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Journal of Dermatology ; 50(1):e32-e34, 2023.
Article in English | Scopus | ID: covidwho-2241939
Ophthalmic Plastic and Reconstructive Surgery ; 39(1):E1-E3, 2023.
Article in English | Scopus | ID: covidwho-2238316


Coronavirus disease 2019 life-threatening signs have aroused a great deal of attention since the beginning of the pandemic. In the initial stages of the pandemic, the pediatric population was mostly protected, and the symptoms in affected children were mild. Here, the authors present a 7-year-old boy with left upper eyelid ciliary madarosis that developed 9 weeks after coronavirus disease 2019 infection. During comprehensive ophthalmologic examination, no conjunctival injection, chemosis, erythema, or crusts on the eyelids and no other meibomian gland disease findings were detected. Comprehensive laboratory workup was performed to exclude any other possible causes of ciliary madarosis. All laboratory parameters tested within normal limits. In addition to the patient's ocular surface and physical examination findings, laboratory results and the timing of the symptoms as well as spontaneous recovery at follow-up visits led the authors to conclude that telogen effluvium was to cause of the isolated, unilateral ciliary madarosis in this case. © 2023 Lippincott Williams and Wilkins. All rights reserved.

SAGE Open Medical Case Reports ; 11, 2023.
Article in English | EMBASE | ID: covidwho-2243951


Alopecia areata is an autoimmune disease resulting in non-scarring hair loss. Alopecia areata can progress to become alopecia totalis (loss of hair from the entire scalp) or alopecia universalis (loss of hair form the entire body), with the progression estimated to range from 7% to 30%. There are no universally proven therapies that both induce and sustain remission, and furthermore, the course of alopecia areata tends to be unpredictable, with ~80% of patients achieving spontaneous remission within 1 year. We herein present the case of a 61-year-old female who presented with a 20-year history of alopecia universalis, and biopsy confirmed widespread granuloma annulare. Hydroxychloroquine was initiated to treat her granuloma annulare, with subsequent significant hair regrowth on her scalp, eyebrows, eyelashes, and arms. A review of the literature is presented showing that hydroxychloroquine has variable success in treatment of alopecia areata, alopecia totalis, and alopecia universalis.

Journal of the European Academy of Dermatology and Venereology ; 37(1):e7-e8, 2023.
Article in English | Scopus | ID: covidwho-2243751
Nature Reviews Immunology ; 23(1):38-54, 2023.
Article in English | Scopus | ID: covidwho-2243352


IL-17 cytokine family members have diverse biological functions, promoting protective immunity against many pathogens but also driving inflammatory pathology during infection and autoimmunity. IL-17A and IL-17F are produced by CD4+ and CD8+ T cells, γδ T cells, and various innate immune cell populations in response to IL-1β and IL-23, and they mediate protective immunity against fungi and bacteria by promoting neutrophil recruitment, antimicrobial peptide production and enhanced barrier function. IL-17-driven inflammation is normally controlled by regulatory T cells and the anti-inflammatory cytokines IL-10, TGFβ and IL-35. However, if dysregulated, IL-17 responses can promote immunopathology in the context of infection or autoimmunity. Moreover, IL-17 has been implicated in the pathogenesis of many other disorders with an inflammatory basis, including cardiovascular and neurological diseases. Consequently, the IL-17 pathway is now a key drug target in many autoimmune and chronic inflammatory disorders;therapeutic monoclonal antibodies targeting IL-17A, both IL-17A and IL-17F, the IL-17 receptor, or IL-23 are highly effective in some of these diseases. However, new approaches are needed to specifically regulate IL-17-mediated immunopathology in chronic inflammation and autoimmunity without compromising protective immunity to infection. © 2022, Springer Nature Limited.

Skin Appendage Disord ; 9(2): 141-143, 2023 Mar.
Article in English | MEDLINE | ID: covidwho-2230289


Introduction: Alopecia areata (AA) is a common autoimmune disease characterized by non-scarring hair loss. New onsets of AA have been associated with coronavirus disease 2019 (COVID-19). Various skin diseases have already been reported because of the vaccines (the Pfizer-BioNTech COVID-19 vaccine, the Moderna COVID-19 vaccine, the AstraZeneca vaccine) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Case Presentation: We report 5 cases of AA after COVID-19 vaccination. The trend shown by patients in this study is an initial worsening after the first dose of the vaccine with the stability of the disease even with subsequent doses. However, it is worth highlighting the case reported by one of our patients who suffered a "booster effect" of the disease with progressive and worsening alopecia with each vaccine booster. Discussion: The possible mechanism of action lies in the ability of COVID-19 vaccines to induce spike protein, which can lead to molecular mimicry phenomena. In an organism predisposed to autoimmunity, the mRNA vaccine acts as a trigger. Furthermore, we would like to point out how even cytokine storm and simple oxidative stress from SARS-CoV-2 infection can induce not only AA but also other types of hair loss such as telogen effluvium. Thus, this highlights how complex and multifaceted the phenomenon is.

