Moderate-to-Severe Psoriasis Tied to Lower Fertility Rates in Women

WEDNESDAY, June 21, 2023 (HealthDay News) -- Patients with moderate-to-severe psoriasis have lower fertility rates than women without psoriasis, according to a study published online June 7 in JAMA Dermatology.

Teng-Chou Chen, Ph.D., from the School of Health Sciences at the University of Manchester in the United Kingdom, and colleagues used data from 63,681 patients with psoriasis and 318,405 matched controls to assess differences in fertility rates and obstetric outcomes.

The researchers found lower fertility rates (rate ratio, 0.75) among patients with moderate-to-severe psoriasis. Pregnancies in patients with psoriasis had a higher risk for loss (odds ratio, 1.06) compared with pregnancies in matched controls without psoriasis. The two groups were similar with respect to the risks for antenatal hemorrhage, preeclampsia, and gestational diabetes.

"In this cohort study, patients with moderate-to-severe psoriasis had a lower fertility rate, and the risk of pregnancy loss was higher than in matched comparators without psoriasis," the authors write. "Future research should identify the mechanism of increased risk of pregnancy loss among patients with psoriasis."

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Diacerina en EBS

Researchers Examine Efficacy Of Diacerein 1% Ointment For Treatment Of EBS

Healio (6/20, Capaldo) reports, "Diacerein 1% ointment was comparable to vehicle in study endpoints but did outperform vehicle when stratified by disease severity in the treatment of patients with epidermolysis bullosa simplex" (EBS), investigators concluded in a study in which "a total of 54 patients with EBS were randomly assigned to receive diacerein 1% (n = 28) or vehicle (n = 26) to be applied once daily for eight weeks, with eight follow-ups during the 16 weeks following treatment." The findings were published online in the Journal of Drugs in Dermatology.

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Abrocitinib remains effective at 96 weeks, in older as well as younger adults

WASHINGTON

– A substantial proportion of adults with moderate to severe atopic dermatitis (AD) treated with oral abrocitinib 100 mg or 200 mg once daily for up to 96 weeks had sustained improvements in skin clearance, itch, and quality of life in a post hoc analysis of the JADE EXTEND phase 3 trial, Andrew F. Alexis, MD, MPH, reported in a late-breaker abstract session at the annual Revolutionizing Atopic Dermatitis conference.

The analysis stratified patients by age – 18-50 and over 50 years – and found that the sustained improvement with the JAK-1 selective inhibitor as monotherapy was seen regardless of age. "In practice, patients who are older tend to have had AD for a longer period of time and tend to be more difficult to treat so it's reassuring to see that even in the over-50 age group, they show substantial responses, even with more stringent endpoints," said Dr. Alexis, professor of clinical dermatology at Weill Cornell Medical College, New York.

At week 96, for instance, the proportion of patients who achieved at least a 75% improvement from baseline on the Eczema Area and Severity Index (EASI-75) was 73% with the 100-mg dose and 85% with the 200-mg dose in the younger age group, and 86% and 89%, respectively, in the older age group.

An EASI-90 response – one of the more stringent outcomes – was achieved by 45% and 58% in the 18-50 group and 58% and 73% in the over 50 group (for 100-mg and 200-mg doses, respectively), Dr. Alexis reported.

The interim analysis also showed dose-dependent efficacy overall up to 96 weeks in the younger age group but only up to 48 weeks in the older age group. Response to some outcome measures in patients over age 50 years was "less clearly dose dependent after week 48" than earlier, Dr. Alexis said.

The ongoing JADE EXTEND trial enrolled patients who had participated in the phase 3 JADE clinical trials. This analysis covered 1,309 patients who were enrolled by a September 2021 cutoff. The patient population leaned young: Eighty percent (1,046) were aged 18-50, and 20% (263) were over 50.

Patients who were randomly assigned to abrocitinib 200 mg or 100 mg in the parent trials continued to receive the same dose in JADE EXTEND with blinding maintained. Those who received placebo in the qualifying trial were randomly assigned to abrocitinib 200 mg or 100 mg. And patients from JADE DARE continued with their dosing of 200 mg. Grouping by age for the analysis was made based on the age recorded at the screening visit of the qualifying trial.

