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Efficacy and Safety of a 0.1% Tacrolimus Nasal Ointment as a Treatment for Epistaxis in Hereditary Hemorrhagic Telangiectasia: A Double-Blind, Randomized, Placebo-Controlled, Multicenter Trial
Open AccessArticle

Trauma Can Induce Telangiectases in Hereditary Hemorrhagic Telangiectasia

1
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043 Marburg, Germany
2
Morbus Osler-Selbsthilfe e.V. (German HHT Self-Help Group), 89264 Weissenhorn, Germany
3
Laboratory of Human Molecular Genetics, de Duve Institute, Université catholique de Louvain, 1200 Brussels, Belgium
4
Institute for Research in Surgical Medicine (IFOM), University of Witten/Herdecke, Campus Merheim, 51109 Cologne, Germany
5
Department of Otorhinolaryngology, Hospitals of the City of Cologne, University of Witten/Herdecke, 51067 Cologne, Germany
6
Department of Otorhinolaryngology, Head and Neck Surgery, Essen University Hospital, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(5), 1507; https://doi.org/10.3390/jcm9051507
Received: 15 April 2020 / Revised: 13 May 2020 / Accepted: 14 May 2020 / Published: 17 May 2020
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease of the fibrovascular tissue resulting in visceral vascular malformations and (muco-) cutaneous telangiectases with recurrent bleedings. The mechanism behind the disease is not fully understood; however, observations from HHT mouse models suggest that mechanical trauma may induce the formation of abnormal vessels. To assess the influence of environmental trauma (mechanical or light induced) on the number of telangiectases in patients with HHT, the number of telangiectases on the hands, face, and lips were counted on 103 HHT patients possessing at least three out of four Curaçao criteria. They were then surveyed for information concerning their dominant hand, exposure to sunlight, and types of regular manual work. Patients developed more telangiectases on their dominant hand and lower lip (Wilcoxon rank sum test: p < 0.001). Mechanical stress induced by manual work led to an increased number of telangiectases on patients’ hands (Mann–Whitney U test: p < 0.001). There was also a positive correlation between sun exposure and the number of telangiectases on the lips (Mann–Whitney U test: 0.027). This study shows that mechanical and UV-induced trauma strongly influence the formation of telangiectases in HHT patients. This result has potential implications in preventive measures and on therapeutic approaches for HHT. View Full-Text
Keywords: hereditary hemorrhagic telangiectasia (HHT); telangiectases; mechanical damage; sun-induced trauma; vascular malformations; Endoglin; activin-receptor-like kinase 1 hereditary hemorrhagic telangiectasia (HHT); telangiectases; mechanical damage; sun-induced trauma; vascular malformations; Endoglin; activin-receptor-like kinase 1
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Geisthoff, U.; Nguyen, H.-L.; Lefering, R.; Maune, S.; Thangavelu, K.; Droege, F. Trauma Can Induce Telangiectases in Hereditary Hemorrhagic Telangiectasia. J. Clin. Med. 2020, 9, 1507.

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