The clinical severity score of chronic actinic dermatitis correlates with <i>in vivo</i> photoallergic reactions and the immunologic parameters related to a shift towards Th2 immunity from the Th2/Th1 balanced status in patients with chronic actinic dermatitis

Ko, Dong-Yeob; Choi, Seung-Hwan; Ha, Seung-Min; Kim, Tae-Hoon; Song, Ki‐Hoon; Kim, Kyeong-Hee; Kim, Kiho

doi:10.1111/phpp.12244

Cited by 19 publications

(24 citation statements)

References 27 publications

(30 reference statements)

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“…However, durable and long-lasting responses reveal that dupilumab targets vital inflammatory pathways of atopic dermatitis (AD) and other Th2 cell-mediated inflammatory skin diseases, such as CAD, As Ko et al have recently suggested that T cells may play a role in the dysbalance of Th1/Th2 in CAD, in atopic dermatitis, there is an over-activation of the Th2 in the acute stage. However, the chronic phase is manifested by Th1 immune response and sustained Th2 -cells activation ( 12 , 13 ). According to the study, UVB-induced CD3+, CD4+, and CD8 − regulatory T cells suppress the immune system through the release of the immune-regulatory cytokines IL-4 and IL-10 ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Clearance of Chronic Actinic Dermatitis With Dupilumab Therapy in Chinese Patients: A Case Series

Ali

Lou

et al. 2022

Front. Med.

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Chronic actinic dermatitis (CAD) is a rare chronic immunological photo-dermatosis resulting in pruritic eczematous eruption on sun-exposed skin to ultraviolet (UV) light. The disease mechanism may include a delay-type hypersensitivity reaction to an endogenous photo-induced antigen, postulated to be UVR-altered DNA, but the exact pathophysiology is unknown. Minimum erythema dosing and patch testing are diagnostic tools of CAD. There are limited safe and effective treatment options for CAD. Herein, a case series of three patients with severe recalcitrant CAD is presented after being treated with dupilumab off-label. The patients in this study had persistent severe disease and taken the first-line management plan, which consists of topical calcineurin inhibitors (TCI), topical corticosteroids (TCS), and strict photoprotection. However, the above treatment options were not able to control the symptoms. The patients were treated with dupilumab 600 mg first dose, 300 mg biweekly subcutaneously (SC), and hydroxychloroquine. Dupilumab showed excellent clinical benefits, including safe and well-tolerated in chronic actinic dermatitis. Further studies are required to be carried out before being applied in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Clearance of Chronic Actinic Dermatitis With Dupilumab Therapy in Chinese Patients: A Case Series

Ali

Lou

et al. 2022

Front. Med.

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“…proposed the concept of photosensitive atopic dermatitis, the clinical features of which include atopic diathesis, eczematous lesions in UV radiation‐exposed body regions and positive photoprovocation reactions, which may be misdiagnosed as CAD. IgE levels were reported to be higher in the severe CAD group than in the others, and are considered to be related to a shift towards T‐helper (Th)2 immunity from the Th2/Th1 balance status 11,12 . In our study, patient 3 had higher IgE levels and positive patch tests to metals, which may also be related to the rapid recurrence of symptoms.…”

Section: Discussionmentioning

confidence: 49%

Ultraviolet A rush hardening for chronic actinic dermatitis: Pilot treatment outcomes

Wang

Gong

Rong

et al. 2020

The Journal of Dermatology

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Chronic actinic dermatitis (CAD) is a common debilitating photodermatosis. Patients often have to completely avoid outdoor activities, which severely impacts their quality of life. Phototherapy is effective for CAD and seems to increase patients’ tolerance towards sunlight and consequently decrease the extent of disease. Unfortunately, the slower onset and time‐consuming nature of phototherapy limits the clinical application. Considering the effectiveness and time‐saving nature of ultraviolet (UV)‐A rush hardening in solar urticaria, we performed a pilot study to determine whether UV‐A rush hardening is effective in CAD. Six patients with CAD were exposed to multiple sessions of UV‐A for 4–5 days at 1‐h intervals/day. Subsequently, maintenance UV‐A exposure was performed at 1–2‐week intervals. Phototesting at baseline showed that three patients were sensitive to both UV‐A and ‐B, and the other three patients only showed UV‐A sensitivity. All of the patients responded well to UV‐A rush hardening and four (67%) maintained a good remission status after 1 year. The results of this pilot study suggest that UV‐A rush hardening phototherapy is effective and well tolerated in the treatment of CAD, while future larger prospective studies using objective scores of disease activity and quality of life are needed.

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“…However, a mechanism of delayed-type hypersensitivity to a UV-induced autoantigen or a contact allergy to exogenous allergens may be inferred. 9 Ko et al 2 found that Th1/Th2 dysbalance may be closely related to the onset of CAD.…”

Section: Discussionmentioning

confidence: 99%

“… 1 Although the pathophysiology of CAD is not well known, it has been claimed that a Th1/Th2 dysbalance caused by suppressor T cells may play a role in the occurrence of CAD. 2 In some recalcitrant cases, conventional treatments based on photoprotection, topical steroids, and immunosuppressive agents are disappointing. Recently, dupilumab, a human monoclonal antibody developed for dampening Th2 signaling and inhibiting the effects of IL-4 and IL-13, 3 has shown promising results in small series and case reports on CAD.…”

Section: Introductionmentioning

confidence: 99%

Successful Treatment of Chronic Actinic Dermatitis with Dupilumab: A Case Report and Review of the Literature

Chen¹,

Li²,

Zhu³

2021

CCID

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Chronic actinic dermatitis (CAD) is a rather rare photosensitive disease characterized by a persistent eczematous eruption in sun-exposed sites. The pathogenesis of CAD has not been completely elucidated. The clinical treatment of CAD is still challenging and not standardized. Some patients with severe CAD have achieved satisfactory clinical results with dupilumab when conventional therapies have failed. We herein report the case of a 45-year-old male with severe CAD who responded rapidly to combined treatment with dupilumab (600 mg for 1 week, and then 300 mg every 2 weeks) in 2 months. The patient experienced continuous improvement and no side effects from dupilumab (300 mg every month), having ceased other systemic medications. Dupilumab could be considered as an alternative or adjunctive treatment for CAD.

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The clinical severity score of chronic actinic dermatitis correlates with in vivo photoallergic reactions and the immunologic parameters related to a shift towards Th2 immunity from the Th2/Th1 balanced status in patients with chronic actinic dermatitis

Abstract: The CSS-CAD correlates with total IgE level, PB eosinophil count and a shift towards Th2 immunity from Th2/Th1. So we suggest the Th1/Th2 dysbalance may be affected by the CSS-CAD.

Cited by 19 publications

References 27 publications

Clearance of Chronic Actinic Dermatitis With Dupilumab Therapy in Chinese Patients: A Case Series

Clearance of Chronic Actinic Dermatitis With Dupilumab Therapy in Chinese Patients: A Case Series

Ultraviolet A rush hardening for chronic actinic dermatitis: Pilot treatment outcomes

Successful Treatment of Chronic Actinic Dermatitis with Dupilumab: A Case Report and Review of the Literature

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