Research at UT Southwestern has shown that targeting metabolism in growing cells holds promise for the treatment of skin diseases like psoriasis that are characterized by skin overgrowth resulting from excess cell division, known as hyperproliferation. A research team led by Dr. Richard Wang, Assistant Professor of Dermatology, demonstrated in mice that inhibit glucose transport may be a safe and effective treatment for these diseases. Actively dividing cells – like those underlying psoriasis – are more dependent on glucose for their growth. By inhibiting glucose transport in those cells, disease-associated skin overgrowth and inflammation were reduced. Their findings were recently published in Nature Medicine.
“This study provides a window for the treatment of various diseases by specifically targeting the metabolic requirements of hyperproliferative skin diseases,” Wang said. “It also broadens our understanding of changes in skin metabolism in response to physiological stressors. Most psoriasis therapies inhibit the immune cells that underlie the disease. They have been limited somewhat by side effects caused by broadly targeting the immune system.”
The study results, if proved effective in humans, may lead to development of new treatments for those with incurable skin conditions like psoriasis, a chronic autoimmune disease that affects more than seven million people in the U.S., according to the Centers for Disease Control and Prevention. The condition manifests as patches of red skin with silvery scales typically found on the elbows, knees, scalp, lower back, face, palms, and soles of feet. Recent studies have shown that people with psoriasis are at an increased risk for other inflammatory diseases, such as arthritis, heart disease/hypertension, diabetes, Crohn’s syndrome, lupus, irritable bowel syndrome, depression, and obesity.
Psoriasis Disease Links
This trickle-down threat resulted in the World Health Organization (WHO) recognizing psoriasis under its umbrella of these four primary noncommunicable diseases: cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes. Affecting more than 125 million people worldwide, psoriasis has a direct causal linkage to several of these diseases. Although psoriasis alone rarely results in death, those with it run a greater risk of various co-occurring diseases including diabetes and cardiovascular disease.
Glucose transport in skin cells called keratinocytes takes place through Glut1. In the study, investigators successfully decreased skin overgrowth in mouse models of psoriasis-like disease by inactivating the transporter protein Glut1, either genetically or with drug-based inhibitors. These experiments did not compromise the skin’s development or functionality.
Researchers also were able to decrease inflammation with topical application of a Glut1 inhibitor. This inhibitor also had a remarkable effect on psoriatic human skin grown in a dish, suppressing both inflammation and the expression of disease-associated genes. “Although I would still consider our findings preliminary, they have the potential to provide novel therapeutic approaches for inflammatory and neoplastic skin diseases,” Wang said.
Easing The Itch Of Poison Ivy And Poison Oak
Troublesome plants such as poison ivy and poison oak can cause mild to severe allergic reactions. The signature leaves of three of the poison ivy plants carry an oil called urushiol that can be an irritant if touched, broken or burned. Poison ivy’s less-common cousin, poison oak, can be identified by leaves that look like hairy oak fronds. While some people are not sensitive to the urushiol oil, others develop a red, itchy or painful rash, swelling or blisters where the irritant comes in contact with the skin. The reaction doesn’t happen right away though. It typically takes at least 24 hours to develop, happening faster each time you are exposed.
What many people don’t know is that poison ivy and poison oak can also become airborne and can be spread by burning piles of wood or brush that includes the leaves. “Sometimes people wake up days later and their eyes are puffy and swelled up so much that they can’t see but they don’t know why,” says Dr. Claire Hollins, a dermatologist at Penn State Health Milton S. Hershey Medical Center. Hollins has also heard of cases where people chop firewood in the summer and the urushiol oil from poison ivy on it is reactivated by burning that wood in the winter months.
Black dot dermatitis – a condition where black dots develop on parts of the skin sprinkled with the oil from the poison ivy plant – is less common, but usually comes from whacking weeds, brush or vines that include the plant. The best prevention is to avoid contact with poison ivy altogether by covering up and wearing long pants, socks and gardening gloves. If you suspect that you have come into contact with a poisonous plant wash your hands immediately with warm, soapy water and dry them on a disposable towel rather than cloth towel to avoid spreading the harmful oils.
If irritation does develop, it can be treated with over-the-counter hydrocortisone ointments. More serious cases may require a course of oral prednisone and stronger topical steroids from a dermatologist or primary care provider. Poison ivy is not typically passed from one person to another unless the oil is still present on clothing or skin. It is also not spread by scratching areas that itch, as the urushiol is not present in blister fluid. Hollins said Hershey Medical Center’s Department of Dermatology is conducting research to look for a vaccine for poison ivy, and researchers are currently testing an urushiol patch to see how effective it is.
