30 Haziran 2019 Pazar

The endocannabinoid system and skin conditions

Although most of the research on the endocannabinoid system focuses on its involvement in the CNS and immune systems, a significant amount of research over the past 20 years has demonstrated that this system also plays a role in maintaining several important functions of the skin. This article will examine the functions of the endocannabinoid system on the skin and its involvement in several skin conditions.

Functions of the endocannabinoid system

The endocannabinoid system is comprised of various endogenous ligands, their receptors, and a complex enzyme and transporter apparatus. Each of the components of the endocannabinoid system is involved in either synthesizing, releasing, transporting and/or degrading various endocannabinoid molecules throughout the body. Furthermore, molecules that have been recognized as exhibiting “cannabinoid-like” roles can also be involved in the endocannabinoid system pathway.
In addition to endogenous cannabinoids that naturally exist throughout our body is a second class of cannabinoids known as phytocannabinoids. To date, more than 100 different phytocannabinoids have been identified from the Cannabis genus, most notable of which include the main active compounds of tetrahydrocannabinol (THC) and cannabidiol (CBD).
Both endocannabinoids and phytocannabinoids have been shown to either activate, antagonize or inhibit a wide variety of different cellular targets in the human body.

The endocannabinoid system in the skin

An extensive amount of research over the past two decades has demonstrated that both endocannabinoids and phytocannabinoids exert various biological effects in the skin homeostasis.
Numerous cell types of the skin, some of which include epidermal keratinocytes, melanocytes, mast cells, fibroblasts, sebocytes, sweat gland cells and certain populations of hair follicles have been shown to host different endocannabinoid molecules and receptors.
With this information in mind, researchers have focused their endeavors on understanding how these endocannabinoid ligands and receptors play a role in skin-related disorders.

Endocannabinoids and skin conditions

The influence of the endocannabinoid system on a wide variety of skin conditions is well-documented. In addition to the skin conditions discussed below, endocannabinoid signaling has also been associated with atopic dermatitis, melanoma, systemic sclerosis, wound healing processes, non-melanoma skin cancers and much more.
Numerous cell types of the skin, some of which include epidermal keratinocytes, melanocytes, mast cells, fibroblasts, sebocytes, sweat gland cells and certain populations of hair follicles have been shown to host different endocannabinoid molecules and receptors.
With this information in mind, researchers have focused their endeavors on understanding how these endocannabinoid ligands and receptors play a role in skin-related disorders.

Endocannabinoids and skin conditions

The influence of the endocannabinoid system on a wide variety of skin conditions is well-documented. In addition to the skin conditions discussed below, endocannabinoid signaling has also been associated with atopic dermatitis, melanoma, systemic sclerosis, wound healing processes, non-melanoma skin cancers and much more.

Acne

One of the most established side effects of cannabinoid abuse is acne, which clearly demonstrates the ability of the phytocannabinoids of this substance to have an effect on human sebaceous glands present within the skin.
Researchers have found that both CB1 and CB2, which are two predominant endocannabinoid-responsive receptors, are expressed in human sebaceous glands. The discovery of CBin human sebaceous glands led to researchers uncovering a role for this receptor in maintaining homeostatic sebaceous lipogenesis (the formation of fats within sebaceous glands). Any dysregulation to the endogenous sebaceous pathway, such as the overstimulation of these receptors, can therefore promote the development of both seborrhea and acne.

Pigmentation disorders

In vitro studies on primary human melanocytes have shown that these cells express various endocannabinoid receptors including CB1 and CB2, endocannabinoid target, GPR119 and the cannabinoid-responsive calcium channel TRPV1.
When exposed to CBD, human epidermal melanocytes were found to exhibit enhanced melanogenesis and tyrosinase activity. The ability to activate this CB1-coupled signaling pathway indicates that this type of treatment could be used to better understand chronic depigmentation conditions like vitiligo.

Psoriasis

Psoriasis is a chronic inflammatory skin disorder. The pathogenesis of psoriasis, while poorly understood, has been associated with both genetic and epigenetic abnormalities, as well as changes in the microbiota and pH of the skin.
Understanding the anti-proliferative and anti-inflammatory properties of various endocannabinoids, such as those involved in the CB1 and CB2 pathways in the skin, has led to the suggestion that targeting these pathways could assist in the development of more effect psoriasis treatments.
In fact, the relationship between the dysregulation of endocannabinoid pathways and psoriasis development has been demonstrated by several different studies. For example, elevated levels of anandamide in the plasma, increased activity levels of fatty acid amide hydrolase and monoacylglycerol lipase in granulocytes and upregulation of GPR55 has been associated with potential involvement in endocannabinoid dysregulation of psoriasis patients.
Source:
Toth, K. F., Adam, D., Biro, T., & Olah, A. (2019). Cannabinoid Signaling in the Skin: Therapeutic Potential of the “C(ut)annabinoid” System. Molecules. 24(918). DOI: 10.3390/molecules24050918.

