Clinical, Cosmetic and Investigational Dermatology最新文献

Background: Horizontal neck lines are an early and conspicuous marker of cutaneous aging. Intradermal hyaluronic acid (HA) injections have become a standard minimally invasive countermeasure, yet comparative data for composite HA solutions in Asian populations remain scarce.

Purpose: To evaluate the efficacy and safety of injectable sodium hyaluronate composite solution (NCTF^® 135 HA) compared with injectable sodium hyaluronate composite solution (HEARTY^®) for the correction of moderate-to-severe neck wrinkles.

Methods: In this prospective, multicenter, randomized, evaluator-blinded, active-controlled, non-inferiority trial, 188 subjects with moderate-to-severe neck wrinkles were randomly assigned (1:1) to the experimental group or the control group, with both groups receiving three sessions of non-cross-linked injectable sodium hyaluronate composite solution at 4-week intervals. Improvement of Allergan Transverse Neck Lines Scale (ATNLS), subject-assessed Global Aesthetic Improvement Scale (GAIS) and adverse events (AEs) were evaluated and compared before the 3 injection sessions and at 4, 12, and 24 weeks post-final injection.

Results: At week 4 post-final injection, the ATNLS response rates were 88.30% in the experimental group and 85.11% in the control group, respectively, with a between-group difference of 3.19% (95% confidence interval (CI): [-0.0723, 0.0987], p = 0.5410), demonstrating non-inferiority of the experimental treatment to the active control. Among the secondary endpoints, neither ATNLS response rates at additional time points nor subject-assessed GAIS responder rates showed statistically significant differences between groups. A total of 128 adverse events were reported, with no statistically significant difference between groups: 26 (27.66%) in the experimental group and 38 (40.43%) in the control group. No device- or procedure-related serious adverse events occurred.

Conclusion: Injectable sodium hyaluronate composite solution (non-cross-linked) provides safe, effective, and non-inferior correction of moderate-to-severe neck wrinkles compared with active control, expanding minimally invasive therapeutic options for cervical rejuvenation.

Background: Inflammatory skin diseases (ISDs) and Alzheimer's disease (AD) share chronic immune activation, but their causal link remains unclear.

Methods: We performed a bidirectional two-sample Mendelian randomization using GWAS summary data from Europeans. Instrumental SNPs were analyzed with inverse-variance weighted (IVW), weighted median, and MR-Egger methods, with sensitivity tests for pleiotropy and heterogeneity.

Results: Forward MR revealed significant causal effects of ISDs on AD, including lichen planus (OR 1.318, p=0.005), psoriasis vulgaris (OR 1.126, p=0.004), psoriasis with arthropathy (OR 1.032, p=0.002), psoriatic arthritis (OR 1.053, p=0.016), psoriasis (OR 1.072, p=0.008), papulosquamous conditions (OR 1.046, p=0.007), and follicular cysts (OR 1.066, p=0.047). No heterogeneity or pleiotropy was detected. Reverse analysis showed no causal effect of AD on ISDs.

Conclusion: These findings support a potential causal role of chronic skin inflammation in AD risk, though effect sizes were modest and clinical implications remain exploratory. This suggests that neuroimmune mechanisms may represent potential targets for further investigation.

Background: Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae and Mycobacterium lepromatosis, primarily affecting the skin and peripheral nerves. Neuropathy in leprosy can result in significant disability, making early detection crucial. Ultrasound offers a non-invasive method to detect neuropathy by assessing echogenicity, cross-sectional area (CSA), and peripheral nerve vascularity.

Objective: This review aimed to map and synthesize diagnostic role of peripheral nerve ultrasound, focusing on echogenicity, cross-sectional area, and vascularization, in detecting leprosy-related neuropathy.

Methods: This scoping review was conducted in accordance with the PRISMA-ScR guidelines and included 15 studies assessing echogenicity, CSA, and vascularity in leprosy patients (sample sizes ranging from 20-308 participants).

