Background. Acute cutaneous graft-versus-host disease (acGVHD) following haematopoietic stem cell transplant (HSCT) is common but difficult to distinguish from other causes of rash. Plasma elafin has been proposed as a diagnostic and prognostic biomarker of skin GVHD. Aim. To evaluate the role of plasma elafin as a biomarker in acGVHD in an Indian population. Methods. Plasma elafin was evaluated in a prospective study of HSCT recipients, conducted over 2 years, taking measurements at baseline and at onset of skin rash after HSCT. Patients were categorized into those with GVHD rash, those with non-GVHD rash and those with no rash and the three groups were compared. Results. Two hundred and sixty-one patients with a median age of 16 years (range 1-61 years) and a male predominance (175 : 86 M/F) underwent HSCT during the study period: 56 patients in the GVHD group, 49 in the non-GVHD group and 156 in the no-rash group. The median baseline elafin was similar in all three groups. At the onset of rash, median elafin level was similar between GVHD and non-GVHD rash (34 549 vs. 32 077 pg/mL; P = 0.58) and between GVHD and no rash (34 549 vs. 26 197 pg/mL; P = 0.08). A rise in elafin from baseline was significantly different between GVHD and no rash (P < 0.001) but not between GVHD and non-GVHD rash (P = 0.44). Conclusion. The utility of plasma elafin as a biomarker of skin GVHD is very limited. Plasma elafin, although elevated in cutaneous GVHD, is not helpful in distinguishing between GVHD rash and other causes of rash following HSCT.
Acute skin graft-versus-host disease (GVHD) classically presents as a pruritic erythematous maculopapular rash. We describe a patient who underwent allogeneic hematopoietic stem cell transplantation and presented with a hand foot and mouth disease like clinical presentation. Histopathology was suggestive of acute GVHD. This case is being reported to make dermatologists aware of this unusual presentation of GVHD.
There is a paucity of data on dermoscopic features of primary cutaneous amyloidosis. We aimed to describe the dermoscopy patterns of cutaneous amyloidosis. A prospective study was conducted between July 2014 and June 2015. Patients with cutaneous amyloidosis, confirmed by histopathology were included. A detailed history, the clinical pattern and the involved sites were recorded. Dermoscopy was done with a non polarised Heine delta 20 dermoscope. The features looked for included presence, type, colour, configuration and pattern of pigmentation and presence of central hub. The dermoscopy features of macular amyloidosis (MA) and lichen amyloidosis (LA) were analysed. Forty-four patients with cutaneous amyloidosis were seen, of which 29 (66%) were females. There were 37 patients with MA and 7 patients with LA. The mean age at presentation was 46 years (+/-10 SD). The reason for consultation was pruritus in 70% and cosmetic concerns in 30% of patients. More than 1 site was affected in 64%. The common sites of involvement were arms (68%), legs (48%) and forearm (43%). A rippled reticular network on dermoscopy was seen in 65% of MA and 43% of patients with LA. Brown dots were seen in 97 % of MA and 86% of LA. The distribution of brown dots were clustered in 68% of patients with MA and 43 % with LA, scattered in 57% of MA and 11% LA. Both clustered and scattered brown dots were seen in 27% of MA and 14% of LA. The other patterns seen in MA included a spoke wheel pattern in 24%, annular pattern in 3%, brown dots in linear pattern in 13%. A central hub was seen in 16% of MA and 43 % of LA. Shiny white streaks were seen in 68% and 11%, white blotches in 62% and 19% of MA and LA respectively. Prominent eccrine openings were seen in 30% of MA and 3% of LA patients. The majority of the patients were females and the most common presenting symptom was pruritus and the commonest dermoscopic finding seen were brown dots. Identification of charactersitic dermoscopic features will help in avoiding biopsy for confirmation of the diagnosis.
Vitiligo is a chronic inflammatory autoimmune disease resulting in skin depigmentation and a high quality of life burden. Vitiligo pathogenesis and progression is driven, in part, by increased IFN-gamma activation and the subsequent downstream signaling through the Janus Kinases (JAK). Ruxolitinib cream (Rux Cream) is a potent JAK inhibitor designed for topical administration. Treatment with Rux Cream was associated with significant skin repigmentation in vitiligo patients (NCT03099304). This study investigated the effects of topical treatment with Rux Cream on inflammatory mediator expression in circulation. Sera from 130 subjects (n¼23 Vehicle, n¼26 0.15% QD, n¼27 0.5% QD, n¼24 1.5% QD, n¼30 1.5% BID) with baseline and week 24 samples were analyzed for broad proteomic changes. Paired t-tests established significant changes within treatment groups at a cutoff of p<0.05. Baseline biomarkers and facial Vitiligo Area Scoring Index (FVASI) were assessed for significance using Spearman's correlation. Expression of 1104 proteins was evaluated for each subject. From baseline to week 24; 204 proteins were significantly (p<0.05) modulated in the 1.5% BID, 162 proteins in 1.5% QD, 71 in 0.5% QD, and 29 proteins in 0.15% QD compared with 56 proteins in the vehicle cohort. Chemokine C-X-C Motif Chemokine Ligand 10 (CXCL10) was significantly down-regulated in both 1.5% QD and BID and plays a central role in pathogenesis by recruiting T cells to the site of inflammation to target melanocytes. Other proteins modulated in 1.5% QD and 1.5% BID included Chemokine (C-C Motif) Ligand 18 (CCL18), Matrix Metalloprotease 12 (MMP12), and CD27. Interleukin 20 receptor subunit alpha (IL-20RA) and Paraoxonase 2 (PON2) were associated with FVASI at baseline. Overall, topical treatment with rux cream, and the associated skin improvement, corresponded with dose dependent modulation of circulating inflammatory mediators.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.