Clinical, Cosmetic and Investigational Dermatology最新文献

Generalized pustular psoriasis (GPP) is a rare, chronic, inflammatory skin disease characterized by persistent symptoms and sudden flares of painful, sterile pustules, and may be accompanied by systemic inflammation. Ongoing symptoms of GPP can have a serious impact on patient quality of life, morbidity, and mortality, and severe flares may be life-threatening if left untreated. Guidelines have been developed for the treatment of GPP flares; however, health care professionals and patients are lacking guidance on the management of long-term, persistent symptoms of GPP. Spesolimab is the only FDA-approved treatment for GPP and is approved for use in adults and pediatric patients aged 12 years or older and weighing at least 40 kg. Spesolimab recently gained FDA approval as a subcutaneous injection to treat GPP when patients are not experiencing a flare. In this podcast episode, we discuss what is known about the chronic disease burden of GPP and how persistent symptoms affect quality of life when patients are not experiencing a flare. We address the need for treatment guidelines for chronic GPP and discuss the results of the EFFISAYIL^® 2 clinical trial, which led to the approval of the subcutaneous formulation of spesolimab to treat GPP when patients are not experiencing a flare. Finally, we discuss what can be done to improve the treatment of patients with chronic GPP, both while experiencing a flare, and while living with persistent symptoms.

Introduction: Vitiligo is an autoimmune disease characterized by the loss of skin pigmentation. This study aims to explore genetic associations between vitiligo and 21 autoimmune diseases using Mendelian randomization (MR) analysis, with a focus on identifying potential risk and protective factors.

Methods: We performed univariable and multivariable Mendelian randomization analyses to assess the causal associations between 21 autoimmune diseases and vitiligo. Confounding factors, including smoking, alcohol consumption, and Body Mass Index (BMI), were integrated into the multivariable analysis. Strongly associated single nucleotide polymorphisms (SNPs) were mapped to genes, followed by Summary-data-based Mendelian Randomization (SMR) analysis with expression Quantitative Trait Loci (eQTL) and methylation Quantitative Trait Loci (mQTL) data. Risk and protective factors were further identified by evaluating inflammatory mediators and immune cell phenotypes.

Results: The MR analysis identified seven autoimmune diseases with potential causal associations with vitiligo. However, after accounting for confounding factors, only Hashimoto's thyroiditis and type 1 diabetes maintained genetic associations with vitiligo. Gene mapping revealed 25 intersecting genes between these two diseases and vitiligo. SMR analysis confirmed Sulfite Oxidase (SUOX) as a protective gene across multiple tissues. Furthermore, several inflammatory factors were identified as risk factors, including C-X-C motif chemokine ligand 9 (CXCL9), C-X-C motif chemokine ligand 10 (CXCL10), Tumor Necrosis Factor (TNF), and Signaling Lymphocytic Activation Molecule (SLAM). In contrast, Osteoprotegerin (OPG) was identified as a protective factor.

Discussion: This study provides novel insights into the shared molecular mechanisms linking vitiligo with other autoimmune diseases. The identification of SUOX as a common protective gene and the discovery of specific inflammatory and immune-related factors may facilitate future therapeutic strategies.

[This corrects the article DOI: 10.2147/CCID.S488663.].

Background: The autologous non-cultured melanocyte-keratinocyte transplantation procedure (MKTP) has emerged as an effective treatment for various types of vitiligo and leukodermas. However, there is limited data on the long-term outcomes of the MKTP, especially in Thai patients.

Objective: To assess the long-term efficacy and safety of the MKTP in patients with vitiligo and other leukodermas.

Methods: This retrospective observational study analyzed data from 23 patients who underwent the MKTP for vitiligo and other leukodermas at the Siriraj MKTP Clinic, Thailand, and had a follow-up period exceeding 12 months. Clinical characteristics and MKTP specifics were evaluated. Repigmentation outcomes were assessed using the Vitiligo Area Scoring Index (VASI).

