Letters to the Editor
investigated the association of single nucleotide polymorphisms (SNP) rs2304365 located in the region of ST18 with pemphigus in a Chinese population. A total of 736 subjects were Han from northern China consisting of 144 PV patients, 117 PF patients and 475 healthy controls. All patients were recruited after diagnosis on the base of clinical features, suprabasal separation on histology, positive direct and indirect immunofluorescence microscopy, and enzyme-linked immunosorbent assay detection of antidesmoglein antibodies. After informed consent and approval of the human medical and ethics committee of Shandong Provincial Institute of Dermatology and Venereology, genomic DNA was extracted from the peripheral blood. Single SNP were genotyped by TaqMan SNP Genotyping Assay Kit on the GeneAmp 7900 Sequence Detection System (Applied Biosystems, Foster City, CA, USA) using specific TaqMan probes. After adjusting for age and sex, statistical analysis was performed using logistic regression in PLINK. We failed to detect any significant association between rs2304365 and PV (P = 0.8088, odds ratio [OR] = 1.065). Afterwards, 117 PF patients were genotyped for the same SNP, which also did not show any evidence of risk enrichment either (P = 0.379, OR = 1.276; Table 1). Thus, in our study, the SNP rs2304365 on the ST18 gene showed no significant association with either PV or PF in a Chinese population, which suggested that ST18-associated variants may predispose to PV with population specificity. Minor allele frequency (MAF) of SNP rs2304365 is reviewed, which are 0.402 (T), 0.208 (T) and 0.119 (T), respectively, in African (AFR), European (EUR) and Han Chinese in Beijing, China (CHB). Obviously, MAF in an AFR population is much higher than that in EUR and CHB populations, which may be the reason that significant evidence of association was only found in an AFR population, but not in German or Chinese ancestries due to the natural evolution in different ethnic populations. To summarize, we confirmed that a Chinese population shows no remarkable association with the SNP rs2304365 in
the region of ST18 and pemphigus, which suggested the relationship of ST18 and pemphigus may act in a populationspecific manner. However, more ethnic lines need to be researched to affirm the consideration in future.
ACKNOWLEDGMENTS: We gratefully acknowledge all the individuals for having participated in this study. CONFLICT OF INTEREST:
None.
Zhenhua YUE,1,2,3 Xi’an FU,1,2 Mingfei CHEN,1,2 Zhenzhen WANG,1,2 Chuan WANG,1,2 Baoqi YANG,4,5 Guizhi ZHOU,1,2 Hong LIU,1,2 Furen ZHANG1,2,4,5 1
Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 2Shandong Provincial Key Lab for Dermatovenereology, 3School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, 4Shandong Provincial Hospital for Skin Diseases, Shandong University, and 5Shandong Provincial Medical Center for Dermatovenereology, Jinan, China doi: 10.1111/1346-8138.12363
REFERENCES 1 Bystryn JC, Rudolph JL. Pemphigus. Lancet 2005; 366: 61–73. 2 Stanley JR, Amagai M. Pemphigus, bullous impetigo, and the staphylococcal scalded-skin syndrome. N Engl J Med 2006; 355: 1800– 1810. 3 Meyer N, Misery L. Geoepidemiologic considerations of auto-immune pemphigus. Autoimmun Rev 2010; 9: A379–A382. 4 Sinha AA. The genetics of pemphigus. Dermatol Clin 2011; 29: 381– 391, vii. 5 Sarig O, Bercovici S, Zoller L et al. Population-specific association between a polymorphic variant in ST18, encoding a pro-apoptotic molecule, and pemphigus vulgaris. J Invest Dermatol 2012; 132: 1798–1805.
