Dermatologic Therapy最新文献

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.

Objective: To investigate the distribution characteristics of specific immunoglobulin E (IgE) to dust mite components in patients with atopic dermatitis (AD), aiming to provide a reference basis for the development of microarray protein chips for allergen component discrimination diagnosis and personalized desensitization therapy.

Methods: A total of 55 patients who visited Huishan District People’s Hospital of Wuxi City, Xishan People’s Hospital of Wuxi City, and People’s Hospital of Wuxi City from January 2023 to December 2023 were selected. The results of serum total IgE (total IgE) and specific IgE detection were analyzed.

Results: Among the 55 patients, 54 (98.2%) were positive (cutoff value > 0.35 Ua/mL, the normal value for serum total IgE is under 150–400 IU/mL) for serum total IgE antibodies, 52 (94.6%) were positive for Dermatophagoides pteronyssinus (Dp)–specific IgE antibodies, and 50 (90.9%) were positive for Dermatophagoides farinae (Df)–specific IgE antibodies. The protein chip results were consistent with the existing Phadia detection results.

Conclusion: The development of chips based on CRD (component-resolved diagnosis) cannot only rely on IgE binding rate to assist in precise treatment of patients but also choose personalized desensitization therapy, providing more practical recommendations for preventing cross-allergy, avoiding allergic environments, or ingesting sensitizing foods for susceptible individuals.

Dermatophyte infections of the skin and nails are frequent, but current antimycotics have several drawbacks. In search of new treatments, we looked into the vast array of herbal active agents. Derived from plants, they are sustainable, agreeable for patients, and may have less side effects than traditional antimycotics. In this study, we assessed 43 herbal agents for their effectiveness against Trichophyton rubrum (T. rubrum), Trichophyton benhamiae (T. benhamiae), Trichophyton tonsurans (T. tonsurans), and Microsporum canis (M. canis), four major human dermatophyte pathogens. The antifungal effect was tested by incorporating the agents into agar plates and measuring the dermatophyte growth after 7 days. Against T. rubrum, 16 out of 43 herbal agents showed total inhibition of dermatophyte growth. 14 out of 43 herbal agents inhibited the growth of T. benhamiae completely. 18 out of 43 herbal agents were effective against T. tonsurans. Against M. canis, 15 out of 43 herbal agents showed total growth inhibition. Twelve herbal agents inhibited the growth of all tested dermatophytes completely. This study demonstrates the high antimycotic potential of herbal therapeutics and identified promising candidates for the topical treatment of dermatomycoses. Substances are highly agreeable and should be tolerated well. Some might even provide new options for the systemic treatment of fungal diseases.

Studies find climate therapy (CT) at the Dead Sea of psoriasis efficient for induction therapy, but few studies address disease relapse, long-term maintenance using CT, confounders, and the patient perspective. CT combines sunlight, balneotherapy, stress reduction, and education. This study aimed to examine Dead Sea CT and relapse of psoriasis over a 2 years period, patients’ satisfaction, and treatment outcome and preference relative to other therapies. A structured questionnaire was offered to patients, who during the recent 2 years had undergone a 4 week course of CT at the Dead Sea. Patients included applied for a new CT session due to relapse of their psoriasis. Questionnaire items covered their recall of relapse, disease severity, potential triggers of relapse and patient’s preference relative to other treatment options. The study enrolled 40 patients, with an average age of 55.5 years. CT was highly effective and resulted in marked reduction in the affected skin area, from 16% to less than 1% of the body surface. The median time from CT to first visible new lesion was 4.8 months, to first bothersome relapse 6.1 months and to full blown relapse 8.0 months. Patient satisfaction with conventional therapeutic modalities, especially oral methotrexate, was reserved, and CT was generally preferred. Relapse after CT was an inclusion criterion, and patients with long-lasting healing were not assessed. CT for 4 week treatment course of moderate to severe psoriasis at the Dead Sea which was studied in patients with relapsing disease was highly efficient for induction for clearing of the skin, matching new biologicals. In the studied group, return to prestate level took median 8 months on average. Patients’ satisfaction with CT scored high, and maintenance through repeated Dead Sea treatments often is best treatment of this segment having intolerance or poor effect of other treatments, or fear of medicines as a personal attitude.

Background. Keloids are benign fibroproliferative tumors that are unique to humans. However, the exact mechanism of keloid formation remains unclear. The inflammatory cytokines released by immune cells can activate fibroblasts, connective tissue cell proliferation, and angiogenesis. Hypoxia is common in the process of fibrosis in many diseases. This study aimed to investigate the relationship between immune response, hypoxia, and keloid formation. Methods. Gene methylation and expression data were downloaded from the GEO database. Thereafter, differentially methylated genes associated with immunity and hypoxia were identified. Machine learning was performed to identify potential diagnostic/immunity/hypoxia-related differentially methylated/expressed genes, followed by analysis of functional enrichment, transcription factors, protein-protein interactions, and expression validation by reverse transcription quantitative polymerase chain reaction and immunohistochemistry. Results. In total, 16 immunity/hypoxia-related hypermethylated low-expression genes and 18 immunity/hypoxia-related hypomethylated high-expression genes were identified in keloids. Based on machine learning, nine differentially methylated and expressed genes were selected as potential diagnostic markers for keloids, including two hypoxia-related genes (CDKN1A and PGAM2) and seven immunity-related genes (DCD, PTGDS, WFIKKN1, SEMA5A, IL1R1, ITGAL, and SOS1). Some significantly enriched signaling pathways were identified, including the FoxO, PI3K-Akt, focal adhesion, and ErbB signaling pathways. SOS1 is involved in disease regulation with 65 transcription factors and has a higher interaction score with other molecules. Conclusions. Two hypoxia-related genes (CDKN1A and PGAM2) and seven immunity-related genes (DCD, PTGDS, WFIKKN1, SEMA5A, IL1R1, ITGAL, and SOS1) could be considered potential diagnostic markers for keloids, and may be helpful in understanding the importance of oxygen balance and immune regulation in keloids.