Dermatologic Therapy最新文献

Current treatment modalities for postinflammatory hyperpigmentation (PIH) often fall short in delivering satisfactory results for some patients. Therefore, this study aimed to assess the efficacy and tolerability of autologous cell-free fat extract (CEFFE) in the treatment of PIH. We enrolled 15 patients with PIH and administered them with five intracutaneous CEFFE injections, each at a two-week interval. Evaluation included efficacy assessment using objective (standard two-dimensional photos, VISIA®-photos, brown spot (BS) index, lesion lightness, lesion color, and trans-epidermal water loss) and subjective (Global Aesthetic Improvement Scale and Likert satisfaction scale) parameters and tolerance assessment. Following CEFFE treatment, significant reductions were observed in the BS index (p < 0.05) and transepidermal water loss (p < 0.05), while skin lightness and lesion color showed significant improvements (p < 0.05) at the 12-month follow-up. Subjectively, 93.33% of patients reported improved or greatly improved conditions after 12 months of treatment. Transient local bruising and stinging were the only observed treatment-related adverse events, with no serious complications reported. These findings demonstrate that intradermal injections of CEFFE are well-tolerated and effective for the treatment of PIH. This trial is registered with ChiCTR2000039381.

Purpose. Sensitive scalp (SScalp) is characterized by abnormal and nociceptive sensations, such as stinging and itching, that lead to scalp discomfort. This study assessed the benefit of a once-daily serum containing Adenosine, Magnesium Sulfate (MgSO₄₎, Vitamin C Glucoside (CG), and pre- and probiotic fractions in subjects with SScalp. Methods. An open-label, single center study in adult subjects with a Global Scalp Discomfort (GSD) score of ≥8 (0–27), defined as the sum of individual symptom scores (0–9) for itching, stinging, and warming sensations. The frequency of scratching was self-declared. Evaluations were performed immediately after the 1^st application (D0Timm) and at D21, during which the cosmetic acceptability was additionally assessed. Transepidermal water loss and skin hydration were assessed at baseline, D21, and D28. Squalene (SQ) and SQOOH were analyzed at D0T0, D21T0, and D28. Tolerance was assessed throughout the study. Results. 42 subjects (30 women and 12 men) participated in this study. The mean age was 44.0 ± 13.0 years. At baseline, the mean GSD was 13.9 ± 3.28. The GSD and symptoms significantly (p  <  0.0001) improved at D0Timm and lasted until the end of the study (D28), with insignificant worsening. There was a significant reduction of SQOOH at D21 and D28. Subject satisfaction was high, associated with a good tolerance. A similar and significant (p  <  0.0001) improvement was observed for subjects with more severe symptoms and a GSD score ≥14 at baseline. Conclusion. The topical serum significantly reduces SScalp, global discomfort, and oxidative stress and is beneficial in the management of sensitive scalp. This TRIAL is registered with NCT05630027.

Background. Several studies have shown that psoriasis patients have a higher prevalence rate of schizophrenia, but none has thoroughly examined this association across different ages and genders. Thus, our systematic review and meta-analysis aims to combine all available evidence and evaluate the risk of schizophrenia in psoriasis patients. Methods. Two independent investigators extracted published studies from PubMed, Embase, Medline, and Web of Science databases from inception until May 2023 and screened 160 articles for eligibility. We included 8 studies in this meta-analysis. A random-effects model was employed to estimate the pooled odds ratio (OR) and 95% confidence interval (CI) for schizophrenia in patients with psoriasis. The study protocol is registered with PROSPERO, number CRD42023428576. Results. A total of eight studies with 889,747,79 participants met the eligibility criteria. The pooled OR of psoriasis in patients with schizophrenia versus subjects without schizophrenia was 1.66 (95% CI: [1.20, 2.29]) with a significant level of heterogeneity (I² = 97%). Specifically, the OR for psoriasis in children with schizophrenia was 12.90 (95% CI: [1.97, 84.64]), with an I² combined value of 98% and psoriasis in adults with schizophrenia 2.57 (95% CI: [1.44, 4.58]), with an I² combined value of 61.3%. The combined OR for all age groups was 5.27 (95% CI: [3.02, 9.19]). Additionally, we found that the OR value for psoriasis in females with schizophrenia was 1.74 (95% CI: [1.74, 2.11]), with an I² combined value of 59%. For male patients, the OR value was 1.58 (95% CI: [1.25, 2.01]), with an I² combined value of 77%. Conclusions. Our study shows an increased risk of schizophrenia in people with psoriasis. We demonstrated a significantly increased risk of schizophrenia among children with psoriasis and found that females with psoriasis were more likely to have schizophrenia than men with psoriasis under the same conditions.

