Dermatologic Therapy最新文献

Introduction. Rosacea is a common chronic inflammatory skin disease of the central facial skin with unknown origin, significantly impacting quality of patient’s life and causing various psychosocial problems. Erythematotelangiectatic rosacea (ETR) is characterized by paroxysmal flushing that occurs repeatedly and is easily resistant to therapeutic drugs. While microinjection of type A botulinum toxin (BTX) can treat ETR, there is no consensus on the injection dose, and strong evidence to verify its efficacy and safety is lacking. This randomized, double-blind, split-face clinical study aimed to investigate the efficacy, safety, and optimal dose of two different single-point injection doses (0.5 U and 1 U) of BTX in the treatment of rosacea. Methods. Twenty-six patients with ETR were randomly assigned to receive different single-point injections of BTX (0.5 U and 1 U, respectively) every 1 cm on one half of the face. The Clinical Erythema Score (CEA), VISIA red area absolute value, Global Aesthetic Improvement Scale Score (GAIS), and recurrence at 12-week follow-up were evaluated at baseline, 2,4, 8, and 12 weeks after injection. Additionally, the Dermatological Quality of Life Index (DLQI) questionnaire survey and adverse reactions were also recorded. Results. All twenty-six patients completed the follow-up visits and were included in the analysis. Compared to the 0.5 UBTX-treated side, the CEA score showed significantly improvement in erythema and flushing at 2, 4, and 8 weeks after injection on the 1 U BTX-treated side (P < 0.05). The mean absolute value of the red area of VISIA was -19.12 ± 51.91 on 1 U BTX-treated side and 2.5 ± 42.08, on 0.5 UBTX-treated side at 4 weeks after treatment, showing significant improvement on the 1 U side (P < 0.05). GAIS and DLQI were also significantly improved from Week 4 to Week 12 and Week 2 to Week 12, respectively (P < 0.05). There was no recurrence of symptoms with either 0.5 U or 1 U injection by 12 weeks. Apart from one patient who experienced facial tightness and three patients who had temporary aggravation of erythema, all of which resolved without treatment, 22 patients did not report any side effects except for injection pain during the procedure. Conclusions. BTX-A can significantly improves symptoms and quality of life in patients with refractory rosacea with few side effects. A single-point injection of 1 U was more effective. This trial is registered with NCT06282679.

Background. Recent studies have revealed that antibiotics are yielding unsatisfactory outcomes in certain patients with acne. Therefore, attention was drawn to antibiotic resistance as a rapidly growing problem that might lead to treatment failure. Objective. The study aims to assess the antibiotic susceptibility patterns of Cutibacterium acne isolates in a sample of Egyptian patients to the antibiotics most frequently prescribed for acne vulgaris. Methods. A total of 155 patients with moderate to severe acne were included in the study. Skin swab samples were collected and inoculated. Cutibacterium acnes was identified based on colonial morphology, Gram stain, and biochemical reactions and further confirmed by VITEK 2 automated systems. Antibiotic susceptibility tests were performed using minimum inhibitory concentrations determined by the Epsilometer test. Results. Cutibacterium acnes was detected in 50 samples (32.2%), alone in 17 (10.9%), and in combination with Staphylococci in 33 (21.3%) cases. The results of the antibiotic susceptibility testing revealed high resistance to erythromycin, followed by clindamycin, tetracycline, trimethoprim/sulfamethoxazole, and doxycycline. Conclusion. Cutibacterium acnes showed high resistance rates to most antibiotics used in the clinical treatment of acne vulgaris.

Background. Port-wine stains (PWS) affect a substantial number of people, and despite the use of pulsed dye laser as the gold standard therapy, some patients fail to respond, and new modalities are needed. Recently, hemoporfin-photodynamic therapy (hemoporfin-PDT) has shown good efficacy and safety in treating PWS, with increasing evidence. Objectives. To evaluate the efficacy and safety of hemoporfin-PDT in the treatment of PWS and to analyze the factors that influence efficacy. Methods. The clinical data of 215 patients (79 men and 136 women aged 3–71 years) from a single center were retrospectively analyzed, out of which 173 were valid for efficacy analysis and 129 for safety analysis. Efficacy was rated as excellent (≥75% improvement), good (≥50% to <75% improvement), fair (≥25% to <50%), and poor (<25% improvement) by two blinded dermatologists. The patient-assessed efficacy was collected based on the aforementioned criteria using an electronic questionnaire. The association of efficacy with possible influential factors was investigated, namely, age, sex, history of previous treatment, combined scars caused by previous treatments, lesion site, lesion type, lesion size, degree of lip involvement, and number of hemoporfin-PDT sessions. Adverse events were investigated to evaluate the safety profile. Results. Excellent, good, fair, and poor efficacy was achieved in 78 (45.1%), 38 (22.0%), 36 (20.8%), and 21 (12.1%) patients, respectively, after a variable number of sessions of hemoporfin-PDT. More treatment sessions (p < 0.001), age ≥18 years (p = 0.037), no previous treatments (p = 0.020), and head/neck location (p = 0.009) were associated with better outcomes. Pain, edema, exudation/crusting, and hyperpigmentation were common adverse events, with satisfactory recovery. Scarring occurred in 2.3% of the patients. Conclusions. For treating PWS with hemoporfin-PDT, more treatment sessions and head/neck location are predictors of better outcomes, whereas previous treatment history is a predictor of poorer outcomes.

