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Dragar B, Kranjc Brezar S, Čemažar M, Jesenko T, Romih R, Kreft ME, Kuret T, Zupančič D. Vitamin A-Enriched Diet Increases Urothelial Cell Proliferation by Upregulating Itga3 and Areg After Cyclophosphamide-Induced Injury in Mice. Mol Nutr Food Res 2025; 69:e70045. [PMID: 40119798 PMCID: PMC12050521 DOI: 10.1002/mnfr.70045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Revised: 03/03/2025] [Accepted: 03/11/2025] [Indexed: 03/24/2025]
Abstract
Vitamin A (VitA) is an essential nutrient, affecting many cell functions, such as proliferation, apoptosis, and differentiation, all of which are important for the regeneration of various tissues. In this study, we investigated the effects of a VitA-enriched diet on the regeneration of the urothelium of the urinary bladder in mice after cyclophosphamide (CP)-induced injury. Female mice were fed VitA-enriched and normal diet for 1 week before receiving an intraperitoneal injection of CP (150 mg/kg). Urinary bladders were removed 1 and 3 days after CP. On Day 1, RNA sequencing showed that VitA upregulated two Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathways: the cell cycle and the PI3K-Akt pathway. This was confirmed by qPCR, which showed significantly increased expression of the Itga3 and Areg genes. In addition, the effect of VitA on the proliferation of urothelial cells was analyzed by immunohistochemistry of Ki-67, which confirmed an increased proliferation rate. No significant effects of the VitA-enriched diet were observed on the expression of apoptosis-related genes and on differentiation-related markers of superficial urothelial cells. Our results suggest that a VitA-enriched diet improves early urothelial regeneration after CP-induced injury by promoting cell proliferation.
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Affiliation(s)
- Brina Dragar
- Institute of Cell Biology, Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | | | - Maja Čemažar
- Department of Experimental OncologyInstitute of OncologyLjubljanaSlovenia
| | - Tanja Jesenko
- Department of Experimental OncologyInstitute of OncologyLjubljanaSlovenia
| | - Rok Romih
- Institute of Cell Biology, Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Mateja Erdani Kreft
- Institute of Cell Biology, Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Tadeja Kuret
- Institute of Cell Biology, Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Daša Zupančič
- Institute of Cell Biology, Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
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Lin TL, Chang YL, Ho HJ, Chen YJ, Wu CY. Psoriatic arthritis risk in psoriasis patients prescribed acitretin versus disease-modifying antirheumatic drugs: a nationwide cohort study. Rheumatology (Oxford) 2024; 63:1624-1631. [PMID: 37656926 DOI: 10.1093/rheumatology/kead446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVES To compare the risk of PsA in psoriasis (PsO) patients treated with acitretin vs DMARDs. METHODS This retrospective study used Taiwan's National Health Insurance Research Database from 1997 to 2013. Adult PsO patients without PsA prescribed acitretin or DMARDs for ≥30 days within a year were assigned to the acitretin cohort or DMARDs cohort, respectively. Patients in the acitretin cohort prescribed DMARDs for >7 days, or in the DMARDs cohort prescribed acitretin for >7 days, were excluded. Cumulative incidence of PsA were determined within both cohorts using the Kaplan-Meier method. The hazard ratio (HR) comparing acitretin to DMARDs was calculated with Cox regression models, adjusting for demographic and clinical covariates including the use of NSAIDs and comorbidities. RESULTS The study included 1948 patients in each cohort. The 5-year cumulative incidence of PsA in the acitretin cohort was lower than that in the reference cohort (7.52% vs 9.93%; P = 0.005), with a more pronounced difference in the subpopulation receiving NSAIDs treatment. However, in subpopulations without NSAIDs treatment, the 5-year cumulative incidence of PsA in the acitretin cohort was comparable to the DMARDs cohort (5.26% vs 6.98%; P = 0.106). Acitretin was not associated with PsA development in PsO (HR 0.83, 95% confidence interval 0.65-1.05). This risk remained consistent regardless of adjustments for NSAID treatment and comorbidities. Other independent risk factors for PsA included female and NSAIDs treatment. CONCLUSION Compared with DMARDs, acitretin was not associated with increased PsA risk in PsO patients.
