Dermatological Health

Diagnostic Value of Anti-Desmoglein 1 and 3 Antibodies and Anti-BP180 and 230 Antibodies in Autoimmune Bullous Dermatoses

Caihong Li — 2024-03-29

Objective: To analyze and evaluate the value of the anti-epidermal intercellular desmosome antibodies, anti-desmoglein (Dsg) 1, and anti-Dsg3, as well as the anti-epidermal basement membrane hemidesmosomes antibodies, anti-BP180, and anti-BP230 in the diagnosis of pemphigus and bullous pemphigoid. Methods: Patients with pemphigus or bullous pemphigoid treated in the Department of Dermatology of Dalian Dermatosis Hospital from July 2019 to July 2021 were selected. They were clinically diagnosed with histopathological and indirect immunofluorescence methods. They were divided into the pemphigus group (n = 102) and the bullous pemphigoid group (n = 175). Additionally, 120 patients who were ruled out of pemphigus and bullous pemphigoid during the same period were selected as the control group. Enzyme-linked immunosorbent assay (ELISA) was used to detect anti-Dsg1, anti-Dsg3, anti-BP180, and anti-BP230 antibodies. Indirect immunofluorescence (IIF) was used to detect the IgG levels of the anti-epidermal intercellular desmosome antibodies and anti-epidermal basement membrane hemidesmosomes antibodies. The positive rate, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic rate of each antibody were evaluated and analyzed comprehensively. Results: In the pemphigus group, bullous pemphigoid group, and control group, the positive rates of anti-Dsg1 are respectively 83.3% (85/102), 0 (0/175), and 1.7% (2/120); the positive rates of anti-Dsg3 are 41.1% (42/102), 0 (0/175), and 0 (0/120), respectively; the positive rates of BP180 are 5.9% (6/102), 85.7% (150/175), and 5% (6/120), respectively; the positive rates of BP230 are 1.9% (2/102), 57.7% (101/175), and 1.7% (1/120), respectively. Meanwhile, the positive rates of anti-epidermal intercellular desmosome antibodies are 69.6% (71/102), 0 (0/175), and 0 (0/120), respectively; the positive rates of anti-epidermal basement membrane hemidesmosome antibodies are 0% (0/102), 51.4% (90/175), and 0 (0/120), respectively. Among the patients with pemphigus, the sensitivity, specificity, PPV, NPV, and diagnostic rates of the anti-epidermal intercellular desmosome antibody test were 65.1%, 100%, 100%, 85.2%, and 92.2%; for anti-Dsg1, respectively, 83.3%, 99.3%, 97.7%, 88.7%, and 95.2%; for anti-Dsg3, respectively, 41.1%, 100%, 100%, 83.1%, and 84.9%. Among the patients with bullous pemphigoid, the sensitivity, specificity, PPV, NPV, and diagnostic rates of the anti-epidermal basement membrane hemidesmosomes antibody test were 51.4%, 100%, 100%, 72.3%, and 78.6%; for anti-BP180, respectively, 85.7%, 94.6%, 92.6%, 89.4%, and 90.7%; for anti-BP230, respectively, 57.7%, 98.2%, 96.2%, 74.7%, and 80.1%. Conclusion: The detection of autoantibodies in serum and the confirmation of the specific target antigens could complement each other to reduce clinical missed diagnosis and increase the positive diagnostic rate if the two tests were conducted simultaneously. The positive result of the anti-epidermal intercellular desmosome antibody and the anti-epidermal basement membrane hemidesmosomes antibody has better accuracy in diagnosing pemphigus and bullous pemphigoid. In contrast, the negative result is of great value in ruling out pemphigus and bullous pemphigoid.

Influence of ABCB1 3435C>T Polymorphism on Methotrexate Safety in Patients with Psoriasis — A Secondary Publication