22 Haziran 2019 Cumartesi

Kim Kardashian sedef için geliştirdiği fondötenini önce kendi daha sonra büyükannesinin üzerinde denedi

Kurucusu olduğu KKW Beauty sayesinde ciddi bir başarı sağlayan ve markasının reklamlarını sadece Instagram hesabından yapan reality şov yıldızı Kim Kardashian yeni vücut ürünüyle yine tüm dikkati üzerine çekti. Sedef rahatsızlığı ile mücadele eden Kim, ürünü önce kendi daha sonra da büyükannesinin üzerinde denedi.


Sedef lekelerini bile gizleyecek bir vücut fondöteni piyasaya süren Kim Kardashian yeni ürününe çok güveniyor.

Fondötenin ne kadar etkili olduğunu göstermek için oldukça etkili örneklerde bulunan Kardashian ürünü önce sedef hastalığı nedeniyle vücudundaki izleri gidermek için denedi. Daha sonra ailesini dahil ederek büyükannesinin ellerinde denedi.

Son olaraksa ürünü, antrenörünün bacaklarında deneyen Kardashian, tüm bunları 142 milyon takipçisi bulunan Instagram hesabından paylaştı.


17 Haziran 2019 Pazartesi

Incyte Announces Positive Results from a Phase 2 Study of Ruxolitinib Cream in Patients with Vitiligo

Incyte (Nasdaq:INCY) today announces 24-week results from its randomized, double-blind, dose-ranging, vehicle-controlled, Phase 2 study evaluating ruxolitinib cream, a nonsteroidal, anti-inflammatory, JAK inhibitor therapy, in adult patients (18 to 75 years of age) with vitiligo. The study met its primary endpoint, demonstrating that significantly more patients treated with ruxolitinib cream for 24 weeks achieved a ‰¥50 percent improvement from baseline in the facial vitiligo area severity index (F-VASI50) score compared to patients treated with a vehicle control (non-medicated cream). F-VASI50 response was most notably achieved with ruxolitinib cream 1.5 percent administered once daily (QD) and twice daily (BID) vs. vehicle control (50 percent and 45 percent vs. 3 percent, respectively; P<0.001).
These results are being presented at the 24th World Congress of Dermatology (WCD) in Milan, Italy, during a late-breaking research session today, June 15, 2019, from 9:25 a.m. CET to 9:35 a.m. CET (3:25 a.m. EDT to 3:35 a.m. EDT). (Location: Room Yellow 3).
The positive 24-week data presented at the World Congress of Dermatology support the potential of ruxolitinib cream to offer a novel treatment option for patients with this chronic autoimmune disease, said Steven Stein, M.D., Chief Medical Officer, Incyte. For patients who choose to seek treatment for their vitiligo, current options are often limited by inadequate efficacy or potential side effects. We look forward to advancing ruxolitinib cream into Phase 3 development for vitiligo in the hope that it may become the first approved treatment for what can be a life-altering disease.
Key 24-week results include:
  • Significantly more patients achieved F-VASI50 after 24 weeks of treatment with all ruxolitinib cream regimens compared to the vehicle control. The highest F-VASI50 response was achieved with ruxolitinib cream 1.5 percent QD and BID compared to vehicle control (50 percent and 45 percent vs. 3 percent, respectively; P<0.001).
  • A ‰¥75 percent improvement from baseline in the facial vitiligo area severity index score was achieved by 17 percent, 30 percent, and 0 patients treated with ruxolitinib cream 1.5 percent QD, BID, and vehicle cream, respectively.
  • Facial Physician Global Vitiligo Assessment (F-PhGVA) scores of clear (no signs of vitiligo) or almost clear (only specks of depigmentation present) skin were achieved by 13 percent, 9 percent, and 0 patients receiving ruxolitinib cream 1.5 percent QD, BID, and vehicle cream, respectively.
  • Ruxolitinib cream was generally well-tolerated at all dosage strengths.
Over-activity of the JAK signaling pathway has been shown to drive inflammation involved in the pathogenesis and progression of vitiligo. These data on ruxolitinib cream, a JAK inhibitor, support the planned initiation of pivotal Phase 3 development later in 2019, for which preparations are already underway.
As a physician, I am looking for safe and effective options that may help my patients achieve their treatment goals, said David Rosmarin, M.D., Assistant Professor at the Tufts University School of Medicine. I am encouraged by these clinical trial results and the potential of ruxolitinib cream to become an important treatment option for the repigmentation of vitiligo lesions.
About Vitiligo
Vitiligo is a chronic, immune-mediated skin disease that is estimated to affect between 2 and 3 million people in the U.S. and for which there is no known cure. It can occur at any age, although many people experience vitiligo symptoms before the age of 20.
