Dermatologic Therapy最新文献

Aims: Guselkumab’s real-world efficacy, drug survival, and patient characteristics from the Australasian Psoriasis Registry (APR) were compared with the data from the Phase III VOYAGE 1 trial.

Methods: Data from patients with severe plaque psoriasis prescribed guselkumab through the Australian Pharmaceutical Benefits Scheme (PBS) were derived from the APR. Demographic and treatment data (including psoriasis area and severity index [PASI]) at defined timepoints from 4^th September 2018 to 1^st October 2022 were analyzed. The baseline was PASI at the commencement of the first biologic. APR and VOYAGE 1 data were compared using 2-sample t-tests and chi-square tests. Associations between patient characteristics and drug survival/time to PASI score were assessed using Cox proportional hazards regression and Kaplan–Meier estimates.

Results: 102 patients were eligible; 87.3% (n = 89) had received prior biologic therapy versus 21.6% patients in VOYAGE 1. Overall drug survival in APR was 99.0%, 93.1%, 83.3% and 77.1% at 3, 9, 15, and 27 months, respectively. At 9 months, drug survival was 100% for bionaïve and 92.1% for bioexperienced patients. In VOYAGE 1, 91.5% continued guselkumab through Week 48 (∼11 months). In the APR, the median PASI was 24.0 (IQR: 17.9–32.2) at baseline, and 1.1 (IQR: 0–2.7) at 9 months. Absolute PASI ≤ 3 and PASI90 were attained by 73.8% and 64.8%, respectively. In VOYAGE 1, 76.3% reached PASI90 at Week 48. Bionaïve patients in the APR had longer drug survival than bioexperienced.

Conclusions: Guselkumab was efficacious in the real-world treatment of psoriasis, consistent with RCT results. Drug retention rates were high through 27 months, despite a higher proportion of bioexperienced patients in the APR than in VOYAGE 1.

Background: Viral warts are the result of keratinocyte infection caused by the human papillomavirus (HPV), usually represent as benign growths of epithelial tissue. Those afflicted often experience a notable decline in their quality of life due to these lesions, which can also lead to functional issues and physical discomfort. Laser technology has introduced novel approaches in treating viral warts, especially ablative lasers such as CO2 and Erbium-YAG (Er:YAG) lasers. Er:YAG laser gained recognition as a safe and effective method for addressing viral warts. Nevertheless, different recurrence rates have been reported in medical literature following treatment using Er:YAG laser, ranging from 24% to 71%. This study aimed to evaluate the recurrence rate and the risk factors that might affect it following successful treatment of warts using an Er:YAG laser.

Methods: A retrospective chart review analysis of all 245 patients who underwent an Er:YAG laser wart removal between January 2019 and July 2023 was conducted. The main outcomes measures were response rate and number of sessions required to get complete clearance.

Results: There was an overall complete resolution rate of 71.6% at 12 months follow-up. Four parameters were found to affect the response rate: the number of sessions until complete response, duration of the wart present before the laser treatment, smoking, and periungual wart location.

Conclusion: Er:YAG laser is an effective method for treating recalcitrant warts, and different risk factors were proven to effect its efficacy.

Data on combined use of dupilumab and Janus kinases inhibitors (JAKi) in refractory atopic dermatitis (AD) are insufficient, impeding proper head-on comparison. This study aimed to explore the effectiveness and safety of dupilumab in combination with JAKi in real-world settings. A total of 16 patients (8 male and 8 female, aged 5–73) with refractory moderate-to-severe AD receiving 16 weeks of combination treatment of dupilumab and JAKi were included in this study: 7 patients treated with dupilumab and baricitinib 2 mg daily, 5 treated with dupilumab and abrocitinib 100 mg daily, and 4 treated with dupilumab and upadacitinib 15 mg daily. Demographics and disease characteristics at baseline, after 2, 4, 8, 12, and 16 weeks, as well as adverse events, were collected. Significant improvement in clinical scores was achieved in all groups, while no significant difference among the three groups was observed. No adverse events led to treatment discontinuation during the 16-week treatment period. The combination of dupilumab and JAKi could be a novel and favorable option for refractory moderate-to-severe AD, and the recommended doses of the three approved JAKi (baricitinib, abrocitinib, and upadacitinib) as add-on therapy were probably similar in effectiveness. Limited by the absence of comparison between JAKi alone and the combination of the two therapies, the conclusion needed to be further validated.

Background: Plantar warts caused by the human papilloma virus (HPV) are one of the most frequent pathologies in podiatry. Diagnosis is usually limited to the clinical presentation of the lesion. Biopsy and polymerase chain reaction (PCR) are expensive and can be difficult to access. However, the dermatoscope is a noninvasive tool that covers the gap between microscopic and macroscopic diagnosis.