Results: Of the 23 patients (24 treated lesions), 78.3% had segmental vitiligo, while the others had nevus depigmentosus, nonsegmental vitiligo, or piebaldism. Most lesions (70.8%) were located on the face. At the 12-month follow-up, repigmentation showed an 80.8% ± 19.3% VASI improvement, which was sustained over 84 months with an 80%-90% VASI improvement. There was no statistically significant difference in repigmentation outcomes between facial and non-facial lesions.

Conclusion: The MKTP demonstrated long-term efficacy and safety in treating vitiligo and other leukodermas, with sustained repigmentation over 84 months. These findings support the use of the MKTP as an effective treatment option for patients with refractory vitiligo and leukodermas, particularly within Thai populations.

Purpose: Facial cosmetic procedures, known for their rising popularity, frequently yield high patient satisfaction. However, certain patient characteristics may influence this satisfaction. Additionally, patients' satisfaction can affect their attitudes and preferences toward these procedures and recommendations to others. Our study aimed to assess post-procedure satisfaction among individuals who have undergone cosmetic facial filling procedures at dermatology clinics.

Patients and methods: This cross-sectional study targeted the Saudi population who had undergone cosmetic facial filling procedures, excluding individuals under 18, those with a history of mental health disorders, or invasive surgical procedures, as well as those unable or unwilling to provide informed consent. Data were collected using a comprehensive questionnaire covering demographics, procedure details, satisfaction, and future plans. A 5-point Likert scale was used to assess self-perception and satisfaction. The questionnaire was developed after expert consultation and a literature review, with overall satisfaction calculated as the mean of all items.

Results: In this study of 408 participants in Saudi Arabia, predominantly young, unmarried females, high satisfaction levels were observed following cosmetic facial filling procedures, with a mean score of 3.9 for procedure results and 3.8 for meeting expectations. Most participants were Saudi nationals (97.8%), aged below 25 (41.7%), and held Bachelor's degrees (80.6%), with a majority being females (87.7%). Notably, factors significantly affecting overall satisfaction included gender (p = 0.001), marital status (p = 0.023), income (p = 0.031), procedure duration (p = 0.003), and procedure type (p = 0.046). These findings offer crucial insights for enhancing patient experiences and outcomes in cosmetic facial filling procedures.

Conclusion: This study unveiled substantial self-satisfaction levels, particularly regarding appearance and social well-being, emphasizing the significance of informative pre-procedure guidance, while gender, marital status, income, procedure duration, and type significantly impacted satisfaction. Healthcare providers must heed these factors to enhance patient contentment and overall procedure success.

Purpose: This study investigates the accuracy of Artificial Intelligence (AI) chatbots, ChatGPT and Bard, in providing information on Hidradenitis Suppurativa (HS), aiming to explore their potential in assisting HS patients by offering insights into symptoms, thus possibly reducing the diagnostic and treatment time gap.

Patients and methods: Using questions formulated with the help of HS patient associations, both ChatGPT and Bard were assessed. Responses to these questions were evaluated by 18 hS experts.

Results: ChatGPT's responses were considered accurate in 86% of cases, significantly outperforming Bard, which only achieved 14% accuracy. Despite the general efficacy of ChatGPT in providing relevant information across a range of HS-related queries, both AI systems showed limitations in offering adequate advice on treatments. The study identifies a significant difference in the performance of the two AIs, emphasizing the need for improvement in AI-driven medical advice, particularly regarding treatment options.

Conclusion: The study highlights the potential of AI chatbots, particularly ChatGPT, in supporting HS patients by improving symptom understanding and potentially reducing the time to diagnosis and treatment. AI chatbots, while promising, cannot yet substitute for professional medical diagnosis and treatment, indicating the importance of enhancing AI capabilities for more accurate and reliable medical information dissemination.

Background: The frequencies of comorbidities in patients with psoriasis have been compared to that in the general population in many studies. Moreover, several studies have investigated the risk factors influencing the number of comorbidities in patients with psoriasis. However, a few studies have examined clusters of patients with psoriasis according to their comorbidities. In this study, we aimed to explore the multicomorbidities of psoriasis vulgaris in terms of risk factors and clusters.

Methods: All diagnoses of 452 patients with psoriasis vulgaris were extracted from electronic medical records of a tertiary hospital. Binary association coefficients were calculated for all pairs of comorbidities. Subsequently, a hierarchical cluster analysis was performed.

