Dermatologic Therapy最新文献

Background: Cutaneous immune-related adverse events (cirAEs) represent a prevalent manifestation of adverse reactions linked to immune checkpoint inhibitors (ICIs) therapy, substantially affecting patients’ quality of life.

Objective: To describe the symptomatic experience of cirAEs in patients with cancer receiving ICIs.

Design: Qualitative interviews on experiences were conducted from the perspective of patients with cancer.

Methods: A purposive sample of 18 patients with cirAEs participated in this semistructured interview. Transcripts were entered into Nvivo 11.0. Qualitative content analysis was used to analyze the data for significant statements and phrases, which were organized into themes and subthemes.

Results: Three main themes were identified in the data: (i) multiple emotions coexist, affecting the quality of life; (ii) insufficient coping capacity for cirAEs management; and (iii) exploring needs and expectations for management with cirAEs.

Conclusions: The results of this study enable healthcare providers to better understand and empathize with the patient’s experience, to truly practice the essence of patient-centered care, and to provide a basis for the development of standardized symptom management programs in the future.

Implications for Clinical Practice: To strengthen patient education by clarifying knowledge of cirAEs and providing evidence-based coping strategies, formulate personalized management plans supported by multidisciplinary collaboration when necessary, establish standardized symptom management protocols incorporating regular monitoring and dynamic strategy adjustments, and promote patient participation in decision-making while building support networks to enhance self-efficacy, thereby laying the foundation for future standardized management protocols through patient-centered integrated management approaches.

Background: Pruritus is the most common initial symptom reported by patients with dermatomyositis (DM) and polymyositis (PM). However, there is limited data regarding the impact of pruritus on cancer and mortality in patients with DM and PM. In this study, we aimed to investigate how pruritus is associated with cancer and mortality in patients with DM and PM.

Methods: This nationwide, population-based retrospective cohort study included adult DM and PM patients from Taiwan’s National Health Insurance Research Database between 2005 and 2022. Sex- and age-matched pruritic patients, identified by over 6 weeks of antipruritic medication use, and nonpruritic patients were analyzed. The primary outcome was cancer occurrence or all-cause mortality. The association between pruritus and these outcomes was estimated using Cox proportional hazards models.

Results: Among 919 matched pairs of pruritic and nonpruritic patients, cancer was observed in 19.96% in the long-term pruritic group (LPG), 14.63% in the short-term pruritic group (SPG), and 10.34% in the non-pruritic group (NPG) (p < 0.0001). All-cause mortality was documented as 30.37% in the LPG, 29.69% in the SPG, and 37.76% in the NPG (p < 0.0001). After adjusting for sex, age, and other comorbidities, pruritus was associated with an increased risk of cancer (hazard ratio (HR) 1.708, 95% confidence interval (CI) 1.229–2.374) and a lower risk of all-cause mortality (HR 0.483, 95% CI 0.409–0.569).

Conclusion: This population-based study revealed that pruritus appeared to be associated with increased risks of cancer and decreased all-cause mortality. Thus, pruritus may serve as a pragmatic factor for risk stratification and tailored treatment strategies in DM and PM. Cancer screening, particularly for nasopharyngeal and breast cancers in East Asian populations, is recommended for patients with DM or PM, especially those presenting with pruritus. Meanwhile, patients without pruritus may require vigilant management for potentially life-threatening complications and comorbidities.

Background: Basal cell carcinoma (BCC) is a nonmelanocytic skin cancer and the most common malignancy in Caucasians. Diagnostics and treatment of BCC cause significant health-related stress for many patients and costs for public health care systems. Differential mobility spectrometry (DMS) is a sensitive method for detection of gaseous molecules. The DMS-derived automatic tissue analysis system (ATAS) utilises diathermy-generated surgical smoke to distinguish cancerous tissue from normal tissue based on lipid profiling between the tissues.

Objectives: The aim of this study was to create a surrogate porcine model to test the feasibility of the ATAS in lipid detection of skin. Another objective was to determine whether BCC of human skin could be identified from healthy skin using lipid profiling.

Methods: Porcine ear skin was used to establish a three-group porcine model for lipid profile detection. Lecithin was chosen as a marker to demonstrate elevated phospholipid levels in one of the groups. We also recruited five BCC patients to collect BCC tumour biopsies and healthy skin biopsies to test the model in human samples. In both models, all samples were processed with the ATAS to test the accuracy of lipid profiling and resolution between the groups.

Results: In the porcine model, the classification accuracy was 74.5% for three groups (unprocessed porcine skin, fine-grained porcine skin, and lecithin-marked fine-grained porcine skin) and 91.8% for two groups (unprocessed porcine skin and fine-grained porcine skin combined into one group in comparison to lecithin-marked fine-grained porcine skin). The support vector machine (SVM) classifier model trained on porcine surrogate samples was then used to analyse a small number of human BCC and healthy skin samples with 95% accuracy.

