minocycline and Sarcoidosis

Cutaneous sarcoidosis can present in pre-existing tattoos. Previous reports suggest modest improvement with systemic or topical corticosteroids or other immunomodulating medications. Tetracyclines have anti-inflammatory properties and have been shown to be efficacious in non-tattoo associated cutaneous sarcoidosis. The pharmacology of minocycline suggests that its higher concentration in the skin may improve its efficacy in the treatment of cutaneous granulomas.. We present a case of a 35-year-old man with a history of pulmonary sarcoidosis who developed raised plaques within tattoos present for over 10 years. Skin biopsy findings revealed non-caseating granulomas consistent with cutaneous sarcoidosis. The patient was started on minocycline 100mg twice daily and had resolution of pruritus in four days and improvement of sarcoidal plaques within one week.. To our knowledge, this is the first report of cutaneous sarcoidosis in tattoos treated with minocycline. Our patient's rapid response to minocycline suggests that minocycline may be a quickly effective medication for cutaneous sarcoidosis and should be considered as a therapeutic option given its favorable side-effect profile.

Topics: Adult; Anti-Bacterial Agents; Biopsy; Diagnosis, Differential; Humans; Male; Minocycline; Sarcoidosis; Skin; Skin Diseases; Tattooing

From time to time there have been reports of autoimmune disease succumbing to tetracycline antibiotics, but many have assumed this was due to coincidence, or to some ill-defined 'anti-inflammatory property' of the tetracyclines. But now the inflammation of sarcoidosis has succumbed to antibiotics in two independent studies. This review examines the cell wall deficient (antibiotic resistant) bacteria which have been found in tissue from patients with sarcoidosis. It examines how such bacteria can infect the phagocytes of the immune system, and how they may therefore be responsible for not only sarcoid inflammation, but also for other autoimmune disease. Proof positive of a bacterial pathogenesis for Sarcoidosis includes not only the demonstrated ability of these studies to put the disease into remission, but also the severity of Jarisch-Herxheimer shock resulting from endotoxin release as the microbes are killed. Studies delineating the hormone responsible for phagocyte differentiation in the Th1 immune response, 1,25-dihydroxyvitamin D, are discussed, and its utility as a marker of Th1 immune inflammation is reviewed. Finally, data showing that the behavior of this hormone is also aberrant in rheumatoid arthritis, systemic lupus erythematosus, and Parkinson's, raise the possibility that these diseases may also have a CWD bacterial pathogenesis.

Topics: Animals; Anti-Bacterial Agents; Arthritis, Rheumatoid; Autoimmune Diseases; Bacteria; Doxycycline; Forecasting; Humans; Lupus Erythematosus, Systemic; Minocycline; Parkinson Disease; Phagocytes; Sarcoidosis; Secondary Prevention; Tetracyclines; Vitamin D

The treatment of patients with sarcoidosis remains an important part of management. The role of corticosteroids has been questioned by some, while others have reported its value even in asymptomatic patients with interstitial lung disease. Cytotoxic agents have become standard therapy for some forms of chronic disease. Newer agents that modulate the immune response have been studied. A key cytokine in chronic sarcoidosis appears to be tumor necrosis factor. Drugs that inhibit its release or block its effect have been reported as effective for sarcoidosis.

Topics: Adjuvants, Immunologic; Anti-Bacterial Agents; Azathioprine; Disease Progression; Glucocorticoids; Humans; Immunosuppressive Agents; Methotrexate; Minocycline; Respiratory Mechanics; Sarcoidosis; Sarcoidosis, Pulmonary; Tumor Necrosis Factor-alpha

To evaluate the safety and efficacy of minocycline in the treatment of sarcoidosis, a nonrandomized, open study was performed in patients with cutaneous sarcoidosis.. Twelve patients with cutaneous sarcoidosis were treated with minocycline, 200 mg/d, for a median duration of 12 months. Three patients had extracutaneous lesions at the time of the study. The median follow-up was 26 months. A clinical response was observed in 10 patients, consisting of complete responses in 8 patients and partial responses in 2 patients. A progression of skin lesions was observed in 1 patient, and lesions remained stable in another patient. Adverse effects were minimal, except in 1 patient, who developed hypersensitivity syndrome. A slight hyperpigmentation occurred in 2 patients at the site of previous lesions, which completely disappeared after minocycline use was discontinued. A relapse of skin symptoms occurred after minocycline withdrawal in 3 patients, who further received doxycycline, 200 mg/d, allowing a complete remission of lesions.. These results support that minocycline and doxycycline may be beneficial for the treatment of cutaneous sarcoidosis. Randomized controlled studies are warranted for the evaluation of the true efficacy of tetracyclines in these patients.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Arm; Female; Follow-Up Studies; Forehead; Humans; Male; Middle Aged; Minocycline; Radiography; Sarcoidosis; Sarcoidosis, Pulmonary; Skin Diseases; Treatment Outcome

