Interactions between Inflammation and Coagulation in Autoimmune and Immune-Mediated Skin Diseases

Abstract

Inflammation and coagulation systems are simultaneously activated in autoimmune and immune-mediated skin disorders, and the cross-talk that amplifies and maintains their activation seems to have both local and systemic implications. This interplay occurs in bullous pemphigoid (BP), the prototype autoimmune blistering disease in which eosinophil recruitment and thrombin generation locally contribute to the formation of bullae and inflammatory tissue damage. Moreover, the systemic activation of coagulation may explain the increased thrombotic risk observed in BP patients. Atopic dermatitis (AD), a chronically relapsing immune-mediated inflammatory skin disease, also involves the local and systemic activation of coagulation, which means that a prothrombotic state could theoretically develop, although the incidence of thrombosis is not increased in AD patients probably because of their young age. In psoriasis, a erythematous-squamous inflammatory immune-mediated skin disorder, the activation of coagulation seems to be mainly systemic and related to systemic inflammation, thus potentially contributing to the disease-related increase in cardiovascular risk in this disease. The activation of coagulation has also been suggested an additional pathomechanism in dermatitis herpetiformis (DH), a chronic-relapsing autoimmune skin disease associated with gluten sensitivity and celiac disease, but its precise role has not yet been defined. Taken together, these data provide the rationale for controlled clinical trials aimed at evaluating the usefulness of anticoagulant treatment in autoimmune skin disorders to counteract the local and systemic effects of coagulation activation.

Eosinophil cationic protein levels parallel coagulation activation in the blister fluid of patients with bullous pemphigoid

“…In conclusion, coagulation activation in BP patients is at least in part eosinophil‐related, contributing to inflammation, tissue damage, blister formation and potentially to thrombosis …”

Plasma Fibrinogen, D-dimer, and Fibrin Degradation Product as Biomarkers of Rheumatoid Arthritis

“…As one of the most important members in the coagulation system, tissue factor could also mediate the production of pro-in ammatory cytokines by activating protease-activated receptors on various cells such as mononuclear cells, endothelial cells, platelets, and so on [13]. Based on these ndings, several studies indicated the important role of coagulation-related indices in assessing the disease activity of autoimmune diseases [14].…”

The Transcriptomic Analysis of Circulating Immune Cells in a Celiac Family Unveils Further Insights Into Disease Pathogenesis

“…This is consistent with data on other inflammatory conditions ( 33 ). For example, in dermatitis herpetiformis, the so-called CD of the skin (1), the contemporary activation of these two pathways is thought to represent a pathogenic mechanism ( 34 ). Additionally, impaired coagulation in UCD has recently been reported.…”