Dermatologic Therapy最新文献

Advanced hidradenitis suppurativa (HS) is often irresponsive to conservative treatment and requires extensive surgery to improve the clinical symptoms and prevent recurrence. This study aimed to assess the effectiveness of single-stage split-thickness skin grafting in patients with Hurley Stage III HS. A retrospective review of all cases of Hurley Stage III HS received skin grafting was done. Data on patient demographics, lesion characters, surgical details, and follow-up information were collected. Fifty-two cases of Hurley Stage III HS located in the axillary, groin, perineum, buttock, and penis were treated with split-thickness skin grafting. There were 20 male and 3 female patients included with a mean age of 38.7 years (range: 24–77). The overall success rate was 96.2% at a mean follow-up time of 29.3 months (range: 2–86). Early complications and late complications were observed in 30.7% (n = 16) and 59.6% (n = 31) of the cases, respectively. Wound scarring was the most common complication reported in 32.7% (n = 17) of the cases. Only one case (1.9%) of recurrence was reported in the perianal region at the postoperative 4.4 months. The satisfaction survey showed that 78.3% (18 of 23) patients were satisfied or very satisfied with the surgical result. Despite the advances in HS surgery, the recurrence rates continue to be high. Single-stage split-thickness skin grafting is a feasible approach for treating Hurley Stage III HS with a high success rate, low HS recurrence rates, and high patient satisfaction during long-term follow-up.

Background. Epstein–Barr virus (EBV) associated skin lesions have been mentioned in case report studies under multiple kinds of lymphoproliferative disorders/lymphoma diagnoses. However, due to the rarity and scattered reporting of cases, it is still unclear whether the related skin symptoms and their pathological findings can guide the clinical diagnosis and treatment of EBV-associated lymphoproliferative disease/lymphoma. Methods. In this review, we summarized the skin symptoms and clinicopathological features mentioned by previously reported cases of EBV-associated lymphoproliferative disorders/lymphoma to assist future clinical diagnosis. The inclusion criteria were based on the population, intervention, comparator, outcomes, and study designs. An electronic search was conducted by September 2023, and the following databases were used: PubMed, EMBASE, Cochrane Library, and Web of Science. Search keywords included “Epstein-Barr Virus Infections,” “Herpesvirus 4, Human,” “Lymphoma,” “Lymphoproliferative Disorders,” and “skin.” Results. The primary outcome was the clinical skin features and pathological findings of EBV-associated lymphoproliferative disease/lymphoma patients. Although it seems unrealistic to differentiate between patients with EBV-related lymphoproliferative disorders/lymphomas with different diagnoses on the basis of cutaneous symptoms and pathological findings alone, based on the evidence summarized in previous case reports, the clinical importance of EBV detection and identification in the differential diagnosis of lymphomas and lymphoproliferative disorders should be recognized. Conclusion. Given the homogeneity of risk factors associated with disease progression found in EBV-associated lymphoproliferative disease/lymphoma patients during the review, future studies can focus on summarizing skin symptoms and pathological outcomes based on possible risk factors for further deterioration in these patients.

Psoriasis is a prevalent chronic inflammatory skin disease impacting 1 to 3% of the general population in the Western World. Topical therapies are the most often used treatment in psoriasis, frequently as ancillary treatments to traditional systemic or biologic treatments in individuals with severe disease. Topical therapy with fixed-dose combination of a vitamin D analogue (calcipotriol (Cal)) and corticosteroid (betamethasone dipropionate (BD)) has been recommended as first-line topical treatment, and its efficacy and safety are supported by an increasing body of evidence. Ointment, gel, cream, and foam are the four distinct formulations of fixed-dose Cal/BD combination that have been authorized for the treatment of psoriasis. Several studies have compared these formulations in terms of efficacy, safety, and patients’ satisfaction. The objective of this study is to review all the comparative studies performed in patients with psoriasis of the Cal/BD foam formulation with respect to other topical treatments containing Cal and BD, either individually or in combination. The results of the studies published on this topic have shown that Cal/BD foam is more efficacious than both individual Cal/BD and Cal/BD ointment, gel, and cream. The safety profile, QoL, patient satisfaction, and cost-effectiveness were also higher for the Cal/BD foam formulation in different studies. Although more real-world clinical experience is required to validate the available data, Cal/BD foam may be the treatment of choice for both flare management and proactive maintenance treatment of psoriasis.