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Affiliation(s)
- Teng-Li Lin
- Department of Dermatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- Ph.D. Program of Interdisciplinary Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Ling Chang
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsiu J Ho
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Ju Chen
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, National Chung-Hsing University, Taichung, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Ying Wu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Public Health, China Medical University, Taichung, Taiwan
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Li J, Wang S, Li XD, Han Y. Combination of secukinumab and acitretin for generalized pustular psoriasis: A case report and review of literature. J Int Med Res 2024; 52:3000605241247702. [PMID: 38661102 PMCID: PMC11047231 DOI: 10.1177/03000605241247702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/31/2024] [Indexed: 04/26/2024] Open
Abstract
Generalized pustular psoriasis (GPP) is characterized by painful and occasionally disfiguring cutaneous manifestations with sepsis-like systemic symptoms, and is a rare severe variant of psoriasis. Currently, there is no standard treatment for GPP. Here, we report a case of a female patient with ankylosing spondylitis (AS) and mild scalp psoriasis, who developed GPP and alopecia following three courses of adalimumab therapy. The patient's condition gradually improved following cessation of adalimumab and treatment with secukinumab and acitretin. After eight weeks of treatment, the patient achieved almost complete clearance of her psoriasis, her alopecia improved, and her AS was relieved. Therefore, we believe that a combination of secukinumab with acitretin may be a rational approach for the treatment of severe GPP.
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Affiliation(s)
- Ji Li
- Department of Dermatology, Central Hospital Affiliated To ShenYang Medical College, 5 Nanqi West Road, 110024, Shenyang, Liaoning, China
| | - Shiyu Wang
- Department of Dermatology, Central Hospital Affiliated To ShenYang Medical College, 5 Nanqi West Road, 110024, Shenyang, Liaoning, China
| | - Xiao-Dong Li
- Department of Dermatology, Central Hospital Affiliated To ShenYang Medical College, 5 Nanqi West Road, 110024, Shenyang, Liaoning, China
| | - Yang Han
- Department of Dermatology, Central Hospital Affiliated To ShenYang Medical College, 5 Nanqi West Road, 110024, Shenyang, Liaoning, China
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Molinelli E, Sapigni C, Simonetti O, D'Agostino GM, Brisigotti V, Rizzetto G, Offidani A. Acitretin plus macrolides and acitretin monotherapy in the management of hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2023; 37:e392-e394. [PMID: 36306173 DOI: 10.1111/jdv.18706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Claudia Sapigni
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Oriana Simonetti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Giovanni Marco D'Agostino
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Valerio Brisigotti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Giulio Rizzetto
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
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Li R, Zhao W, Wang H, Toshiyoshi M, Zhao Y, Bu H. Vitamin A in children's pneumonia for a COVID-19 perspective: A systematic review and meta-analysis of 15 trials. Medicine (Baltimore) 2022; 101:e31289. [PMID: 36281101 PMCID: PMC9592144 DOI: 10.1097/md.0000000000031289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To systematically review and meta-analyze the efficacy of vitamin A as an adjuvant therapy for pneumonia in children. METHODS We searched in PubMed, the Cochrane Library, Chinese National Knowledge Infrastructure, WanFang Database and Chongqing VIP information network from libraries building to March 2022, screening randomized controlled trials (RCT) about vitamin A combined with conventional therapy for pneumonia in children. Two researchers used the Cochrane risk of bias tool to assess the quality of included studies dependently. Data analysis was conducted in the RevMan 5.3. RESULTS 15 trials involving 3496 patients (treated group: 1898; control group: 1598) were analyzed in this study. The Meta-analysis showed that vitamin A combined with conventional therapy improved clinical efficacy (P < .05), shortened the duration of fever and cough, negative time of chest X-ray, and the hospitalization, lung rale disappearance, choking milk disappearance, shortness of breath disappearance and perilabial cyanosis disappearance (P < .05). However, vitamin A combined with conventional therapy did not reduce the mortality of pneumonia in children (P > .05). CONCLUSION Vitamin A contributes to relieve the clinical symptoms and signs, and also shorten the hospitalization.
