ABSTRACT
This article focuses on the management of discoid lupus erythematosus, subacute cutaneous lupus erythematosus, and systemic lupus erythematosus when the usual therapeutic arsenal such as oral antimalarial drugs and topical/oral steroids fail or provide insufficient treatment efficacy. Many of the treatments listed are the same or similar to each other because of similarities in the pathogenesis of various subtypes of cutaneous lupus. The clinical challenge is to determine the indications for topical versus systemic therapy, and to also identify the scenarios when combined therapy is necessary.
Subject(s)
Immunosuppressive Agents/therapeutic use , Lupus Erythematosus, Cutaneous/drug therapy , Lupus Erythematosus, Discoid/drug therapy , Lupus Erythematosus, Systemic/drug therapy , Therapies, Investigational , Administration, Topical , Adolescent , Adult , Anti-Inflammatory Agents/therapeutic use , Antimalarials/therapeutic use , Azathioprine/therapeutic use , Calcineurin Inhibitors , Calcium/therapeutic use , Child , Combined Modality Therapy , Cyclophosphamide/therapeutic use , Female , Glucocorticoids/therapeutic use , Humans , Male , Methotrexate/therapeutic use , Retinoids/therapeutic use , Vitamin D/therapeutic use , Young AdultABSTRACT
Atopic dermatitis (AD) patients with predominantly head and neck involvement react to patch tests of the yeast Malassezia sympodialis (Ms). Protein patch testing methods and interpretation are controversial, but subgroups of AD patients may have unique triggers for disease activity. The aim of the study was to identify clinical characteristics of patients who are patch test-positive to Dermatophagoides farinae/pteronyssinus (Df) and Ms and characterize cutaneous cytokine profiles of the atopy patch tests (APTs). 25 AD patients and 27 control dermatitis patients were patch tested with Ms and Df. Qualitative analysis of Th-1 and Th-2 cytokines by RT-PCR mRNA was obtained from positive APTs. Atopic dermatitis patients with a textile pattern or head and neck involvement demonstrated more positive APTs to Ms than control patients. Early positive APTs (<6 hr) did not exhibit a Th-1 type cytokine profile. The subgroup of adult AD patients with head, neck and upper torso pattern of dermatitis seems most likely to react to Ms (and Df). The immune mechanism of protein patch tests includes a Th-1 cell-mediated component after 6 hr or more.
Subject(s)
Allergens/immunology , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Atopic/diagnosis , Malassezia/immunology , Pyroglyphidae/immunology , Adolescent , Adult , Aged , Aged, 80 and over , Animals , Antigens, Dermatophagoides/immunology , Case-Control Studies , Dermatitis, Allergic Contact/etiology , Dermatitis, Allergic Contact/immunology , Dermatitis, Allergic Contact/pathology , Dermatitis, Atopic/etiology , Dermatitis, Atopic/immunology , Dermatitis, Atopic/pathology , Female , Head , Humans , Male , Middle Aged , Neck , Patch Tests , RNA, Messenger/analysis , Reverse Transcriptase Polymerase Chain Reaction , Th1 Cells/immunology , Th2 Cells/immunologyABSTRACT
We have observed that the majority of our vulvodynia patients give a previous history of vaginal candidiasis that was treated but was followed by symptoms of chronic vulvodynia. 27 vulvodynia patients were patch-tested to a standard series of contact allergens, a customized vulvar series and commensal organisms including ultraviolet-killed Candida albicans. Comparison tests for the commensal organism were made to a group of 13 female atopic dermatitis patients and to 19 female dermatitis patients without a history of childhood flexural dermatitis who were undergoing patch test evaluation in our clinic. Patients reporting vulvodynia were significantly (P < 0.05) more likely to react to C. albicans than the dermatitis comparison group. Interestingly, lower concentrations of C. albicans caused more positive patch tests than higher concentrations. Our findings suggest that previous C. albicans infection may predispose patients to a subsequent hypersensitivity response to C. albicans that is expressed only in areas of high cutaneous peripheral fibre density. Low levels of C. albicans may also be required to elicit this response as high levels of C. albicans may actually result in decreased cutaneous inflammation and decreased intensity of C. albicans patch test responses.
