Dermatologic Therapy最新文献

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.

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.