Dermatologic Therapy最新文献

Background

Partial unilateral lentiginosis (PUL) is a rare acquired hyperpigmented disorder presenting as clusters of small, brown macules on otherwise normal skin, limited to one side of the body, and typically emerging in childhood. Only a few cases of successful treatment have been documented, and a consistently effective therapy for achieving favorable cosmetic results has yet to be established.

Objectives

This study was performed to investigate the effectiveness and safety of golden parameter therapy (GPT) employing a high-fluence 1064-nm Q-switched Nd:YAG laser (QSNL) for the treatment of PUL.

Methods

The study involved 87 Korean patients with PUL, where 79 patients received weekly treatments using a 1064-nm QSNL under GPT for a total of 30–50 sessions. Treatment parameters included a 7 mm spot size, a 2.2 J/cm² fluence, and a 10 Hz pulse rate, with a single pass applied using a sliding-stacking technique over the PUL area. In contrast, a small alternative therapy group of eight patients underwent monthly treatment with a 532-nm picosecond laser for three sessions, using a 3 mm spot size, a 1 J/cm² fluence, and a 2 Hz pulse rate.

Results

Following 30–50 GPT sessions using 1064-nm QSNL, 48 of the 79 patients achieved complete clearance (confluent brown patches type and mixed type: 60.8%), whereas 31 of 79 patients attained excellent clearance (grouped independent lentigines type: 39.2%). No significant side effects, such as purpura, crusting, postinflammatory hyperpigmentation, mottled hypopigmentation, or scarring, were observed. Additionally, no recurrences occurred in any patients over the 6–24-month follow-up period. In contrast, the small alternative therapy group of eight patients treated with the 532-nm picosecond laser showed poor treatment outcomes (100%).

Conclusions

We propose that GPT with a high-fluence 1064-nm QSNL is a new, safe, and effective treatment for PUL, reducing side effects and preventing recurrences.

Background

Intense pulsed light (IPL) therapy has demonstrated clinically satisfactory outcomes as a nonablative and noninvasive modality for skin tightening and rejuvenation. However, no self-controlled study to date has directly compared the efficacy of single-wavelength filter IPL versus multiwavelength filter IPL in the treatment of facial photoaging.

Methods

Twelve patients received three IPL treatment sessions at 4-week intervals. Each patient underwent split-face therapy: one facial side was treated with a single-wavelength filter, while the contralateral side received multiwavelength filter treatment. Photoaging severity was assessed 1 month posttreatment using a standardized grading scale, with objective quantitative measurements obtained via the VISIA-CR imaging system.

Results

Significant improvements in photoaging indicators were observed bilaterally following three IPL sessions. The multiwavelength filter–treated side exhibited superior enhancement in pigmentation, skin texture, and facial laxity compared to the single-wavelength filter–treated side.

Conclusion

Both single- and multiwavelength filter IPL therapies effectively improve facial photoaging. The multiwavelength approach, however, appears to yield superior outcomes, likely due to more targeted photothermal effects on diverse cutaneous chromophores and tissue structures.

Trial Registration: Chinese Clinical Trial Registry: ChiCTR2500112082

Background

Localized scleroderma (LS) is a disfiguring chronic inflammatory disease characterized by fibrosis of the skin and subcutaneous tissue. As the available therapeutic options are limited, developing effective and safe treatment protocols is crucial.

Methods

This study included both animal experiments and a single-arm, open-label clinical trial.

Results

In the animal experiments, ablative fractional carbon dioxide laser (CO₂-AFL) treatment (reaching the deep dermis) improved skin fibrosis, reduced dermal thickness, and induced collagen restructuring, promoting hair follicle proliferation. MMP-1, Krt15, and PCNA clearly increased after treatment. The subsequent clinical trial demonstrated that CO₂-AFL treatment significantly improved the appearance and key parameters of skin lesions in LS patients. The tested therapy was associated with reduced skin hardening, restoration of the adipose tissue structure, and increased hair follicle growth. Following laser treatment, VAS scores decreased from 5.61 (1.09) to 3.90 (1.03), clinical ratings from 5.06 (1.32) to 3.68 (1.49), and ultrasound-based lesion activity scores from 4.79 (1.34) to 2.67 (1.85), all with p < 0.001. No severe adverse effects were observed.

Conclusions

This study underscores CO₂-AFL as a promising therapeutic option for LS patients, elucidating underlying mechanisms and establishing a foundation for advancing future therapeutic strategies.

Trial Registration

Chinese Clinical Trial Register (ChiCTR2200065939).

Background

Phosphodiesterase-4 (PDE4) inhibitors exert therapeutic effects by blocking intracellular signal transduction pathways. Recently, their use in the treatment of psoriasis (PSO) has shown promising results in several clinical trials. However, methodological data on their safety and efficacy are limited.

Methods

A search for randomized controlled trials (RCTs) involving PDE4 inhibitors in PSO and psoriatic arthritis (PsA) was conducted using PubMed, Embase, and Cochrane Library databases from January 2012 to October 2023. For PSO and PsA, the Psoriasis Area and Severity Index (PASI) 75 and the American College of Rheumatology (ACR) 20 were set as the primary efficacy endpoints. Adverse events (AEs) were categorized based on eight human body systems.

Results

A comprehensive analysis of 28 RCTs involving 6825 patients who were orally or topically administered PDE4 was performed. Those who were administered 30 mg apremilast twice daily demonstrated boosted response rates for ACR 20 and PASI 75. To a lesser extent, enhanced response rates for PASI 75 and ACR 20 were observed in patients who received 20 mg apremilast twice daily. Adverse effects were predominantly minor and included diarrhea, nausea, and headache.

Conclusions

The analysis concluded that the efficacy of PDE4 in treating PSO and PsA was superior to that of the placebo, particularly with apremilast at a dosage of 30 mg taken twice daily. The adverse reactions were mild.

Background

Rosacea is a chronic inflammatory skin disorder primarily affecting the face. While conventional treatments include drug interventions and light device interventions. However, their efficacy is often limited. New therapeutic approaches are therefore needed. In this study, we aimed to compare the efficacy and safety of broadband light (BBL) with photodynamic therapy (PDT) (BBL-PDT) and BBL therapy alone in treating rosacea.

Methods

This retrospective study included 52 patients with rosacea treated with either BBL therapy alone or BBL-PDT. Efficacy was assessed using Investigator’s Global Assessment (IGA) success, Clinical Erythema Assessment (CEA) success, telangiectasia improvement, lesion counts, and Rosacea Quality of Life (RosaQoL). Adverse reactions were also recorded.

Results

At the 12th week of treatment, IGA success was achieved in 26.92% patients in the BBL group and 69.23% in the BBL-PDT group (P = 0.002); CEA success rates were 61.54% (BBL) and 73.08% (BBL-PDT) (P = 0.38). Flushing improvement occurred in 65.38% (BBL) and 61.54% (BBL-PDT) (P = 0.77), whereas telangiectasia improvement occurred in 57.69% (BBL) and 61.54% (BBL-PDT) (P = 0.78). The BBL-PDT group showed significantly fewer lesions (P  <  0.001) and lower RosaQoL scores (P = 0.003). However, they reported higher levels of pain (P  <  0.0001) and more local adverse effects.

Conclusion

BBL-PDT is more effective than BBL alone in reducing inflammatory lesions and improving quality of life in rosacea.