Objectives. To reveal the role of long pentraxin 3 (PTX3) and nuclear factor kappa beta (NF-kB) in vitiligo and their relationship with disease severity. Materials and Methods. The study groups consisted of a total of 54 patients, including 27 patients diagnosed with vitiligo and 27 healthy controls without any cutaneous disease. Patients with amelanotic, sharply demarcated, and chalk-white macular lesions were defined as vitiligo. The diagnosis of vitiligo was confirmed by Wood’s lamp examination. No biopsies were taken from the lesions, and no additional laboratory testing was performed. Skin and hair pigmentations in lesions other than hands and feet were evaluated. Vitiligo grading was done using the largest macules overall. Spreading rates were evaluated in selected lesions with Wood’s lamp. The long pentraxin 3 and NF-kB levels in serum samples of participants were measured by the ELISA method. Results. According to the Vitiligo European Task Force consensus 16 of 27, vitiligo patients were in the slow progressive phase, and 11 patients were in the active progressive phase. The serum PTX3 levels of the patients in the vitiligo group were found to be significantly higher than those of the control group (8.21 ± 2.11 ng/ml vs. 6.76 ± 1.90 ng/ml, p < 0.03). Similarly, the serum NF-kB levels of the patients in the vitiligo group were significantly higher than those of the patients in the control group (15.03 ± 3.45 ng/ml vs. 12.19 ± 4.20 ng/ml, p < 0.01). A positive and significant correlation was found between serum NF-kB and PTX3 (r = 0.677 and p < 0.01). PTX3 and NF-kB levels were significantly higher in patients in the active progressive phase than in patients in the slow progressive phase. PTX3 and NF-kB values in the active progressive phase tended to be higher than those detected when the disease was in the slow progressive phase. Conclusions. High serum PTX3 and NF-kB levels in vitiligo are evidence of impaired proinflammatory activity and innate and adaptive immunity.

Introduction. Vitiligo is an acquired autoimmune disease associated with high psychosocial burden. As novel treatments are being developed in clinical trials, assessing vitiligo disease burden extends beyond physical manifestations. Including quality of life (QoL) measures in vitiligo clinical trials can better capture disease-specific psychosocial concerns and facilitate cross comparisons amongst interventions. Objective. To determine the frequency and types of QoL measures utilized in vitiligo clinical trials and comment on how this has changed longitudinally. Methods. A search of vitiligo clinical trials using clinicaltrials.gov was conducted. Phase 2 and phase 3 trials published in English from January 2000 to July 2023 were eligible for this review. Characteristics of clinical trial parameters were compared to those of non-QoL reporting clinical trials using Pearson’s χ² tests (or Fisher’s if low n). Results. A total of 60 clinical trials were eligible for this review, of which 40% included a QoL measure in their study design. Phase 3 clinical trials (p = 0.002), larger (100+ participants) trials (p = 0.063), U.S. trials (p = 0.029), and pharmaceutical interventions (p = 0.022) were more likely to include QoL measures in their design. The number of clinical trials has been increasing over time, with 8 trials from 2000 to 2010, 32 total trials from 2011 to 2020, and 20 trials from 2021 to 2023. The most commonly used QoL measures were the Dermatology Life Quality Index (DLQI, 55.2%), Children′s Dermatology Life Quality Index (CDLQI, 13.8%), and Vitiligo-specific quality of life instrument (VitiQoL, 13.8%). Over time, the VitiQoL and CDLQI have been used more frequently. Conclusion. Although vitiligo is associated with high psychological and emotional burden, less than half of vitiligo trials utilize QoL measures. The general dermatology QoL measures, namely the DLQI and CDLQI, are the most commonly used QoL assessments. As the number of clinical trials is increasing, vitiligo-specific questionnaires may better capture unique vitiligo-specific concerns. Standardizing the types of and implementation of QoL questionnaires in clinical trials can aid in assessing outcome measures across clinical trials worldwide and allow for better data interpretation, comparability, and clinical application of results.

