Dermatologic Therapy最新文献

Background. Breaking the itch-scratch cycle and facilitating lesion healing are pivotal in managing prurigo nodularis (PN). This study seeks to assess the efficacy of baricitinib, an oral JAK1/2 inhibitor, for treating PN. Methods. In this prospective pilot study, 12 patients with moderate to severe PN were administered oral baricitinib at a dosage of 4 mg/day for 12 weeks. The primary objective was to assess the efficacy of baricitinib in PN patients using the numeric rating scale (NRS) for pruritus, NRS sleep score, a 5-point investigator’s global assessment (IGA) scale, dermatology life quality index (DLQI), and nodular lesion count at weeks 0, 1, 2, 4, 8 and 12. In addition, the NRS pruritus and sleep scores were assessed via phone on days 2 and 4 after baricitinib treatment. Results. Baricitinib treatment led to a statistically significant improvement in the mean NRS pruritus and sleep scores, evident as early as day 2 (57.7% change from baseline; P < 0.001, and 34.7% change from baseline, P = 0.029, respectively) and consistently declining thereafter. Evaluation of nodular lesions revealed a significant reduction starting from week 2 (mean difference of 37.08 from baseline; P < 0.001). Analysis of other endpoints, including mean DLQI and IGA scores, also demonstrated substantial improvement at all time points (week 1, 2, 4, 8, and 12) compared to baseline. However, it is important to acknowledge the limitation of a small sample size. This constraint warrants consideration when interpreting the results and generalizing the findings. Conclusion. This preliminary study underscores baricitinib’s potential for PN treatment by providing a rapid clinical response. The larger and longer randomized controlled trials are essential to determine the effectiveness, longevity, and safety of baricitinib in managing PN. This trial is registered with TCTR20230227002.

The vehicles used for topical dermatological treatments can significantly contribute to treatment effects while also delivering ingredients to maintain skin barrier function and reduce irritation. Tazarotene 0.045% lotion was developed using proprietary polymeric emulsion technology to provide uniform and efficient delivery of the active ingredient as well as improved safety and tolerability compared to higher-dose tazarotene formulations. The lotion vehicle additionally provides rapid and sustained improvements in moisturization and skin barrier function with patient-friendly application and cosmetic properties. Compared with trifarotene 0.005% cream, tazarotene 0.045% lotion demonstrated ∼30% greater spreadability and a lower potential for irritation. In clinical trials and investigator-initiated studies, tazarotene 0.045% lotion demonstrated efficacy in the treatment of facial and truncal acne and improved skin oiliness. Facial acne improvements were similar among study participants grouped by sex, race, ethnicity, or age. In a head-to-head study, efficacy was comparable to tazarotene 0.1% cream with approximately half the rate of treatment-emergent adverse events. Tazarotene 0.045% lotion is a beneficial acne treatment option for patients of varying ages, races, ethnicities, and skin types, delivered in a formulation that can be easily used on the face, back, and chest.

Background. Edematous fibrosclerotic panniculopathy (EFP), commonly known as cellulite, is a cosmetic concern affecting a large percentage of women. Radiofrequency diathermy (RFD) and focused ultrasound (FUS) are noninvasive treatments proposed for the reduction of EFP. Objective. This study aimed to evaluate the efficacy of RFD versus FUS, both combined with intermittent pneumatic compression (IPC) for the treatment of EFP in female thighs. Methods. A randomized intrasubject assessor-blind trial was conducted (NCT03474523) on 40 lower limbs of 20 women with EFP grades I, II, or III according to the Nürnberger & Müller scale. Each lower limb was randomly assigned to receive either seven RFD sessions or seven FUS sessions, both combined with IPC. Measurements were collected at baseline and post-treatment, including lower limb circumferences at different levels, weight, grade of EFP, and physical activity level. Results. Both RFD and FUS treatments, both combined with IPC, showed significant intragroup reduction in thigh circumference measurements for RFD at 15 cm (p = 0.001), 20 cm (p = 0.024), and midpoint (p = 0.008) and for FUS at 15 cm (p = 0.001), 20 cm (p = 0.010), midpoint (p = 0.008), 30 cm (p = 0.020), and 40 cm (p = 0.048). No statistically significant differences were observed between the two treatments. Weight did not change with treatment, and physical activity levels did not significantly affect EFP improvement. Conclusion. Both RFD and FUS, combined with IPC, were effective noninvasive methods for treating EFP. This study found that there was no significant difference between RFD and FUS in terms of efficacy in reducing EFP in the thighs. Therefore, both techniques can be used to treat EFP from a clinical perspective. Further studies with objective measurements are required to confirm these results and to guide clinical decision-making. This trial is registered with NCT03474523.