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Affiliation(s)
- Ruoxi Li
- Graduate School, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Wenli Zhao
- Liver Center, Saga University Hospital, Saga University, Saga, Japan
| | - Hongwu Wang
- School of Health Science and Engineering, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Maeda Toshiyoshi
- International Education College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ye Zhao
- Department of Public Health, International College, Krirk University, Bangkok, Thailand
- *Correspondence: Ye Zhao, Department of Public Health, International College, Krirk University, Bangkok 10220, Thailand (e-mail: )
| | - Huaien Bu
- School of Health Science and Engineering, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Lin L, Wang Y, Lu X, Wang T, Li Q, Wang R, Wu J, Xu J, Du J. The Inflammatory Factor SNP May Serve as a Promising Biomarker for Acitretin to Alleviate Secondary Failure of Response to TNF-a Monoclonal Antibodies in Psoriasis. Front Pharmacol 2022; 13:937490. [PMID: 35814239 PMCID: PMC9263382 DOI: 10.3389/fphar.2022.937490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 11/26/2022] Open
Abstract
Psoriasis is a common immune-mediated inflammatory skin disease. Although biological agents have achieved good clinical efficacy in the treatment of moderate-to-severe psoriasis, the phenomenon of secondary non-response (SNR) has been gradually recognized. SNR refers to the gradual decline of efficacy after the patient achieves clinical remission with biological agents such as TNF-α biologics. Acitretin, as an immunomodulatory systemic drug for psoriasis, can improve the SNR to biological agents with good tolerance, but there are still individual differences in efficacy. Single-nucleotide polymorphisms (SNPs) of many related inflammatory cytokines have been shown to be important factors of individual differences in drug response in psoriasis, but there have been few reports on the use of pharmacogenomics to alleviate the SNR to biological agents. This study recruited 43 patients with psoriasis and 24 normal controls to investigate whether SNPs of inflammatory cytokines could be used as biomarkers for acitretin to alleviate SNR to TNF-α biologics in psoriasis, including rs1800795 (IL-6), rs6887695 (IL-12b), rs3212227 (IL-12b), rs10484879 (IL-17a), rs4819554 (IL-17ra), rs763780 (IL-17F), rs11209032 (IL23R), rs11209026 (IL23R), and rs2201841 (IL23R). The study also analyzed the correlation between the abovementioned SNPs and the efficacy of acitretin-only patients so as to understand whether the improvement is attributable to the intervention of acitretin on SNR or a simple response of acitretin. We found that in patients with homozygous AA (χ2 = 6.577, p = 0.02) at the SNP rs112009032 (IL-23R), acitretin could improve the SNR to TNFα monoclonal antibody. Patients with the genotype of TG (χ2 = 6.124, p = 0.035) at rs3212227 (IL-12B) were more sensitive to using acitretin in the treatment of psoriasis. Rs3212227 (χ2 = 7.664, p = 0.022) was also associated with the susceptibility to psoriasis. The study might provide a clinical decision reference for personalized treatment of secondary loss of response to psoriasis biologics.
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Affiliation(s)
- Lanmei Lin
- Department of Dermatology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yilun Wang
- Department of Dermatology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Xiaonian Lu
- Department of Dermatology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Tianxiao Wang
- Department of Pharmacy, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Qunyi Li
- Department of Pharmacy, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Runnan Wang
- Department of Dermatology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jinfeng Wu
- Department of Dermatology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
- *Correspondence: Jinfeng Wu, ; Jinhua Xu, ; Juan Du,
| | - Jinhua Xu
- Department of Dermatology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
- *Correspondence: Jinfeng Wu, ; Jinhua Xu, ; Juan Du,
| | - Juan Du
- Department of Dermatology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
- *Correspondence: Jinfeng Wu, ; Jinhua Xu, ; Juan Du,
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7
