomodulating medications were suspended for at least four weeks in all dogs before obtaining serum and skin samples. PF patients showed significantly higher serum concentrations of tumor necrosis factor-α, interleukin (IL)− 6, IL-8, IL-18, CCL2, KC-like, and granulocyte-macrophages colony-stimulating factor when compared to healthy controls (Mann-Whitney U test; p < 0.05 for all). Lesional PF skin exhibited significant expression and upregulation of pro-inflammatory/T helper (Th1) 1 markers IL-1β, MX1, GZMB, OAS1, and IFN-γ as well as Th2 cytokines IL-13, IL-33, TSLP, IL-31 and Th17/22 markers IL-17A and IL-22 (Mann-Whitney U test; p < 0.05 for all). Taken together, the findings from this study describe the role of numerous cytokines and chemokines associated with immune response in the skin and serum of canine PF patients. Further larger-sample proteomics and RNA-sequencing transcriptomics studies are needed to understand the immune pathogenesis of canine PF skin lesions.

IL-17A exacerbates psoriasis in a STAT3 overexpressing mouse model.

Psoriasis is an autoimmune skin disease characterized by immunocyte activation, excessive proliferation, and abnormal differentiation of keratinocytes. Signal transducers and activators of transcription 3 (STAT3) play a crucial role in linking activated keratinocytes and immunocytes during psoriasis development. T helper (Th) 17 cells and secreted interleukin (IL)-17A contribute to its pathogenesis. IL-17A treated STAT3 overexpressing mouse model might serve as an animal model for psoriasis. In this study, we established a mouse model of psoriasiform dermatitis by intradermal IL-17A injection in STAT3 overexpressing mice. Transcriptome analyses were performed on the skin of wild type (WT), STAT3, and IL-17A treated STAT3 mice. Bioinformatics-based functional enrichment analysis was conducted to predict biological pathways. Meanwhile, the morphological and pathological features of skin lesions were observed, and the DEGs were verified by qPCR. IL-17A treated STAT3 mice skin lesions displayed the pathological features of hyperkeratosis and parakeratosis. The DEGs between IL-17A treated STAT3 mice and WT mice were highly consistent with those observed in psoriasis patients, including S100A8, S100A9, Sprr2, and LCE. Gene ontology (GO) analysis of the core DEGs revealed a robust immune response, chemotaxis, and cornified envelope, et al. The major KEGG enrichment pathways included IL-17 and Toll-like receptor signaling pathways. IL-17A exacerbates psoriasis dermatitis in a STAT3 overexpressing mouse.

Anti-NC16A IgA from Patients with Linear IgA Bullous Dermatosis Induce Neutrophil-Dependent Subepidermal Blistering in Mice

Linear IgA bullous dermatosis (LABD) is an acquired autoimmune subepidermal blistering skin disease characterized by circulating and tissue-bound IgA autoantibodies that recognize epitopes within the hemidesmosomal protein BP180, including its NC16A domain. Histologically, LABD has long been defined by neutrophil infiltration and dermal-epidermal separation. However, the pathogenic roles of anti-NC16A IgA and neutrophils in LABD, as well as their interactions, have not been thoroughly studied. We show that passive transfer of patient-derived anti-NC16A IgA induce clinical and histologic LABD pathology in humanized NC16A mice that are reconstituted locally or systemically with human neutrophils. The lesional skin of mice exhibits significantly elevated levels of the neutrophil chemoattractants CXCL-1 and CXCL-2. Furthermore, we show significantly increased levels of the neutrophil chemoattractant IL-8 in blister fluids of patients with LABD. This study provides direct evidence that anti-NC16A IgA in patients with LABD are pathogenic and interact with neutrophils to mediate tissue injury and subepidermal blister formation. This study further corroborates the importance of neutrophil-mediated tissue injury in LABD disease physiology and establishes a clinically relevant invivo model system that can be used to systematically dissect the immunopathogenesis of LABD.

The Safety and Effectiveness of Decapeptide in Patients With Vitiligo: A Real-World Study.

