ABSTRACT
Ultraviolet (UV) therapy is an effective and well-tolerated therapeutic method for various dermatologic conditions due to its antiproliferative and immunosuppressive effects. Contemporary phototherapy includes broadband UVB, narrowband UVB, UVA1, PUVA, and excimer laser therapy. The coronavirus disease 2019 pandemic has resulted in the closure of many patient care facilities, including phototherapy units worldwide. Home phototherapy, thalassotherapy, and other UV therapy modalities are an alternative for many patients with chronic dermatoses. We highlighted possible interactions of UV therapy effects and the coronavirus disease 2019 pandemic, and focused on organization and measures against transmission of infections in phototherapy units. Dermatology departments have reopened their units, assessing the risks and benefits for patients, optimizing safety regulations, and adhering to the rules for disinfection.
Subject(s)
COVID-19 , Ultraviolet Therapy , Humans , Pandemics , Phototherapy , SARS-CoV-2ABSTRACT
Autoimmune connective tissue diseases are a heterogeneous group of clinical entities sharing a common feature-an impairment of structural components like collagen and elastin, arising by autoimmune mechanisms. Because most patients are on a long-term immunosuppressive therapy, which renders them vulnerable to infections, a new challenge appears in front of physicians in the coronavirus disease 2019 (COVID-19) era. Immune mechanisms are substantial for the control and ceasing of viral infections, and their impairment may cause serious complications; however, data from immunosuppressed transplant patients do not reveal a higher frequency or diseases' severity in those infected by COVID-19. Several immunotherapies used to treat autoimmune connective tissue diseases favorably modulate the immune response of severe acute respiratory syndrome coronavirus (SARS-CoV-2)-infected patients. The present review highlights the problems of susceptibility, severity, and therapeutic options in patients with autoimmune connective tissue diseases during the COVID-19 pandemic. The relationship between autoimmune connective tissue diseases and COVID-19 infection is explained with antiviral protection genes expression, hypercytokinemia, and lymphohistiocytosis/macrophage activation mechanisms. Recommendations concerning therapy for prevention during the pandemic period or in case of concomitant COVID-19 infection are also presented. Clinical trials are ongoing regarding COVID-19 therapy blocking the cytokine response. © 2021 Elsevier Inc. All rights reserved.
Subject(s)
COVID-19/complications , Dermatomyositis , Lupus Erythematosus, Systemic , Scleroderma, Systemic , Vasculitis , Antibodies, Monoclonal, Humanized/therapeutic use , Antimalarials/therapeutic use , COVID-19/epidemiology , Dermatomyositis/complications , Dermatomyositis/drug therapy , Dermatomyositis/immunology , Disease Susceptibility , Humans , Hydroxychloroquine/therapeutic use , Immunosuppressive Agents/therapeutic use , Janus Kinase Inhibitors/therapeutic use , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/drug therapy , Lupus Erythematosus, Systemic/immunology , Patient Acuity , SARS-CoV-2 , Scleroderma, Systemic/drug therapy , Scleroderma, Systemic/immunology , Thromboembolism/etiology , Vasculitis/drug therapyABSTRACT
BACKGROUND: Connective tissue diseases are a heterogeneous group of autoimmune disorders affecting not only skin, but also various organs and systems. First-line treatment of connective tissue diseases is systemic steroids as monotherapy or combined with immunosuppressive drugs. Since intravenous immunoglobulins (IVIGs) have been found to be effective for various autoimmune dermatoses, their indications have expanded tremendously. OBJECTIVE: The aim this review article is to highlight the indications, effectiveness, and side effects of high doses immunoglobulins for treatment of patients with connective tissue diseases. METHODS: MEDLINE was searched for prospective clinical studies and case reports on IVIG treatment of lupus erythematosus, dermatomyositis, systemic sclerosis, and mixed connective tissue disease (MCTD). Included studies were analyzed and discussed in terms of the different disease entities. RESULTS AND CONCLUSION: IVIGs are a valuable alternative for treating therapy-resistant patients with lupus erythematosus, dermatomyositis, systemic sclerosis, or MCTD. However, more placebo-controlled clinical studies are needed to evaluate the exact indications and therapeutic regimens.
Subject(s)
Connective Tissue Diseases , Immunoglobulins, Intravenous/therapeutic use , Connective Tissue Diseases/drug therapy , Dermatology , Dermatomyositis , Humans , Lupus Erythematosus, Systemic , Prospective StudiesABSTRACT
Intravenous immunoglobulins (IVIGs), a mixture of variable amounts of proteins (albumin, IgG, IgM, IgA, and IgE antibodies), as well as salt, sugar, solvents, and detergents, are successfully used to treat a variety of dermatological disorders. For decades, IVIGs have been administered for treatment of infectious diseases and immune deficiencies, since they contain natural antibodies that represent a first-line defense against pathogens. Today their indication has expanded, including the off-label therapy for a variety of autoimmune and inflammatory diseases. In dermatology, IVIGs are administered for treatment of different disorders at different therapeutic regimens, mostly with higher doses then those administered for treatment of infectious diseases. The aim of this prospective review is to highlight the indications, effectiveness, side effects, and perspectives of the systemic treatment with IVIGs for patients with severe, life-threatening, and resistant to conventional therapies autoimmune or inflammatory dermatoses.