Dermatologic Therapy最新文献

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.

Background. Both stromal vascular fraction (SVF) and extracellular matrix (ECM) are of great concern to adipogenesis and angiogenesis. SVF and ECM are rich in adipose tissue and may provide structural and biochemical support and form a microenvironment for free granular fat. The present study was to investigate whether SVF-gel, a mixture of SVF and ECM harvested by mechanical emulsification, could improve the long-term volume retention of fat grafts. Methods. Human SVF-gel of different percentages was mixed with microfat. According to the percentages of SVF-gel into microfat, 4 groups were included in the study; they are the microfat group, 10% gel group, 30% gel group, and gel group. The fat grafts were transplanted in the subcutaneous layer on each flank in nude mice. The sample volume was measured to evaluate the fat retention rate 90 days post-transplantation. Tissue integrity, collagen content, numbers of viable adipocytes, and density of blood vessels were examined by further detection. Results. The retention volume rates in the 30% gel group and gel group were significantly higher than the microfat group and the 10% gel group (p < 0.05). Equivalent fat integrity was observed in the four groups. Higher collagen volume, enhanced mRNA expression of VEGF, TNF-α and adiponectin, more CD31-positive blood vessels, and more regenerative adipocytes were observed in the 30% gel group and the gel group. The fat tissue in the 30% gel group showed similar structures as the normal fat tissue, while almost of the tissue in the gel group exhibited as fibrous tissue. Conclusion. SVF-gel could improve fat graft retention while it came to a certain ratio into microfat via proangiogenic effect and fat regeneration which may be provided by SVF and ECM synergistically. SVF-gel-assisted fat grafting is a promising strategy to be used in clinical operations.

Senile gluteal dermatosis (SGD) is an underdiagnosed skin condition that mostly affects the elderly. It appears as hyperkeratotic or lichenoid papules or plaques over the gluteal area, unilaterally or bilaterally. The etiopathogenesis of this condition is not yet known, but it is considered to be caused by prolonged mechanical stress on the affected area leading to neovascularization and epidermal hyperplasia. SGD poses unique problems in diagnosis and management due to its clinical characteristics and histological findings matching other common conditions. Due to its lesser-known status, it is frequently misdiagnosed as lichen simplex chronicus, inverse psoriasis, or cutaneous amyloidosis, which results in a variable response to treatment. Lifestyle modifications aiming at reducing pressure at the affected site remain the mainstay of treatment, but some reports have shown better results with topical or systemic retinoids. SGD is underreported in the scientific literature and is still not mentioned significantly in textbooks. This review attempts to give a thorough overview of SGD regarding its clinical presentation, etiology, pathogenesis, dermoscopy, diagnostic standards, differential diagnoses, and accessible treatments. Healthcare practitioners can enhance early recognition and provide the right care for afflicted people by raising knowledge and understanding of this disorder.

Background. Lichen planopilaris is the leading cause of cicatricial alopecia, and its management is challenging for dermatologists. It is a cell-mediated autoimmune disorder in which activated T-lymphocytes attack hair follicles. Aim. To compare the efficacy and safety of methotrexate versus azathioprine, two medications that affect lymphocyte function, in treating LPP. Methods. 32 LPP patients were randomly assigned to receive either 15 mg/week methotrexate or 2 mg/kg azathioprine for six months. Treatment efficacy was evaluated using the Lichen Planopilaris Activity Index (LPPAI), trichoscopy, and photography after 2, 4, and 6 months of treatment. Results. Both methotrexate and azathioprine groups showed significant improvements in LPPAI (P < 0.001) and perifollicular scaling on trichoscopy (P < 0.01). However, the two groups had no significant difference during the study. The azathioprine group significantly improved perifollicular erythema on trichoscopy (P = 0.002), but this was not significantly different from the methotrexate group (P = 0.69). Photographic assessment showed that more than 75% of patients in both groups improved without significant differences between the two groups. Conclusion. Methotrexate and azathioprine are two antilymphocyte medications which are both equally effective and well-tolerated for managing LPP. This trial is registered with IRCT20191006045005N2.

Diverse cutaneous adverse reactions associated with the messenger RNA-based BNT162b2 coronavirus disease 2019 (COVID-19) vaccine have been reported, usually developing within 3 weeks after the first vaccination. However, the long-term cutaneous effects of this vaccine remain poorly understood. We hypothesized that the BNT162b2 vaccine might trigger late-onset (>4 weeks after the first dose) maculopapular eruptions associated with elevated varicella-zoster virus (VZV) complement-fixing antibody (VZV-CF Ab) titers indicative of recent subclinical VZV reactivation. Therefore, we conducted a hospital-based cross-sectional study at the Dermatology Department of Kita-Harima Medical Center, Ono City, Japan, between July 1, 2021, and June 30, 2022, to investigate the correlations among the BNT162b2 vaccine, maculopapular eruptions, and VZV-CF Ab titers. Fifteen eligible patients (EPs) who experienced maculopapular eruptions on the trunk and extremities no earlier than 4 weeks after the first BNT162b2 vaccine dose and 12 control patients (CPs) were enrolled. The mean age of EPs and CPs was 73.7 and 77.6 years, respectively, and the median interval between the first BNT162b2 vaccination and onset of maculopapular eruptions was 90 days. The median VZV-CF Ab titer of EPs was significantly higher than that of CPs (×8 vs. ×4). Although people of all ages, except children aged ≤12 years, received BNT162b2 vaccinations, all EPs were aged ≥57 years. All EPs presented between July 2021 and March 2022. There were no EPs from April 2022 to December 2023. These results suggest that the BNT162b2 vaccine triggers elevated VZV-CF Ab titer-associated maculopapular eruptions as late-onset cutaneous adverse reactions in older adults. Furthermore, the observation that two EPs concurrently experienced delayed large local reactions, also known as COVID arm, along with maculopapular eruptions, supported our hypothesis. Our findings may improve the diagnosis of BNT162b2 vaccine-triggered elevated VZV-CF Ab titer-associated late-onset maculopapular eruptions and facilitate further investigation of diverse BNT162b2 vaccine-induced adverse events.