Background Vitiligo, a chronic autoimmune depigmenting skin disease, affects a significant portion of the global population. One of the topical treatment options for vitiligo is basic fibroblast growth factor (bFGF)-related decapeptide (bFGFrP) 0.1% solution. This study aimed to assess the real-world effectiveness and safety of decapeptide in treating vitiligo. Methods This retrospective analysis utilized data collected from routine clinical practice in the management of vitiligo, focusing on patients treated with topical decapeptide lotion (Melgain™, manufactured by Zydus Healthcare Ltd., Ahmedabad, India). The primary outcome measures included the extent of re-pigmentation (EOR) and the grade of re-pigmentation (GOR) assessed at each follow-up visit. Results The analysis included data from 65 patients (24 males and 41 females) with an average age of 30.83 years. Segmental vitiligo was present in 52.31% of cases, with the face being the most commonly affected site. Among the patients, 33 received decapeptide as monotherapy, while 32 received decapeptide alongside adjuvant drug/phototherapy. The mean duration of treatment was five months. The first, second, and final follow-ups were observed to be at a mean of 45 days, two months, and five months, respectively. During the second and final follow-up, a significant response (>75% re-pigmentation) was observed in 12% (eight) and 71% (46) of the patients. A mild response (<50% re-pigmentation) was noted in 45% (29) of the patients during the first follow-up visit, 15% (10) during the second follow-up visit, and 6% (four) during the final follow-up visit. Grade 6 and 7 re-pigmentation occurred in a higher number of patients at the final visit, indicating treatment effectiveness. Overall, nearly all patients (96.92%) reported excellent tolerability of the decapeptide lotion based on the global assessment of tolerability. Conclusion This real-world study demonstrates that decapeptide promotes re-pigmentation and improves patient outcomes in vitiligo. Both decapeptide regimens, as monotherapy or in combination with other therapies, were effective and well tolerated by most patients. Thus, decapeptide represents a safe and effective therapeutic option for vitiligo treatment.

Acute and Sub-acute Toxicity Studies of a &lt;i&gt;Siddha&lt;/i&gt; Medicine &lt;i&gt;Ganthaga Mezhugu&lt;/i&gt; by Oral Administration in Sprague Dawley Rats

Psoriasis, a chronic auto-immune skin disease, is troubling 1-3 % of the world population with a 0.44-2.8% prevalence rate in India affecting more males than females. It is considered a dermatologist’s menace as it is challenging to treat the condition. Siddha, one of the traditional systems of medicine practised more in South India, includes a wide range of medicines that are used to treat or manage various ailments, including psoriasis. One such medicine is Ganthaga Mezhugu (GM) used in treating skin diseases like psoriasis. This present study deals with the evaluation of the safety of GM as per the Organization for Economic Co-operation and Development (OECD) Guidelines 423 and 407 in Sprague Dawley (SD) rats. In the Acute Toxicity study, SD female rats were grouped into five, in which Groups I and II received elemental Sulphur in two different doses, Groups III and IV received Sulphur ‘purified’ with two different Siddha processes and Group V received GM (2000mg/kg b.wt.). In the subacute toxicity study, SD rats of both sexes were grouped into six in which Group 1 served as vehicle control, Groups 2, 3, and 4 as low, mid, and high dose groups and the last two (Groups 5 and 6) as satellite control and satellite high-dose groups. In the acute study, no mortality, toxic signs or any gross pathological changes were noted. Hence, the LD50 value of GM was found to be greater than 2000mg/kg b.wt. In the sub-acute toxicity study, no mortality or morbidity occurred. There was a gradual increase in body weight with normal food and water intake indicating normalcy in its metabolism. There were no significant changes in hematological and biochemical parameters, serum electrolytes and gross pathology. Also, no pathological changes were found in the histopathology of organs in treated animals when compared with control group animals. Based on the results, regarding the Globally Harmonized System of Classification and Labelling of chemicals, GM can be classified as Category−5, which implies its safety for human consumption. Moreover, the results of the sub-acute study also confirm the safety of GM up to the dose of 400mg/kg b.wt.

Cutaneous lupus erythematosus is associated with an increased risk of cardiac and vascular diseases: a large-scale, propensity-matched global retrospective cohort study.