Conclusion: DMS-based differentiation of porcine skin samples based on surgical smoke is possible. This study is a step towards a method to distinguish human BCC from healthy skin from surgical smoke by the ATAS. The presented skin identification of DMS analysis of surgical smoke opens the possibility to research the method in a larger sample number of human BCC and healthy skin samples as well as develop the method and ATAS towards a clinical tool for margin assessment.

Background and Aim: Androgenetic alopecia (AGA) is a common hair disorder with a low cure rate. Nonablative Er:YAG laser therapy is a novel treatment modality for AGA, representing an alternative to pharmacological and surgical treatment. To date, several small scale studies employing this laser treatment have demonstrated good results but the evidence is still limited. The aim of this study was to evaluate effectiveness and safety of a nonablative 2940 nm Er:YAG laser for treating AGA in female and male patients with both early and advanced stages of AGA.

Methods: Patients (22 male and 10 female) with active AGA were treated with 2940 nm nonablative Er:YAG laser (SMOOTH™ mode, 7 mm spot size, 7.5–10 J/cm², and frequency 2.5 Hz). Efficacy of treatment was evaluated clinically on a scale of 0–10 and with blind evaluation of hair appearance as seen in global photographs. Global photographs were taken before treatment and at 1-month follow-up and evaluated on a 5-point scale. Patient satisfaction was evaluated with a questionnaire on a scale from 0 to 3 and pain during treatment was evaluated with a pain scale from 0 to 10.

Results: Median clinical improvement was 6 (1–9), median satisfaction score was 3 (0–3), and median pain degree was 3 (0–10). According to blind evaluation, hair appearance at the 1-month FU was better in 63% and much better in 9% of the patients compared with the baseline. No adverse reactions were reported.

Conclusions: The results of this study corroborate the effectiveness of treatment with nonablative Er:YAG laser therapy for AGA. Six biweekly sessions resulted in general patient satisfaction and visible improvement in hair appearance.

The aim of this study was to determine the effect of night peeling with azelaic acid (AA) on the parameters of mature facial skin after 28 days of use. The sample consisted of 28 participants (six participants did not complete the study for reasons unrelated to cosmetic intolerance), aged 40–68 years old, including both men and women, with dry and/or normal skin types, closed comedones, and visible signs of aging. The study lasted 28 days, during which all participants were evaluated before and after the treatment with the night peeling containing AA. The results showed that not all parameters changed significantly. Significant changes was observed in the skin moisture level (increased by 4%), skin elasticity (improved by 11%), and wrinkle length (reduced by 4%). In addition, it reduced wrinkle count by an average of 15%, wrinkle volume by an average of 8%, and wrinkle area by an average of 5%. These findings indicate a successful response to the night peeling treatment with AA. However, the study was relatively small in size and could be extended to include more subjects and investigate the use of the product over a longer period of time.

Secukinumab is a biologic agent known for its durable efficacy in chronic plaque psoriasis (PsO), psoriatic arthritis (PsA) and ankylosing spondylitis (AS). Monitoring the safety of secukinumab is a priority to ensure its long-term usage. We aimed to provide an extended safety assessment of secukinumab treatment in a real-world setting. This bicentric observational study enrolled 332 patients with PsO, PsA and AS who received subcutaneous injections of secukinumab for up to 9 years. Adverse events (AEs) were reported annually as exposure-adjusted incidence rates (EAIRs) per 100 patient-years (pt-y). The total secukinumab exposure was 1129 pt-y. The retention rate was 73%, with 16 (4.8%) of patients discontinuing due to AEs. Despite most AEs being reported within the first 2 years, their incidence was low and decreased over time. The EAIR of any AEs was the highest in the initial 6 months (32.72/100 pt-y), followed by year 1 (7.62/100 pt-y), and year 2 of treatment (3.01/100 pt-y). Common AEs included respiratory and urinary tract infections, candidiasis, and diarrhoea. Secukinumab showed sustained safety over an extended 9-year treatment period, supporting its use for the long-term management of these immune-inflammatory disorders.

Seborrheic dermatitis (SD) presents treatment challenges due to its complex pathogenesis. A nonsteroidal cream (NSC) with antifungal, antimicrobial, anti-inflammatory, and antiseborrheic properties containing piloctone olamine, biosaccharide gum-2, stearyl glycyrrhetinate, and zinc PCA has shown promise in previous studies with the design that lacked control groups and demographic diversity. To validate its efficacy, this randomized, assessor-blinded, controlled trial included 50 Thai subjects with mild-to-moderate facial SD. Participants were randomized 1:1 to apply either NSC or a hydrophilic cream (control) twice daily for 8 weeks. Assessments at week (W) 0, 4, 8, and 12 (4 weeks posttreatment) included severity scores (mSDASI), Investigator Global Assessment (IGA), pruritus, and skin biophysics (erythema index, hydration, TEWL, and sebum levels). The use of triamcinolone acetonide 0.02% cream as rescue medication was recorded. Both NSC (n = 25) and control (n = 25) groups showed clinical improvement from W4, peaking at W8 and continuing to W12. The NSC group’s mSDASI significantly differed from controls at W8 (p = 0.043). The proportion of subjects achieving successful IGA (> 80% improvement) was significantly higher in the NSC group at W8 (44% vs. 16%, p = 0.048). NSC also significantly reduced erythema index at all visits and sebum levels at W4, with lower trends toward pruritus and rescue medication use during treatment. No adverse effects were reported. Overall, NSC demonstrated positive therapeutic effects for mild to moderate facial SD in Southeast Asians, highlighting its potential as a treatment option.

