Clinical and Experimental Dermatology最新文献

Introduction: Rituximab (Rtx) and dexamethasone pulse (DP) are the two commonly used therapeutic regimens in pemphigus vulgaris (PV).

Objectives: To compare the clinical efficacy, side effect profile, cost-effectiveness, and changes in desmoglein levels in PV patients treated with RTX biosimilar and DP.

Methods: This open-label, prospective randomized controlled study included 50 active PV patients from November 2018 to September 2023 at a tertiary center in New Delhi. Patients were randomized into two groups: Group A (Rtx) and Group B (DP), both receiving oral prednisolone in a tapering regimen with azathioprine or mycophenolate mofetil. Follow-ups were conducted monthly until remission, then quarterly for at least a year or until relapse. Primary outcomes were remission rates and time to remission; secondary outcomes included relapse rates, adverse events, and cost-effective analysis. Serum anti-desmoglein titers were measured at baseline, remission, and relapse.

Results: Both groups achieved disease control in 96% of patients within a median of one month. Remission rates were 92% in the RTX group and 84% in the DP group, with a similar median time to remission of three months. Relapse occurred twice as frequently in the DP group (76% vs. 39%) after a median of 10.5 months. Serum anti-Dsg1 and anti-Dsg3 declined significantly at remission and rose again at relapse. Adverse events, including gastrointestinal and general disorders, were more common in the DP group. Cost analysis revealed RTX was 20% more cost-effective than DP.

Conclusion: While both regimens were equally effective in inducing remission in PV, RTX offered superior long-term disease control, fewer relapses and adverse events, along with greater cost-effectiveness.

Background: Alopecia areata (AA) is an autoimmune disorder characterized by non-scarring hair loss, significantly impacting patients' quality of life. Rapid hair regrowth is the primary goal of treatment, particularly for super-responders (SRs), who demonstrate remarkable and swift improvement. The advent of Janus kinase (JAK) inhibitor has transformed AA management, yet predictors of SRs in AA remain underexplored.

Objective: This study aimed to characterize SRs among AA patients treated with tofacitinib, identify clinical and demographic predictors of SRs, and analyze treatment outcomes over 12 months.

Methods: We conducted a single-center, longitudinal retrospective analysis of 80 AA patients treated with tofacitinib at Xiangya Hospital, Central South University, from February 2021 to August 2024. Patients were classified as SRs if they achieved a ≥80% reduction in the Severity of Alopecia Tool (SALT) score by the 3rd month or a 100% reduction by the 6th month. Clinical data, treatment outcomes, and potential predictors of SR status were analyzed using binary logistic regression.

Results: SRs comprised 37.5% of the cohort. Significant predictors of SR status included older age and the absence of prior JAK inhibitor treatment. Female patients and those without previous corticosteroid use also trended toward higher SR rates, though these factors were not statistically significant. SRs demonstrated faster and more sustained hair regrowth, with 93.3% achieving SALT100 by 6 months, compared to 42% of non-super-responders (NSRs) at 12 months.

Conclusion: This study is the first to define and characterize SRs in AA treated with JAK inhibitor, providing a reference for dermatologists to optimize AA management. Identifying SRs early may improve patient outcomes and inform treatment strategies, particularly in those with a history of JAK inhibitor use. Further research is warranted to validate these findings in larger, multicenter cohorts.

Background: Vitiligo-like leukoderma is being increasingly reported in patients with breast cancer treated with cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors.

Objective: The aim of the study was to systematically review the characteristics of CDK4/6 inhibitor-induced vitiligo-like leukoderma.

Methods: A comprehensive literature search was conducted to identify published cases of vitiligo-like leukoderma following CDK4/6 inhibitor therapy administered for advanced breast cancer. Three additional cases from our tertiary vitiligo clinic are reported.

Results: Thirteen publications met the inclusion criteria, for a study population of 62 patients, including the 3 newly reported patients attending our vitiligo clinic. All patients were female; median age was 61 years (range 39 to 87 years). Ribociclib was the CDK4/6 inhibitor most frequently associated with vitiligo-like leukoderma, in 75.8% of cases. The condition predominantly affected sun-exposed areas (87.8%) and caused symptoms such as intense pruritus in 63.6% of cases. Despite multiple treatment methods, 55.7% of the patients showed no repigmentation. CDK4/6 inhibitor therapy was discontinued in 13 patients (20.1%) for various reasons, including vitiligo-like leukoderma; however, cessation did not improve the outcome. Most studies lacked data on progression-free survival.

Conclusion: CDK4/6-inhibitor-induced vitiligo-like leukoderma has distinct clinical characteristics compared to classic vitiligo and is mostly recalcitrant to treatment. Stopping CDK4/6 inhibitors does not alleviate or improve the condition. Further research is essential to elucidate its prognostic significance.

The use of teledermatology is increasing to meet rising demands, particularly for urgent suspected skin cancer referrals. High quality photography is imperative in facilitating clinical assessment. We therefore seek to evaluate different modalities of image capture obtained by clinical photographers (CPs), general practitioners (GP) and patients to support reliable and scalable teledermatology services.

With generative artificial intelligence demonstrating potential in dermatologic education, assessment of skin tone diversity is imperative to ensure comprehensive patient care. Evaluating DALL-E3, Midjourney, and DreamStudio Beta, we generated five images for eight common dermatologic conditions designated by the American Academy of Dermatology. The Massey-Martin Skin Color Scale was used to evaluate the images, and interrater reliability was further assessed by a non-rater. Sex determination was based on identifying features. 120 images were generated: 88 (73.3%) had concordant skin tone ratings and 109 (90.8%) displayed an identifiable sex. Of the 88 images, 85 (96.6%) rated light-toned, 3 (3.4%) rated medium-toned, and 0 rated dark-toned. Of the 109 images, 74 (68%) were male, and 35 (32%) were female. Highlighting substantial biases currently present in common AI platforms, this study underscores the need for AI algorithms to address both skin tone and sex biases as they continue to skyrocket in popularity.