Results: Among the patients, 30.5% had no comorbidities, 28.8% had a single comorbidity, and 40.7% had multiple comorbidities. The number of comorbidities was positively associated with age and follow-up duration but not with sex. The most striking cluster of comorbidities was composed of diabetes, hepatosteatosis, hyperlipidemia, hypertension, cancer, and cardiovascular disease.

Conclusion: This cluster could be explained by cardiometabolic multimorbidity. Exploring such clusters may provide a more forward-looking perspective for the management of psoriasis patients.

Aim: Data of objective skin barrier parameters in acne patients with and without therapy compared with normal controls are limited. This information could provide more insight into the pathogenesis of acne vulgaris and optimal acne treatment.

Purpose: To measure and compare skin barrier parameters in a large cohort of acne patients with and without therapy compared with normal controls.

Methods: This cross-sectional analytic study was conducted on healthy Thai volunteers. After completing a questionnaire on their general information and skincare routine, volunteers received a full skin examination and were divided into subjects with and without acne. Skin barrier parameters, including the transepidermal water loss (TEWL), skin hydration and sebum production were measured and compared between the two groups. Factors that may affect each parameter were analysed and adjusted for in a multivariate regression analysis. In addition, data from acne patients with and without treatment were evaluated.

Results: The study included 316 volunteers (164 acne patients, 152 controls), mostly female (79% acne, 78% controls). The mean age of the acne group was considerably lower than that of the control group (34 vs 48.6 years (p < 0.001)). Acne patients showed significantly higher TEWL (13.16 vs 10.63 g/m²/day, p < 0.001), sebum production (median 3 vs 0 A.U, p = 0.002), and skin hydration (244.60 vs 222.60 uS, p = 0.001). These differences remained significant after adjusting for confounding factors. Additionally, significant differences were observed between controls, acne. Patients receiving and not receiving acne medications. The highest TEWL was observed in acne patients receiving treatment, followed by untreated acne patients and normal controls (p = 0.0003). Skin hydration exhibited a comparable pattern (p = 0.03).

Conclusion: There were significantly higher TEWL, sebum production and hydration in acne patients. Acne treatment further impaired the skin barrier. These findings support the possible benefits of moisturisers with barrier-enhancing properties in patients receiving acne medications.

Skin photoaging, resulting from prolonged exposure to ultraviolet (UV) radiation, is characterized by intricate biological changes involving oxidative damage and structural alterations. Despite an increasing demand for effective interventions, the current therapeutic options for treating skin photoaging are limited. We discovered through literature data search on PubMed that recent research has shifted its focus to the application of microneedle patches as an innovative approach to address this concern. Microneedle patches, serving as a novel transdermal delivery system, exhibit the potential to deliver bioactive substances such as cytokines, cellular vesicles, gene fragments and even alive algae to mitigate the effects of skin photoaging. This review aims to provide a comprehensive overview of recent advancements in research about utilizing microneedle patches for the treatment of skin photoaging and potential future directions in leveraging microneedle patches as clinical therapeutic agents for skin rejuvenation. Ultimately, we believe that microneedle patches have a broader application prospect in the fields of medical cosmetology and anti-photoaging.

D-penicillamine is used as the mainstay of chelation therapy for Wilson's disease and for heavy metal intoxication. D-penicillamine itself has been noted to cause several systemic side effects as well as symptoms related to the skin. Common cutaneous side effects such as acute hypersensitivity reactions, elastic fiber abnormalities, and bullous diseases have been occasionally described. Herein, we report a case of a 23-year-old Thai female with gold intoxication who developed Stevens-Johnson syndrome (SJS) following the treatment of D-penicillamine. To our knowledge, D-penicillamine-induced SJS is exceptionally rare. To raise awareness of potentially fatal cutaneous adverse drug reaction triggered by D-penicillamine, published literature regarding SJS induced by this agent has also been reviewed. D-penicillamine should be regarded as a possible culprit in patients presenting with SJS following D-penicillamine administration and should be promptly discontinued.