Autoimmune skin diseases can expedite various systemic sequelae involving other organs. Although limited to the skin, cutaneous lupus erythematosus (CLE) was noted to be associated with thromboembolic diseases. However, small cohort sizes, partially discrepant outcomes, missing data on CLE subtypes, and incomplete risk assessment limits these findings. The Global Collaborative Network of TriNetX provides access to medical records of more than 120 million patients worldwide. We used TriNetX to elucidate the risk for cardiac and vascular diseases after diagnosis of CLE, and its subtypes chronic discoid (DLE) and subacute cutaneous lupus erythematosus (SCLE). We included 30,315 CLE, 27,427 DLE, and 1613 SCLE patients. We performed propensity-matched cohort studies determining the risk to develop cardiac and vascular diseases (ICD10CM:I00-99) following diagnosis of CLE, DLE, or SCLE. Patients with systemic lupus erythematosus were excluded. We document that CLE and its subtype DLE but less so SCLE are associated with a higher risk for various cardiac and vascular diseases. This included predominantly thromboembolic events such as pulmonary embolism, cerebral infarction, and acute myocardial infarction, but also peripheral vascular disease and pericarditis. For example, the hazard ratio of arterial embolism and thrombosis was 1.399 (confidence interval: 1.230-1.591, p<0.0001) following CLE diagnosis. The study is limited by retrospective data collection and reliance on ICD10-disease classification. CLE and its major subtype DLE are associated with an increased risk for the development of a wide range of cardiac and vascular diseases. This research was funded by Deutsche Forschungsgemeinschaft (EXC 2167, CSSL/CS01-2022) and the Excellence-Chair Program of the State of Schleswig-Holstein.

The Effect of Transplantation of Cultured Autologous Melanocytes on CXCL9, CXCL10 and CXCL11 Expressions in Vitiligo.

Vitiligo is an acquired chronic autoimmune skin disorder with an estimated prevalence of 1% worldwide. The CD8+ T-cell-mediated chemokines such as CXCR3, CXCL9 and CXCL10 are the non-specific action immunomodulators that are responsible for the depigmentation and progression in vitiligo. This study aimed to explore the expression levels of serum CXCL9-11 in vitiligo patients who received the transplantation of cultured autologous melanocytes (TCAMs) before and after the operation and correlate their expressions with clinical stage, subtype and course of the vitiligo disease. The expression levels of serum CXCL9-11 were measured in the peripheral blood of 26 progressive vitiligo patients, 24 stable vitiligo, 13 TCAM patients and 30 healthy control (HC) cases using enzyme-linked immunosorbent assay (ELISA). The potential correlations between their expressions and disease features such as stage, type and surgical treatment were evaluated using Student's t-test. The expression levels of serum CXCL9-11 increased by ~1.4, ~1.6 and ~2.3-fold in vitiligo patients compared with HCs (P < 0.01). The expression levels of all chemokines were significantly higher in progressive vitiligo patients than in stable vitiligo (P < 0.01). The increasing expression levels of serum CXCL9, CXCL10 and CXCL11 were significantly related to the different types of vitiligo patients (P < 0.05). Preoperative expression levels of serum CXCL9-11 were significantly higher than the post-operative expression levels (P < 0.01). Our results demonstrate that increasing expression levels of the CXC family play a key role in the immunopathogenesis of vitiligo. The abnormal expression of the CXC family may be considered an effective and therapeutic target for TCAM treatment.

Гнездная алопеция — классическая коморбидность витилиго

INTRODUCTION: Vitiligo is an acquired autoimmune skin disease clinically manifested by foci of depigmentation due to the death of epidermal melanocytes. Although vitiligo most often runs in isolation, being limited to a pathological process in skin, this disease can lead to the development of a number of comorbid disorders. Alopecia areata also being an autoimmune disorder of skin appendages, is one of the most common comorbid disorders in vitiligo, manifesting along with the main disease, against the background main disease, or as the main disease itself. In the article, a clinical case of association of vitiligo and alopecia areata is presented, similarities and differences in their pathogenesis are discussed, and other comorbid disorders are described. CONCLUSION: Determination and identification of comorbid disorders with the underlying chronic dermatosis is an important task aiming to prevent the development of probable autoimmune and autoinflammatory disorders. Despite the fact that vitiligo usually runs without systemic manifestations, identification and prevention of a comorbid pathology of the dermatosis should not be ignored by clinicians of different profiles.