IGA, PP-NRS, and DLQI results

At week 96, the proportion of patients 18-50 years of age who achieved the Investigator's Global Assessment (IGA) score of 0 or 1 (clear or almost clear) with at least a 2-grade improvement from baseline was 44% in the 100-mg group and 55% in the 200-mg group. Among patients over 50, these proportions were 51% and 58%, respectively.

The proportion of patients who achieved at least a 4-point improvement from baseline in the Peak Pruritus Numerical Rating Scale (PP-NRS) score was 54% and 66% (on 100 mg and 200 mg, respectively) among those aged 18-50, and 79% and 80%, respectively, among those over 50.

Looking at more stringent outcomes, 26% and 38% in the 18-50 group on 100 mg and 200 mg, respectively, achieved a PP-NRS of 0/1, as did 54% and 44% in the over-50 group.

Lastly, a score of less than 2 on the Dermatology Life Quality Index (DLQI 0/1) was achieved by 32% and 41% of patients aged 18-50 and by 51% and 48% of patients over 50, for the 100-mg and 200-mg doses, respectively.

Related

FDA approves two JAK-1 inhibitors for moderate to severe atopic dermatitis 

The decline in dose-dependent efficacy in the older age group after 48 weeks may be due to the smaller sample of older patients and/or the fact that a higher proportion of older patients had moderate baseline disease per their IGA score, versus severe disease, compared with the younger patients, Dr. Alexis said. "We see a skewing toward a bit more severe [disease] in the younger age group compared to the older," he noted.

Abrocitinib (Cibinqo) is approved for the treatment of moderate to severe AD in adolescents aged 12 and up and adults whose disease is not adequately controlled with other systemic treatments or those for whom the use of these drugs is not advised. It is available in a 50-mg dose for dose adjustments in special populations, but this dose was not studied in the clinical trials, Dr. Alexis noted. The interim analysis did not include safety data.

In a separate presentation in which he reviewed long-term data on AD medications, Raj Chovatiya, MD, PhD, assistant professor of dermatology at Northwestern University, Chicago, said that most patients who meet defined endpoints at week 12 of treatment with abrocitinib maintain that response over time. "By and large, there's a steep initial rise that flattens over the long run, which is what you want to see. People getting that response are generally staying there over the course of treatment," he said, referring to the JADE EXTEND data up to week 48.

It's important to also appreciate, however, that the proportion of patients meeting efficacy outcomes in the trials of abrocitinib has grown well beyond 12 weeks, Dr. Chovatiya said.

Pointing to data presented at a 2021 RAD meeting depicting the proportion of 12-week nonresponders achieving a response at weeks 24 and 48 on IGA 0/1, EASI-75, and PP-NRS, Dr. Chovatiya said the level of response grew at both time points. "You're capturing a chunk of people well beyond the primary endpoint if you keep them on therapy continuously, suggesting that ... we may need to reframe how we're thinking about oral JAK inhibitors," he said. "Not only are they rapidly acting, but they are medications that can provide good control and changes in the long run."

Dr. Alexis and Dr. Chovatiya disclosed ties with Pfizer, which funded the study.

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FDA Warns of Tattoo Ink Tied to Dangerous Infections

The FDA draft guidance released this week on possible contamination of tattoo ink was not concerning Whitney Donohue, 34, owner of Forget Me Not Tattoo in Billings, Montana.

"I get our ink directly through the manufacturer — not at a store or through Amazon or eBay," she said. "You never know if it's going to be repackaged."

Tattoo artists themselves, she said, regulate the quality of ink they use.

Still, the threat is real, said Bruce Brod, MD, a clinical professor of dermatology at the University of Pennsylvania Health System. "I've seen several different infections from tattooing, and they are from organisms that tend to contaminate things in damp, liquid-type environments."

The FDA released the new draft guidanceMonday aiming to reduce the use of pathogen-contaminated tattoo ink, which can cause stubborn infections that are especially hard to treat, dermatologists said.

"Tattooing involves puncturing the epidermis about 100 times per second with needles and depositing ink 1.5 to 2 millimeters below the surface of the skin, deep into the dermis," the guidance states. "Contaminated tattoo ink can cause infections and serious injuries. Because these inks are injected, pathogens or other harmful substances in these inks can travel from the injection site through the blood and lymphatic systems to other parts of the body."

The guidance comes as body art continues to get more popular. According to a 2019 poll, 30% of Americans had at least one tattoo — up from 21% in 2012. Forty percent of people 18-34 and 36% of those ages 35-54 had at least one tattoo. And though they are commonplace, tattoos come with medical risks that should be known beforehand, doctors said.