Vitiligo is characterized by the progressive loss of pigmentation in patches of skin across the body, causing the skin to appear lighter. This occurs when pigment-producing cells known as melanocytes are destroyed or stop functioning. Vitiligo can affect any area of skin on the body and may also affect hair, eyes or the inside of the mouth. The exact cause of vitiligo is unknown, though recent research suggests that changes in the immune system may be responsible for the disease.
About the Study
The safety and efficacy of ruxolitinib cream were evaluated in an Incyte-sponsored randomized, double-blind, dose-ranging, vehicle-controlled, Phase 2 study (NCT03099304), which began in April 2017. The Phase 2 study program is comprised of three parts spanning 104 weeks. The first part of the study “ the findings for which are being presented at the 24th WCD “ spanned 24 weeks and enrolled 157 adults (aged 18-75 years) diagnosed with vitiligo and with depigmented areas of at least 0.5 percent of the body surface area (BSA) on the face and at least 3 percent of the total BSA on nonfacial areas.
Patients were equally randomized across five treatment arms, including: ruxolitinib cream 1.5 percent, 0.5 percent or 0.15 percent administered QD; ruxolitinib cream 1.5 percent administered BID; or vehicle control for 24 weeks.
The primary efficacy endpoint was the percentage of patients treated with ruxolitinib cream who achieved F-VASI50 score at Week 24, compared to patients treated with vehicle control. Key secondary endpoints included the proportion of patients who achieved a F-PhGVA score of 0 or 1 at Week 24 and the safety and tolerability of ruxolitinib cream.
For more information about the study, please visit: https://clinicaltrials.gov/ct2/show/NCT03099304
About Ruxolitinib Cream
Ruxolitinib cream is a proprietary formulation of Incytes selective JAK1/JAK2 inhibitor ruxolitinib that has been designed for topical application. Ruxolitinib cream is currently in Phase 3 development for the treatment of patients with mild to moderate atopic dermatitis (TRuE-AD) with results expected in the first half of 2020, and is expected to enter Phase 3 development for the treatment of certain patients with vitiligo (TRuE-V) in the second half of 2019. Incyte has worldwide rights for the development and commercialization of ruxolitinib cream.
Conference Call Information
Incyte will host an investor conference call and webcast at 8:00 a.m. EDT on Monday, June 17, 2019the call and webcast can be accessed via the Events and Presentations tab of the Investor section of www.incyte.com.
To access the conference call on Monday, June 17, 2019, please dial 877-407-3042 for domestic callers or +1-201-389-0864 for international callers. When prompted, provide the conference identification number, 13689599.
If you are unable to participate, a replay of the conference call will be available for 30 days. The replay dial-in number for the United States is 877-660-6853 and the dial-in number for international callers is +1-201-612-7415. To access the replay you will need the conference identification number, 13689599.
About Incyte
Incyte Corporation is a Wilmington, Delaware-based biopharmaceutical company focused on the discovery, development and commercialization of proprietary therapeutics. For additional information on Incyte, please visit the Companys website at www.incyte.com.
Follow @Incyte on Twitter at https://twitter.com/Incyte.
Forward Looking Statements
Except for the historical information set forth herein, the matters set forth in this press release, including statements regarding the Companys plans to initiate a Phase 3 program for ruxolitinib cream in vitiligo, the timing and potential results of such a Phase 3 program, the potential for ruxolitinib cream to be an effective treatment option for patients with vitiligo and whether or when ruxolitinib cream will be approved for the treatment of vitiligo, contain predictions, estimates and other forward-looking statements. These forward-looking statements are based on the Companys current expectations and subject to risks and uncertainties that may cause actual results to differ materially, including unanticipated developments and the risks related to the efficacy or safety of the Companys development pipeline, the results of further research and development, the high degree of risk and uncertainty associated with drug development, clinical trials and regulatory approval processes, other market or economic factors and competitive and technological advances; and other risks detailed from time to time in the Companys reports filed with the Securities and Exchange Commission, including its Form 10-Q for the quarter ending March 31, 2019. Incyte disclaims any intent or obligation to update these forward-looking statements.
Media
Catalina Loveman
+1 302 498 6171
cloveman@incyte.com
Investors
Michael Booth, DPhil
+1 302 498 5914
mbooth@incyte.com

