Dermatologic Therapy最新文献

Atopic dermatitis (AD) is a chronic inflammatory skin disorder affecting approximately 20% of children and 10% of adults. While previous studies have linked AD to allergen exposure, disruption of the skin barrier, and Type 2 immune responses, the precise pathophysiology of AD remains elusive, significantly limiting the effectiveness of current treatments. Noncoding RNAs (ncRNAs), a diverse group of transcripts that do not encode proteins and account for at least 98% of the human genome, are implicated in numerous physiological and pathological processes. A growing body of evidence underscores the pivotal role of ncRNAs in the pathogenesis and progression of AD. This review offers a detailed synthesis of the latest insights into the involvement of ncRNAs in AD, as well as their potential as diagnostic biomarkers and therapeutic targets.

Background: Chronic pruritus (CP) is a common and distressing symptom among renal transplant recipients (RTRs), yet its pathogenesis remains poorly understood. Recent evidence suggests that dysregulation of the endogenous opioid system may contribute to pruritus in various conditions, but its role in RTRs has not been thoroughly investigated.

Objective: This study aimed to assess the concentrations of specific endogenous opioids (β-endorphin, dynorphin A, met-enkephalin, and leu-enkephalin) in RTRs with and without pruritus to explore their potential role in pruritus pathogenesis.

Methods: A total of 129 RTRs and 47 healthy controls were included in the study. Serum levels of β-endorphin, dynorphin A, met-enkephalin, and leu-enkephalin were measured using enzyme-linked immunosorbent assays (ELISAs). Pruritus severity was assessed using the Worst Pruritus Numerical Rating Scale (WP-NRS) and the 4-Item Itch Questionnaire (4IIQ).

Results: Pruritic RTRs had significantly lower serum β-endorphin levels compared to nonpruritic RTRs (p = 0.008). However, there were no significant differences in dynorphin A, met-enkephalin, or leu-enkephalin levels between pruritic and nonpruritic RTRs or between RTRs and healthy controls. The β-endorphin to dynorphin A ratio also did not differ significantly between groups.

Conclusion: The study suggests that disturbances in the endogenous opioid system, particularly involving β-endorphin, may play a role in the pathogenesis of pruritus in RTRs. Further research is needed to elucidate the precise mechanisms and to explore potential therapeutic interventions targeting the opioid system in this population.

Background: Melasma is a challenging hyperpigmentation disorder without absolute treatment.

Aims: This study aimed to evaluate the effects of intradermal botulinum toxin A (BoNT-A) on melasma and the protective effects of BoNT-A on UVA-induced melanogenesis in B16F10 melanoma cells.

Patients/Methods: This study is a split-face randomized, double-blind, placebo-controlled trial in 12 melasma patients who received intradermal abobotulinumtoxinA injection into melasma lesions. An in vitro study was also conducted in B16F10 melanoma cells treated with different concentrations of BoNT-A prior to exposure to UVA. Cell viability and cellular melanogenesis were determined.

Results: The adjusted MASI scores on the BoNT-A side were significantly lower than the control at 3 months after injection, 2.8 versus 4.5 (p < 0.001), respectively. BoNT-A injection significantly reduced the MASI score at 2 and 3 months compared with the baseline of 4.1–3.2 (22%) (p < 0.001) and 2.8 (31.7%) (p < 0.001), respectively. Melanin content and tyrosinase activity in B16F10 cells with or without UVA irradiation were significantly reduced by treatment with BoNT-A in a dose-dependent manner without causing cytotoxicity.

Conclusions: BoNT-A has a potentially beneficial effect in the treatment of melasma due to its antimelanogenic effect.

Trial Registration: Clinical Trial Registry identifier: TCTR20250118001

The rising incidence of thyroid cancer globally is increasing the number of thyroidectomies, causing visible scars that can greatly affect the quality of life due to cosmetic, psychological, and social impacts. In this study, we explored the application of deep learning algorithms to objectively assess post-thyroidectomy scar morphology using computer-aided diagnosis. This study was approved by the Institutional Review Board of Yonsei University College of Medicine (approval no. 3-2021-051). A dataset comprising 7524 clinical photographs from 3565 patients with post-thyroidectomy scars was utilized. We developed a deep learning model using a convolutional neural network (CNN), specifically the ResNet 50 model and introduced a multiple clinical photography learning (MCPL) method. The MCPL method aimed to enhance the model’s understanding by considering characteristics from multiple images of the same lesion per patient. The primary outcome, measured by the area under the receiver operating characteristic curve (AUROC), demonstrated the superior performance of the MCPL model in classifying scar subtypes compared to a baseline model. Confidence variation analysis showed reduced discrepancies in the MCPL model, emphasizing its robustness. Furthermore, we conducted a decision study involving five physicians to evaluate the MCPL model’s impact on diagnostic accuracy and agreement. Results of the decision study indicated enhanced accuracy and reliability in scar subtype determination when the confidence scores of the MCPL model were integrated into decision-making. Our findings suggest that deep learning, particularly the MCPL method, is an effective and reliable tool for objectively classifying post-thyroidectomy scar subtypes. This approach holds promise for assisting professionals in improving diagnostic precision, aiding therapeutic planning, and ultimately enhancing patient outcomes in the management of post-thyroidectomy scars.

The management of HIV-positive psoriasis patients places a heavy burden on the healthcare system, as there are no standard treatment regimens for these patients and the use of biologics has only been reported sporadically. Here, we conducted a systematic review over the past six years and identified 22 articles containing 34 patients treated with inhibitors against tumor necrosis factor alpha (TNF-α), interleukin (IL)-12/23, IL-17, or IL-23. Our analysis focuses on the effectiveness and safety profile of biological agents, highlighting IL-23 inhibitor’s superior clinical response and tolerability for plaque psoriasis in concomitant HIV-positive patients. Therefore, we suggest IL-23 inhibitor as a promising treatment option for moderate-to-severe psoriasis in HIV-positive patients.

Vitiligo is a complex skin disease with multiple genes and multiple targets. Its etiology is complex, and the final link is the death or dysfunction of melanocytes. Melanocytes are derived from neural crest cells, and their mechanism of death is complex. Currently, more studies have focused on apoptosis, necrosis, ferroptosis, and autophagy. Aiming to reveal the key to the terminal stage of vitiligo: the death form of melanocytes, we summarize the origin, differentiation, and migration of melanocytes, analyze the ontogenetic and morphological characteristics of melanocytes and various death forms of melanocytes, and discuss their corresponding mechanism in this reviews.

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.