Alopecia areata (AA) is a common chronic relapsing nonscarring alopecia. Severe forms of AA commonly manifest during childhood. Treatment of AA is challenging due to the variability of the disease course as well as unpredictable responses to treatment. There is no uniform approved treatment for cure or sustained remission in children till now. Tofacitinib emerged as a novel drug in the treatment of AA, but few studies have been conducted on its safety and efficacy in children. Limitation of this study includes retrospective nature, small sample size, and lack of prolonged follow-up. Aim. This retrospective study aimed to assess the efficacy and safety of oral tofacitinib in children with AA. Method. In this retrospective study, we included patients aged 18 years or younger with AA. The scalp blandness of included patients was greater than 20% and they were on oral tofacitinib for at least two months. The demographic data, clinical characteristics, tofacitinib efficacy, and adverse effects were recorded. The primary endpoint was the last recorded percent change in the Severity of Alopecia Tool (SALT) score during treatment. Results. We included 26 patients (12 males and 14 females) with AA with a mean age of 11.6 ± 4.42 (3–18) years. Eighteen of them were in the alopecia areata (AA) group, whereas eight patients had alopecia totalis (AT) or alopecia universalis (AU). The mean disease duration before starting treatment with tofacitinib was 3.9 ± 3.3 years. Most of the patients were on a tofacitinib daily dose of 5 mg (53.85%) and 10 mg (38.46%). Patients were on tofacitinib for 6.73 ± 3.79 months. The patients’ baseline SALT score was recorded as 68.58 ± 32.65 and the final SALT score was 17.65 ± 23.88. Thus, the patients achieved a 50.92% reduction in the SALT score. Interestingly, there were no statistically significant differences in clinical efficacy between subtypes of AA and AT/AU. Conclusion. Tofacitinib was significantly effective in treating AA and AT/AU in children, with mild tolerable adverse effects, although relapse during treatment and tapering was recorded. Future randomized clinical trials with longer follow-up periods are needed to evaluate the safety of oral tofacitinib in children.

Background. Alopecia areata (AA) is a nonscarring alopecia that can affect any hairy area of the body. Excimer light at 308 nm with immunosuppressive effects is recommended as a promising management method for AA. Objectives. To assess the efficacy and safety of excimer light at 308 nm alone versus a combination of tacrolimus 0.1% and excimer light in the treatment of alopecia areata. Methods. Forty patients with AA of the scalp were divided into two groups, group A was treated with an excimer lamp twice per week for three months, and group B was treated with a combination of tacrolimus 0.1% and an excimer light. The efficacy of the treatment was evaluated by the SALT score and serum T-regulatory cells at the baseline, after 3 months from the baseline, and after 6 months from the beginning of treatment. Results. In group (A), the median SALT decreased from the baseline (13.15) to (6.15) 3 months after the baseline and further decreased after 6 months of follow-up to (3.3). While in group (B), the median SALT score was decreased from the baseline (11.15) to (0.5) after 6 months from the beginning of treatment. After 3 months, there was improvement in Treg function in both groups A and B (4.98 ± 1.02, 5.50 ± 0.84), respectively. There was a significantly higher improvement in group B (85.19 ± 8.55) than group A (70.05 ± 9.95). Dermoscopic findings reveal decreased signs of activity in group B more than group A. Conclusion. The combination of excimer light and tacrolimus is more effective than excimer light alone in treatment of AA.