Source: 

Incyte, Vitiligo Hastalarında Faz 2 Ruxolitinib Krem Çalışması Olumlu Sonuçlarını Açıkladı



Incyte, bugün erişkin hastalarda rastlantısal, çift kör, doz aralığı değişen, araç kontrollü, ruxolitinib kremini, nonsteroidal, antienflamatuar, JAK inhibitör tedavisini değerlendiren Faz 2 çalışmasından elde ettiği 24 haftalık sonuçları açıkladı ( Vitiligo ile 18 ila 75 yaş). Çalışma, primer sonlanım noktasıyla karşılaştı ve 24 hafta boyunca ruxolitinib kremi ile tedavi edilen hastaların yüz vitiligo alan şiddeti endeksindeki (F-VASI50) skoru bir taşıt kontrolü ile tedavi edilen hastalara kıyasla (F-VASI50)% 50'lik bir iyileşme elde ettiğini gösterdi. ilaçsız krem). F-VASI50 yanıtı, en belirgin şekilde, günde bir kez (QD) ve günde iki kez (BID), araç kontrolüne (yüzde 50 ve yüzde 45'e karşılık, sırasıyla yüzde 50) uygulanan yüzde 1.5 oranında uygulanan ruxolitinib kremi ile elde edildi (P <0.001).
Bu sonuçlar 24 sunulan ediliyor inci 09:35 CET (3 09:25 CET, bir Sondakika araştırma oturumu bugün 15 Haziran 2019 döneminde Milan, İtalya, dermatoloji (WCD) Dünya Kongresi: 25, EDT ila 03:35 EDT). (Yer: Oda 3 Sarı).
Dünya Dermatoloji Kongresi'nde sunulan 24 haftalık olumlu veriler, bu kronik otoimmün hastalığı olan hastalar için yeni bir tedavi seçeneği sunma olasılığını destekliyor, dedi. Vitiligoları için tedavi aramayı seçen hastalar için mevcut seçenekler genellikle yetersiz etkinlik veya potansiyel yan etkiler ile sınırlıdır. Yaşamı değiştiren bir hastalık olabileceği için ilk onaylı tedavi olabileceği umuduyla vitiligo için ruxolitinib kremini Faz 3 gelişimine ilerletmeyi umuyoruz.
24 haftalık kilit sonuçlar şunları içerir:
  • Belirgin derecede daha fazla hasta, tüm ruxolitinib krem ​​rejimleri ile 24 haftalık tedaviden sonra araç kontrolüne kıyasla F-VASI50 elde etti. En yüksek F-VASI50 tepkisi, araç kontrolüne kıyasla ruxolitinib cream yüzde 1.5 QD ve BID ile elde edildi (sırasıyla yüzde 50 ve yüzde 45'e karşı yüzde 3; P <0.001).
  • Yüz vitiligo bölgesi ciddiyet indeksi skorunda taban çizgisinden yüzde 75'lik bir iyileşme, sırasıyla yüzde 17, yüzde 30 ve ruxolitinib krem ​​yüzde 1,5 QD, BID ve araç kremiyle tedavi edilen 0 hasta ile elde edildi.
  • Yüz Hekimi Global Vitiligo Değerlendirmesi (F-PhGVA) açık (vitiligo belirtisi yok) veya hemen hemen açık (sadece depigmentasyon lekeleri var) cildi puanları yüzde 13, yüzde 9 ve ruxolitinib kremi alan 0 hasta, yüzde 1,5 QD, BID ve sırasıyla araç kremi.
  • Ruxolitinib kremi genellikle tüm dozaj kuvvetlerinde iyi tolere edildi.
JAK sinyal yolunun aşırı aktivitesinin, vitiligo patogenezinde ve ilerlemesinde rol oynayan enflamasyonu yönlendirdiği gösterilmiştir. Bir JAK inhibitörü olan ruxolitinib krem hakkındaki bu veriler, 2019'da daha sonra hazırlıkları devam eden pivotal Faz 3 gelişiminin planlı olarak başlatılmasını desteklemektedir.
Tufts Üniversitesi Tıp Fakültesi'nde Yardımcı Doçent Doktor David Rosmarin, bir doktor olarak hastalarımın tedavi hedeflerine ulaşmalarına yardımcı olabilecek güvenli ve etkili seçenekler aradığımı söyledi. Bu klinik çalışma sonuçları ve vitiligo lezyonlarının repigmentasyonu için ruxolitinib kreminin önemli bir tedavi seçeneği olma potansiyeli ile teşvik ediyorum.

5 Haziran 2019 Çarşamba

Endokannabinoid sistem ve cilt koşulları

Endokannabinoid sistemi üzerine yapılan araştırmaların çoğu, CNS ve bağışıklık sistemlerine dahil olmasına odaklansa da, son 20 yılda yapılan önemli miktarda araştırma, bu sistemin cildin önemli fonksiyonlarının korunmasında da rol oynadığını göstermiştir. Bu makale, endokannabinoid sistemin cilt üzerindeki işlevlerini ve bunun birkaç cilt koşulunda rolünü incelemektedir.




Endokannabinoid sistemin işlevleri

Endokannabinoid sistemi, çeşitli endojen ligandlardan, reseptörlerinden ve karmaşık bir enzim ve taşıyıcı aygıttan oluşur. Endokannabinoid sisteminin bileşenlerinin her biri, vücutta çeşitli endokannabinoid moleküllerinin sentezlenmesi, salınması, taşınması ve / veya parçalanması ile ilgilidir. Ayrıca, "kanabinoid benzeri" roller sergilediği bilinen moleküller, endokannabinoid sistem yolunda da yer alabilir.
Vücudumuzda doğal olarak bulunan endojen kannabinoidlere ek olarak, fitokannabinoidler olarak bilinen ikinci bir kannabinoid sınıfıdır. Bugüne kadar Cannabiscinsinden, en önemlisi tetrahidrokannabinol (THC) ve kannabidiol (CBD) ana aktif bileşiklerini içeren 100'den fazla farklı fitokanabinoid tanımlanmıştır .
Hem endokannabinoidlerin hem de fitokannabinoidlerin insan vücudunda çok çeşitli farklı hücresel hedefleri aktif hale getirdiği, antagonize ettiği veya inhibe ettiği gösterilmiştir.