This paper systematically reviews the current articles regarding the use of dupilumab in the treatment of bullous pemphigoid (BP) to evaluate its safety and efficacy. PubMed, Embase, Cochrane Library, and Web of Science databases were searched for publications on dupilumab for BP from inception to 10 March, 2023. A total of 26 studies were included for systematic review. The primary outcome was clinical remission, and the secondary outcomes were recurrence and adverse events. Among 96 patients, 71.8% (n = 69/96) received systemic or topical steroids, immunosuppressants, immunomodulators, intravenous immunoglobulins, antihistamines, plasmapheresis, rituximab, and omalizumab, but none of them were successful. After dupilumab treatment, 66.7% (n = 64/96) of patients achieved complete remission, 25.0% (n = 24/96) had partial remission, 5.2% (n = 5/96) showed no remission, and no patients experienced deterioration. In addition, 1.0% (n = 1/96) and 2.0% (n = 2/96) patients stopped using dupilumab due to adverse reactions and cost, respectively. The average remission time was 4.5 months. 46.2% (n = 25/96) of the patients were followed up with a median follow-up of 8 months and only 2 patients relapsed at 8 and 7 months, respectively. Adverse event was 16.9% (n = 12/71), of which transient eosinophilia was the most common. This study indicates that the dupilumab is a promising treatment for BP with high clinical benefit associated with low recurrence rate, adverse event rate, and mortality. However, a large-scale randomized controlled trial is needed to further confirm the safety and efficacy of dupilumab in patients with BP treatment.

Background. Cutaneous warts are caused by the human papillomavirus that can affect a patient’s quality of life. Current treatments have high cost, low efficacy, adverse effects, and recurrence. Therefore, novel therapeutic approaches are needed. Complementary and Alternative Medicines (CAMs) are gaining popularity as a therapeutic approach. Phoenix dactylifera L. (date palm) is used in folk medicine to treat warts. Antiviral effects of P. dactylifera L. have been demonstrated due to its polyphenolic compounds, especially gallic acid and tannins in various studies. So, this trial evaluates the efficacy and safety of P. dactylifera L. leaf extract (formulated as WartOver®) as a novel treatment for cutaneous warts. Study Design. Based on the results of our previously published pilot clinical trial and the CONSORT guideline, this randomized, double-blind, and placebo-controlled study was performed on 70 eligible patients divided into intervention and placebo groups (N = 35/per group). Every 2 weeks, patients were examined to assess the rate of complete clearance, duration of treatment, patient satisfaction (measured using a Likert scale), and occurrence of any adverse effects and recurrence in a maximum of 12 weeks of treatment and at the 6-month follow-up. Results. Based on the intention-to-treat (ITT) analysis approach, complete clearance was achieved in 24 patients in the intervention group (68.57%; confidence interval 95% = 0.51–0.81), which was significantly higher than that in the placebo group (8.57%; CI 95% = 0.02–0.23, p < 0.0001). The time to complete clearance was 7.6 weeks (mean ± SD: 53.30 ± 17.17 days). The treatment was very satisfactory (Likert score of 4.24 ± 1.15 (mean ± SD)) with no recurrence or adverse effects. Conclusion. WartOver® is a novel efficacious treatment for cutaneous warts with minimal risk for adverse events or recurrence. Due to the rising popularity of CAM approaches in medicine, including herbal medicines, WartOver® can be a valuable choice for clinicians against cutaneous warts. This trial is registered with IRCT20200509047352N2.

Background. Actinic keratosis (AK) is a common premalignant skin condition. Its diagnosis is based on a clinical and sometimes dermoscopic examination, but, in some situations, a skin biopsy may be necessary. Dynamic optical coherence tomography (D-OCT) can often bypass this need, by noninvasive evaluation of skin morphology. Early and effective treatment of AKs is important to prevent the progression to invasive squamous cell carcinoma (iSCC). Tirbanibulin 1% ointment, a new topical field therapy for AKs, has recently been introduced. Objectives. The aim of this study was to evaluate the efficacy and safety of tirbanibulin 1% ointment for the field treatment of nonhyperkeratotic, nonhypertrophic AKs (Olsen grade 1) on the face and/or scalp in adults, using D-OCT technology. Methods. Patients, presenting multiple, mild to moderate AKs on the face and scalp, in treatment with tirbanibulin 1% ointment for five consecutive days of an area measuring 25 cm², were evaluated with videodermoscopy (V-track Vidix 4.0) and D-OCT (VivoSight Dx, Michelson Diagnostics Ltd., Kent, England, United Kingdom), as normal clinical practice. The lesions were staged according to the Olsen classification, excluding the most aggressive lesions. Results. We retrospectively evaluated 50 patients (27 males and 23 females, mean age 76 ± 7.9 years). At 57 days posttreatment, the complete clearance rate was 68% (n = 34) and partial clearance rate was 76% (n = 38). D-OCT showed markedly improved morphology, including a better recognizable dermal-epidermal junction (DEJ), associated with reduced inflammation. The most common adverse events reported were erythema and scaling, which were mostly mild and self-limiting. Conclusions. This study demonstrated that tirbanibulin may be considered an effective and well-tolerated treatment option for nonhyperkeratotic, nonhypertrophic AKs. It showed a favorable safety profile, with mostly mild adverse events. D-OCT can be considered a useful tool for personalizing AK treatment and monitoring.