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Kłujszo EH, Zarębska-Michaluk D, Kręcisz B, Witkowska A. Safety of therapies using ustekinumab in patients with psoriasis who have had hepatitis B virus infection. Dermatol Ther 2021; 35:e15274. [PMID: 34921578 DOI: 10.1111/dth.15274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/10/2021] [Indexed: 12/22/2022]
Abstract
Biological therapies used in psoriasis treatment pose a risk of reactivation of hepatitis B virus (HBV) infection. This risk occurs not only in patients with HB surface antigen (HBsAg) (+) but also in patients with past or occult HBV infection (with negative HBsAg, positive HB core antibodies (HBcAb), and positive HBV deoxyribonucleic acid [DNA]). Ustekinumab (UST) is a biologic agent acts by blocking the IL-12/23 pathway. Thus, hindering this response may lead to HBV reactivation. UST therapy is associated with mild HBV-r risk; however, there is insufficient data to confirm that hypothesis. Herein, we present observations on the safety of UST therapy in patients with psoriasis and serologically proved past HBV infection. One-hundred and six consecutive patients with moderate to severe psoriasis treated with biological therapy between May 2013 and January 2020 were retrospectively analyzed. Out of 106 patients, there were five who reported having past HBV. Those five patients were tested for the presence of HBsAg, HBcAb, HBsAb as well as HBV DNA at baseline and at the end of the follow-up period. HBV reactivation was defined as changing of "undetectable" to "detectable" viremia. All five patients were treated with UST. Five patients in our cohort group were found to have resolved HBV infection: HBsAg (-), HBcAb (+), and HBV DNA (-); 4/5 were HBsAb (+) and 1/5 HBsAb (-). None of the patients experienced an increase in their liver function tests values and no signs of hepatitis or HBV reactivation were observed at any point during the study. All the patients were HBsAg and HBV DNA negative at the end of the follow-up period. The average treatment time was 82.4 (28, 96) weeks. The average follow-up time was 75.2 (31, 176) weeks. Based on the available literature and the results from our observations, UST therapy seems to be a safe option for patients with resolved HBV infection.
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Affiliation(s)
| | | | - Beata Kręcisz
- Faculty of Medicine and Health Science, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Anna Witkowska
- Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland
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Carazo A, Macáková K, Matoušová K, Krčmová LK, Protti M, Mladěnka P. Vitamin A Update: Forms, Sources, Kinetics, Detection, Function, Deficiency, Therapeutic Use and Toxicity. Nutrients 2021; 13:1703. [PMID: 34069881 PMCID: PMC8157347 DOI: 10.3390/nu13051703] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/07/2021] [Accepted: 05/13/2021] [Indexed: 12/12/2022] Open
Abstract
Vitamin A is a group of vital micronutrients widely present in the human diet. Animal-based products are a rich source of the retinyl ester form of the vitamin, while vegetables and fruits contain carotenoids, most of which are provitamin A. Vitamin A plays a key role in the correct functioning of multiple physiological functions. The human organism can metabolize natural forms of vitamin A and provitamin A into biologically active forms (retinol, retinal, retinoic acid), which interact with multiple molecular targets, including nuclear receptors, opsin in the retina and, according to the latest research, also some enzymes. In this review, we aim to provide a complex view on the present knowledge about vitamin A ranging from its sources through its physiological functions to consequences of its deficiency and metabolic fate up to possible pharmacological administration and potential toxicity. Current analytical methods used for its detection in real samples are included as well.
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Affiliation(s)
- Alejandro Carazo
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Charles University, Akademika Heyrovského 1203, 500 05 Hradec Králové, Czech Republic;
| | - Kateřina Macáková
- Department of Pharmacognosy, Faculty of Pharmacy, Charles University, Akademika Heyrovského 1203, 500 05 Hradec Králové, Czech Republic;
| | - Kateřina Matoušová
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Králové, Sokolská 581, 500 05 Hradec Králové, Czech Republic; (K.M.); (L.K.K.)
| | - Lenka Kujovská Krčmová
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Králové, Sokolská 581, 500 05 Hradec Králové, Czech Republic; (K.M.); (L.K.K.)