Derideki endokannabinoid sistem


Son yirmi yılda yapılan kapsamlı araştırmalar, hem endokannabinoidlerin hem de fitokannabinoidlerin cilt homeostazında çeşitli biyolojik etkiler gösterdiğini göstermiştir.
Bazılarının epidermal keratinositleri, melanositleri, mast hücrelerini, fibroblastları, sebositleri, ter bezi hücrelerini ve bazı saç folikül popülasyonlarını içerdiği cildin sayısız hücre tipinin farklı endokannabinoid moleküllerini ve reseptörlerini barındırdığı gösterilmiştir.
Bu bilgiyi akılda bulundurarak, araştırmacılar bu endokannabinoid ligandlarının ve reseptörlerinin cilt ile ilgili hastalıklarda nasıl bir rol oynadıklarının anlaşılmasına yönelik çabalarına odaklanmışlardır.

Endokannabinoidler ve cilt hastalıkları

Endokannabinoid sistemin çok çeşitli cilt koşulları üzerindeki etkisi iyi belgelenmiştir. Aşağıda tartışılan cilt koşullarına ek olarak, endokannabinoid sinyalleri ayrıca atopik dermatit, melanom, sistemik skleroz, yara iyileşme süreçleri, melanom dışı cilt kanserleri ve daha fazlası ile de ilişkilendirilmiştir.

Akne

Kannabinoid istismar en köklü yan etkilerinden biri olan sivilce açıkça cilt içinde mevcut insan yağ bezleri üzerinde etkisi için bu maddenin phytocannabinoids yeteneğini gösteriyor.
Araştırmacılar, her iki CB bulduk 1 ve CB 2 iki baskın endocannabinoid duyarlı reseptörleri vardır, insan yağ bezleri cinsinden ifade edilir. CB 2'nin insan yağ bezlerinde keşfi, araştırmacıların bu reseptörün homeostatik sebasöz lipogenezinin (yağ bezleri içinde yağların oluşumu) korunmasındaki rolünü ortaya çıkarmasına yol açmıştır. Bu reseptörlerin aşırı uyarılması gibi endojen sebasöz yoldaki herhangi bir düzensizlik, bu nedenle hem sebore hem de aknenin gelişimini destekleyebilir.

Pigmentasyon bozuklukları

İn vitro olarak , birincil insan melanositler üzerinde çalışmalar bu hücrelerin CB dahil olmak üzere çeşitli endokanabinoid reseptörlerini ifade göstermiştir 1 ve CB 2, endokanabinoid hedef, GPR119 ve kanabinoid duyarlı kalsiyum kanalının TRPV1.
CBD'ye maruz kaldıklarında, insan epidermal melanositlerinin, artan melanogenez ve tirozinaz aktivitesi gösterdiği bulunmuştur. Bu CB etkinleştirmek yeteneği 1 sinyalizasyon yolunun -coupled tedavi bu tip daha iyi vitiligo gibi kronik depigmentasyon koşullarını anlamak için kullanılabileceğini belirtir.

sedef hastalığı

Sedef hastalığı kronik bir enflamatuar cilt hastalığıdır. Psoriasisin patogenezi, tam olarak bilinmemesine rağmen, hem genetik hem de epigenetik anormallikler, aynı zamanda derinin mikrobiyota ve pH'sındaki değişiklikler ile ilişkilendirilmiştir.
Derideki CB 1 ve CB 2 yollarında yer alanlar gibi çeşitli endokannabinoidlerin anti-proliferatif ve antienflamatuar özelliklerini anlamak, bu yolların hedeflenmesinin daha etkili sedef hastalığı tedavisi gelişimine yardımcı olabileceği önerisine yol açmıştır.
Aslında, endokannabinoid yolaklarının düzenlenmesi ile sedef gelişimi arasındaki ilişki birkaç farklı çalışma ile gösterilmiştir. Örneğin, plazmadaki yüksek anandamid seviyeleri, granülositlerdeki yağ asidi amid hidrolaz ve monoasilgliserol lipaz aktivitesinin artmış olması ve GPR55'in yukarı doğru düzenlenmesi, psoriasis hastalarının endokannabinoid disregülasyonunda potansiyel tutulumla ilişkilendirilmiştir.

Kaynak:
Toth, KF, Adam, D., Biro, T. ve Olah, A. (2019). Derideki Kannabinoid Sinyali: “C (ut) annabinoid” Sisteminin Terapötik Potansiyeli. Moleküller. 24 (918). DOI: 10.3390 / moleküller24050918.

Araştırmacılar vitiligo için topikal kalsinörin inhibitörlerinin kullanımını teşvik ediyor


