Dermatologic Therapy最新文献

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.

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.