Results: Ultrasound consistently identified nerve abnormalities across 15 studies, including hypoechogenicity and fascicular pattern loss (up to 72% of nerves), CSA enlargement, and Doppler vascularity (11-45%) correlating with active inflammation. Reported CSA cut-offs (10-50 mm²) yielded sensitivities of 63-90% and specificities of 67-100% across studies. Ultrasound demonstrated superior sensitivity over clinical palpation and nerve conduction studies for subclinical neuropathy detection.

Conclusion: This scoping review demonstrates ultrasound's utility for early leprosy-related neuropathy detection. Ultrasound shows superior sensitivity over clinical palpation for subclinical involvement, particularly valuable for household contacts and pure neural leprosy. However, methodological heterogeneity precludes definitive diagnostic thresholds. Future research should standardize protocols and validate ultrasound parameters to optimize clinical application and disability prevention in endemic regions.

Background: Verrucous carcinoma (VC) are always considered to be a variant of well-differentiated squamous cell carcinoma (SCC). If Keratoacanthoma (KA) is a variant of well-differentiated SCC, it is controversial currently. Both β-catenin and Wnt5a are key factors in the classical and non-classical Wnt signaling pathways, which are often used in the differential diagnosis of benign and malignant tumors. However, the expression of these two factors in these three diseases remains unclear. The goal of the current study was to explore the expression of β-catenin and Wnt5a in KA, VC, and well-differentiated SCC and to determine their value in differential diagnosis.

Methods: Twenty samples were collected from VC lesions, 30 from KA lesions, and 30 from cutaneous well-differentiated SCC lesions. The expression of Wnt5a and β-catenin in paraffin-embedded tissue sections was analyzed by immunohistochemistry. The histo (H) score was used to evaluate positive cases.

Results: There were no statistically significant differences in sex or age between KA, VC, and well-differentiated SCC patients (P-value>0.05). Immunohistochemical analysis showed that β-catenin was expressed in all tissues. For Wnt5a and β-catenin staining intensity, H score and H-score category, there were significant differences between the well-differentiated SCC and KA groups, as well as VC and KA groups (P-value<0.01 for all). However, there were no differences between the well-differentiated SCC and VC groups (P-value>0.05).

Conclusion: In this study, the differential expression of Wnt5a and β-catenin suggests that the benign tumor KA and well-differentiated SCC may be two distinct entities. We identified that Wnt5a and β-catenin could be used as adjuvant immunohistochemical markers for the differential diagnosis of KA from well-differentiated SCC.

Rituximab, an anti-CD20 monoclonal antibody, is being used more frequently to treat refractory autoimmune disorders such as myasthenia gravis. While it is usually well tolerated, rare cases of paradoxical immune-mediated skin reactions have been rarely reported. However, the concurrent development of vitiligo and alopecia universalis following rituximab therapy has not been previously described. We report a rare case of simultaneous vitiligo and alopecia universalis developing during long-term treatment with rituximab in a patient with myasthenia gravis and discuss the clinical course and treatment response. This case report describes a 30-year-old woman with myasthenia gravis who developed vitiligo followed by alopecia universalis during a long term of Rituximab therapy. Cutaneous findings included well-demarcated depigmented patches on the trunks and bilateral arms and diffuse non-scarring alopecia affecting the scalp, eyebrows, eyelashes, and body hair, consistent with 100% score of Severity of Alopecia tool (SALT) indicating Alopecia universalis. Rituximab was discontinued due to a possible drug-reaction. Treatment with oral Baricitinib was initiated to target both vitiligo and alopecia universalis. Within three months, there was significant scalp hair regrowth and re-pigmentation of vitiligo patches with minimal adverse effects. This case highlights a unique temporal association of rituximab therapy and the simultaneous onset of vitiligo and alopecia universalis. Although the relationship between the drug and the onset of the skin diseases cannot be established, it is important to be aware of the possibility of immune-related skin adverse effects during rituximab therapy. Early intervention and the use of Janus kinase inhibitors, such as baricitinib, may lead to good clinical outcomes.