BI20 Generalized pustular psoriasis in a patient receiving pembrolizumab for metastatic lung adenocarcinoma

Abstract Skin toxicities are the most common immune-related adverse events (irAEs) associated with immune checkpoint inhibitor (ICI) treatment, an emerging field in dermatology. A wide spectrum of skin irAEs, including lichenoid reactions, vitiligo, bullous pemphigoid and other autoimmune skin diseases, have been reported. Psoriasiform irAEs may occur as an exacerbation of pre-existing disease or de novo and often occur later than other skin irAEs. Most cases reported to date are of chronic plaque and palmoplantar psoriasis. Generalized pustular psoriasis has been reported in fewer than 10 cases. We present a patient with mild pre-existing psoriasis who developed plaque psoriasis, evolving into severe pustular psoriasis after 4 months of pembrolizumab therapy for lung cancer. A 67-year-old man with stage 4 lung adenocarcinoma developed a widespread, itchy psoriasiform rash 3 months after starting pembrolizumab. He had a history of rheumatoid arthritis (RA) and pembrolizumab was started when he had progressed through chemotherapy. The RA was controlled on prednisolone, which was increased when methotrexate was discontinued shortly after diagnosis of lung cancer. He had a family history of psoriasis, and although he had previously been noted to have limited plaque and nail psoriasis, this had required minimal treatment. Within 2 months of starting pembrolizumab, he developed scaly, red plaques affecting more than 30% body surface area (BSA). The oncology team diagnosed a grade 3 skin toxicity and increased doses of oral steroids. Upon steroid tapering, the rash flared and was diagnosed in dermatology as consistent with exacerbation of pre-existing plaque psoriasis secondary to pembrolizumab and high-dose steroids. He partially responded to skin-directed treatment, but 2 months later following his sixth cycle of pembrolizumab, he progressed to generalized suberythrodermic pustular psoriasis. He was treated with acitretin and methotrexate. The incidence of ICI-mediated psoriasis and psoriasiform irAEs is approximately 4% of all skin toxicities. A cohort study by the European Network for Cutaneous Adverse Event to Oncologic Drugs group reported that 70% of 115 patients had no history of psoriasis. Ten per cent of psoriasiform irAEs were categorized as severe, involving more than 30% BSA. However, only eight (7%) had pustular involvement and 2% erythroderma. Treatment options include acitretin, methotrexate, apremilast and biologics. Guttate psoriasis and grade 2/3 disease were significant positive predictors for the antitumour response of ICIs. In summary, ICI-related psoriasis is an increasingly common problem with widespread use of immunotherapy. Early diagnosis and adequate management with agents that do not interfere with immunotherapy, or with the underlying malignancy, and close liaison with oncology are crucial.

005 Association between prescription drugs and vaccines commonly prescribed to older people and bullous pemphigoid: a UK population-based study