Advanced melanoma and nonmelanoma skin cancer or cutaneous metastases not amenable to surgery often require alternate therapy. Although surgery is first-line treatment for early-stage melanoma, it can be challenging with multifocal disease, sites with high morbidity, large lesions such as lentigo maligna on the head and neck, and patients with comorbidities that add surgical risk. Intratumoral therapy is a safe method of treating advanced melanoma which avoids the toxicities of systemic therapies. Our review examined the overall response rates and adverse effects of the following experimental and standard intralesional agents: ipilimumab, rose bengal (PV-10), cathelicidin LL37, SD-101, coxsackie A21 V937, and talimogene laherparepvec. Injection of oncolytic virus, immune-modulating drugs, cytotoxic agents, or studied combinations was well-tolerated and effective alternative treatments for advanced melanoma and cutaneous metastases. Response to treatment was observed in both injected and noninjected lesions demonstrating systemic antitumor effects of these intralesional therapies. Further utility of intralesional agents can be explored as neoadjuvant treatment of large lentigo maligna lesions or those in cosmetically sensitive areas. Intralesional therapy should be developed further for morbidity reduction in challenging melanoma cases.

Topical dapsone is an alternative medication for acne treatment. However, which topical dapsone formulation is superior remains uncertain. Furthermore, data on the efficacy of dapsone compared with other topical acne treatments are lacking. We aimed to review the efficacy and safety of topical dapsone at different concentrations and to compare it with other topical acne treatments. We systematically reviewed literature related to the use of topical dapsone in treating acne published from January 2005 to September 2022. We searched databases from selected research studies for inclusion criteria and performed a network meta-analysis to compare the efficacy of using dapsone at different concentrations. Nine eligible studies were identified; among these, two studies with 7,350 patients were analyzed using network meta-analysis. At 12 weeks, the percentage of achieving a Global Acne Assessment Score and the mean percentage reduction in inflammatory acne were higher with 7.5% than with 5% dapsone, but the difference was not statistically significant. However, the mean percentage reduction in noninflammatory acne and total acne lesion-count at 12 weeks was lower with 7.5% than with 5% dapsone, but the difference was not statistically significant. Both concentrations of dapsone were more effective in treating inflammatory than comedonal acne and particularly effective in female patients and those aged ≥18 years. The side effects of dapsone were mild. Thus, topical dapsone is an effective alternative treatment for acne. Both concentrations of topical dapsone are effective in treating acne with no significant difference in efficacy and minimal side effects.

The efficacy of platelet-rich plasma (PRP) therapy for androgenic alopecia (AGA) varies among diverse populations. While prior research has emphasized the pivotal role of growth factors as active components in PRP, the specific relationship between growth factors and treatment outcomes of AGA remains unclear. This study aims to explore how the efficacy of PRP therapy for AGA is influenced by the types and concentrations of growth factors. The analysis of PRP samples from 46 AGA patients involved assessing seven growth factors using an enzyme-linked immunosorbent assay. Patients received a course of three PRP treatments along with traditional medicines. The assessment of treatment outcomes involved conducting trichoscopy tests before and after the treatment, measuring both hair density (HD) and hair caliber (HC). The findings revealed that HD increased in 36 patients, positively correlating with glial cell-derived neurotrophic factor (GDNF) concentration (p = 0.005). In addition, HC increased in 35 patients, demonstrating a positive correlation with platelet-derived growth factor-BB (PDGF-BB) concentration (p < 0.05). Notably, a gender-based analysis identified a statistically significant difference in HC increase post-PRP therapy (p = 0.005). In addition, no correlations were observed between demographic factors and changes in HD/HC (p > 0.05). The study confirms the beneficial influence of certain growth factors in PRP on AGA treatment outcomes. Future research should further clarify their mechanisms in promoting hair growth, paving the way for the development of novel therapeutic agents.

Background. Current psoriasis treatment goals emphasize achieving complete or near-complete skin clearance while preserving the quality of life, necessitating treatment modification for a suboptimal or inadequate response. Despite risankizumab’s demonstrated efficacy, evidence remains limited for patients switching from ustekinumab, particularly those with suboptimal or inadequate response. Objective. This study assesses risankizumab’s real-world effectiveness in patients with suboptimal response (PASI 2-3), inadequate response (PASI 3–5), or failure (PASI >5) to ustekinumab, based on a multicenter retrospective cohort in Spain. Method. A multicenter retrospective study across 24 Spanish hospitals included 102 patients previously treated with ustekinumab and switched to risankizumab. Results. Out of 102 patients, 78 experienced ustekinumab treatment failure (PASI >5), while 24 had an inadequate response (PASI 3–5), including 6 with a suboptimal response (PASI 2-3). Remarkably, after one year of treatment with risankizumab, all patients demonstrated improvement, achieving near-complete or complete skin clearance (PASI 0-1). Conclusion. Risankizumab displayed effectiveness in patients with suboptimal/inadequate response or treatment failure to ustekinumab, aligning with the current treatment goals of complete or near-complete skin clearance. These real-world results corroborate clinical trial data, emphasizing risankizumab’s potential as a powerful therapeutic alternative for this patient population. Further prospective studies are essential to validate these findings.