J Cutan Med Surg ; : 12034754221138249, 2022 Nov 20.
Article in English | MEDLINE | ID: covidwho-2234210
Journal of Cutaneous Immunology and Allergy ; 2023.
Article in English | EMBASE | ID: covidwho-2208929
Skinmed ; 20(6):452-455, 2022.
Article in English | EuropePMC | ID: covidwho-2168432
Iranian Journal of Dermatology ; 25(3):230-239, 2022.
Article in English | EMBASE | ID: covidwho-2204994
J Cutan Med Surg ; : 12034754221138249, 2022 Nov 20.
Article in English | MEDLINE | ID: covidwho-2138769
Pediatric Dermatology ; 39(5):785, 2022.
Article in English | EMBASE | ID: covidwho-2114263
Rheumatology (Bulgaria) ; 30(2):105-107, 2022.
Article in English | Scopus | ID: covidwho-2057094
Clinical Case Reports ; 10(9), 2022.
Article in English | Web of Science | ID: covidwho-2030943
Adv Ther ; 39(11): 4910-4960, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2007274


Baricitinib is an oral, selective inhibitor of Janus kinase (JAK)1/JAK2 that transiently and reversibly inhibits many proinflammatory cytokines. This mechanism is a key mediator in a number of chronic inflammatory diseases; accordingly, baricitinib has been studied and approved for the treatment of several rheumatological and dermatological disorders, as well as COVID-19. This narrative review summarises and discusses the safety profile of baricitinib across these diseases, with special focus on adverse events of special interest (AESI) for JAK inhibitors, using integrated safety data sets of clinical trial data, and puts findings into context with the underlying risk in the respective disease populations, using supporting literature. We show that rates of infection with baricitinib generally reflected the inherent risk of the disease populations being treated, with serious infections and herpes zoster being more frequent in rheumatic diseases than in dermatological disorders, and herpes simplex being reported particularly in atopic dermatitis. Similarly, rates of major adverse cardiovascular events (MACE), venous thromboembolism (VTE) and malignancies were generally within or below the ranges reported for the respective disease populations, thereby reflecting the underlying risk; these events were therefore more frequent in patients with rheumatic diseases than in those with dermatological disorders, the latter of whom generally had low absolute risk. AESI were usually more common in patients with risk factors specific for each event. When a population similar to that of ORAL Surveillance was considered, the incidence rate of MACE with baricitinib was numerically lower than that reported with tofacitinib and similar to that of tumour necrosis factor inhibitors. No safety concerns were observed in hospitalised patients with COVID-19 who received baricitinib for up to 14 days. Identifying the patterns and likelihoods of AEs that occur during treatment in large groups of patients with different diseases can help the physician and patient better contextualise the benefit-to-risk ratio for the individual patient.

The oral selective inhibitor of Janus kinase (JAK)1/JAK2 baricitinib transiently and reversibly inhibits elements of the inflammatory pathway, which are key mechanisms for several chronic, inflammatory rheumatological and dermatological diseases but, as with all drugs, it can be associated with unwanted effects. This narrative review summarises adverse events of special interest (AESI) for baricitinib, considered as such either because of characteristics of patients with the disease being treated (rheumatological and dermatological disorders and COVID-19) or the mechanism of action of the drug. The risk of these events is considered in light of the inherent risk of each event in populations with the respective diseases. We show that serious infections and herpes zoster during baricitinib therapy were most common in patients with rheumatological disorders, and herpes simplex was reported particularly in patients with atopic dermatitis, likely because of disease-related risk factors. MACE, VTE and malignancies generally occurred in baricitinib-treated patients with a frequency within or below the ranges reported for the respective disease populations. Rates generally reflected the underlying risk of the disease populations, being higher in patients with rheumatological diseases than in those with dermatological disorders, and mostly occurring in patients with underlying risk factors for the AESI. No safety concerns were observed in hospitalised patients with COVID-19 who received baricitinib for up to 14 days. Characterising patterns and likelihoods of unwanted events that occur during treatment in large groups of patients with different diseases can help put the actual risk to an individual patient into perspective.

Arthritis, Rheumatoid , COVID-19 Drug Treatment , Dermatology , Janus Kinase Inhibitors , Rheumatology , Arthritis, Rheumatoid/drug therapy , Azetidines , Cytokines , Humans , Janus Kinase Inhibitors/adverse effects , Purines , Pyrazoles , Sulfonamides , Tumor Necrosis Factor Inhibitors
Journal of Pakistan Association of Dermatologists ; 32(3):532-538, 2022.
Article in English | EMBASE | ID: covidwho-2003417
Cureus ; 14(8): e27953, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1994485


Alopecia areata (AA) is a patchy autoimmune nonscarring hair loss. Various pathophysiological explanations are described with immune dysregulation being the most well established. In this report, we describe a 63-year-old lady with AA recurrence, in the form of AA universalis, after 32 years of remission, following administration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. We also briefly reviewed published cases with similar presentations after receiving the SARS-CoV-2 vaccine.