Dermatologic Therapy最新文献

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.

Facial threading, a popular nonsurgical cosmetic procedure, involves inserting threads into the skin to lift, tighten, and rejuvenate facial tissues. Threads made of materials like polydioxanone or poly-L-lactic acid cater to different treatment needs but have sparked controversy regarding their effectiveness. Originally inspired by theories in acupuncture, this technique aimed to induce tissue contraction and firmness. Modern advancements expanded its focus beyond skin layers, targeting deeper connective tissues to enhance firmness and stimulate fibroblast activation and proliferation. Recent trends emphasize combined therapies, including fillers, botulinum toxins, and energy-based devices, to create overall facial harmony rather than merely lifting or tightening specific areas. Mono threads have evolved from basic designs to volume threads, offering skin tightening, acting as fillers, and modifying facial shapes. They stimulate collagen regeneration, tissue metabolism, and fat tissue liquefaction, reducing volume and enhancing skin quality. The primary effects of these threads are supportive, akin to reinforcing concrete blocks, while barbed threads offer lifting effects by anchoring tissues upwards, inhibiting muscle movements that cause wrinkles. Histologically, threads induce tissue reactions, leading to fibrosis, but debates persist about the lasting lifting effects after complete thread absorption. Ongoing innovations focus on thread designs to optimize cosmetic outcomes, requiring evaluation for desired aesthetic goals. Despite widespread use, ongoing research aims to clarify mechanisms and improve thread designs for better cosmetic results.

There have been several reports of dupilumab use and the development of CTCL; however, the risk of CTCL development has not been adequately evaluated at the population level. The objective of this study is to determine whether dupilumab administration for AD is associated with an increased risk of developing CTCL and to identify at-risk populations within this group. This retrospective cohort study used TriNetX, a deidentified medical record database including over 107 million patients, to identify eligible patients. Treatment and control groups were evaluated for the development of CTCL. Patients of any age with a documented diagnosis of AD were included. The treatment cohort included individuals treated with dupilumab, while the control cohort included AD patients treated with alternative therapies. Selected biologics were excluded from both groups. Subgroup analyses were performed to evaluate three age groups and to identify whether the risk of CTCL development was higher within a given time frame after starting dupilumab. We identified a total of 1,181,533 patients with AD. Of these, 19,612 patients were prescribed dupilumab. Both treatment and control groups included 19,612 patients matched for age, race, and sex. The mean age was 32.3 years (P = 0.96), and females accounted for approximately 52% (P = 0.93) in both groups. Patients treated with dupilumab for AD had an increased relative risk (RR) of developing CTCL compared to those never treated with dupilumab (RR = 4.59, 95% confidence interval 2.459–8.567, P < 0.0001). Subgroup analysis revealed that about half of the CTCL cases after dupilumab therapy (54.5%, 30/55) occurred in patients over the age of 60 years. In contrast, all CTCL cases (100%, 12/12) within the untreated cohort were observed in individuals over the age of 60. Of the patients diagnosed with CTCL following dupilumab use, the majority (62%, 34/55) were diagnosed within the first year. Overall, we find that the use of dupilumab for treating AD is associated with an increased relative risk of developing CTCL. This risk is highest in the first year of therapy and in adult patients. These findings suggest exercising caution in treating select groups of patients with dupilumab.

Introduction. Hyaluronic acid fillers are widely used to correct nasolabial folds. This treatment provides favorable aesthetic outcomes. The aim of this study was the safety and efficacy evaluation of Lunaphil Ultra intradermal filler for correcting nasolabial folds in the Iranian population with Fitzpatrick skin types III and IV. Methods. In this before and after clinical study, Lunaphil Ultra dermal filler was injected in nasolabial folds of 24 female and 6 male volunteers (mean age: 43.36 and SD: 11.55). Two independent physicians assessed the severity of nasolabial folds before injection and 2, 12, and 24 weeks later, according to the Allergan scale. The volume, depth, and area of both nasolabial folds and the thickness and density of the dermis in the right nasolabial fold were also measured. Adverse events and subject satisfaction were also recorded. Results. One grade or more improvement was detected in 81%, 57%, and 65% of participants at weeks 2, 12, and 24, respectively. The median score for the Allergan scale decreased significantly in all follow-up visits. The median value of the area of nasolabial folds significantly reduced in all follow-up visits. Two weeks after injection, dermis density showed a significant increase. The mean score for pain level during the injection was 1.96 out of 10. Adverse events were mild and transient. The median satisfaction scores were 9-10 out of 10 at different visits. Conclusion. The findings showed that cross-linked hyaluronic acid dermal filler containing lidocaine could be applied in clinical practice for correction of nasolabial folds in skin types III and IV, with high safety and efficacy. More comprehensive future research could approve these results. This trial is registered with IRCT20150101020514N11.