Background. Dupilumab has shown good effectiveness and safety in patients with moderate-to-severe atopic dermatitis. However, there is a lack of clinical data that focuses solely on the treatment response for the endpoint to observe the short-term goal (12 weeks) in the treatment-to-target (T2T) concept. Study on predictors of early treatment response is also limited. Objective. To evaluate the early effectiveness and safety of dupilumab in the treatment of moderate-to-severe atopic dermatitis and to identify possible predictors of response. Methods. Using a retrospective study method, patients with moderate-to-severe atopic dermatitis who received dupilumab for ≥12 weeks at the Southwest Hospital between September 2019 and April 2022 were included. Results. Totally 16.25% of patients achieved EASI75 after 4 weeks and 53.75% achieved EASI75 after 12 weeks. SCORAD, EASI, and NRS were 50.17 ± 17.35, 13.51 ± 12.33 and 7.10 ± 1.82 in turn at baseline, and decreased to 29.94 ± 15.01, 6.97 ± 7.92, 3.64 ± 1.39 and 14.96 ± 10.31, 3.05 ± 4.16, 2.19 ± 1.09 after 4 and 12 weeks, respectively, with statistically significant differences (p < 0.01). After 12 weeks, the changes in peripheral blood eosinophil count (decreased from (0.60 ± 0.43) ∗ 10^9/L to (0.30 ± 0.21) ∗ 10^9/L), total IgE level (decreased from 547.00 (179.00, 2167.50) IU/ml to 216.50 (106.00, 825.00) IU/ml), and LDH (decreased from (166.11 ± 171.59) IU/L to (67.54 ± 70.68) IU/L) from baseline were significant (p < 0.01). Elevated peripheral blood eosinophil counts might be associated with an inadequate response to dupilumab (SCORAD12w: p = 0.007; EASI12w: p = 0.003; NRS12w: p = 0.030). The most common adverse events were reactions at the injection site (6/80) and conjunctivitis (4/80). Conclusion. Dupilumab showed good early effectiveness and safety in real-world practice in Chinese patients with moderate-to-severe atopic dermatitis.

Isotretinoin (ISO) is a synthetic retinoid approved for the treatment of acne vulgaris. Despite satisfactory results, it is still controversial due to numerous adverse events (AE). However, there is a lack of literature examining the factors affecting the frequency and severity of these AEs. Lifestyle patterns may have an impact as they have the greatest impact on a person’s overall health. The aim of the research is to evaluate the impact of lifestyle patterns on the occurrence and severity of systemic ISO AEs in patients suffering from acne. A retrospective cohort study was conducted using a database of collected information about adults diagnosed with acne and treated with systemic ISO. Patients were divided into several groups according to their smoking status (nonsmokers, smokers), BMI (normal weight, overweight), physical activity (active, inactive), and compliance with the Mediterranean diet (adherent, not adherent). Considering all mentioned lifestyle factors, responders were categorized into healthy and unhealthy lifestyle groups. 124 adults with acne, undergoing systemic ISO therapy, made up the study group. There were generally no significant differences in patient characteristics across groups (P > 0.05). Almost all classes and subclasses of AEs showed no significant differences in groups (P > 0.05). ISO is still the most effective drug in the treatment of acne and despite the AEs, therapy should not be abandoned. Moreover, lifestyle factors such as physical activity, smoking, and eating habits do not affect the incidence and severity of AEs, which proves the safety of ISO regardless of unhealthy habits.

Background. Atopic dermatitis control tool (ADCT) is a patient-reported measure to assess disease control of atopic dermatitis (AD), consisting of the severity of symptoms, itch duration, bother, sleep, daily activities, and mood/emotions. Objectives. We evaluated the alterations of total and individual ADCT item scores during treatment with Janus kinase 1 inhibitor upadacitinib in AD patients. Methods. Forty-seven patients aged ≥12 years with moderate-to-severe AD were treated with oral upadacitinib 15 mg/day plus topical corticosteroids. Total and individual ADCT item scores, eczema area, and severity index (EASI) and peak pruritus numerical rating scale (PP-NRS) were evaluated. Results. Before treatment, total ADCT correlated with EASI and PP-NRS. The median percent reduction at months 1, 3, and 6 of upadacitinib treatment was 80%, 76.2%, and 67.4% in total ADCT, 75.28%, 85.06%, and 81.73% in EASI, 66.67%, 75%, and 75% in PP-NRS, respectively, and percent reduction of total ADCT correlated with that of EASI and PP-NRS except for no correlations with that of EASI at month 1. The percent reduction of ADCT no.4 was the highest among the 6 items. Conclusions. These results suggest that changes in ADCT reflect the therapeutic effects of upadacitinib and that ADCT can be a treatment target for upadacitinib therapy. Upadacitinib might preferentially improve sleep disturbance.