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Mar 2012

DIRA, DITRA, and New Insights Into Pathways of Skin Inflammation: What's in a Name?

Arch Dermatol. 2012;148(3):381-384. doi:10.1001/archdermatol.2011.3014

Dermatology has a long-standing affinity for acronyms. From AGEP (acute generalized exanthematous pustulosis) to XP (xeroderma pigmentosum), acronyms have become a part of our dermatology lexicon, perhaps occasionally to the consternation of our colleagues in other specialties. In this issue, Brau-Javier et al1 describe a patient with a severe pustular skin disease called “DIRA ” —an acronym for “deficiency of the interleukin 1 (IL-1) receptor antagonist, ” which we first described in 9 pediatric patients in 2009.2 As its name suggests, DIRA is a new autoinflammatory disease linked to activation of the IL-1 pathway (Figure), joining the ranks of other IL-1 –associated conditions with a prominent dermatologic component, foremost the cryopyrin-associated periodic fever syndromes (CAPS) —familial cold –induced autoinflammatory syndrome (FCAS), Muckle-Wells syndrome, and neonatal-onset multisystem inflammatory disease (NOMID).3

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