Trail Registration: Thai Clinical Trials Registry: TCTR20230811003

Background: To ensure equitable and successful treatment outcomes for hidradenitis suppurativa (HS), the recruitment and retention of diverse participants in clinical trials is critical. However, current approaches may neglect under-represented populations, potentially limiting the result application.

Objective: This study aimed to evaluate existing recruitment and retention strategies in HS trials, identifying gaps and proposing methods to improve inclusivity and participant retention.

Methods: We conducted a cross-sectional analysis of 36 HS clinical trials from January 2018 to December 2023, following PRISMA guidelines. Trial characteristics and specific recruitment/retention approaches were assessed through data extraction and Stata 18 SE statistical analysis.

Results: Of the 36 trials, 18/36 (50.0%) reported use of specific retention strategies, while 1/36 (2.8%) of the trials documented recruitment strategies for under-represented groups. Diversity goals were also unreported in recruitment processes. Most trials (63.9%) received industry funding, and therapeutic intervention was the most common treatment type (97.2%).

Limitations: Only articles from 2018 to 2023 were analyzed, limiting the finding generalizability over broader timeframes.

Conclusion: This study reveals significant gaps in recruitment/retention strategies within HS trials, which is important for enhancing result relevance and inclusivity, particularly among historically marginalized populations. Implementing specific approaches and innovative methods is critical for improving HS treatment efficacy and reducing health inequities.

Mycosis fungoides (MF) is an indolent form of cutaneous T-cell lymphoma. Its early lesions are important to be distinguished from atopic dermatitis (AD) because of their similar immune microenvironment. We have previously demonstrated that several chemokines are involved in the pathogenesis of advanced MF. Therefore, we sought to comprehensively analyze the changes in the immune environment during the advanced phase of MF by focusing on serum cytokines and chemokines and to identify potential biomarkers for the early detection of the transition to the advanced phase of MF. Sera from 11 cases of advanced-stage MF, 16 cases of mild AD (median EASI score = 5.75), 16 cases of severe AD (median EASI score = 28.1), and 21 healthy volunteers were analyzed using the Bio-Plex 40 multiplex immunoassay system. The results revealed significant increases in immunosuppressive macrophage-related factors (IL-4, MIF, CCL3) in MF patients compared to those with AD and healthy controls. In contrast, IL-2, CCL1, CCL7, CCL21, CCL25, and CCL26 were significantly increased in severe AD patients compared to MF patients and healthy controls. Our findings suggest that several chemokines and cytokines contribute to an immunosuppressive environment favorable for tumor growth, distinguishing MF from AD. Moreover, T-cell proliferation and migration factors, which are mainly involved in maintaining inflammation, are elevated in severe AD compared to MF. In addition to elucidating the differences in the pathogenesis of these diseases, these factors may be important in the differential diagnosis of early MF and AD. Further studies are warranted to confirm these findings.

Background and Objective: Elderly individuals face heightened risks of infections, thrombosis, cardiovascular issues, and neoplasms, necessitating increased vigilance regarding adverse drug events (ADEs). The safety of apremilast in elderly patients has not been adequately explored in clinical trials. This study was to evaluate the safety profile of apremilast in young and middle-aged patients and elderly patients separately, through data mining of the US Food and Drug Administration Adverse Event Reporting System (FAERS).

Methods: Reports in the FAERS from the third quarter of 2014 to the second quarter of 2023 were collected and analyzed. Disproportionality analyses (the reporting odds ratio (ROR), the proportional reporting ratio (PRR), the Bayesian confidence propagation neural network (BCPNN), and the multi-item gamma Poisson shrinker (MGPS) algorithms) were employed to quantify the ADE signals of apremilast in the age groups of 18–65 years and over 65 years.

Results: After data cleaning, a total of 54,926 and 14,156 ADE reports were retrieved, with 66 and 61 ADE signals identified in young and middle-aged patients and in elderly patients, respectively. Several unexpected ADE signals not listed in the drug labeling information were detected, including pericarditis, increased cholesterol levels, liver injury, postoperative thrombosis, serum calcium, and parathyroid abnormalities. Furthermore, weight loss, psychiatric abnormalities, and infections in particular sites (ear, bursa mucosa, and central nervous system) were more significant in elderly patients.

Conclusions: The study indicated several unexpected ADEs through disproportionality analysis and highlighted unique safety features in the elderly group. These findings may assist clinicians in managing psoriasis with apremilast.