Background. Rapid efficacy is an important item to psoriasis patients. Risankizumab, a humanised immunoglobulin G1 monoclonal antibody that inhibits IL-23, has demonstrated early and sustained efficacy in patients with moderated-to-severe psoriasis. Effectiveness data in real world, particularly regarding short-term response, however, are scarce. Objective. To explore the short-term effectiveness of risankizumab in patients with moderate-severe psoriasis in normal clinical practice. Methods. This was an observational, retrospective, multicentre study carried out at thirteen hospitals in Valencia, Spain. It was conducted on a sample of adult outpatients over 18 years of age, diagnosed with moderate-to-severe psoriasis who received at least one subcutaneous injection of 150 mg of risankizumab. Psoriasis Area and Severity Index (PASI) was used to assess the short-term (4 weeks) effectiveness of risankizumab. Results. One hundred and sixteen patients (63.8% men) with a mean age (standard deviation (SD)) of 50 (16) years were included in the study. 90.6% were overweight or obese, and 22.7% were biologic-naïve. The mean (SD) PASI score decreased from 11.9 (7.2) at the baseline to 3.3 (2.7) at week 4, with a median (SD) PASI score reduction of 8.6 (2.3) (p < 0.05). The absolute PASI score of <2 was reached by 52.6% of patients. Overall, PASI scores of 75, 90, and 100 were achieved in 56%, 37.1%, and 25.9% of patients, respectively, at week 4. PASI 90 was achieved by a significantly higher proportion of naïve patients than biologic-experience failure patients (59.3% vs. 30.3%; p = 0.01). Conclusion. This study, which reflects our initial risankizumab experience in a real-life setting, seems to show quick effectiveness in psoriasis treatment after one single dose. This trial is registered with NCT04862286.

Introduction. Increasing microbial resistance to conventional pharmaceuticals calls for nonpharmaceutical treatments of vaginitis. This systematic review summarizes the efficacy of the antiseptic agent boric acid (BA) as a treatment option for microbial vaginitis in comparison to conventional therapies and proposes clinical recommendations. Materials and Methods. PubMed and Embase were searched for “boric acid” and “microbial vaginitis.” A protocol was registered on PROSPERO (CRD42020160146). Inclusion criteria included clinical trials, observational and interventional studies, including case series/reports. Exclusion criteria included in vitro and animal studies, non-English language, and no BA treatment outcome. Primary outcomes included microbial, clinical, and complete cure. Secondary outcomes included adverse events, relapse/reinfection rates, evidence levels, microorganisms, treatment regimens, and follow-up time. Data were extracted to a predefined Excel sheet. Results. Of 195 identified unique articles, 54 were retrieved and 41 met our inclusion criteria. Heterogeneity precluded the conduction of a meta-analysis. Conclusion. An average cure rate of 76% was found for vulvovaginal candidiasis BA treatment. Recurrent bacterial vaginosis was controlled with BA and 5-nitroimidazole with promising results. Maintenance BA was equal to maintenance oral itraconazole therapy in vulvovaginal candidiasis and bacterial vaginosis in a retrospective study. Prolonged BA monotherapy cured three of six recurrent Trichomonas infections. Adverse events (7.3%) were typically mild and temporary. Based on our findings and the rising antimicrobial therapy resistance, we suggest intravaginal BA 600 mg/day for 2 weeks for (recurrent) vulvovaginal candidiasis and 600 mg/day for 2-3 weeks for recurrent bacterial vaginosis. Rare resistant Trichomonas infections can be treated with BA 600 mg × 2/day for months and in combination with oral antimicrobials. We suggest a maintenance regimen of BA 600 mg × 2/week for recurrent vulvovaginal candidiasis. In case of resistant bacterial vaginosis, we suggest BA 600 mg × 2-3/week. Data on maintenance therapy and BA treatment of bacterial vaginosis and trichomoniasis are however limited.

Introduction. Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent painful or suppurative lesions due to follicular occlusion. Biologics and other treatment modalities such as surgical excision are commonly used in the treatment of severe HS. However, despite the frequent use of biologics and surgical interventions in the treatment of patients with HS, an assessment of their combined effects is lacking. This systematic review aims to qualitatively analyze the efficacy of combined biologic and surgical treatment for HS. Methods. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed. The databases PubMed (MEDLINE), Embase, Cochrane (CENTRAL), ClinicalTrials.gov, MedRxiv.org, and the International Clinical Trial Registry were searched from inception until May 1, 2023. Results. A total of 1,145 studies were screened, with eight studies included for data extraction. Patients receiving combined biologic and surgical treatment showed greater improvement in the severity measurements of HS, including HS Impact Assessment, HS Physician Global Assessment, HS Sartorius Score, International Hidradenitis Suppurative Severity Score, HS recurrence rate, and Dermatology Life Quality Index. However, three studies reported a prolongation of wound healing with combined biologic and surgical treatment. Conclusion. Our systematic review highlights the additive effects of using biologics and surgery together to treat HS compared to either treatment alone. However, when both treatment modalities are used simultaneously, the potential risk of prolonged wound healing must be considered. Due to the limited number and heterogeneity of the included studies, more clinical trials are needed to establish diagnostic conclusions.