Commonly reported symptoms of tattoo ink-associated infections include rashes, blisters, painful nodules, and severe abscesses. One of the most common bacteria found in contaminated tattoo ink is nontuberculous mycobacteria (NTM), which is related to the bacteria that causes tuberculosis and can be found in soil and water.

The guidance lists several unsanitary manufacturing conditions that may lead to ink contamination, including:

• Preparing or packing of tattoo inks in facilities that are hard to sanitize, such as carpeted areas

• Ink or ink components left uncovered, especially near open air ducts

• Unsanitary mixing of tattoo inks, including with unclean utensils or containers

• Lack of appropriate attire by staff, failure to use hairnets, lab coats, aprons, gowns, masks, or gloves

"Infections will often spread along the drainage channels in the skin and create squiggly, uneven lines of big red, lumpy nodules," Brod said.

Between 2003 and 2023, there were 18 recalls of tattoo inks that were contaminated with various microorganisms, according to the FDA. In May 2019, the FDA issued a safety alertadvising consumers, tattoo artists, and retailers to avoid using or selling certain tattoo inks contaminated with microorganisms.

Reputable ink manufacturers use a process called gamma radiation, which refers to electromagnetic radiation of high frequencies to kill microorganisms in the ink and its packaging.

Most of the trustworthy, high-quality ink manufacturers are well-known among tattoo artists, Donohue said.

While she has seen customers with sensitive skin have allergic reactions, she has not seen someone come back with an infection in her 9 years working in the tattoo industry.

Because tattoo ink is considered a cosmetic product, there is not much regulatory oversight involved, which means the sterility and quality of ingredients vary, said Teo Soleymani, MD, an assistant clinical professor of dermatology and dermatological surgery at the UCLA David Geffen School of Medicine.

"Cosmeceuticals aren't regulated by the FDA like prescription medication," he said. "What we've seen many times is inadvertent contamination during the application process or contamination while the inks are being made."

In years past, unclean needles spreading hepatitis and HIV were more of a concern, but those rates have dropped significantly, Soleymani said.

The infections that have increased are from rare bacteria that exist in stagnant water. And they are injected into a part of the body that allows them to evade the immune system, he said: shallow enough that there aren't many associated blood vessels, but not still below the layer of skin that gets sloughed off every 28 days.

Sometimes, antibiotics alone won't cut it, and the tattoo will require surgical removal.

"The aesthetic you were going for has to be not only removed, but you're left with a surgical scar," Soleymani said. "Tattoos can be beautiful, but they can come with unwanted visitors that can cause months of misery."

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Effect of Exposure to Biologic Therapy Before and During Pregnancy in Patients With Psoriasis

Abstract

Biologicals have transformed the management of severe disease phenotypes in psoriasis and are often prescribed in women of childbearing age. However, information on safety of biologicals in pregnancy are lacking. We conducted a systematic review and meta-analysis aimed to describe the characteristics and pregnancy outcomes in women with psoriasis exposed to biologics within 3 months before or during pregnancy, and to estimate the pooled prevalence of spontaneous, elective and total abortions, and congenital malformations in their newborns. Bibliographic searches were performed in the PubMed, Embase, Scopus and Web of Science databases up to 14 April 2022. No restrictions on sample size or publication date were applied. Review performance complied with PRISMA guidelines, and two reviewers assessed randomized controlled trials and nonrandomized studies reporting pregnancy outcomes in women exposed to biologics indicated for psoriasis during the pre-gestational and/or gestational period. Studies focusing on rheumatologic or gastroenterological immune-mediated inflammatory diseases were excluded. Regardless of data heterogeneity, a random-effects model was used to pool prevalence estimates. We included 51 observational studies, involving 739 pregnancies exposed to approved biologics for psoriasis. Administration was mostly (70.4%) limited to the first trimester, and the most common drug was ustekinumab (36.0%). The estimated prevalence of miscarriage was 15.3% (95% confidence interval [CI] 12.7-18.0) and elective abortions, 10.8% (95% CI 7.7-14.3). Congenital malformations occurred in about 3.0% (95% CI 1.6-4.8) of live births exposed to biologics during pregnancy. Altogether, exposure to biologics for psoriasis during pregnancy and/or conception does not seem to be associated with an increased risk of miscarriage/abortion or congenital malformations, showing similar rates to the general population. These results suggest that biologic drugs are safe and pose an acceptable risk to the fetuses/neonates.