SERENA is an ongoing European noninterventional longitudinal study evaluating retention, effectiveness, safety, and quality of life (QoL) in secukinumab-treated patients with active moderate-to-severe plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis. Herein, 3-year interim results among patients with psoriasis enrolled in Greece are presented. Consented adults receiving secukinumab according to the approved label for ≥16 weeks were included. Of 292 patients enrolled, 290 eligible patients (mean age 48.4 years, 71.7% male) were analyzed. At treatment initiation, 65.9% of patients were biologic-naïve and mean total Psoriasis Area Severity Index (PASI) score was 29.0. At enrolment, mean treatment duration was approximately 1.0 year. The treatment retention rate at 1/2/3 years after enrolment was 94.4/87.3/85.9%; main reasons for discontinuation were lack of effectiveness and adverse events (AEs) (43.6% and 28.2% of discontinuations, respectively). At enrolment, the mean PASI score was 4.0, 61.3% of patients had PASI ≤ 3, 71.7% had Physician’s Global Assessment (PGA) score 0/1, 59.5% had Dermatology Life Quality Index (DLQI) score 0/1, while the mean EuroQoL Visual Analogue Scale (EQ-VAS) score was 82.0. At 1/2/3 years postenrolment, the mean PASI score was 1.9/1.6/1.0, 86.6/89.4/90.0% had PASI ≤ 3, 89.5/94.8/97.5% had PGA 0/1, 71.1/75.9/81.8% had DLQI 0/1, and mean EQ-VAS score was 85.7/90.0/92.0. Of enrolled patients, 7.2% experienced secukinumab-related AEs, while special interest AEs (candida infections, malignancy, and major adverse cardiovascular events) were reported in ≤2 patients, each. These results demonstrate high secukinumab persistence in the Greek population up to three years after study enrolment, accompanied by sustained improvements in both clinical and QoL parameters and a favorable safety profile.

The most common cause of periorbital dermatitis is allergic contact dermatitis. This study aimed to determine the patch test results and demographic characteristics in patients diagnosed with periorbital dermatitis by evaluating their patch test results between 2012 and 2022. The thin-layer rapid-use epicutaneous test (T.R.U.E. test) results of patients diagnosed with periorbital dermatitis over the specified period were retrospectively evaluated. Of the 102 patients included in the study, 58 (56.9%) had a positive reaction to at least one allergen. The most common allergens to which the patients had positive reactions were nickel sulfate (31.0%), gold sodium thiosulfate (19.0%), fragrance mix (13.8%), balsam of Peru (10.3%), colophony (10.3%), cobalt dichloride (8.6%), formaldehyde resin (6.9%), thimerosal (5.2%), quaternium-15 (5.2%), carba mix (5.2%), and potassium dichromate (5.2%). This study provides comprehensive data on the demographic characteristics and patch test results of patients with periorbital dermatitis.

Background: The urge to scratch is, by definition, an integral part of the perception of itch. Consequently, scratch lesions can reflectthe patient’s perception of itch, and underlying disease. However, only little is known about . scratch patterns among different itchy conditions. Methods: In this cross-sectional study, we analyzed and compared the prevalence, type, site, and distribution of scratch lesions in patients across 11 diagnostic groups of itchy conditions. Statistical analysis was performed using chi-squared test or Mann–Whitney U tests when appropriate. Results: A total of 124 patients with acute or chronic pruritus were enrolled, 82 (66.1%) of whom presented scratch lesions. Among these, erosions/excoriations were the most prevalent (56.1%), followed by erythematous striated lesions (36.6%) and crusts (35.4%). Scratch lesions were present in descending prevalence on the arms (78.2%), trunk (75.6%), legs (74.4%), and head (19.2%). Distinct scratch lesions were identified in some diagnoses, enabling us to develop a diagnostic algorithm. Conclusions: In the present study, we characterized scratch patterns in various itchy skin conditions and developed a diagnostic algorithm accordingly. However, larger studies are necessary to support our findings.

Melasma is a common chronic acquired pigmentation disorder that is recognized as a type of photoaging disorder. Although the exact etiology and pathogenesis of melasma remain elusive, it is widely believed that it is triggered by multiple factors and involves multiple cells. Because of its impact on appearance and self-confidence, melasma can affect the mental health and quality of life of patients. Various types of therapies have been used to treat melasma; however, the treatment of melasma remains challenging because of its eradication difficulty and almost constant relapses. Energy-based and combination therapies have recently become a new trend with surprising therapeutic outcomes. This work provides an overview of the clinical characteristics, etiology, pathogenesis, histopathologic features, and management of melasma.