Abstract Bullous pemphigoid (BP) is the most common autoimmune blistering skin disease, manifested by painful itching of the skin and mucous membranes. Despite high mortality, poor quality of life and increasing incidence in older people, BP can be overlooked due to its rarity in the general population. The cause of BP is unknown, but there are reports of drug-induced BP and remission after the withdrawal of suspected drugs. Systematic reviews have found prescription drugs such as gliptins and loop diuretics to be associated with BP. However, previous studies did consider multiple drug exposures and had selected populations. Our UK population-based study aimed to determine whether drugs/vaccines prescribed between 1998 and 2021 for common conditions in older people are associated with BP. We conducted a population-based nested case–control study using the UK Clinical Practice Research Datalink (representing 8% of the UK population). Each person with BP (case) was matched by age, sex and general practice to up to five controls at the diagnosis time of their case. Multivariable conditional logistic regression was used to determine adjusted odds ratios (aOR) of developing BP within 1 year of taking at least one prescription for the following therapeutic groups: antibiotics, antidiabetics and insulin, antihypertensives, antithrombotics, lipid modifiers, analgesics, dementia drugs, antiepileptics, antipsychotics, antidepressants and influenza vaccine. Where possible, we report results for classes of drugs or subclasses. The results were adjusted for multiple exposures and corrected for multiple testing. We also explored potential confounders: ethnicity, deprivation, stroke, Parkinson disease and dementia. Six months of antibiotics prescriptions before the BP diagnosis was excluded to account for treating undiagnosed BP symptoms. We identified 16 844 patients with BP and 79 493 controls (mean age 76 years; 44% male). The drugs associated with an increased risk of BP were penicillinase-resistant penicillins [aOR 2.6, 95% confidence interval (CI) 2.4–2.8]; macrolides (aOR 1.5, 95% CI 1.4–1.7); gliptins (aOR 2.8, 95% CI 2.4–3.3); centrally acting anticholinesterases (aOR 2.3, 95% CI 2.0–2.7); N-methyl-D-aspartate receptor antagonists (aOR 2.2, 95% CI 1.7–2.9); antiepileptics (aOR 2.4, 95% CI 2.3–2.6); influenza vaccine (aOR 1.4, 95% CI 1.4–1.5) and loop diuretics (aOR 1.3, 95% CI 1.2–1.4). Reduced BP risk was associated with nonsteroidal anti-inflammatory drugs (aOR 0.8, 95% CI 0.8–0.9) and opioids (aOR 0.8, 95% CI 0.8–0.9). Potential confounders did not affect odds ratio estimates. All P values were &amp;lt; 0.001. No association was found for broad-spectrum penicillins, lipid-modifying drugs, anticoagulants, beta blockers, calcium channel blockers and potassium-sparing diuretics with another diuretic. Clinicians need to be aware of BP risk in older people following administration of penicillinase-resistant penicillins, gliptins, dementia and epilepsy drugs, in order to recognize BP early and consider withdrawal of the suspect drug.

P19 Diagnostic conundrums in paraneoplastic pemphigus

Abstract Paraneoplastic pemphigus (PNP) is a subset of pemphigus, a group of autoimmune blistering skin disorders. A 51-year-old man presented with paraneoplastic pemphigus associated with a hepatic neoplasm. He described an epigastric mass and associated mucositis affecting the orogenital mucosae, as well as the sclerae. Both computed tomography and magnetic resonance imaging demonstrated a 14-cm mass arising from the left lobe of the liver. A liver biopsy showed features of an atypical spindle-cell neoplasm, but a definite diagnosis was not possible. A diagnostic skin biopsy was taken from his outer lip mucosae. Histology showed surface ulceration with an acute inflammatory infiltrate, lichenoid lymphoplasmacytic infiltrate with focal basal vacuolar change, degenerate keratinocytes and adjacent suprabasal acantholysis and spongiosis. Perilesional direct immunofluorescence (DIF) was negative; however, indirect immunofluorescence (IIF) showed intercellular IgG antibodies on transitional epithelium with a high titre of 1 : 800 to rat bladder. These finding were consistent with the suspected clinical diagnosis of paraneoplastic pemphigus. The patient was commenced on oral prednisolone 1 mg kg−1 daily. Topical therapy included budesonide mixed with sweetener applied to the oral mucosae. Following this, a trial of 3 days of intravenous methylprednisolone along with 2% cocaine mouthwash, triple mouthwash (betamethasone, doxycycline and nystatin) and Dermovate® ointment was commenced, with improvement noted in pain, haemorrhage and ulceration. Intravenous immunoglobulin was administered preoperatively. The patient was subsequently transferred to a specialist centre for hepatobiliary surgery and listed for debulking of the liver mass. Postoperatively, he had plasmapheresis, with a noted reduction in mucosal ulceration and significant improvement in pain. Chemotherapy with doxorubicin and ifosfamide was initiated thereafter. PNP is a severe autoimmune blistering disorder characterized clinically by flaccid blisters and erosions. Although much is yet to be understood regarding the pathophysiology of PNP, studies show that the development of autoantibodies to the plakin family and desmogleins 1 and 3 play a particular role in its pathogenesis. In addition to autoantibodies, CD8+ T cells have also been shown to contribute to the development of PNP. In adults, the majority of cases are associated with an underlying haematological malignancy and, rarely, a solid-organ tumour. DIF findings include IgG and C3 deposition along the intercellular and basement membrane zones, while IIF detects autoantibodies to proteins found in transitional or stratified squamous epithelium. As in our case, reports have shown that the DIF can be negative, with one study showing a positive DIF in only 41% of cases. This case highlights the complex diagnostic and treatment challenges practitioners face when dealing with PNP and the patients it affects.