TAKE-HOME MESSAGE

• This systematic review and meta-analysis assessed pregnancy outcomes in women with psoriasis exposed to biologics within 3 months before or during pregnancy. Most administrations occurred during the first trimester, primarily with ustekinumab, followed by etanercept, infliximab, and ixekizumab. The prevalence of miscarriage was estimated at 15.3%, elective abortions at 10.8%, and congenital malformations at approximately 3.0% of live births exposed to biologics during pregnancy, rates similar to those in the general population.
• Biologic drugs commonly used for patients with psoriasis may have a favorable safety profile during pregnancy, with potentially acceptable risks to fetuses/neonates.

–  Rob Quiring, MD

Journal of the European Academy of Dermatology and Venereology: JEADV

Exposure to biologic therapy before and during pregnancy in patients with psoriasis. Systematic review and meta-analysis

J Eur Acad Dermatol Venereol 2023 Jun 01;[EPub Ahead of Print], V Sánchez-García, R Hernández-Quiles, E de-Miguel-Balsa, Á Giménez-Richarte, JM Ramos-Rincón, I Belinchón-Romero 

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Sucralose Damages DNA, Linked to Leaky Gut: Study

A new study reveals health concerns about the sugar substitute sucralose so alarming that researchers said people should stop eating it and the government should regulate it more.

Sucralose is sold under the brand name Splenda and is also used as an ingredient in packaged foods and beverages.

The findings were published this week in the Journal of Toxicology and Environmental Health, Part B. The researchers conducted a series of laboratory experiments exposing human blood cells and gut tissue to sucralose-6-acetate. The findings build on previous research that linked sucralose to gut health problems.

The researchers found that sucralose causes DNA to break apart, putting people at risk for disease. They also linked sucralose to leaky gut syndrome, which means the lining of the intestines are worn down and become permeable. Symptoms are a burning sensation, painful digestion, diarrhea, gas, and bloating.

When a substance damages DNA, it is called genotoxic. Researchers have found that eating sucralose results in the body producing a substance called sucralose-6-acetate, which the new study now shows is genotoxic. The researchers also found sucralose-6-acetate in trace amounts in off-the-shelf products that are so high, they would exceed the safety levels currently allowed in Europe.

"It's time to revisit the safety and regulatory status of sucralose because the evidence is mounting that it carries significant risks. If nothing else, I encourage people to avoid products containing sucralose," said researcher Susan Schiffman, PhD, adjunct professor of biomedical engineering at North Carolina State University, in a statement. "It's something you should not be eating." 

The FDA says sucralose is safe, describing it as 600 times sweeter than table sugar and used in "baked goods, beverages, chewing gum, gelatins, and frozen dairy desserts."

"To determine the safety of sucralose, the FDA reviewed more than 110 studies designed to identify possible toxic effects, including studies on the reproductive and nervous systems, carcinogenicity, and metabolism," the agency explained on its website. "The FDA also reviewed human clinical trials to address metabolism and effects on patients with diabetes."

Sources 

North Carolina State University: "Chemical Found in Common Sweetener Damages DNA."

Cleveland Clinic: "Leaky Gut Syndrome."

Journal of Toxicology and Environmental Health, Part B: "Toxicological and pharmacokinetic properties of sucralose-6-acetate and its parent sucralose: in vitro screening assays."

FDA: "Aspartame and Other Sweeteners in Food."

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Common Gut Bacteria Linked to Parkinson's Disease

A common gut bacteria may play a role in the development of Parkinson's disease (PD) by causing aggregation of the alpha-synuclein protein, a key feature in the pathology of PD, a small study suggests.

Environmental factors as well as genetics are also suspected to play a role in PD etiology, although the exact cause remains unknown.

"Our findings indicate that specific strains of Desulfovibrio bacteria are likely to cause Parkinson's disease," study investigator Per Erik Saris, PhD, from the University of Helsinki, Finland, says in a news release.

The study was published online online May 1 in Frontiers in Cellular and Infection Microbiology. 

Screen and Treat? 

It builds on earlier work by the researchers that showed that Desulfovibrio bacteria were more prevalent and more abundant in quantity in patients with PD, especially patients with more severe disease, than in healthy individuals.

