A major variety of Americans expertise power inflammatory pores and skin circumstances with no pinpointed trigger and sometimes no efficient therapies past symptom administration. Now a brand new research might pave the best way for precision-medicine primarily based diagnostic testing and focused remedy.
In a current paper revealed within the Nature journal Scientific Reports, researchers from the University of Maryland School of Medicine described a brand new pores and skin illness in a male affected person with erythroderma, inflicting 80 p.c of his pores and skin to be coated with pink, exfoliating pores and skin lesions that itched and burned. After present process months of remedy with conventional therapies for erythroderma, which included the steroid prednisone, anti-itch lotions, and immunosuppressive medication, the affected person skilled little reduction.
“We remoted particular person circulating blood cells and created a brand new blood take a look at utilizing stream cytometry to establish particular cytokine signatures,” mentioned research corresponding writer Shawn Kwatra, MD, the Joseph W. Burnett Endowed Professor and Chair of Dermatology at UMSOM and Chief of Service Dermatology on the University of Maryland Medical Center (UMMC).
The authors obtained a patent for this new technique, involving “peripheral blood stream cytometry-based immunophenotyping enabled us to establish a novel type of a extreme and probably life-threatening pores and skin illness.”
Erythroderma is a uncommon however extreme and probably life-threatening irritation that happens on many of the physique’s pores and skin floor. It causes redness and scaling of the pores and skin that spreads over the physique and causes the pores and skin to peel (slough) off. This can result in issues with the physique’s means to handle temperature and may trigger protein and fluid loss, resulting in extreme issues.
To decide which of the immune system’s parts have been driving the inflammatory illness, Dr. Kwatra and his crew used a brand new stream cytometry platform approach, for which they obtained a patent, to immunophenotype pores and skin illnesses. They discovered that two of those cytokines, known as interleukin-13 and interleukin-17, have been at elevated ranges on this affected person in comparison with wholesome controls in addition to when in comparison with sufferers with different recognized causes of erythroderma. Subsequently, focused remedy with biologic inhibitors of IL-13 and IL-17 reversed the affected person’s illness.
“We discovered a brand new position for interleukin-13 and interleukin-17 within the blood samples taken from this affected person which supported the usage of these two specific drugs,” mentioned research first writer Hannah Cornman, MD, an incoming dermatology resident on the University of North Carolina who carried out the analysis as a medical pupil at UMSOM. “These cytokines seemed to be the important thing cytokines in defining the illness.”
When the affected person was handled with a twin remedy of two monoclonal antibodies, dupilumab and secukinumab, his signs dramatically decreased and finally resolved, basically curing him of his erythroderma. The authors additionally recognized the cell sources of those pathological cytokines and monitored the decline in immunopathogenic (disease-causing) cell numbers, and the decline of interleukin-13, and interleukin-17 ranges within the affected person’s blood all through the remedy course.
We created a brand new diagnostic take a look at to find a beforehand undescribed pores and skin illness and provoke applicable remedy. We are actually exploring growing our diagnostic take a look at to a spread of different inflammatory pores and skin.”
Dr. Shawn Kwatra, MD, the Joseph W. Burnett Endowed Professor and Chair of Dermatology at UMSOM and Chief of Service Dermatology on the University of Maryland Medical Center
The research was funded by the National Institutes of Health. Co-authors from Duke University School of Medicine, George Washington University School of Medicine, and Johns Hopkins University School of Medicine, additionally contributed to the analysis.
“This analysis represents a promising first step in the direction of the event of refined diagnostic instruments that make use of immunophenotyping to pinpoint the causes of non-specific inflammatory circumstances. Patients with these circumstances urgently want entry to precision-based therapies to assist them higher handle their signs and lead productive lives,” mentioned Mark T. Gladwin, MD, who’s the John Z. and Akiko Ok. Bowers Distinguished Professor and Dean of University of Maryland School of Medicine.
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Journal reference:
Cornman, H. L., et al. (2025). Targeted twin biologic remedy for erythroderma of unknown etiology guided by high-parameter peripheral blood immunophenotyping. Scientific Reports. doi.org/10.1038/s41598-024-81060-3.