Eosinophils, Basophils, and Neutrophils in Bullous Pemphigoid.

Bullous pemphigoid (BP) is an autoimmune blistering skin disease, of which the incidence has increased in recent years. BP is characterized by circulating IgG and IgE autoantibodies against the hemidesmosomal proteins BP180 and BP230. Although autoantibodies trigger inflammatory cascades that lead to blister formation, effector cells and cell-mediated autoimmunity must also be considered as important factors in the pathogenesis of BP. The aim of this review is to outline the current knowledge on the role of eosinophils, basophils, and neutrophils in BP.

Baricitinib Lipid-Based Nanosystems as a Topical Alternative for Atopic Dermatitis Treatment.

Atopic dermatitis (AD) is a chronic autoimmune inflammatory skin disorder which causes a significant clinical problem due to its prevalence. The ongoing treatment for AD is aimed at improving the patient's quality of life. Additionally, glucocorticoids or immunosuppressants are being used in systemic therapy. Baricitinib (BNB) is a reversible Janus-associated kinase (JAK)-inhibitor; JAK is an important kinase involved in different immune responses. We aimed at developing and evaluating new topical liposomal formulations loaded with BNB for the treatment of flare ups. Three liposomal formulations were elaborated using POPC (1-palmitoyl-2-oleoyl-glycero-3-phosphocholine), CHOL (Cholesterol) and CER (Ceramide) in different proportions: (i) POPC, (ii) POPC:CHOL (8:2, mol/mol) and (iii) POPC:CHOL:CER (3.6:2.4:4.0 mol/mol/mol). They were physiochemically characterized over time. In addition, an in vitro release study, ex vivo permeation and retention studies in altered human skin (AHS) were also performed. Histological analysis was used to study the tolerance of the formulations on the skin. Lastly, the HET-CAM test was also performed to evaluate the irritancy capacity of the formulations, and the modified Draize test was performed to evaluate the erythema and edema capacity of the formulations on the altered skin. All liposomes showed good physicochemical properties and were stable for at least one month. POPC:CHOL:CER had the highest flux and permeation, and the retention in the skin was equal to that of POPC:CHOL. The formulations exhibited no harmful or irritating effects, and the histological examination revealed no changes in structure. The three liposomes have shown promising results for the aim of the study.

Changing Trends of Cutaneous Lupus Erythematosus (CLE) in a Tertiary Care Hospital in Northern Odisha, India.

Cutaneous lupus erythematosus (CLE) is a chronic autoimmune inflammatory skin disorder. Several studies have been published regarding its prevalence, demographic details, clinical spectrum, and various associated factors. In our out patient department (OPD), we noticed an increase in the number of cases of CLE in our area in the last few years. Therefore, the current cross-sectional study was conducted to assess the trends of CLE among patients who reported to a tertiary care hospital. The current study is a record-based cross-sectional study of 81 patients of CLE, who attended the dermatology OPD of a tertiary care hospital. Data were collected from 2017 to 2022 and were divided into three different periods of time (2017-2018, 2019-2020, and 2021-2022). Demographic details, clinical examination findings, and laboratory investigation reports were also collected. There was a rising trend in the cases of CLE. Females outnumbered males (2:1, 66.67%). The increase in cases from 2017-2018 to 2019-2020 was 157% and from 2019-2020 to 2021-2022 was 204%. In 2021-2022, 52% of cases of chronic CLE (CCLE) were males. Photosensitivity was the most common finding. The majority of patients were addicted to smoking. The current study noticed an increasing trend in all types of CLE. So, this rising trend should be investigated for possible triggering factors like climatic changes,infections, and drug factors with a larger sample size.