Dupilumab, approved for the treatment of moderate-to-severe atopic dermatitis (AD), has been proven to improve skin barrier and postinflammatory hyperpigmentation on nonlesional areas. Previous studies, however, are only based on subjective visual assessments rather than objective biophysical measurements. We aimed to objectively measure transepidermal water loss (TEWL) and skin tone improvements after dupilumab treatment through bioengineering devices. Nineteen patients with severe AD were enrolled. Biophysical measurements were conducted in three nonlesional skin areas, the cheek, forearm, and lower abdomen, on a monthly basis for 5 months since the first dupilumab injection. TEWL was measured using a Tewameter®. Skin tones represented by L^∗ (lightness), a^∗ (redness), and b^∗ (yellowness) parameters were measured by the spectrophotometer®; the erythema and melanin index measured by the narrow-band reflectance spectrophotometer® were additionally assessed. Improvement from baseline was evaluated by the Wilcoxon’s rank-sum test and Bonferroni correction. Correlation among biophysical parameters was evaluated by Pearson’s correlation. p < 0.05 was considered statistically significant. TEWL and skin tone parameters in all anatomical regions showed significant improvement. The L^∗ and a^∗ values of the arm and trunk significantly improved after 2 months of dupilumab therapy and the face 3 months after. Similarly, b^∗ value of all anatomical regions significantly decreased after 1 month of treatment, and the TEWL did so after 2 months. When compared between anatomic regions, the trunk demonstrated higher improvement in L^∗ value, the arm in erythema index, and the face in melanin index. TEWL positively correlated with erythema index (r = 0.51, p < 0.05), melanin index (r = 0.45, p < 0.05), and a^∗ (r = 0.50, p < 0.05); negative correlation was observed with L^∗ (r = −0.48, p < 0.05). On top of AD symptom relief, dupilumab objectively improves the skin barrier and skin tone of nonlesional areas.

Biologic disease-modifying antirheumatic drugs (bDMARDs) and particularly tumor necrosis factor inhibitors (TNFi) have dramatically changed the natural history of psoriatic arthritis (PsA), making complete clinical remission possible in most patients. However, TNFi drugs are not without potential adverse effects such as increased infectious risk. In addition, their extensive use is associated with a significant economic burden. This prospective longitudinal cohort study involving 45 PsA patients treated with TNFi in stable remission aimed to evaluate by both clinical examination and ultrasound timing and predictive factors of disease relapse after discontinuation of TNFi treatment. Thirty-nine (86.6%) of 45 enrolled patients experienced disease relapse during the follow-up period, while six patients (13.4%) maintained remission beyond the scheduled 104 weeks. The median survival time of drug-free remission after TNFi discontinuation was 24 weeks (95% confidence interval (CI): 22.6–25.4). Disease relapse was characterized by marked clinical and ultrasound worsening of dermatologic and rheumatologic conditions. However, resuming previously discontinued treatment allowed all patients to quickly regain clinical remission. Interestingly, axial involvement was a key feature of the symptomatological pattern of disease relapse, being the main reason for treatment restart in 26% of our cohort. Based on a multivariate Cox model, three variables (VAS pain, tender joint count, and swollen joint count) of the clinical assessment performed at the time point of TNFi treatment onset negatively influenced the time to disease relapse. In conclusion, temporary discontinuation of TNFi drugs is feasible and relatively safe. However, as few predictors of the risk and timing of disease relapse have been identified, patients should be closely monitored when therapy is discontinued.