Desulfovibrio is a genus of gram-negative bacteria commonly found in aquatic environments in which levels of organic material are elevated, as well as in waterlogged soils.

In their latest study, Saris and colleagues looked for Desulfovibrio species in fecal samples from 10 patients with PD and their healthy spouses. Isolated Desulfovibrio strains were fed to a strain of Caenorhabditis elegans roundworms that expressed human alpha-syn fused with yellow fluorescent protein.

They found that worms fed Desulfovibriobacteria from patients with PD harbored significantly more (P < .001) and larger alpha-syn aggregates (P < .001) than worms fed Desulfovibrio bacteria from healthy individuals or worms fed E coli strains.

In addition, worms fed Desulfovibrio strains from patients with PD died in significantly higher quantities than worms fed E coli bacteria (P < .01).

Desulfovibrio strains isolated from patients with PD and strains isolated from healthy individuals appear to have different traits. Comparative genomics studies are needed to identify genetic differences and pathogenic genes from Desulfovibrio strains from patients with PD, the researchers note.

"Taking into account that aggregation of alpha-syn is a hallmark of PD, the ability of Desulfovibrio bacteria to induce alpha-syn aggregation in large numbers and sizes, as demonstrated in the present study, provides further evidence for the pathogenic role of Desulfovibrio bacteria in PD, as previously suggested," they add.

The findings highlight the potential for screening and targeted removal of harmful Desulfovibrio bacteria, Saris suggests in the news release.

No Clinical Implications 

Reached for comment, James Beck, PhD, chief scientific officer at the Parkinson's Foundation, cautioned that "this research is in a very early stage, uses a nonvertebrate animal model, and the number of participants is small.

"Understanding the role of the gut microbiome in influencing PD is in its infancy. These are important steps to determining what ― if any ― link may be between gut bacteria and PD," Beck told Medscape Medical News.

"Right now, there are no implications for the screening/treatment of carriers," Beck said.

"It seems that a lot of people, whether with PD or not, harbor Desulfovibrio bacteria in their gut. More research is needed to understand what is different between the Desulfovibrio bacteria of people with PD vs those who do not have PD," Beck added.

The study was supported by the Magnus Ehrnrooth Foundation and the Jane and Aatos Erkko Foundation. Saris and Beck have disclosed no relevant financial relationships. 

Front Cell Infect Microbiol. Published online May 1, 2023. Full text

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Safety of Administering Formaldehyde-Containing Vaccines in Patients With Positive Patch Test to Formaldehyde

TAKE-HOME MESSAGE

• This retrospective single-center study from Denmark investigated the safety of administering formaldehyde-containing vaccines in patients with positive patch tests to formaldehyde. No hypersensitivity reactions occurred in the 130 patients with positive patch tests to formaldehyde who subsequently received one or more formaldehyde-containing vaccines.
• This study suggests that contact allergy to formaldehyde should not be a contraindication to receiving formaldehyde-containing vaccines, and healthcare providers and patients can be reassured of the safety.

–  Ruth McTighe, MD

Abstract 

BACKGROUND

Prophylactic vaccination against influenza and other epidemic viruses is recommended for citizens above 65 years. Several vaccines may contain traces of formaldehyde and are contra-indicated in patients hypersensitive (in the broadest possible meaning) to formaldehyde. Thorough knowledge on the various subtypes of hypersensitivity is sparse among non-dermatologists and non-allergists, and therefore many patients are prevented from vaccination based on a positive patch test to formaldehyde. The purpose of this retrospective study was to investigate whether patients with positive patch test to formaldehyde subsequently receiving a formaldehyde-containing vaccine and developed a severe adverse reaction.

METHODS/MATERIALS

From January 2000 to June 2021, 169 patients (>50 years) had a positive formaldehyde patch test at the Department of Dermatology and Allergy Center, Odense University Hospital and were included into this retrospective study. The electronic medical record was assessed for receipt of a formaldehyde-containing vaccine after patch test and for subsequent contact with the Acute Ward in the Region of Southern Denmark within 14 days after vaccination.

RESULTS

Of the 158 patients residing in the Region of Southern Denmark, 130 patients were vaccinated with one or more formaldehyde-containing vaccines of whom 123 received an influenza vaccine. No contacts to the acute wards were identified.

DISCUSSION

Although prospective studies would be beneficial, patients with positive patch test to formaldehyde can be safely vaccinated with formaldehyde-containing vaccines.