Topikal kalsinörin inhibitörleri vitiligo hastalarında, monoterapinin çocuklarda ve yüz ve boyun lezyonlarında etkili olduğu ortaya çıkarak olumlu bir cevap verebilir.
Ji Hae Lee, MD , “ Bulgularımız, [dar bant UV-B] 'nin eş zamanlı kullanımıyla iyileştirilmiş tedavi yanıtını gösteren Janus kinaz inhibitörleri hakkındaki son raporlarla tutarlıdır ve fototerapi ve [topikal kalsinörin inhibitör] tedavisinin sinerjistik rolünü yeniden doğruladı”, Ji Hae Lee Doktora , dermatoloji bölümünden St. Vincent's Hastanesi, Tıp Fakültesi, Kore Katolik Üniversitesi ve meslektaşları yazdı.
Araştırmacılar Medline, Embase, Web of Science ve Cochrane Library veri tabanlarını araştırmış ve topikal kalsinörin inhibitör (TCI) mekanizması üzerinde 11, TCI monoterapisinde 36, TCI artı fototerapi ve biri TCI bakım terapisinde 11 çalışma tanımlamışlardır.
Etki mekanizması, tedavi cevapları, TCI'lerin bakım tedavisi ve güvenlik için kullanımı sistematik derlemenin odağını oluşturdu. Repigmentasyon dereceleri en az ılımlı (% 25 repigmentasyon), en az ılımlı (% 50 repigmentasyon) ve işaretli (% 75 repigmentasyon) olarak derecelendirilmiştir.
TCI tedavisine tedaviye yanıtı değerlendirmek için kırk altı çalışma seçilmiştir; TCI monoterapi grubunda 941, TCI artı fototerapi grubunda 558 olmak üzere 1.499 hasta çalışmaya dahil edildi.
TCI monoterapisinde, 21 çalışmada 560 hastanın% 55'inde (% 95 CI,% 42.2 -% 67.8) hafif bir yanıt, 23 çalışmada (% 95 CI, 28.2), 619 hastanın% 38.5'inde orta derecede bir cevap elde edildi. % -48.8%) ve 19 çalışmada 520 hastanın% 18.1'inde belirgin bir yanıt elde edildi (% 95 CI,% 13.2 -% 23.1).
Çocuklarda TCI monoterapi tedavisi yanıtı için, araştırmacılar beş çalışmada 162 hastanın% 66.4'ünde (% 95 CI,% 43.2 -% 89.7)% 66.4'ünde hafif bir yanıt ve beş çalışmada (% 95 CI)% 31.7'sinde belirgin bir yanıt bildirdi % 6.7 -% 56.8).
Yüz ve boyundaki lezyonlar, 14 çalışmada 312 hastanın% 73,1'inde hafif yanıt ve 16 çalışmada 353 hastanın% 35,4'ünde belirgin bir yanıt ile en fazla iyileşmeyi göstermiştir . Gövde ve ekstremitelerdeki lezyonlar, yedi çalışmada 153 hastanın% 34.2'sinde hafif bir yanıt ve sekiz çalışmada 185 hastanın% 2.3'ünde belirgin bir yanıt vermiştir. El ve ayaklardaki lezyonlar, üç çalışmada 48 hastanın% 15.1'inde hafif bir yanıt gösterirken, dört çalışmada 52 hastada belirgin bir yanıt görülmedi.
TCI plus fototerapide, sekiz çalışmada 433 hastanın% 89.5'inde (% 95 CI,% 81.1 -% 97.9) hafif bir cevap, 10 çalışmada 486 hastanın% 72.9'unda (% 95 CI) orta derecede bir yanıt elde edildi. Dokuz çalışmada (% 57,6 -% 88,2) ve 490 hastanın% 47,5'inde belirgin bir cevap elde edildi (% 95 CI,% 3,06 -% 64,4).
TCI artı fototerapi ile tedavi edilen yüz ve boyun lezyonlarında, dört çalışmada 103 hastanın% 93.7'sinde hafif bir yanıt ve dört çalışmada 103 hastanın% 55.2'sinde belirgin bir yanıt elde edildi. Gövde ve ekstremitelerdeki lezyonlarda, üç çalışmada 161 hastanın% 85,3'ünde hafif yanıt, üç çalışmada 161 hastanın% 16,1'inde belirgin bir yanıt elde edildi. El ve ayak lezyonları analiz edilmedi çünkü bu grupta iki çalışmada yanıt oranı minimaldi.
En sık bildirilen advers olaylar, yanma hissi, kaşıntı ve eritem idi, ancak ek tedavi gerektirmedi.
Araştırmacılara göre, iki terapinin sinerjik etkileri olduğu için fototerapi uygulanan vitiligo hastalarında TCI tedavisi teşvik edilmelidir. Üstelik, remisyonu sürdürmek için TCI'lerin kullanılması, vitiligoların yüksek tekrarlanma oranı göz önüne alındığında, umut verici olabilir. Abigail Sutton tarafından

Vitiligo hastalarında Madagaskar'da vitaminoterapi ile birlikte çok güçlü topikal kortikosteroidlere verilen tedavi yanıtları