Аlexey А. Кubanov — 2024-03-29

Background: Methotrexate is a highly effective systemic treatment for moderate to severe psoriasis, but drug toxicity may limit its use. Recent evidence suggests that it is necessary to take into account the individual characteristics of methotrexate pharmacokinetics, which are determined by the presence of polymorphisms of genes encoding methotrexate carrier proteins, to predict the risk of methotrexate-induced toxicity. Aim: The research aims to assess the associations of ABCB1 rs1045642 (3435C>T) polymorphism with methotrexate safety for patients with moderate and severe psoriasis. Methods: The study included 75 psoriasis patients treated with methotrexate with 21 days of follow-up duration. Data on adverse drug reactions (ADR) were collected using a clinically structured questionnaire, and complete and biochemical blood tests, and urinalysis were performed. The severity of ADR was assessed using visual analog scales and the CTCAE toxicity scale. The severity of gastrointestinal ADR was assessed using the GSRS questionnaire. Genotyping was carried out by real-time PCR. Results: Gastrointestinal toxicity was detected in 38 patients (50.67%). The mean GSRS score was 7.97 ± 9.18. Analysis of differences in the ADR incidence showed the presence of statistically significant differences in the frequency of ADR in the gastrointestinal tract: the toxic effect of methotrexate was more often observed in carriers of the T allele of the ABCB1 rs1045642 polymorphism (3435C>T), (CC: 2 (14.3%), TC: 18 (52.9%), TT: 18 (66.7%), P = 0.006). Binomial regression demonstrated the presence of a statistically significant effect of the rs1045642 single-nucleotide polymorphism of the ABCB1 gene on the incidence of ADR from the gastrointestinal tract (OR = 8.64, P = 0.008). Conclusion: An association of ABCB1 rs1045642 single-nucleotide polymorphism with the safety of methotrexate therapy in patients with moderate and severe psoriasis was revealed. The data obtained can be used to personalize the prescription of methotrexate to psoriasis patients.

Topical Antifungal Therapy Combined with Nail Abrasion for the Treatment of Dermatophytoma: Single-Center Results — A Secondary Publication

Kunitaro Fukuyama — 2024-03-29

Objective: Recently, topical antifungal agents have become available for the treatment of dermatophytoma. However, there are few reports of topical onychomycotic agents in combination with debridement of dermatophytoma. Methods: Twelve patients with dermatophytoma diagnosed and treated between April 2017 and March 2020 at the Department of Dermatology, Kansai Rosai Hospital were selected, including two patients with lesions on both toe nails and 14 nails. At the initial visit, the affected nail plate was removed and topical treatment was administered. The observation was terminated when the lesions were completely healed within 1 year. If the patients were not completely healed, the initial efficacy was determined at the date of the first visit closest to 1 year after the start of treatment. The second efficacy evaluation was conducted at the last visit or when the concomitant drug was changed. Results: Three patients dropped out of the study before the time of the initial efficacy evaluation. In the second efficacy evaluation, eight nails were completely healed, one nail was significantly healed, and one nail was effective. Conclusions: Dermatophytoma can be treated with topical onychomycotic agents in combination with surgical debridement to improve efficacy.

Research Progress on the Role of Rubia cordifolia in the Treatment of Lichen Planus

Baixue Liu — 2024-03-29

Lichen planus is a chronic inflammatory skin disease. Due to its unclear etiology, the treatment is slow and complicated. Rubia cordifolia is a drug with a long history, with the effects of cooling blood and removing blood stasis, promoting blood circulation, and dredging meridians. Modern research suggests that the components of Rubia cordifolia have the effects of immune regulation, anti-inflammation, liver protection, and antioxidation. It may be a potential drug for the treatment of lichen planus. However, the specific mechanism of Rubia cordifolia in the treatment of this disease is still under study. This article reviews the mechanism of Rubia cordifolia in the treatment of lichen planus, in order to provide references for the clinical application of the drug.

Analysis of the Efficacy of Intense Pulsed Light Combined with Doxycycline in the Treatment of Rosacea

Zhengfang Sun — 2024-03-29

Objective: To investigate the clinical efficacy of intense pulsed light combined with doxycycline in the treatment of rosacea. Methods: A sample of 60 patients with rosacea admitted to our hospital from January 2021 to December 2023 were selected and grouped into the observation group (n = 30) and the control group (n = 30) by using the randomized numerical table sampling method. The patients in the control group were treated with doxycycline, and the patients in the observation group were treated with intense pulsed light combined with doxycycline. The clinical effective rate and recurrence rate, clinical symptom score, skin barrier function indexes, and the incidence of adverse reactions in the two groups were compared. Results: The clinical effective rate of the observation group was higher than that of the control group, and the recurrence rate was lower than that of the control group (P < 0.05); the clinical symptom score of the observation group was lower than that of the control group after treatment (P < 0.05); the water content of the stratum corneum of the observation group was higher than that of the control group after treatment, and the amount of transepidermal water loss was lower than that of the control group (P < 0.05); the incidence of adverse reactions of the two groups did not have any significant difference in comparison (P > 0.05). Conclusion: The treatment effect of intense pulsed light combined with doxycycline in rosacea patients is remarkable. It can alleviate clinical symptoms and improve the skin barrier function, with a lower recurrence rate after treatment and higher therapeutic safety, which is suitable for popularization and use in healthcare institutions.