Objective: This study compares the effectiveness of diagnosis of plantar warts using a dermatoscope versus visual clinical signs.

Methods: The study evaluated 25 patients with suspected HPV plantar warts by visual or dermatoscopic signs. Upon clinical suspicion of HPV, a sample was taken for PCR analysis. A dermatoscopic image of the plantar wart was collected, and the characteristic clinical signs were evaluated, including the discontinuity of dermatoglyphs, hemorrhagic dots, reddish linear vessels, verruciform surface and frog-spawn appearance.

Results: All 25 patients showed positive results in molecular testing. Dermatoscopic findings compatible with HPV were obtained for 100% (25/25) of patients, while clinical signs were observed in 84% (21/25). The most common finding was the alteration of dermatoglyphs, which was present in all patients at the dermoscopic level. The sensitivity of the dermatoscope was 100% and identical to that of PCR.

Conclusion: The dermatoscope appears to be a useful, noninvasive and rapid tool for clinical use in the diagnosis of plantar warts.

Brentuximab vedotin (BV) has been approved for CD30-positive cutaneous T-cell lymphoma (CTCL) after at least one previous systemic treatment in China. However, real clinical practice is still limited. We aim to retrospectively review our experience with BV in a cohort of Chinese patients with CTCL, focusing on its efficacy and safety. We included 17 CTCL patients treated with BV at Peking Union Medical College Hospital from January 2021 to June 2024, including 12 with mycosis fungoides (MF)/Sézary syndrome (SS) and five with primary cutaneous anaplastic large-cell lymphoma (pc-ALCL). Patients had previously received a median of three treatment regimens (including acitretin, interferon, methotrexate, histone deacetylase inhibitors, phototherapy, radiotherapy, and chemotherapy). Sixteen patients received BV treatment at an initial dose of 1.8 mg/kg intravenously every 3 weeks, either as monotherapy (7/17) or in combination with gemcitabine, chidamide, or multiagent chemotherapy. The median treatment cycle has six cycles. Two patients received BV as the last treatment before undergoing allogeneic stem cell transplantation (alloSCT). The overall response rate (ORR) was 71% (13/17), with 18% (3/17) achieving complete remission (CR). In the MF/SS group, the ORR was 58% (7/12), while in the pc-ALCL group, it was 100% (5/5). Adverse events (AEs) were observed in 12 patients, including peripheral neuropathy (PN) in three cases, fever in six cases, neutropenia in three cases, exfoliative dermatitis in two cases, and abnormal liver function in one case. Only one patient experienced ≥ Grade 3 AEs. Based on clinical experience in our center, BV, either as monotherapy or combined with chemotherapy, showed a good response in the treatment of advanced CTCL patients with good tolerability.

Rosacea, a common chronic, predominantly centro-facial dermatosis, has previously been classified into distinct subtypes with a range of morphological signs that overlap with other inflammatory skin disorders. Recently, there has been a move towards diagnosis of clinical phenotypes, largely driven by a better understanding of the pathophysiology of rosacea and clinical trial endpoints. Despite this, treatment remains a challenge. The Australasian Medical Dermatology Group held a Rosacea workshop in November 2022 to develop a practical narrative. Eighteen recommendations were agreed upon using a modified eDelphi process in the first round, including a rosacea treatment algorithm.

There are two main isoforms of glucocorticoid receptor (GR) α- and β-isoforms. GRβ isoform is the dominant inhibitor of the GRα receptor and plays a significant role in a poor response to systemic glucocorticoids (GCs) under numerous conditions. The A3669G (rs6198) polymorphism (SNP) in the untranslated region of human GR stabilizes the mRNA of the dominant-negative GRβ isoform. However, the mechanisms which generate mRNA encoding the GRβ isoform have been poorly defined, especially in pemphigus patients who do not respond to GCs. The main aim was to study gene SNP of GR in patients with pemphigus vulgaris (PV) and healthy controls. We investigated whether the A3669G SNP of the human GRβ gene is a susceptibility allele for PV and contributes to GC resistance development. The presence of the A3669G SNP was determined by high-resolution melting analysis and then confirmed by direct sequencing. GR A3669G SNP (AG genotype) occurred more frequently in PV patients (n = 72; 25%) compared with healthy controls (n = 92; 3.2%; p < 0.001). Allele G was significantly more presented in PV patients (p < 0.001). Out of 48 patients with AA genotype of A3669G SNP, only 6 had GC resistance, whereas 11 out of 18 with AG genotype developed GC resistance (p < 0.0001). The frequency of a poor response to GC in the group of patients with AG genotype was 4.89 times higher compared to AG negative one (p < 0.0001).

