Clinical and Experimental Dermatology最新文献

Acquired dermal macular hyperpigmentation (ADMH) encompasses conditions including lichen planus pigmentosus, erythema dyschromicum perstans, ashy dermatosis, Riehl melanosis and pigmented contact dermatitis. This group of cosmetically distressing pigmentary disorders poses a therapeutic challenge, yet to our knowledge, there have been no systematic reviews published that describe their impact on quality of life (QoL). An electronic database search of PubMed, Embase, PsycINFO and Cochrane Library was performed in December 2022 to search for articles published from inception until 15 December 2022. Articles were included if they (i) were a primary clinical publication, (ii) reported QoL in patients with ADMH, and (iii) were available in full text. Overall, the review highlighted a considerable gap in the literature concerning the impact of ADMH on QoL. Seven studies fulfilling the inclusion criteria were included, with a total of 259 patients. All seven studies reported impaired QoL in patients with ADMH. The currently available literature on this topic indicates that ADMH has a significant adverse impact on QoL, likely to a greater degree than melasma, and to a similar or lesser degree than vitiligo. Five of seven studies reported the QoL impairment for patients with ADMH based on the Dermatology Life Quality Index (DLQI); these studies consistently found a mean DLQI score reflective of a moderate effect on patients' QoL. Clinicians must be aware of the significant psychosocial burden associated with ADMH. This impact is often overlooked but should be considered when taking a holistic approach to management.

Background: Melasma is a common condition that affects a patient's quality of life. Metformin is a cheap, well-tolerated and relatively safe medication that is widely prescribed for the treatment of diabetes. Topical metformin has shown promising results in treating melasma as well as several other dermatological conditions such as acne and recalcitrant central centrifugal cicatricial alopecia.

Objectives: To study the efficacy and safety of a once-weekly topical metformin-30%-loaded peel-off mask for treating melasma.

Methods: Twenty female patients with melasma were recruited for the application of a metformin mask and placebo mask to either side of the face once weekly for 12 weeks. The hemi-Melasma Area Severity Index (hemi-MASI) was calculated at baseline, at each visit and 12 weeks after the end of treatment.

Results: At baseline, the hemi-MASI score matched between both metformin and placebo sides [7.1 (SD 2.6) and 7.1 (SD 2.6), respectively, P = 0.99]. At the end of the active treatment period, the metformin side showed a significantly better improvement in hemi-MASI score in comparison with placebo [68% (SD 0.2%) improvement on the metformin side in contrast to 20% (SD 0.2%) on the placebo side]. Although scores decreased 3 months after stopping the active treatment [52% (SD 0.2%) improvement on the metformin side compared with the placebo side 15% (SD 0.2%)], they were still significantly better than baseline. No adverse effects were reported.

Conclusions: Topical metformin-loaded peel-off masks can be a promising, safe and effective treatment for melasma. Although applied only once weekly, metformin peel-off masks show comparable efficacy to previously reported daily usage formulations.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that significantly impacts patients' quality of life and mental health. Effective management often involves both medical and surgical interventions. The aim of the study was to assess the effectiveness of wide local excision and secondary intention healing in improving quality of life and mental health in patients with moderate to severe HS.

Methods: A single-center prospective study was conducted with 40 patients suffering from moderate to severe HS, refractory to prior treatments. Pre-surgical ultrasound mapping of lesions was performed using Ultra High-Frequency Ultrasound (UHFUS). Patients underwent wide surgical excision followed by secondary intention healing based on HS-TIME principles. Quality of life was measured using Skindex-16, and mental health was assessed using the Hospital Anxiety and Depression Scale (HADS), with subscales for anxiety (HADS-A) and depression (HADS-D). Assessments were conducted at baseline, 4 weeks post-surgery, and after complete wound healing. Statistical analyses included paired t-tests and multiple linear regression to determine factors influencing outcomes.

Results: The study included 14 males and 26 females with a mean age of 39 years. Significant improvements were observed in Skindex-16 scores (pre: 57.92, post: 16.03) and HADS scores (HADS-A: pre: 6.13, post: 2.63; HADS-D: pre: 5.50, post: 3.21), indicating reduced pain, discomfort, and psychological distress. Multivariate analysis revealed that improvements were associated with male sex, HS stage II, longer disease duration, and lower BMI.

Conclusion: Wide local excision combined with secondary intention healing significantly improves quality of life and mental health in HS patients. The findings suggest that a comprehensive approach addressing both surgical and psychological aspects can enhance patient outcomes. Future research should focus on long-term benefits and the development of standardized postoperative care protocols.

Atopic dermatitis (AD) is a chronic, inflammatory skin condition which affects over 200 million people worldwide, with patients commonly presenting with dry, itchy and sore skin. The challenge in finding optimal treatment for AD stems from the heterogenous nature of the disease and its multifaceted aetiology: skin barrier dysfunction, immune system dysregulation, genetic factors, environmental factors and alterations in skin microorganisms. Traditional treatments for AD such as corticosteroids, calcineurin inhibitors and immunosuppressants have several limitations such as reoccurrence of symptoms when discontinued, lack of targeted action and risk of adverse effects. The aim of this literature review was to explore and summarise the role of aryl hydrocarbon receptor (AHR) agonists (namely Tapinarof) as potential future therapy for AD. AHR agonists hope to overcome the limitations of traditional AD therapies and exert their therapeutic value by maintaining integrity of the skin barrier, defending against oxidative stress, modulating immune activity and inflammation and restoring a healthy skin microbiome. Tapinarof, a topical AHR agonist, is showing promising results and is currently in phase 3 trials (ADORING 3). For Tapinarof to be integrated into the AD treatment pathway, further research must be conducted on its efficacy, durability, potential remittive effect and safety across different AD subtypes in a large, diverse patient population. In addition, Tapinarof's cost-effectiveness compared to its topical counterparts needs to be considered and multidisciplinary collaboration is required between researchers, clinicians and policy makers.

Background: Trials evaluating the effectiveness of topical treatments for actinic cheilitis (AC) are scarce. Despite no comparative data, phenol-croton peeling has been reported as effective in treating this condition.

Methods: An open, randomized trial was conducted to compare the effectiveness and tolerability of 1.6% phenol-croton peeling versus topical 5% imiquimod for the treatment of AC. Thirty-six patients with biopsy-proven AC were allocated into two groups (1:1): the 5%-IMI group received 5% topical imiquimod three times a week for 30 days, and the 1.6%-CROTON group underwent one session of 1.6% phenol-croton peeling. The primary outcome was the clearance of AC after 56 days. Secondary outcomes included clinical and histological parameters, adverse effects, and clinical results after 180 days.

Results: Complete clinical clearance of AC at D56 and D180 occurred in 17 (94%) participants from the 1.6%-CROTON group but in none from the 5%-IMI group (p<0.01). Improvement in all clinical parameters was more prominent in the 1.6%-CROTON group (p≤0.01). Complete histologic normalization at D56 occurred in 72% of the 1.6%-CROTON group and only 17% in the 5%-IMI group (p<0.01). Histological parameters such as atypia, solar elastosis, and hyperkeratosis reduced in intensity only in the 1.6%-CROTON group (p<0.05). Adverse effects were most intense on D7 in the 1.6%-CROTON group and persisted until D21 in the 5%-IMI group. The study was prematurely terminated at the interim analysis.

Conclusions: A single session of 1.6% phenol-croton peeling produced clinically and histologically superior results with less downtime compared to imiquimod for treating AC.