The Language Of Skin Care Labels
When it comes to skin care product labels, people shouldn’t necessarily believe everything they read. “The language on the label is not always an accurate description of the product inside the bottle or its potential effects on your skin,” says board-certified dermatologist Rajani Katta, MD, FAAD, a clinical assistant professor of medicine at the Baylor College of Medicine in Houston. “Manufacturers may use certain language for marketing purposes, and the same terms may mean different things on different products – and that makes it difficult to determine what they mean for our skin.”
Patients may choose products labeled “for sensitive skin” or “hypoallergenic” because they believe these products will be gentle on their skin and less likely to cause an allergic reaction. Because these terms are not regulated by the U.S. Food and Drug Administration, however, there is no guarantee that these products won’t irritate the skin or cause a reaction. Also, be wary of the term “all-natural,” since products containing natural ingredients are not necessarily good for the skin. “Remember, poison ivy is ‘all-natural,’” Katta says. “And even if a natural ingredient is good for your skin, some products may combine that ingredient with additives or preservatives that could be harmful.”
Language related to fragrances also may be misleading. Under current labeling laws, manufacturers are permitted to use the term “fragrance-free” on products that include fragrance chemicals if those chemicals are used for another purpose – such as moisturizing – rather than changing the product’s scent. The term “unscented” may be used on products that use fragrances to mask a strong existing odor instead of creating a new scent. “Unfortunately, there isn’t any labeling language that guarantees a product is hypoallergenic and suitable for sensitive skin,” Katta says. “However, there are steps you can take to avoid adverse reactions to new products, and a board-certified dermatologist can help you if you do experience a reaction.”
Patients with sensitive skin should test a small amount of a product on their forearm for a week to see if it causes a reaction, and make sure to follow all product directions. Patients who are experiencing skin inflammation should avoid new products altogether, since their skin’s protective barrier is already compromised, making it susceptible to further irritation. If a skin care product does cause an adverse reaction, it may not always be easy to identify the culprit.
“There’s a common misconception that allergic reactions happen instantaneously,” Katta says, “but they may take a couple of days to show up, and some people may develop an allergy to a skin care ingredient after using it for months or years. If you’re not sure what’s causing a reaction on your skin, visit a dermatologist, who can help determine the cause. Dermatologists also can help you navigate the confusing world of skin care product labels. If you’re not sure how to select the right products for your skin, visit your dermatologist. We can answer your questions about ingredients, and help you identify the products that will work best for your skin type and address your skin care concerns.”
New Treatment Option Shows Promise For Skin And Hair Conditions
Alopecia areata, atopic dermatitis and vitiligo are highly visible dermatologic conditions that can have a negative effect on patients’ quality of life and overall health. An emerging treatment option, however, could provide effective therapy for patients with these conditions. Board-certified dermatologist Brett King, MD, MPH, FAAD, an assistant professor of dermatology at the Yale School of Medicine in New Haven, Conn., is at the forefront of research into new uses for a class of drugs known as Janus kinase inhibitors, or JAK inhibitors. Recent studies suggest that these medications can disrupt the immune response that fuels alopecia areata, which can cause patchy or total hair loss; atopic dermatitis, which causes severe itch and red rash; and vitiligo, which causes the skin to lose its color.
“While alopecia areata, atopic dermatitis and vitiligo may not seem alike on the surface, they are all fueled by the body’s immune system,” King says. “JAK inhibitors seem to address immune system dysfunction in all three diseases. I believe that this class of medicines is going to redefine how dermatologists approach these diseases and provide a revolutionary new therapy for patients.”
A relatively new class of drug, JAK inhibitors were approved about five years ago by the U.S. Food and Drug Administration to treat rheumatoid arthritis and bone marrow disorders. After researchers at Columbia University in New York used these medications to successfully treat alopecia areata in mice, King used a JAK inhibitor off label in a human patient with the condition. After observing hair regrowth in this patient and others, he turned to patients with atopic dermatitis and vitiligo, who experienced significant improvement in their symptoms after taking JAK inhibitors.
While these results are promising, King says that JAK inhibitors are not currently FDA-approved for the treatment of alopecia areata, atopic dermatitis or vitiligo. The next step toward that end would be for pharmaceutical companies to conduct large-scale clinical trials, which are already in progress for atopic dermatitis and alopecia areata. “If JAK inhibitors are approved for dermatologic use, these medications would provide dermatologists with a powerful tool for treating multiple common diseases that have a profound negative impact on patients,” King says. “We need new and innovative treatments to help our patients, and for those with alopecia areata, atopic dermatitis and vitiligo, JAK inhibitors could be a life-changing therapy.”