Topics: Animals; Central Nervous System Diseases; Cephalexin; Disease Models, Animal; Humans; Hyperalgesia; Microglia; Minocycline; Muscle Spasticity; Neuralgia; Sarcoidosis

Although tetracycline has been used to treat cutaneous sarcoidosis, the mechanism of action for this treatment remains unclear. This study evaluated the efficacy of minocycline treatment on cutaneous sarcoidosis and the relationship between its efficacy and the presence of Propionibacterium acnes in skin sarcoid lesions.. We retrospectively reviewed results in 13 patients with cutaneous sarcoidosis treated with minocycline at Saitama Medical Center between 2010 and 2017. To demonstrate the presence of P. acnes in the skin lesions, skin biopsy specimens from 11 of the 13 patients were evaluated with immunohistochemistry using a specific monoclonal antibody against P. acnes (PAB antibody).. Of the 13 patients treated with minocycline, six patients (46%) achieved a complete response (CR) and seven (54%) had a partial response (PR). The skin lesions regressed in 1.5-5 months (average, 3.2 months) after treatment with minocycline. No relapse had occurred during the minocycline therapy. Elevated serum angiotensin-converting enzyme levels were observed in five of the patients, and the levels reduced after treatment with minocycline. P. acnes, identified as round bodies that reacted with PAB antibody, were observed in the skin sarcoid granulomas in all patients tested. The number of PAB-positive round bodies was significantly higher in the skin lesions of patients who had CR than in those who had PR.. These results suggest the effectiveness of minocycline for the treatment of cutaneous sarcoidosis and an association of P. acnes with the efficacy of minocycline therapy for cutaneous sarcoidosis.

Topics: Acne Vulgaris; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Biopsy; Female; Humans; Japan; Male; Middle Aged; Minocycline; Propionibacterium acnes; Recurrence; Retrospective Studies; Sarcoidosis; Skin; Treatment Outcome

Propionibacterium acnes (P. acnes) is a commensal bacterium indigenous to the skin. Previous reports have suggested that infection with P. acnes causes sarcoidosis, a systemic granulomatous disease. We present the case of a 63-year-old woman who developed subcutaneous nodules. A skin biopsy revealed necrotizing vasculitis and noncaseating granulomas, which are characteristic of sarcoidosis. Immunohistostaining revealed a P. acnes skin infection, which led to the diagnosis of sarcoidosis. Minocycline treatment resolved the infection and improved the patient's symptoms. We herein report a case in which immunohistochemistry was useful in the diagnosis of sarcoidosis.

Topics: Anti-Bacterial Agents; Antibodies, Monoclonal; Biopsy; Female; Granuloma; Humans; Immunohistochemistry; Japan; Middle Aged; Minocycline; Propionibacterium acnes; Sarcoidosis; Treatment Outcome; Vasculitis

Topics: Aged; Anti-Bacterial Agents; Anti-Inflammatory Agents; Drug Therapy, Combination; Facial Dermatoses; Female; Humans; Male; Middle Aged; Minocycline; Prednisone; Sarcoidosis

Topics: Anti-Bacterial Agents; Female; Humans; Male; Minocycline; Sarcoidosis; Skin Diseases

Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Female; Humans; Male; Minocycline; Retrospective Studies; Sarcoidosis; Sex Factors; Skin Diseases; Treatment Outcome

Hypopigmented patches and plaques are a rare presentation of cutaneous sarcoidosis. We describe a case of generalized hypopigmented cutaneous sarcoidosis that showed good response to minocycline therapy.