Vitiligo'nun Madagaskar'daki yönetiminde araştırmacılar, çok güçlü topikal kortikosteroidleri (TCS), vitaminoterapiyi (B12 ve C) ve mikrotravazmın baskılanmasını birleştiren terapötik bir protokolün başlamasından 10 yıl sonra elde edilen sonuçları değerlendirdi. Araştırmaya, çok güçlü TCS (10 gün boyunca iki uygulama / gün ve daha sonra 10 gün boyunca bir uygulama / gün), 20 gün boyunca oral C vitamini 500 mg / gün birleştiren tedavi protokolünü izlemeyi kabul eden hastalar dahil edildi. günler ve oral vitamin B12 20 gün boyunca 100 mg / gün. Detaylar vitiligolu 308 hasta (ort. Yaş 33.3) idi. Bu prospektif ve tanımlayıcı çalışmaya göre, 239 hasta mükemmel terapötik uyum göstermiş ve düzenli takiplere katılmıştır. 14 yaşından küçük 50 hastada mükemmel repigmentasyon gözlendi. 31 hastada, 1 yıldan daha az sürede gelişen lezyonlar mükemmel tedavi yanıtına sahipti. 108 hastada olağanüstü repigmentasyon ile lokalize lezyonlar tedaviye olumlu yanıt verdi. Bu bulgular, terapötik yanıtın gençlik için, 1 yıldan daha az evrim geçirmiş lezyonlar ve vitiligonun yüz ve boyun yerleşimi için daha iyi olduğunu göstermektedir.

Treatment responses in patients with vitiligo to very potent topical corticosteroids combined with vitaminotherapy in Madagascar

In the management of nonsegmental vitiligo in Madagascar, researchers evaluated outcomes obtained 10 years after the initiation of a therapeutic protocol which combines very potent topical corticosteroids (TCS), vitaminotherapy (B12 and C), and suppression of microtraumas. Included in the research were patients who agreed to follow the treatment protocol, which combined very potent TCS (two applications/day for 10 days, and then one application/day for the following 10 days), oral vitamin C 500 mg/day for 20 days, and oral vitamin B12 100 mg/day for 20 days. Details were evaluated for 308 patients (mean age was 33.3 years) with vitiligo. According to this prospective and descriptive study, 239 patients had excellent therapeutic compliance and attended regular follow-up. In 50 patients less than 14 years of age, excellent repigmentation was noted. In 31 patients, lesions that developed in less than 1 year had excellent treatment response. With outstanding repigmentation in 108 patients, localized lesions responded favorably to treatment. These findings indicate that therapeutic response is better for youth, lesions of less than 1 year of evolution, and for facial and neck localization of vitiligo.

The endocannabinoid system and skin conditions

Although most of the research on the endocannabinoid system focuses on its involvement in the CNS and immune systems, a significant amount of research over the past 20 years has demonstrated that this system also plays a role in maintaining several important functions of the skin. This article will examine the functions of the endocannabinoid system on the skin and its involvement in several skin conditions.

Functions of the endocannabinoid system

The endocannabinoid system is comprised of various endogenous ligands, their receptors, and a complex enzyme and transporter apparatus. Each of the components of the endocannabinoid system is involved in either synthesizing, releasing, transporting and/or degrading various endocannabinoid molecules throughout the body. Furthermore, molecules that have been recognized as exhibiting “cannabinoid-like” roles can also be involved in the endocannabinoid system pathway.
In addition to endogenous cannabinoids that naturally exist throughout our body is a second class of cannabinoids known as phytocannabinoids. To date, more than 100 different phytocannabinoids have been identified from the Cannabis genus, most notable of which include the main active compounds of tetrahydrocannabinol (THC) and cannabidiol (CBD).
Both endocannabinoids and phytocannabinoids have been shown to either activate, antagonize or inhibit a wide variety of different cellular targets in the human body.

The endocannabinoid system in the skin

An extensive amount of research over the past two decades has demonstrated that both endocannabinoids and phytocannabinoids exert various biological effects in the skin homeostasis.
Numerous cell types of the skin, some of which include epidermal keratinocytes, melanocytes, mast cells, fibroblasts, sebocytes, sweat gland cells and certain populations of hair follicles have been shown to host different endocannabinoid molecules and receptors.
With this information in mind, researchers have focused their endeavors on understanding how these endocannabinoid ligands and receptors play a role in skin-related disorders.

Endocannabinoids and skin conditions

The influence of the endocannabinoid system on a wide variety of skin conditions is well-documented. In addition to the skin conditions discussed below, endocannabinoid signaling has also been associated with atopic dermatitis, melanoma, systemic sclerosis, wound healing processes, non-melanoma skin cancers and much more.
Numerous cell types of the skin, some of which include epidermal keratinocytes, melanocytes, mast cells, fibroblasts, sebocytes, sweat gland cells and certain populations of hair follicles have been shown to host different endocannabinoid molecules and receptors.
With this information in mind, researchers have focused their endeavors on understanding how these endocannabinoid ligands and receptors play a role in skin-related disorders.

Endocannabinoids and skin conditions

The influence of the endocannabinoid system on a wide variety of skin conditions is well-documented. In addition to the skin conditions discussed below, endocannabinoid signaling has also been associated with atopic dermatitis, melanoma, systemic sclerosis, wound healing processes, non-melanoma skin cancers and much more.

Acne

One of the most established side effects of cannabinoid abuse is acne, which clearly demonstrates the ability of the phytocannabinoids of this substance to have an effect on human sebaceous glands present within the skin.
Researchers have found that both CB1 and CB2, which are two predominant endocannabinoid-responsive receptors, are expressed in human sebaceous glands. The discovery of CBin human sebaceous glands led to researchers uncovering a role for this receptor in maintaining homeostatic sebaceous lipogenesis (the formation of fats within sebaceous glands). Any dysregulation to the endogenous sebaceous pathway, such as the overstimulation of these receptors, can therefore promote the development of both seborrhea and acne.