Pityriasis rosea-like arranged eruption after infliximab therapy in a patient with psoriasis vulgaris Dear Editor, Infliximab has been shown to be efficacious in patients with moderate-to-severe plaque psoriasis.1 A case of pityriasis rosea-like arranged eruption after infliximab therapy is reported. A 63-year-old woman presented with erythematous plaques on her trunk and extremities that had been present for several years. She had been treated with topical application
of steroid ointment with success. However, the erythematous plaques repeatedly appeared after stopping the application. Histological examination led to the diagnosis of psoriasis vulgaris. Treatment with infliximab infusion (3 mg/kg) and topical application of steroid ointment was started. Two weeks after the start of these therapies, psoriatic erythematous plaques resolved. Six weeks after, however, erythematous plaques
Correspondence: Tsutomu Ohtsuka, M.D., Ph.D., Department of Dermatology, International University of Health and Welfare Hospital, 537-3 Iguchi Nasushiobara, Tochigi 329-2763, Japan. Email: [email protected]
354
© 2014 Japanese Dermatological Association
Letters to the Editor
(a)
(b)
(c)
like scales (Fig. 1b). Histological examination showed a superficial perivascular dermal infiltrate that consisted predominantly of lymphocytes with occasional erythrocyte extravasation (Fig. 1c). These results led to the diagnosis of pityriasis rosea-like eruption due to infliximab therapy. Infliximab therapy was stopped, and treatment with an oral antihistaminergic drug and topical application of steroid ointment was started. Four weeks after the treatment start, the erythema completely resolved. Infliximab therapy was restarted, and the same eruption appeared again. Infliximab is indicated for treatment of moderate-tosevere plaque psoriasis that cannot be controlled with other systemic therapies.1 Tumor necrosis factor (TNF)-a antagonists have been associated with the induction of de novo or worsening psoriasis.2 Plaque psoriasis, palmoplantar pustulosis, scalp psoriasis, generalized pustular psoriasis, erythrodermic psoriasis and inverse psoriasis are the cutaneous presentations. A systematic review identified 127 cases of induction and exacerbation of psoriasis with TNFblockade therapy.3 Palmoplantar pustular psoriasis was observed in 40.5% of the cases, with plaque-type psoriasis in 33.1%, and other types comprising the remainder. Topical corticosteroids were the most commonly employed treatment modality but led to resolution in only 26.8% of cases in which they were employed solely. Switching to a different anti-TNF agent led to resolution in 15.4% of cases. Cessation of anti-TNF therapy with systemic therapy led to resolution in 64.3% of cases. A report presented two cases of Gibert’s pityriasis rosea occurring during etanercept therapy and discussed possible links between this exanthema and anti-TNF-a drugs.4 Accordingly, several drugs including infliximab may rarely show pityriasis rosea-like eruption during the use.
CONFLICTS OF INTEREST:
None.
Tsutomu OHTSUKA Department of Dermatology, International University of Health and Welfare Hospital, Nasushiobara, Japan Figure 1. (a) The lesions, found chiefly on the trunk, neck and proximal extremities, consisted of round to oval salmoncolored patches following the lines of cleavage. (b) The lesions showed peripherally attached thin, cigarette paper-like scales. (c) Histological examination showed a superficial perivascular dermal infiltrate that consists predominantly of lymphocytes with occasional erythrocyte extravasation (hematoxylin–eosin, original magnification 9200).
appeared on her trunk and extremities. Trunk predominance was found. The lesions, found chiefly on the trunk, neck and proximal extremities, consisted of round to oval salmon-colored patches following the lines of cleavage (Fig. 1a). The lesions showed peripherally attached, thin, cigarette paper-
© 2014 Japanese Dermatological Association
doi: 10.1111/1346-8138.12445
REFERENCES 1 Barker J, Hoffmann M, Wozel G et al. Efficacy and safety of infliximab vs. methotrexate in patients with moderate-to-severe plaque psoriasis: results of an open-label, active-controlled, randomized trial (RESTORE1). Br J Dermatol 2011; 165: 1109–1117. 2 Shmidt E, Wetter DA, Ferguson SB, Pittelkow MR. Psoriasis and palmoplantar pustulosis associated with tumor necrosis factor-a inhibitors: the Mayo Clinic experience, 1998 to 2010. J Am Acad Dermatol 2012; 67: e179–e185. 3 Ko JM, Gottlieb AB, Kerbleski JF. Induction and exacerbation of psoriasis with TNF-blockade therapy: a review and analysis of 127 cases. J Dermatolog Treat 2009; 20: 100–108. 4 Guarneri C, Polimeni G, Nunnari G. Pityriasis rosea during etanercept therapy. Eur Rev Med Pharmacol Sci 2009; 13: 383–387.
