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A significant number of Americans experience chronic inflammatory skin conditions with no pinpointed cause and often no effective treatments beyond symptom management. Now, a new study could pave the way for precision-medicine-based diagnostic testing and targeted treatment.
In a paper published in Scientific Reports, researchers from the University of Maryland School of Medicine described a new skin disease in a male patient with erythroderma, which covered 80% of his skin with red, exfoliating lesions that itched and burned.
After undergoing months of traditional therapies, including prednisone, anti-itch creams, and immunosuppressive drugs, the patient experienced little relief.
“We isolated individual circulating blood cells and created a new blood test using flow cytometry to identify specific cytokine signatures,” said study corresponding author Dr. Shawn Kwatra, the Joseph W. Burnett Endowed Professor and Chair of Dermatology at UMSOM and Chief of Service Dermatology at the University of Maryland Medical Center (UMMC).
The authors received a patent for this new method, which involves “peripheral blood flow cytometry-based immunophenotyping that enabled us to identify a novel form of a severe and potentially life-threatening skin disease.”
Erythroderma is a rare but severe and potentially life-threatening inflammation that affects most of the body’s skin surface. It causes redness, scaling, and skin peeling, which can impair temperature regulation and lead to protein and fluid loss, resulting in severe complications.
To determine the immune system components driving the inflammation, Dr. Kwatra and his team used their patented flow cytometry platform to immunophenotype skin diseases. They discovered elevated levels of interleukin-13 and interleukin-17 cytokines in the patient, which differed from known causes of erythroderma. Targeted treatment with biologic inhibitors of IL-13 and IL-17 reversed the patient’s disease.
“We found a new role for interleukin-13 and interleukin-17 in the blood samples taken from this patient, which supported the use of those two particular medications,” said study first author Dr. Hannah Cornman, an incoming dermatology resident at the University of North Carolina, who conducted the research as a medical student at UMSOM.
When the patient was treated with a dual therapy of monoclonal antibodies dupilumab and secukinumab, his symptoms dramatically decreased and eventually resolved, essentially curing him of erythroderma. The researchers also identified the cell sources of these pathological cytokines and monitored the decline in disease-causing cells and cytokine levels throughout the treatment.
“We created a new diagnostic test to discover a previously undescribed skin disease and initiate appropriate treatment. We are now exploring developing our diagnostic test for a range of other inflammatory skin conditions,” said Dr. Kwatra.
Co-authors from Duke University School of Medicine, George Washington University School of Medicine, and Johns Hopkins University School of Medicine also contributed to the research.
“This research represents a promising first step toward the development of sophisticated diagnostic tools that employ immunophenotyping to pinpoint the causes of non-specific inflammatory conditions. Patients with these conditions urgently need access to precision-based therapies to help them better manage their symptoms and lead productive lives,” said Dr. Mark T. Gladwin, John Z. and Akiko K. Bowers Distinguished Professor and Dean of the University of Maryland School of Medicine.
Disclaimer
The information provided in this article is for educational and informational purposes only and is not intended as medical advice. Individuals experiencing similar symptoms should consult a qualified healthcare provider for proper diagnosis and treatment.