Background. Low-fluence Q-switched Nd: YAG laser (LF-QSNY) and picosecond 755 nm alexandrite laser (PSAL) have shown superiority in the treatment of nevus of Ota (NO). Objective. To compare the efficacy and safety of PSAL and LF-QSNY in the treatment of NO. Methods. 15 patients randomly underwent split-lesion treatment of the two lasers within three months. The visual analogue scale (VAS) was used to evaluate the efficacy outcomes. The patient’s preferences, recurrence rate, and adverse events were also documented. Results. Fifteen patients with 34 lesions finished the trial. Lesions, operated with LF-QSNY and PSAL, reached VAS scores of 3.47 ± 0.67 and 3.51 ± 0.87, respectively (P > 0.05). Most significant improvement in LF-QSNY was achieved after the first session (VAS = 1.84). One (6.67%) patient experienced a relapse on the PSAL side. Temporary hypopigmentation and hyperpigmentation mainly occurred on the PSAL side. Patients under five years demonstrated superior efficacy (3.81 ± 0.47 vs 3.08 ± 0.66, P = 0.046) than those over with the treatment of LF-QSNY. Limitations. Limited sample and lack of objective evaluation. Conclusion. The difference between the LF-QSNY and PSAL in the treatment of NO was statistically insignificant, while LF-QSNY may be a better choice for the treatment of early NO. This trial is registered with ChiCTR1900022690.

Sexually transmitted diseases (STDs), including condyloma acuminatum (CA), syphilis, gonorrhea, genital Chlamydia trachomatis (CT), and acquired immune deficiency syndrome (AIDS)/human immunodeficiency virus (HIV) infection, are a group of diseases primarily transmitted through sexual contact, similar behaviors, and indirect contact. These diseases exert a profound impact on both the physical and mental health of patients and impose a substantial socioeconomic burden. Nonetheless, there is a lack of satisfactory treatment options and preventive strategies currently. Research has revealed aberrant expression patterns of microRNAs (miRNAs) in the tissues and blood of individuals with STDs, which are involved in the regulation of essential cellular processes, including proliferation, differentiation, and apoptosis. Consequently, miRNAs hold promise as crucial biomarkers for early diagnosis, disease assessment, prognosis, and potential therapeutic targets for STDs. This systematic review presents pertinent research on miRNAs in the context of STDs to establish a theoretical foundation for clinical diagnosis and treatment strategies.

Background. Vitiligo is a dermatological disorder characterized by the depletion of melanocytes. The key to its treatment lies in the promotion of melanin regeneration. The Wnt/β-catenin signalling pathway assumes a pivotal role in this regenerative process. Fire needle therapy (FNT), a traditional Chinese medical technique, has emerged as a promising intervention. Methods. We analyzed gene expression associated with the Wnt/β-catenin signalling pathway in both normal skin and the lesions of patients with vitiligo in the Gene Expression Omnibus database (GEO database). Furthermore, we evaluated the gene expression of this pathway and assessed the effects of FNT on pigmentation and its influence on the Wnt/β-catenin signalling pathway in a vitiligo mouse model. Results. Compared to that of the normal skin, the mRNA levels of WNT10A, WNT10B, WNT2, WNT2B, WNT3, WNT3A, WNT4, WNT5B, WNT7B, and LEF1 displayed significant decreases in the lesions of patients with vitiligo. Moreover, vitiligo mouse skin lesions improved following FNT, and the number of melanocytes and melanin levels increased. In addition, posttreatment, genes associated with the Wnt/β-catenin signalling pathway were revealed to be upregulated. Conclusion. FNT may play an important role in promoting pigmentation in vitiligo through modulation of the Wnt/β-catenin signalling pathway. This adds to the growing body of literature supporting the use of FNT to treat vitiligo. This, in turn, may inform clinical practice and improve patient outcomes.

Background. Heparin-induced bullous hemorrhagic dermatosis (HBHD) is a rare cutaneous adverse effect of heparin and has unclear clinical features. We explored the clinical features of HBHD to provide evidence for the safe use of heparin. Methods. We collected HBHD-related case reports for a retrospective analysis by searching the Chinese and English databases from inception to December 31, 2022. Results. Seventy-two patients, including 51 males (70.8%), were included, and they had a median age of 71.5 years (range: 21, 94). Low-molecular-weight heparin was used in 62 patients (86.1%), and unfractionated heparin was used in 10 patients (13.9%). The median time for HBHD to appear was 7 days (range: 0.25, 270). Lesions appeared far from the injection site, and the extremities (57 patients, 79.2%) were the most frequently involved site. The blisters were mainly located in the intraepidermal (34 patients, 47.2%), subcorneal (10 patients, 13.9%), and subepidermal (9 patients, 12.5%) regions. Thirty-seven patients (51.4%) had no obvious dermal inflammatory infiltration, and 20 patients (27.8%) had lymphocytic inflammatory infiltration. Sixty-seven patients (93.1%) recovered from their skin lesions after the discontinuation of heparin or despite continuing heparin and at a median treatment time of 14 days (range: 2, 141). Conclusion. HBHD is a rare self-limiting disease that occurs far from the injection site. Clinicians should be aware of BHD during the administration of heparin. Heparin can be discontinued or continued depending on the patient’s condition.