Our study showed that the A3669G SNP was more present in PV patients. Moreover, GC resistance appeared more frequently in patients with the AG genotype (p < 0.0001). Since those patients predominantly with severe pemphigus had GC resistance (p = 0.001), we feel that A3669G SNP (AG genotype) contributes to its development. However, more studies are needed to determine whether A3669G SNP of the human GR gene associated with the disease severity and poor response to GCs in these patients.

Background and Aim: Atopic dermatitis (AD) impacts the quality of life of patients and their families. This survey-based study aimed to understand the perspectives of physicians in Egypt and Lebanon regarding available educational initiatives and support programs for patients with AD, which was complemented by the social analytics study, offering a more comprehensive understanding of the perceptions of AD among social media users.

Methods: The survey included 200 physicians, comprising primary care physicians, family medicine physicians, pediatricians, and dermatologists from Egypt and Lebanon. The social analytics study leveraged artificial intelligence to analyze 100 million websites across the region, identifying mentions of AD-related terminologies.

Results: The physician survey uncovered gaps in AD awareness and education in Egypt and Lebanon, with limited educational initiatives and digital applications available for patients. The perceptions of physicians varied regarding the use of telemedicine in dermatological disease management. According to the social analytics study, online discussions about AD predominantly originated from Egypt, featuring educational content on causes, diagnosis, management, and AD patient journey. Discussions included news about training programs, AD-related healthcare initiatives, and drug approvals. Some authors, beauty clinics, and manufacturers actively promoted their services and products. Patients actively engaged in online discussions on self-care and natural remedies, sharing their experiences of living with AD. Notably, there were substantial volumes of incorrect and inaccurate information being shared and promoted by some authors.

Conclusion: Education about AD is crucial for patients and healthcare professionals. While social media offers opportunities for increased patient engagement, the prevalence of misinformation poses a significant challenge. Addressing issues related to education and discerning misinformation is essential for achieving optimal outcomes in the management of AD within the region.

Background: Chronic pruritus of unknown origin (CPUO) is a highly debilitating disease that lacks effective treatment. There have been case reports of effective use of Janus Kinase (JAK) inhibitors in CPUO, including a case treated with baricitinib, a selective JAK 1/2 inhibitor.

Objectives: To evaluate if itch in a cohort of CPUO patients was effectively reduced after treatment with baricitinib.

Patients and Methods: This is a retrospective case series examining all patients with CPUO who were treated with baricitinib from February 2022 to August 2023 at the National Skin Center, Singapore. Itch scores on a 0–10 numerical rating scale (NRS) at 0.5-point intervals were recorded and analyzed over time.

Results: Sixteen patients (56% women, mean age of 62.2 ± 19.7 years old) with CPUO were included in the analysis. Their mean [range] duration of chronic itch was 15.4 [1–50] years, and the mean follow-up period of baricitinib treatment was 10.2 ± 6.7 months. The median [IQR] NRS itch score before and after baricitinib treatment were 8.5 [6.5–10.0] and 3.5 [1.25–5.0], respectively, with a mean reduction in the itch score of 4.9 ± 2.7 (p < 0.0001). All except one patient reported significant improvement in itch severity. There were no reports of symptomatic side effects, except for a drop in hemoglobin in a patient with thalassemia and a dry throat in another patient. There were five cases of mild elevation in creatine kinase levels, three of which normalized over time, and two cases of mild elevation in creatinine levels.

Conclusion: This study suggests that baricitinib can effectively reduce pruritus in patients with CPUO and supports the conduct of randomized placebo-controlled trials to better elucidate the efficacy of JAK inhibitors in management of CPUO.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects the quality of life (QoL) of afflicted patients. This current study was designed to assess the QoL of first-degree relatives of HS patients and the various associated parameters.

Methods: We conducted this cross-sectional study at the Outpatient Dermatology Clinics of Shahid Faghihi Hospital and Imam Reza Clinic, affiliated with Shiraz University of Medical Sciences, Shiraz, Iran, from 2021 to 2022. Thirty-nine first-degree relatives of thirty-nine patients with HS were selected to enter this cross-sectional study, through the census sampling method. The Family Dermatology Life Quality Index (FDLQI) was used to determine the scores.

Results: A total of 39 patients (24 men and 15 women) with HS were included in the present study. The mean total score of the FDLQI questionnaire was 9.10 ± 6.77, which indicates a moderate impact on the QoL of the first-degree relatives of HS patients. In HS patients with underlying diseases, FDLQI scores were greater. Other first-degree relatives had a higher average overall FDLQI score than the patient’s spouse. Comorbid first-degree relatives showed considerably higher FDLQI scores than those without. FDLQI scores increased with first-kin age.

Conclusion: The FDLQI score of first-degree relatives of HS patients is considerably affected by any other underlying condition. Additionally, FDLQI scores were substantially associated with the first-degree relative’s relationship with the patient (spouse vs. other relation) and the patient’s and relative’s underlying diseases.