- Department of Analytical Chemistry, Faculty of Pharmacy, Charles University, Akademika Heyrovského 1203, 500 05 Hradec Králové, Czech Republic
| | - Michele Protti
- The Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum–University of Bologna, Via Belmeloro 6, 40126 Bologna, Italy;
| | - Přemysl Mladěnka
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Charles University, Akademika Heyrovského 1203, 500 05 Hradec Králové, Czech Republic;
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9
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Zhang S, Xu X, Liu Y, Xue R, Li C, Chen P, Zhang X, Liang J. Successful clearance of extensive/recalcitrant cutaneous warts by acitretin monotherapy: A case series study. Dermatol Ther 2020; 33:e13390. [PMID: 32268448 DOI: 10.1111/dth.13390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/25/2020] [Accepted: 04/04/2020] [Indexed: 11/30/2022]
Abstract
Most available options for the treatment of warts are limited by the potential for scarring, pain, lack of response, or recurrences, and the patients are often unable to tolerate and accept those experiences. The aim of this study was to evaluate the clinical efficacy and safety of oral systemic acitretin monotherapy in patients with extensive/recalcitrant cutaneous warts. The patients were given a dose of acitretin of 0.8 mg kg-1 day-1 , and the clinical efficacy and safety of acitretin was assessed every 2 weeks for 2 months. A total of 14 patients (12 males and 2 females) were included, with an age of 14-60 years (mean 33 ± 14.7 years) and a course of 4-48 months (mean 21.6 ± 13.4 months). After 2 months of acitretin treatment, 42.9% (6/14) of patients (including warts of the feet, legs, and hands) exhibited complete response, 28.6% (4/14) excellent response, and 28.6% (4/14) good response. All patients demonstrated significant improvement, and the drug was well tolerated, with no patients discontinuing therapy due to side effects. Common mild side effects included dry skin and cheilitis. There were no recurrences during a follow-up period of 6 months. Acitretin monotherapy is an effective, safe, and well-tolerated treatment for patients with extensive/recalcitrant cutaneous warts who are unsuitable for or unwilling to accept traditional treatment methods.
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Affiliation(s)
- Sanquan Zhang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Xiao Xu
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Yumei Liu
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Rujun Xue
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Changxing Li
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Pingjiao Chen
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Xibao Zhang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Jingyao Liang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
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10
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Kearns DG, Chat VS, Zang PD, Han G, Wu JJ. Review of treatments for generalized pustular psoriasis. J DERMATOL TREAT 2020; 32:492-494. [PMID: 31697211 DOI: 10.1080/09546634.2019.1682502] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Generalized pustular psoriasis (GPP) is an uncommon variant of psoriasis that is characterized clinically by sterile pustule formation superimposed over inflamed, erythematous skin. METHODS In June 2019, we conducted a systematic search of the PubMed Medline database using the keywords 'pustular psoriasis' and 'treatment'. RESULTS First-line treatment for the condition consists of established therapies, such as acitretin, cyclosporine, methotrexate, and infliximab. Several medications targeting IL-17 or IL-23 have also emerged recently with drugs such as ixekizumab, secukinumab, brodalumab, guselkumab, and ustekinumab having shown some efficacy. CONCLUSIONS This review highlights the research in support of common treatments of GPP, including classically used medications and newer monoclonal antibodies, and addresses the continued need for high quality studies regarding treatments for this condition.
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Affiliation(s)
| | - Vipawee S Chat
- Medical College of Georgia at Augusta University, Augusta, CA, USA
| | - Peter D Zang
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - George Han
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, CA, USA
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11
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Abstract
Vitamin A is an essential micronutrient that comes in multiple forms, including retinols, retinals, and retinoic acids. Dietary vitamin A is absorbed as retinol from preformed retinoids or as pro-vitamin A carotenoids that are converted into retinol in the enterocyte. These are then delivered to the liver for storage via chylomicrons and later released into the circulation and to its biologically active tissues bound to retinol-binding protein. Vitamin A is a crucial component of many important and diverse biological functions, including reproduction, embryological development, cellular differentiation, growth, immunity, and vision. Vitamin A functions mostly through nuclear retinoic acid receptors, retinoid X receptors, and peroxisome proliferator-activated receptors. Retinoids regulate the growth and differentiation of many cell types within skin, and its deficiency leads to abnormal epithelial keratinization. In wounded tissue, vitamin A stimulates epidermal turnover, increases the rate of re-epithelialization, and restores epithelial structure. Retinoids have the unique ability to reverse the inhibitory effects of anti-inflammatory steroids on wound healing. In addition to its role in the inflammatory phase of wound healing, retinoic acid has been demonstrated to enhance production of extracellular matrix components such as collagen type I and fibronectin, increase proliferation of keratinocytes and fibroblasts, and decrease levels of degrading matrix metalloproteinases.
