The role of gut microbiome in inflammatory skin disorders: a systematic review

The close relationship between the intestine and the skin has been widely stated, seen from gastrointestinal (GI) disorders often accompanied by skin manifestations. Exactly how the gut microbiome is related to skin inflammation and influences the pathophysiology mechanism of skin disorders are still unclear. Many studies have shown a two-way relationship between gut and skin associated with GI health and skin homeostasis and allostasis. This systematic review aimed to explore the associations between the gut microbiome with inflammatory skin disorders, such as acne, psoriasis, atopic dermatitis, and urticaria, and to discover the advanced concept of this relationship. Methods: The literature search was limited to any articles published up to December 2020 using PubMed and EBSCOHost. The review followed the PRISMA guidelines for conducting a systematic review. Result: Of the 319 articles screened based on title and abstract, 111 articles underwent full-text screening. Of these, 23 articles met our inclusion criteria, comprising 13 AD, three psoriasis, four acne vulgaris, and four chronic urticaria articles. Discussion: Acne vulgaris, atopic dermatitis, psoriasis, and chronic urticaria are inflammation skin disorders that were studied recently to ascertain the relationship of these disorders with dysbiosis of the GI microbiome. All acne vulgaris, psoriasis, and chronic urticaria studies stated the association of gut microbiome with skin manifestations. However, the results in atopic dermatitis are still conflicting. Most of the articles agree that Bifidobacterium plays an essential role as anti-inflammation bacteria, and Proteobacteria and Enterobacteria impact inflammation in inflammatory skin disorder.

Plasmapheresis: Is it a potential alternative treatment for chronic urticaria?

Background Chronic urticaria is a common disease. Plasmapheresis is an alternative treatment that can be appropriate for patients who are resistant to treatment with 2nd generation antihistamines or for whom treatment with omalizumab is unsuitable. Objective To investigate the effect of plasmapheresis treatment in chronic urticaria. Methods A retrospective analysis was performed based on the data of 98 patients suffering from refractory chronic urticaria who received plasmapheresis as an alternative treatment in Vilnius University’s Hospital Santaros Clinics from 2000 to 2020. The efficiency of the treatment was evaluated by clinical judgment. Results 58.2% of the patients exhibited a complete or significant response; of these, 37.8% had temporary relief of symptoms and 20.4% achieved disease remission; 41.8% showed no response to the plasmapheresis. Men (34.8%) had a tendency to achieve disease remission more often than women (16%) (p < 0.05). One patient did not finish the plasmapheresis treatment due to the symptoms’ exacerbation and treatment with omalizumab was initiated. Conclusion Plasmapheresis is a safe and effective alternative treatment when traditional treatment is unavailable or does not relieve symptoms completely. Our data showed that plasmapheresis was effective in more than half of our patients.

Features of cytokine spectrum in chronic urticarial

Urticaria is a serious medical and social problem due to its high prevalence, lack of unified approaches to diagnosis and treatment, with high financial costs for therapy and rehabilitation. Long-term recurrent course of the disease, resistance to traditional methods of therapy lead to a significant decrease in the quality of life of patients with chronic urticaria. Itching accompanying this disease leads to deterioration in the patient’s general well-being, frequent sleep disturbances and, as a result, significant decrease in working capacity. Up to the present moment, etiopathogenesis of urticaria is a complex challenge due to the multivector nature of cytokine response, interference of protides of the complement system, patterns of kininbradykinin interference, peculiar expression of the immune response. The problem of current population is lipotrophy – chronic, heterogeneous, cytokine mediating, progressive inflammatory disease attributed by abnormal accumulation of excessive adipose tissue. Adipose tissue, being a sporadic organ of endocrine system secretes multiple hormone-like substances, mediators, cytokines and chemokines which have been given a common name, i.e., adipokines or adipocytokines. True signs of destructive parenchymal changes of liver in the form of increasing bilirubin and AST, decreasing level of vitamin D in patients with chronic recurrent urticarial in presence of obesity have been revealed during the study performed. The action of cytokines, as mediators of intercellular interaction is closely related to the physiological and pathophysiological responses of the body with modulation of both local and systemic defense mechanisms. It is assumed that the cytokine status of patients with chronic urticaria is dominated by cytokines that increase allergic inflammation of the skin. Analysis of 12 T regulatory biomarker concentrations revealed increased concentrations of IL-10, IL-19, IL-20, IL-27, IL-35, IFNλ2 and IFNλ1 in blood serum of patients with chronic urticaria. It was found that in the group of patients with chronic urticaria and increased body mass index (BMI), the level of all investigated T regulatory cytokines is lower than in the patients with normal BMI, except for IL-10. Decreased levels of biologically active IFN I (α/β) and, especially, IFN II (γ) types of blood leukocytes in patients with chronic urticaria were revealed. The levels of 12 Treg cytokines were determined in blood serum of patients with chronic urticaria, showing trend for imbalance of Treg cytokines: IL-10, IL-19, IL-20, IL-27, IL-35, IFNλ2 and IFNλ1.

Chronic Urticaria: A Swedish Registry-based Cohort Study on Population, Comorbidities and Treatment Characteristics

Swedish databases present unique opportunities to research population data on diseases and treatments. The current study is, to our knowledge, the most comprehensive registry-based study on a chronic urticaria population in Sweden to date. The aim of this study was to describe the chronic urticaria population in Stockholm County regarding epidemiology, demographics, comorbidity, healthcare usage and treatment patterns in relation to current international guidelines. Real-world data were extracted between 2013 and 2019, yielding 10,642 adult patients. Study period prevalence of chronic urticaria was 0.53%, the mean annual incidence was approximately 0.08%, and 68% of patients were female. Regarding diagnosis, 58% were first diagnosed in primary care, approximately 50% were diagnosed before the age of 40 years. Regarding type of urticaria, 89% had chronic spontaneous urticaria, 11% had chronic inducible urticaria, and 5% of patients with chronic urticaria had coexisting angioedema. Common coexisting diagnoses were, for example, asthma, allergy, psychiatric and behavioural disorders and cardiometabolic disorders. Treatment patterns generally followed guidelines, yet data indicated that guidelines were not fully implemented, especially in primary care.