Association of Personality Traits with Treatment Adherence in Vitiligo

Background: Vitiligo is an acquired, auto-immune chronic skin disorder with different treatment modalities. Insufficient adherence to treatment is closely related to the efficacy of a prescribed treatment, and also, there are some associations between adherence behaviour and personality. Therefore, the study aimed to assess a relationship between five-factor personality traits and treatment adherence in patients with vitiligo.&#x0D; Methods: In this cross-sectional study, patients with vitiligo who received Ultraviolet B (UVB) phototherapy were recruited. The Morisky Medication Adherence Scale (MMAS-8) assessed treatment adherence, and personality factors were evaluated by NEO Five-Factor Personality Inventory (NEO-FFI). Data were analysed using t-tests, correlations, and multiple regression.&#x0D; Results: Among 70 participants, 62.9% had low adherence, 24.3% had medium adherence, and 12.9 % had high adherence. There was a positive correlation between neuroticism (p&lt;0.001) and adherence score. Furthermore, a negative correlation between Agreeableness (p=0.13), Conscientiousness (p&lt;0.001), Openness to experiences (p=005), Extraversion (p&lt;0.001), and adherence score was obtained. In the regression analysis method, only the factors of neuroticism (p&lt;0.001) and openness ( p=0.001), and conscientiousness ( p=0.016) predicted the dependent variable (adherence score) at the significance level.&#x0D; Conclusion: This study demonstrated that openness to experience and conscientiousness positively affected adherence, while Neuroticism negatively affected adherence. Considering these personality factors can effectively screen poor adherence and improve treatment adherence.

Divergent in situ expression of IL-31 and IL-31RA between bullous pemphigoid and pemphigus vulgaris.

Bullous pemphigoid (BP) and pemphigus vulgaris (PV) are two major autoimmune blistering skin diseases. Unlike PV, BP is accompanied by intense pruritus, suggesting possible involvement of the pruritogenic cytokine IL-31. However, the underlying mechanisms of the clinical difference between BP and PV in terms of pruritus are not fully understood. To compare the expression levels of IL-31 and its receptor IL-31RA in the lesional skin, including peripheral nerves in BP and PV patients, immunohistochemical staining for IL-31 and IL-31RA was performed in skin samples of BP and PV patients and healthy controls (HC). The IL-31RA-expressing area in epidermis and peripheral nerves was analysed using ImageJ and the percentage of positive cells for IL-31/IL-31RA in dermal infiltrating cells was manually quantified. Quantitative analyses revealed that IL-31/IL-31RA expressions in the epidermis and dermal infiltrate were significantly increased in BP compared to PV and HC. The difference between BP and PV became more obvious when advanced bullous lesions were compared. Peripheral nerves in BP lesions presented significantly higher IL-31RA expression compared to PV lesions. In conclusion, we found significantly augmented expressions of IL-31/IL-31RA in BP lesions, including peripheral nerves, in comparison to PV. These results suggest a possible contribution of IL-31/IL-31RA signalling to the difference between BP and PV in the facilitation of pruritus and local skin inflammation, raising the possibility of therapeutic targeting of the IL-31/IL-31RA pathway in BP patients.

Breakthroughs and bottlenecks of psoriasis therapy: Emerging trends and advances in lipid based nano-drug delivery platforms for dermal and transdermal drug delivery