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Affiliation(s)
- Monica E Polcz
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adrian Barbul
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,The Tennessee Valley Nashville VA Medical Center, Nashville, Tennessee, USA
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12
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Affiliation(s)
- E Sbidian
- UPEC, département de dermatologie, hôpitaux universitaires Henri-Mondor, AP-HP, 94010 Créteil, France; UPEC, EA 7379 EpidermE, université Paris-Est Créteil, 94010 Créteil, France.
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13
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Bonifati C, Lora V, Graceffa D, Nosotti L. Management of psoriasis patients with hepatitis B or hepatitis C virus infection. World J Gastroenterol 2016; 22:6444-6455. [PMID: 27605880 PMCID: PMC5006156 DOI: 10.3748/wjg.v22.i28.6444] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/25/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
The systemic therapies available for the management of Psoriasis (PsO) patients who cannot be treated with more conservative options, such as topical agents and/or phototherapy, with the exception of acitretin, can worsen or reactivate a chronic infection. Therefore, before administering immunosuppressive therapies with either conventional disease-modifying drugs (cDMARDs) or biological ones (bDMARDs) it is mandatory to screen patients for some infections, including hepatitis B virus (HBV) and hepatitis C virus (HCV). In particular, the patients eligible to receive an immunosuppressive drug must be screened for the following markers: antibody to hepatitis B core, antibody to hepatitis B surface antigen (anti-HBsAg), HBsAg, and antibody to HCV (anti-HCV). In case HBV or HCV infection is diagnosed, a close collaboration with a consultant hepatologist is needed before and during an immunosuppressive therapy. Concerning therapy with immunosuppressive drugs in PsO patients with HBV or HCV infection, data exist mainly for cyclosporine a (CyA) or bDMARDs (etanercept, adalimumab, infliximab, ustekinumab). The natural history of HBV and HCV infection differs significantly as well as the effect of immunosuppression on the aforementioned infectious diseases. As a rule, in the case of active HBV infection, systemic immunosuppressive antipsoriatic therapies must be deferred until the infection is controlled with an adequate antiviral treatment. Inactive carriers need to receive antiviral prophylaxis 2-4 wk before starting immunosuppressive therapy, to be continued after 6-12 mo from its suspension. Due to the risk of HBV reactivation, these patients should be monitored monthly for the first 3 mo and then every 3 mo for HBV DNA load together with transaminases levels. Concerning the patients who are occult HBV carriers, the risk of HBV reactivation is very low. Therefore, these patients generally do not need antiviral prophylaxis and the sera HBsAg and transaminases dosing can be monitored every 3 mo. Concerning PsO patients with chronic HCV infection their management with immunosuppressive drugs is less problematic as compared to those infected by HBV. In fact, HCV reactivation is an extremely rare event after administration of drugs such as CyA or tumor necrosis factor-α inhibitors. As a rule, these patients can be monitored measuring HCV RNA load, and ALT, aspartate transaminase, gamma-glutamyl-transferase, bilirubin, alkaline phosphatase, albumin and platelet every 3-6 mo. The present article provides an updated overview based on more recently reported data on monitoring and managing PsO patients who need systemic antipsoriatic treatment and have HBV or HCV infection as comorbidity.
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Akçali C, Guven EH, Kirtak N, Inaloz HS, Ozgoztasi O, Guvenc U. Serum concentrations of interleukin-2 and tumour necrosis factor-α under cyclosporine versus acitretin treatment in plaque-type psoriasis. J Int Med Res 2014; 42:1118-22. [PMID: 25143337 DOI: 10.1177/0300060514539280] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2025] Open
Abstract
OBJECTIVE A prospective, randomized clinical study to compare the short-term effects of cyclosporin and acitretin on psoriasis severity, and serum interleukin (IL)-2 and tumour necrosis factor (TNF)-α concentrations. METHODS Patients with moderate-to-severe plaque-type psoriasis were randomly assigned to receive either 3 mg/kg per day cyclosporine or 0.3-0.5 mg/kg per day acitretin for 8 weeks. Disease severity (psoriasis area severity index [PASI] score) and serum IL-2 and TNF-α concentrations were determined before and after treatment. RESULTS PASI scores and serum IL-2 and TNF-α concentrations were significantly decreased after treatment with either cyclosporine (n = 21) or acitretin (n = 25). There were no statistically significant between-group differences in any parameter. CONCLUSIONS Acitretin and cyclosporine are equally effective in the treatment of moderate-to-severe plaque-type psoriasis.