Pigmentation disorders

In vitro studies on primary human melanocytes have shown that these cells express various endocannabinoid receptors including CB1 and CB2, endocannabinoid target, GPR119 and the cannabinoid-responsive calcium channel TRPV1.
When exposed to CBD, human epidermal melanocytes were found to exhibit enhanced melanogenesis and tyrosinase activity. The ability to activate this CB1-coupled signaling pathway indicates that this type of treatment could be used to better understand chronic depigmentation conditions like vitiligo.

Psoriasis

Psoriasis is a chronic inflammatory skin disorder. The pathogenesis of psoriasis, while poorly understood, has been associated with both genetic and epigenetic abnormalities, as well as changes in the microbiota and pH of the skin.
Understanding the anti-proliferative and anti-inflammatory properties of various endocannabinoids, such as those involved in the CB1 and CB2 pathways in the skin, has led to the suggestion that targeting these pathways could assist in the development of more effect psoriasis treatments.
In fact, the relationship between the dysregulation of endocannabinoid pathways and psoriasis development has been demonstrated by several different studies. For example, elevated levels of anandamide in the plasma, increased activity levels of fatty acid amide hydrolase and monoacylglycerol lipase in granulocytes and upregulation of GPR55 has been associated with potential involvement in endocannabinoid dysregulation of psoriasis patients.
Source:
Toth, K. F., Adam, D., Biro, T., & Olah, A. (2019). Cannabinoid Signaling in the Skin: Therapeutic Potential of the “C(ut)annabinoid” System. Molecules. 24(918). DOI: 10.3390/molecules24050918.

Researchers encourage use of topical calcineurin inhibitors for vitiligo

Topical calcineurin inhibitors may produce a favorable response in patients with vitiligo, with monotherapy appearing to be effective in children and in those with lesions on the face and neck.
“Our findings are consistent with recent reports on Janus kinase inhibitors showing the improved treatment response with the concomitant use of [narrowband UV-B], and reaffirm the synergistic role of phototherapy and [topical calcineurin inhibitor] treatment,” Ji Hae Lee, MD, PhD, from the department of dermatology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, and colleagues wrote.
Researchers conducted a search of Medline, Embase, Web of Science and Cochrane Library databases and identified 11 studies on the topical calcineurin inhibitor (TCI) mechanism, 36 on TCI monotherapy, 12 on TCI plus phototherapy and one on TCI maintenance therapy.
Mechanism of action, treatment responses, the use of TCIs for maintenance therapy and safety were the focus of the systematic review. Degrees of repigmentation were rated as at least mild (25% repigmentation), at least moderate (50% repigmentation) and marked (75% repigmentation).
Forty-six studies were chosen to evaluate treatment response to TCI therapy; 1,499 patients were included, 941 in the TCI monotherapy group and 558 in the TCI plus phototherapy group.
In TCI monotherapy, a mild response was achieved in 55% of 560 patients in 21 studies (95% CI, 42.2%-67.8%), a moderate response was achieved in 38.5% of 619 patients in 23 studies (95% CI, 28.2%-48.8%) and a marked response was achieved in 18.1% of 520 patients in 19 studies (95% CI, 13.2%-23.1%).
For TCI monotherapy treatment response in children, the researchers reported a mild response in 66.4% of 162 patients in five studies (95% CI, 43.2%-89.7%) and a marked response in 31.7% of patients in five studies (95% CI, 6.7%-56.8%).
Lesions on the face and neck showed the most improvement, with a mild response in 73.1% of 312 patients in 14 studies and a marked response in 35.4% of 353 patients in 16 studies. Lesions on the trunk and extremities had a mild response in 34.2% of 153 patients in seven studies and a marked response in 2.3% of 185 patients in eight studies. Lesions on the hands and feet showed a mild response in 15.1% of 48 patients in three studies, whereas no marked response was observed in 52 patients in four studies.
In TCI plus phototherapy, a mild response was achieved in 89.5% of 433 patients in eight studies (95% CI, 81.1%-97.9%), a moderate response was achieved in 72.9% of 486 patients in 10 studies (95% CI, 57.6%-88.2%) and a marked response was achieved in 47.5% of 490 patients in nine studies (95% CI, 3.06%-64.4%).
In face and neck lesions treated with TCI plus phototherapy, a mild response was achieved in 93.7% of 103 patients in four studies and a marked response was achieved in 55.2% of 103 patients in four studies. In lesions on the trunk and extremities, 85.3% of 161 patients in three studies achieved a mild response and 16.1% of 161 patients in three studies achieved a marked response. Hand and foot lesions were not analyzed because the response rate was minimal in two studies in this group.
The most common adverse events reported were a burning sensation, pruritus and erythema, but they did not require additional treatment.
TCI treatment should be encouraged in patients with vitiligo who are undergoing phototherapy, as the two therapies have synergistic effects, according to the researchers. Moreover, the use of TCIs to maintain remission may be promising, considering the high recurrence rate of vitiligo, they wrote. – by Abigail Sutton