Psoriasis is a chronic autoimmune skin disease characterised by abnormal epidermal keratinocytes, hyperproliferation, and inflammatory infiltration. The main challenges that make treating psoriasis difficult are the complex aetiology, frequency of administration, and multiple side effects of traditional therapeutics. Clinicians often face difficulties while treating serious wounds caused by psoriasis. The therapeutic advantages of existing molecules can be maximised by administering them at the correct place for an extended period. Over the past two to three decades, there has been an increase in the availability of lipid-based nanocarriers for cosmetic and skin-care applications. However, there is still significant room for the development of additional lipid-based nanocarriers that are both highly biocompatible and capable of stimulating skin regeneration processes. This review discusses the contemporary trends and latest progress in research on various lipid-based nanodrug delivery systems employed for the effective management of psoriasis. Here, we first recapitulated skin structure and its function. Second, we discussed an overview of pathophysiology of psoriasis and challenges of existing therapies in psoriasis treatment. We outlined skin delivery through various lipid-based nano-drug delivery systems like liposomes, transferosomes, niosomes, ethosomes, transethosomes, phytosomes, solid lipid nanoparticles, cerosomes, glyceroethosomes, and spanlastics for the effective management of psoriasis. Finally, we outlined in vitro assays and models for anti-psoriatic activity assessment. It will assist clinicians and formulation scientists in treating skin diseases, particularly psoriasis.

Aberrant inflammasome activation as a driving force of human autoimmune skin disease.

Autoimmune skin diseases are understood as conditions in which the adaptive immune system with autoantigen-specific T cells and autoantibody-producing B cells reacting against self-tissues plays a crucial pathogenic role. However, there is increasing evidence that inflammasomes, which are large multiprotein complexes that were first described 20 years ago, contribute to autoimmune disease progression. The inflammasome and its contribution to the bioactivation of interleukins IL-1β and IL-18 play an essential role in combating foreign pathogens or tissue damage, but may also act as a pathogenic driver of myriad chronic inflammatory diseases when dysfunctionally regulated. Inflammasomes containing the NOD-like receptor family members NLRP1 and NLRP3 as well as the AIM2-like receptor family member AIM2 have been increasingly investigated in inflammatory skin conditions. In addition to autoinflammatory diseases, which are often associated with skin involvement, the aberrant activation of the inflammasome has also been implied in autoimmune diseases that can either affect the skin besides other organs such as systemic lupus erythematosus and systemic sclerosis or are isolated to the skin in humans. The latter include, among others, the T-cell mediated disorders vitiligo, alopecia areata, lichen planus and cutaneous lupus erythematosus as well as the autoantibody-driven blistering skin disease bullous pemphigoid. Some diseases are characterized by both autoinflammatory and autoimmune responses such as the chronic inflammatory skin disease psoriasis. Further insights into inflammasome dysregulation and associated pathways as well as their role in forming adaptive immune responses in human autoimmune skin pathology could potentially offer a new field of therapeutic options in the future.

BCL11B Is Involved in Stress-Induced Differentiation of Keratinocytes and Has A Potential Role in Psoriasis Pathogenesis.

Psoriasis is a common, auto-immune skin disease characterized by abnormal proliferation and differentiation of keratinocytes. Studies revealed the role of stress stimulators in the pathogenesis of psoriasis. Oxidative stress and heat shock are two important stress factors tuning differentiation and proliferation of keratinocytes, regarding to psoriasis disease. BCL11B is a transcription factor with critical role in embryonic keratinocyte differentiation and proliferation. Given this, in keratinocytes we have investigated potential role of BCL11B in stress-induced differentiation. Furthermore, we searched for a potential intercommunication between BCL11B expression and psoriasis-related keratinocyte stress factors. In this experimental study, data sets of psoriatic and healthy skin samples were downloaded in silico and BCL11B was chosen as a potential transcription factor to analyze. Next, a synchronized in vitro model was designed for keratinocyte proliferation and differentiation. Oxidative stress and heat shock treatments were employed on HaCaT keratinocytes in culture, and BCL11B expression level was measured. Cell proliferation rate and differentiation were analyzed by synchronized procedure test. Flow cytometry was done to analyze cell cycle alterations due to the oxidative stress. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) data revealed a significant upregulation of BCL11B expression in keratinocytes, by 24 hours after initiating differentiation. However, it was followed by a significant down-regulation in almost all the experiments, including the synchronized model. Flow cytometer data demonstrated a G1 cell cycle arrest in the treated cells. Results indicated a remarkable role of BCL11B in differentiation and proliferation of HaCaT keratinocytes. This data along with the results of flow cytometer suggested a probable role for BCL11B in stress-induced differentiation, which is similar to what is happening during initiation and progression of normal differentiation.