355
investigated the association of single nucleotide polymorphisms (SNP) rs2304365 located in the region of ST18 with pemphigus in a Chinese population. A total of 736 subjects were Han from northern China consisting of 144 PV patients, 117 PF patients and 475 healthy controls. All patients were recruited after diagnosis on the base of clinical features, suprabasal separation on histology, positive direct and indirect immunofluorescence microscopy, and enzyme-linked immunosorbent assay detection of antidesmoglein antibodies. After informed consent and approval of the human medical and ethics committee of Shandong Provincial Institute of Dermatology and Venereology, genomic DNA was extracted from the peripheral blood. Single SNP were genotyped by TaqMan SNP Genotyping Assay Kit on the GeneAmp 7900 Sequence Detection System (Applied Biosystems, Foster City, CA, USA) using specific TaqMan probes. After adjusting for age and sex, statistical analysis was performed using logistic regression in PLINK. We failed to detect any significant association between rs2304365 and PV (P = 0.8088, odds ratio [OR] = 1.065). Afterwards, 117 PF patients were genotyped for the same SNP, which also did not show any evidence of risk enrichment either (P = 0.379, OR = 1.276; Table 1). Thus, in our study, the SNP rs2304365 on the ST18 gene showed no significant association with either PV or PF in a Chinese population, which suggested that ST18-associated variants may predispose to PV with population specificity. Minor allele frequency (MAF) of SNP rs2304365 is reviewed, which are 0.402 (T), 0.208 (T) and 0.119 (T), respectively, in African (AFR), European (EUR) and Han Chinese in Beijing, China (CHB). Obviously, MAF in an AFR population is much higher than that in EUR and CHB populations, which may be the reason that significant evidence of association was only found in an AFR population, but not in German or Chinese ancestries due to the natural evolution in different ethnic populations. To summarize, we confirmed that a Chinese population shows no remarkable association with the SNP rs2304365 in
the region of ST18 and pemphigus, which suggested the relationship of ST18 and pemphigus may act in a populationspecific manner. However, more ethnic lines need to be researched to affirm the consideration in future.
ACKNOWLEDGMENTS: We gratefully acknowledge all the individuals for having participated in this study. CONFLICT OF INTEREST:
None.
Zhenhua YUE,1,2,3 Xi’an FU,1,2 Mingfei CHEN,1,2 Zhenzhen WANG,1,2 Chuan WANG,1,2 Baoqi YANG,4,5 Guizhi ZHOU,1,2 Hong LIU,1,2 Furen ZHANG1,2,4,5 1
Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 2Shandong Provincial Key Lab for Dermatovenereology, 3School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, 4Shandong Provincial Hospital for Skin Diseases, Shandong University, and 5Shandong Provincial Medical Center for Dermatovenereology, Jinan, China doi: 10.1111/1346-8138.12363
REFERENCES 1 Bystryn JC, Rudolph JL. Pemphigus. Lancet 2005; 366: 61–73. 2 Stanley JR, Amagai M. Pemphigus, bullous impetigo, and the staphylococcal scalded-skin syndrome. N Engl J Med 2006; 355: 1800– 1810. 3 Meyer N, Misery L. Geoepidemiologic considerations of auto-immune pemphigus. Autoimmun Rev 2010; 9: A379–A382. 4 Sinha AA. The genetics of pemphigus. Dermatol Clin 2011; 29: 381– 391, vii. 5 Sarig O, Bercovici S, Zoller L et al. Population-specific association between a polymorphic variant in ST18, encoding a pro-apoptotic molecule, and pemphigus vulgaris. J Invest Dermatol 2012; 132: 1798–1805.