Purpose: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition often linked with metabolic dysfunction and insulin resistance. Antidiabetic medications have been explored as adjunctive therapies due to their anti-inflammatory and anti-androgenic effects. This systematic review evaluated the effectiveness and safety of antidiabetic agents in HS management.

Patients and methods: A comprehensive search was conducted in PubMed, Scopus, Web of Science, CINAHL Ultimate, and Google Scholar. Eligible studies assessed the efficacy or safety of antidiabetic drugs in HS patients. Fifteen studies, comprising 3721 participants, met inclusion criteria.

Results: Metformin was the most studied drug, included in 10 studies. Several investigations showed reductions in HS lesion counts, flare frequency, and disease severity scores (Hurley stage, Sartorius score, Visual Analog Scale). Quality of life improvements, measured by the Dermatology Life Quality Index (DLQI), were observed with metformin, liraglutide, and tirzepatide. Gastrointestinal side effects were the most frequently reported, particularly with metformin. However, no severe or unexpected adverse events were linked to GLP-1 receptor agonists or SGLT2 inhibitors.

Conclusion: Overall, antidiabetic medications, especially metformin and GLP-1 receptor agonists, appear beneficial for HS. They may reduce disease severity and improve quality of life while maintaining a favorable safety profile. Nevertheless, additional high-quality randomized controlled trials are urgent to confirm these findings.

Background: Immune-mediated inflammatory diseases (IMIDs) often coexist, but treatment options for multi-system comorbidities are limited. This report evaluated the efficacy and safety of the selective JAK1 inhibitor upadacitinib (UPA) in a patient with refractory alopecia areata (AA), vitiligo, ankylosing spondylitis (AS), and allergic asthma-nasal syndrome comorbidity.

Case presentation: A 52-year-old male patient, who had not responded to previous treatments including glucocorticoids, immunosuppressants, and biologics, received UPA (15 mg once daily) for 12 weeks. After treatment, all systemic symptoms significantly improved: the Severity of Alopecia Tool (SALT) score for AA decreased from 15 to 0.9, the vitiligo lesions re-colored and stabilized, spinal joint mobility increased, and the frequency of nasal and asthma attacks decreased. The serum total IgE level decreased from 295 ng/mL to 243 ng/mL.

Conclusion: UPA achieved rapid and simultaneous improvements in this patient with refractory multi-system immune comorbidity. A transient liver function abnormality (ALT 478.6 U/L, AST 167 U/L) occurred during treatment, which was considered related to concomitant medication and resolved spontaneously after close monitoring and maintenance of the original regimen. This case suggests that UPA is effective for such complex comorbidities and has controllable safety under monitoring, providing a clinical basis for the "targeting upstream common pathways" strategy.

An 88-year-old female patient presented with a persistent ulcer in the right flank region following incision and drainage of an abscess. After the relevant examinations and debridement procedures, a deep internal sinus tract approximately 2-3 cm in length was discovered, extending to the lateral border of the external intercostal muscles. Based on local histopathological examination including the tuberculosis PCR, the condition was diagnosed as a cutaneous tuberculous sinus tract caused by Mycobacterium tuberculosis infection. Cutaneous tuberculosis is a relatively uncommon form of extrapulmonary tuberculosis, primarily affecting the skin and subcutaneous soft tissues. The patient has recovered well following an anticipated nine-month course of triple anti-tuberculosis therapy without pyrazinamide. To date, no literature reports have documented persistent deep skin fistulas resulting from this disease.

Background: Skin aging is linked to oxidative stress, and functional decline of keratinocytes is a core feature. Common chemical anti-aging agents, such as retinoic acid, often cause skin irritation, whereas traditional Chinese medicine formulas, with multiple components and relatively low toxicity, may offer alternative strategies.