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Affiliation(s)
- Cenk Akçali
- Department of Dermatology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Ebru Homurlu Guven
- Department of Dermatology, Avukat Cengiz Gokcek State Hospital, Gaziantep, Turkey
| | - Necmettin Kirtak
- Department of Dermatology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - H Serhat Inaloz
- Department of Dermatology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Orhan Ozgoztasi
- Department of Dermatology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Ulas Guvenc
- Dermatology Clinic, Medical Park Hospital, Tarsus, Turkey
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Abstract
Acitretin, a synthetic retinoid, is the pharmacologically active metabolite of etretinate. It is currently approved by the US Food and Drug Administration for the treatment of severe psoriasis in adults and has been established as a second-line therapy for the treatment of psoriasis resistant to the use of topical therapy. It is also an option for generalized pustular psoriasis, palmoplantar pustulosis, exfoliative erythrodermic psoriasis, and severe psoriasis in the setting of acitretin. It also has been shown to have chemo-preventative characteristics. Acitretin is limited by its teratogenicity and therefore considered inappropriate in most female patients of childbearing age. Common side effects include mucocutaneous dryness and elevated triglycerides.
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Affiliation(s)
- Noelani E Gonzalez Ortiz
- Department of Dermatology, St. Luke's-Roosevelt Hospital Center, New York, New York; Beth Israel Medical Center, New York, New York
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Abstract
Acitretin, an active metabolite of etretinate, is the most widely used systemic retinoid in the treatment of psoriasis. There are several unique characteristics of this drug, which set it apart from other options in the therapeutic armamentarium of psoriasis. It is highly efficacious as monotherapy in some specific clinical subtypes of psoriasis. It has dose-sparing effects when used as combination therapy with conventional systemic drugs as well as the biologics. It is a good option for long-term maintenance therapy. Side effects are common but usually mild and can be managed by its proper dosing and monitoring. With appropriate patient selection, gradual dose escalation, and patient counseling, we can deliver good results in psoriasis with this useful drug. This review gives a comprehensive recount of acitretin use in the present era of biologics in psoriasis.
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Affiliation(s)
- Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Carretero G, Ribera M, Belinchón I, Carrascosa J, Puig L, Ferrandiz C, Dehesa L, Vidal D, Peral F, Jorquera E, Gonzalez-Quesada A, Muñoz C, Notario J, Vanaclocha F, Moreno J. Acitretina: guía de uso en psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.ad.2013.01.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Carretero G, Ribera M, Belinchón I, Carrascosa JM, Puig L, Ferrandiz C, Dehesa L, Vidal D, Peral F, Jorquera E, González-Quesada A, Muñoz C, Notario J, Vanaclocha F, Moreno JC. Guidelines for the use of acitretin in psoriasis. Psoriasis Group of the Spanish Academy of Dermatology and Venereology. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:598-616. [PMID: 23891453 DOI: 10.1016/j.adengl.2013.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 01/20/2013] [Indexed: 02/01/2023] Open
Abstract
Phototherapy, classic systemic treatments (methotrexate, acitretin, and ciclosporin), and biologic agents (etanercept, infliximab, adalimumab, and ustekinumab) constitute a broad therapeutic arsenal that increases the likelihood of achieving control of severe and extensive disease in patients with psoriasis. Acitretin continues to be a very valuable tool in both monotherapy, in which it is combined with other systemic treatments (classic or biologic), and in sequential therapy. Thanks to its lack of a direct immunosuppressive effect and its ability to achieve a long-term response, acitretin has an important role in the treatment of psoriasis, although this has not always been acknowledged in relevant treatment guidelines. We present consensus guidelines for the use of acitretin in psoriasis drawn up by the Psoriasis Group of the Spanish Academy of Dermatology and Venereology. These guidelines provide a detailed account of acitretin, including pharmacological properties, indications and contraindications, adverse effects, and factors that should be taken into account to enhance the safe use of this drug. They also propose treatment strategies for use in routine clinical practice. The overall aim of these guidelines is to define the criteria for the use and management of acetretin in psoriasis.
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Affiliation(s)
- G Carretero
- Grupo de Psoriasis de la Academia Española de Dermatología y Venereología, Spain.
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