Pityriasis rosea-like arranged eruption after infliximab therapy in a patient with psoriasis vulgaris Dear Editor, Infliximab has been shown to be efficacious in patients with moderate-to-severe plaque psoriasis.1 A case of pityriasis rosea-like arranged eruption after infliximab therapy is reported. A 63-year-old woman presented with erythematous plaques on her trunk and extremities that had been present for several years. She had been treated with topical application
of steroid ointment with success. However, the erythematous plaques repeatedly appeared after stopping the application. Histological examination led to the diagnosis of psoriasis vulgaris. Treatment with infliximab infusion (3 mg/kg) and topical application of steroid ointment was started. Two weeks after the start of these therapies, psoriatic erythematous plaques resolved. Six weeks after, however, erythematous plaques
Correspondence: Tsutomu Ohtsuka, M.D., Ph.D., Department of Dermatology, International University of Health and Welfare Hospital, 537-3 Iguchi Nasushiobara, Tochigi 329-2763, Japan. Email: [email protected]
354
© 2014 Japanese Dermatological Association
Letters to the Editor
(a)
(b)
(c)
like scales (Fig. 1b). Histological examination showed a superficial perivascular dermal infiltrate that consisted predominantly of lymphocytes with occasional erythrocyte extravasation (Fig. 1c). These results led to the diagnosis of pityriasis rosea-like eruption due to infliximab therapy. Infliximab therapy was stopped, and treatment with an oral antihistaminergic drug and topical application of steroid ointment was started. Four weeks after the treatment start, the erythema completely resolved. Infliximab therapy was restarted, and the same eruption appeared again. Infliximab is indicated for treatment of moderate-tosevere plaque psoriasis that cannot be controlled with other systemic therapies.1 Tumor necrosis factor (TNF)-a antagonists have been associated with the induction of de novo or worsening psoriasis.2 Plaque psoriasis, palmoplantar pustulosis, scalp psoriasis, generalized pustular psoriasis, erythrodermic psoriasis and inverse psoriasis are the cutaneous presentations. A systematic review identified 127 cases of induction and exacerbation of psoriasis with TNFblockade therapy.3 Palmoplantar pustular psoriasis was observed in 40.5% of the cases, with plaque-type psoriasis in 33.1%, and other types comprising the remainder. Topical corticosteroids were the most commonly employed treatment modality but led to resolution in only 26.8% of cases in which they were employed solely. Switching to a different anti-TNF agent led to resolution in 15.4% of cases. Cessation of anti-TNF therapy with systemic therapy led to resolution in 64.3% of cases. A report presented two cases of Gibert’s pityriasis rosea occurring during etanercept therapy and discussed possible links between this exanthema and anti-TNF-a drugs.4 Accordingly, several drugs including infliximab may rarely show pityriasis rosea-like eruption during the use.
CONFLICTS OF INTEREST:
None.
Tsutomu OHTSUKA Department of Dermatology, International University of Health and Welfare Hospital, Nasushiobara, Japan Figure 1. (a) The lesions, found chiefly on the trunk, neck and proximal extremities, consisted of round to oval salmoncolored patches following the lines of cleavage. (b) The lesions showed peripherally attached thin, cigarette paper-like scales. (c) Histological examination showed a superficial perivascular dermal infiltrate that consists predominantly of lymphocytes with occasional erythrocyte extravasation (hematoxylin–eosin, original magnification 9200).
appeared on her trunk and extremities. Trunk predominance was found. The lesions, found chiefly on the trunk, neck and proximal extremities, consisted of round to oval salmon-colored patches following the lines of cleavage (Fig. 1a). The lesions showed peripherally attached, thin, cigarette paper-
© 2014 Japanese Dermatological Association
doi: 10.1111/1346-8138.12445
REFERENCES 1 Barker J, Hoffmann M, Wozel G et al. Efficacy and safety of infliximab vs. methotrexate in patients with moderate-to-severe plaque psoriasis: results of an open-label, active-controlled, randomized trial (RESTORE1). Br J Dermatol 2011; 165: 1109–1117. 2 Shmidt E, Wetter DA, Ferguson SB, Pittelkow MR. Psoriasis and palmoplantar pustulosis associated with tumor necrosis factor-a inhibitors: the Mayo Clinic experience, 1998 to 2010. J Am Acad Dermatol 2012; 67: e179–e185. 3 Ko JM, Gottlieb AB, Kerbleski JF. Induction and exacerbation of psoriasis with TNF-blockade therapy: a review and analysis of 127 cases. J Dermatolog Treat 2009; 20: 100–108. 4 Guarneri C, Polimeni G, Nunnari G. Pityriasis rosea during etanercept therapy. Eur Rev Med Pharmacol Sci 2009; 13: 383–387.
355