Contact Dermatitis

Patients with positive patch test to formaldehyde can be safely vaccinated with formaldehyde-containing vaccines

Contact Derm 2023 May 24;[EPub Ahead of Print], U Bindslev-Jensen, CG Mortz, KE Andersen, C Bindslev-Jensen 

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Lycorice for Scleroderma

A SWEETER APPROACH TO TREATING SCLERODERMA?

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By Warren R. Heymann, MD
March 14, 2017

Scleroderma fingernail changes. A, Longitudinal ridging and pitting. B, Brachyonychia. C, Trachyonychia. D, Thickened and enlarged cuticles. E, Thickened, enlarged, and irregular cuticles. F, Nailfold capillaroscopy: presence of enlarged and giant capillaries. G, Nailfold capillaroscopy: presence of enlarged and giant capillaries, loss of capillaries, and disorganization of microvascular array.
Credit: JAAD

We're like licorice. Not everybody likes licorice, but the people who like licorice really like licorice — Jerry Garcia

Patients with scleroderma may learn to love licorice.
 
Treating scleroderma is a difficult task. The pathogenesis of scleroderma is based on the interplay of autoimmunity, vasculopathy, and fibrosis. According to Aringer and Erler, "Most rheumatologists would agree that systemic sclerosis (SSc) still can be a dreadful disease and that the advances we see in other areas have not yet arrived." They outline current and impending therapies that may be useful in addressing each contributory component of the pathogenic triad: 1) autoimmunity (cyclophosphamide, azathioprine, mycophenolate mofetil, rituximab, tocilizumab, autologous stem cell transfer; 2) vasculopathy (ACE inhibitors, bosentan, iloprost, sildenafil); and 3) fibrosis (nintedanib) (1).

There may be a medication that addresses all 3 components of scleroderma — glycyrrhizin — the active ingredient of licorice.

Glycyrrhiza glabra has been used medicinally since antiquity and such use has been well documented in written form starting with the ancient Greeks. Glycyrrhizin is the major active constituent obtained from licorice roots, one of the most widely used herbs for the treating liver disease. The plant is used as an anti-inflammatory, spasmolytic, laxative, anti-depressive, anti-ulcer and anti-diabetic agent (2).

Yamashita et al studied the potential impact of glycyrrhizin on the key pathological manifestations of SSc, including inflammation, vasculopathy, and tissue fibrosis. They utilized bleomycin-treated mice mimicking the fibrotic and inflammatory components of SSc and endothelial cell-specific Fli1-knockout mice recapitulating SSc vasculopathy. Glycyrrhizin significantly ameliorated dermal fibrosis in bleomycin-treated mice, which was partly attributable to blockade of transforming growth factor-beta signaling in dermal fibroblasts through the down-regulation of thrombospondin 1, a latent transforming growth factor-beta receptor, and transcription factors Smad3 and Ets1. Furthermore, bleomycin-dependent induction of T helper type 2-skewed immune polarization, M2 macrophage infiltration, and endothelial-to-mesenchymal transition were greatly suppressed in mice administered glycyrrhizin. Glycyrrhizin also improved vascular permeability of endothelial cell-specific Fli1-knockout mice by increasing the expression of molecules regulating vascular integrity. The authors concluded that glycyrrhizin ameliorates bleomycin-induced dermal fibrosis through the inhibition of fibroblast activation, T helper type 2-skewed immune polarization, M2 macrophage infiltration, endothelial-to-mesenchymal transition, and improves endothelial Fli1 deficiency-dependent vascular disintegrity. This suggests that glycyrrhizin may be a disease-modifying drug for SSc (3).

Wouldn't that be sweet?

1. Aringer M, Erler A. Recent advance in managing systemic sclerosis. F1000Res 2017
2. Dastagir G, Rizvi MA. Review – glycyrrhiza glabra L. (Licquorice). Pak J Pharm Sci 2016; 29: 1727-33.
3. Yamashita T, et al. Glycyrrhizin ameliorates fibrosis, vasculopathy, and inflammation in animal models of systemic sclerosis. J Invest Dermatol 2017; 137: 631-40.

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All content found on Dermatology World Insights and Inquiries, including: text, images, video, audio, or other formats, were created for informational purposes only. The content represents the opinions of the authors and should not be interpreted as the official AAD position on any topic addressed. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

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