Methods: To investigate its antiaging effects and mechanisms, an in vitro oxidative stress model was established using H2O2-treated human HaCaT cells. The cellular safety of Danggui Buxue Decoction was assessed by CCK-8 assay and cell morphology. The effects of pretreatment on cell viability, intracellular reactive oxygen species, superoxide dismutase and glutathione peroxidase activities, and malondialdehyde content were evaluated. Real-time quantitative PCR was used to determine the mRNA expression of senescence- and oxidative stress-related genes.

Results: Exposure to 600 μmol/L H2O2 for 1 h established an oxidative stress model, reducing cell viability to 66.3%, increasing ROS and MDA levels, and decreasing SOD and GSH-Px activities. Danggui Buxue Decoction showed no cytotoxicity at 6.25-1600 μg/mL. Pretreatment with 400 μg/mL Danggui Buxue Decoction provided protection against oxidative damage, improving cell viability, lowering ROS and MDA levels, and restoring SOD and GSH-Px activities. Specifically, 400 μg/mL Danggui Buxue Decoction increased cell viability by 31.7%, enhanced SOD and GSH-Px activities by 91.3% and 32.2%, respectively, and reduced MDA content by 27.9%. Gene expression analysis indicated that pretreatment prevented the H₂O₂-induced decrease in SOD2 and MMP1 expression and attenuated the H₂O₂-induced overexpression of PPARα and P21.

Conclusion: Danggui Buxue Decoction exerts preventive antiaging protective effects on HaCaT cells by scavenging excess reactive oxygen species, preventing impairment of the endogenous antioxidant enzyme system, inhibiting lipid peroxidation, and regulating key genes such as SOD2, MMP1, PPARα, and P21, thereby interrupting the vicious cycle of oxidative stress-induced cellular senescence and supporting its potential as a natural anti-aging agent. In vivo and clinical studies are needed to validate the translational applicability of these findings in the future.

Purpose: This multicentre cross-sectional study aimed to quantify caregiver burden among elderly patients with atopic dermatitis (AD) and to identify its principal clinical, functional, and symptomatic determinants. Specifically, we evaluated the relative contributions of functional impairment, caregiving intensity, and inflammatory severity to overall caregiver burden.

Patients and methods: A total of 213 patient-caregiver dyads were consecutively recruited from four tertiary dermatology centers in Italy. Eligible patients were aged ≥65 years with dermatologist-confirmed AD. Clinical assessments were performed by board-certified dermatologists at each participating centre and included the Eczema Area and Severity Index (EASI), body surface area (BSA), pruritus and sleep disturbance (numeric rating scales), comorbidities, and functional status measured by Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Caregivers completed a structured questionnaire on caregiving responsibilities and the Caregiver Burden Inventory (CBI). Associations were examined using Spearman correlation and multivariable linear regression models.

Results: Patients had a mean age of 73.3 ± 7.3 years and moderate disease severity (mean EASI 13.3 ± 11.2). Functional impairment was common (median ADL 4.0), and caregivers reported a median of 2.5 daily hours of assistance. Overall burden was moderate (mean CBI 32.0 ± 14.0). CBI correlated most strongly with ADL impairment (ρ = -0.50) and daily caregiving hours (ρ = 0.47), with additional associations for sleep disturbance (ρ = 0.35) and EASI (ρ = 0.31). In multivariable analysis, ADL impairment (p < 0.001), caregiving hours (p = 0.031), sleep disturbance (p < 0.001), and EASI (p = 0.005) remained independently associated with burden; pruritus was not significant after adjustment.

Conclusion: Caregiver burden in elderly AD is primarily driven by functional dependence and caregiving intensity, with additional contributions from sleep disturbance and inflammatory severity. Integrating functional assessment and caregiver-focused strategies into routine care may improve outcomes for both patients and caregivers.