Topics: Anti-Bacterial Agents; Humans; Hypopigmentation; Male; Middle Aged; Minocycline; Sarcoidosis; Skin Diseases; Treatment Outcome

Vitamin D research is discussed in light of the hypothesis that the lower average levels of vitamin D frequently observed in autoimmune disease are not a sign of deficiency. Instead, it is proposed that the lower levels result from chronic infection with intracellular bacteria that dysregulate vitamin D metabolism by causing vitamin D receptor (VDR) dysfunction within phagocytes. The VDR dysfunction causes a decline in innate immune function that causes susceptibility to additional infections that contribute to disease progression. Evidence has been accumulating that indicates that a number of autoimmune diseases can be reversed by gradually restoring VDR function with the VDR agonist olmesartan and subinhibitory dosages of certain bacteriostatic antibiotics. Diseases showing favorable responses to treatment so far include systemic lupus erythematosis, rheumatoid arthritis, scleroderma, sarcoidosis, Sjogren's syndrome, autoimmune thyroid disease, psoriasis, ankylosing spondylitis, Reiter's syndrome, type I and II diabetes mellitus, and uveitis. Disease reversal using this approach requires limitation of vitamin D in order to avoid contributing to dysfunction of nuclear receptors and subsequent negative consequences for immune and endocrine function. Immunopathological reactions accompanying bacterial cell death require a gradual elimination of pathogens over several years. Practical and theoretical implications are discussed, along with the compatibility of this model with current research.

Topics: Animals; Anti-Bacterial Agents; Arthritis, Reactive; Arthritis, Rheumatoid; Autoimmune Diseases; Bacterial Infections; Calcifediol; Calcitriol; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Humans; Imidazoles; Minocycline; Psoriasis; Receptors, Calcitriol; Sarcoidosis; Scleroderma, Systemic; Sjogren's Syndrome; Spondylitis, Ankylosing; Tetrazoles; Thyroid Diseases; Uveitis

A 47-year-old female was diagnosed to have pulmonary, ocular, and nodular-type muscular sarcoidosis. Seven years later, nodules developed in all limb muscles. She received minocycline 200 mg daily, which resulted in an obvious reduction of the muscular sarcoidosis with a significant decrease in the serum angiotensin-converting enzyme level. Nine months later, the minocycline was discontinued, thus resulting in a rapid recurrence of the disease. The immediate readministration of minocycline again resulted in a prompt improvement. We detected Propionibacterium acnes within the granulomas in the affected muscle by an immunohistochemistry. More interestingly, we found a decrease in the circulating levels of interleukin-12 p40 and interferon-inducible protein-10 during the minocycline therapy. The minocycline therapy may be effective for sarcoidosis and the fact that the disease rapidly relapsed after discontinuation of the minocycline administration suggests that the mechanism of action in this case may be immunomodulating but not antimicrobial effect.

Topics: Anti-Bacterial Agents; Female; Humans; Immunologic Factors; Middle Aged; Minocycline; Sarcoidosis

Topics: Administration, Oral; Adult; Choroid Diseases; Conjunctival Diseases; Female; Humans; Kidney Diseases; Lacrimal Apparatus Diseases; Minocycline; Obesity, Morbid; Peptidyl-Dipeptidase A; Sarcoidosis; Sarcoidosis, Pulmonary; Skin Diseases; Tomography, X-Ray Computed

Long-term treatment with minocycline is occasionally associated with the development of black thyroid syndrome in which thyroid cancer is frequently found. Here, we report a patient with cutaneous, pulmonary and thyroid sarcoidosis who developed papillary thyroid carcinoma in the presence of a black thyroid syndrome after being treated with minocycline for 2.5 years.

Topics: Adult; Anti-Bacterial Agents; Carcinoma, Papillary; Female; Humans; Minocycline; Pigmentation; Sarcoidosis; Thyroid Neoplasms; Thyroidectomy

Necrobiosis lipoidica dibeticum (NLD) is a granulomatous skin disease mostly associated with diabetes mellitus. NLD has been reported in patients with other systemic disease. Also, the lesions of NLD may be clinically, and sometimes even histologically indistinguishable from other inflammatory skin lesions. We described three patients with established diagnosis of sarcoidosis that developed skin lesions consistent with NLD. The association of NLD-like skin lesion in sarcoidosis is not widely appreciated. The subject of NLD and sarcoidosis is reviewed.

Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Methotrexate; Middle Aged; Minocycline; Naproxen; Necrobiosis Lipoidica; Prednisone; Sarcoidosis; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Cushing Syndrome; Drug Therapy, Combination; Female; Foot; Glucocorticoids; Hand; Humans; Minocycline; Potassium Iodide; Prednisolone; Sarcoidosis

Topics: Anti-Bacterial Agents; Bronchial Diseases; Bronchoscopy; Clarithromycin; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Middle Aged; Minocycline; Radiography; Sarcoidosis; Time Factors; Treatment Outcome