Introduction. Despite the availability of effective biologic therapies for psoriasis, there is no gold-standard treatment for nonpustular palmoplantar psoriasis (ppPsO). Methods. G-PLUS, a phase IIIb, double-blind, placebo-controlled, multicentre clinical trial, randomised adults with moderate-to-severe nonpustular ppPsO and limited plaque psoriasis (Psoriasis Area and Severity Index (PASI) ≥3 but <10) to guselkumab (an interleukin-23p19 blocker) or placebo. Placebo participants were crossed over to receive guselkumab at week (Wk) 16. The primary efficacy endpoint was the proportion of participants achieving palmoplantar PASI (ppPASI) 75 response at Wk16; clinical, biomarker, and quality-of-life endpoints were assessed through Wk48 and safety through Wk56. Results. At Wk16, ppPASI75 response was achieved by 35.9% of the guselkumab participants compared with 28.2% in the placebo group, resulting in a 7.7% difference in response rates (95% confidence interval: −11.5 and 24.7), which was not statistically significant (p = 0.533). More pronounced numerical improvements favouring guselkumab were observed for more stringent efficacy endpoints, such as Wk16 palmoplantar Investigator’s Global Assessment (ppIGA) 0/1 response (guselkumab 34.6% vs. placebo 15.4%). Through Wk48, further improvements were observed in ppPASI75 response (55.1% and 64.1%) and ppIGA 0/1 response (42.3% and 48.7%) for the guselkumab and placebo-crossover groups, respectively. Dermatology Life Quality Index responses showed comparable trends at both timepoints. Safety and pharmacodynamic findings were consistent with the established profile for guselkumab. Serum biomarker levels were significantly reduced with guselkumab and correlated with the baseline PASI score but not the ppPASI score. Conclusion. Although the primary endpoint was not met, analysis of stringent secondary endpoints and post hoc analyses showed numerical improvements favouring guselkumab at Wk16. There were no new safety signals. Further studies are warranted to better understand the impact of guselkumab treatment in patients with ppPsO. This trial is registered with NCT03998683.

Pemphigus is a group of autoimmune bullous diseases that can affect the skin and mucous membranes, and it is vital to recognize the exact pathogenesis of this disease. This study aimed to investigate the role of E-cadherin in the pathogenesis of pemphigus vulgaris (PV) and compare the expression of E-cadherin in the lesions of PV patients with that in healthy individuals’ skin. Thirty tissue samples from histopathologically confirmed PV patients as the case group and 30 skin samples from healthy individuals as the control group were evaluated for E-cadherin expression via the immunohistochemical method. Data analysis was performed using SPSS software version 25; chi-squared and Fisher’s exact tests were used to examine the relationship between qualitative variables. Immunohistochemical staining revealed decreased E-cadherin expression in the basal and suprabasal layers of the epidermis of PV patients compared with healthy individuals (P < 0.001). E-cadherin expression was 1+ in 53.3% of patients, 2+ in 40% of patients, and 3+ in only one (3.3%) patient. On the other hand, the expression of E-cadherin in other layers of the epidermis was 1+ in one patient, 2+ in five patients (25%), and 3+ in 14 patients (70%). Also, the expression of E-cadherin in all layers of the epidermis was 3+ in all controls. E-cadherin expression in the basal and suprabasal layers of the epidermis appears to be lower in patients with PV compared with controls. Therefore, E-cadherin immunohistochemical staining helps diagnose PV along with other diagnostic methods. Moreover, these findings may shed light on the role of E-cadherin as a potential target for disease treatment aiming at disease stabilization. However, more studies are needed to clarify this issue.

Introduction. Visibly enlarged facial pores are familiar dermatologic concerns. Macrofocused ultrasound energy without visualization (MaFU-WV) showed efficacy in facial tightening and an improvement in skin textural irregularities which opened the potential of the positive effects in reducing the appearance of facial pores. This study aims to assess the safety and efficacy of MaFU-WV in tightening facial pores. Methods. This was a prospective, single-blinded pilot study. Thirty-four Thai subjects with enlarged pores received a single treatment of MaFU-WV using a 2.0 mm transducer on bilateral malar areas of the face. Primary outcome measures included the pore count, pore volume, and pore index measurements using an instrument with a camera for image acquisition and software for analysis of skin. Secondary outcome measures incorporated two blinded dermatologists’ evaluation of clinical photographs and the subjects’ perception of improvement in their facial pores using a 6-point scale. Measurements were taken at baseline, 1 week, 1 month, 3 month, and 6 month after treatment. Results. The pore count significantly decreased from baseline to 6 month after treatment (p  < 0.001). Pore volume was significantly lowered from baseline to 1 week and 1, 3, and 6 months after treatment (p < 0.05). The pore index was likewise significantly reduced from baseline in every visit (p < 0.05). The majority of photographic evaluations by blinded dermatologists were scored as a 1–25% pore minimizing effect across nearly all follow-up visits. On the other hand, patient satisfaction kept improving until the end of the study at 6 months. No adverse events occurred throughout the conduct of the study. Conclusion. Macrofocused ultrasound energy using a 2 mm transducer is a safe and effective treatment for facial pore tightening. The trial is registered with registration number: TCTR20220719001.