Dermatologic Therapy最新文献

Background

Alopecia areata (AA) is a cell-mediated, tissue-specific autoimmune disease. While AA primarily affects hair follicles, it has also been associated with various comorbidities due to immune dysregulation. Several studies have investigated cardiovascular risk in AA; however, no research has specifically assessed carotid intima-media thickness (CIMT) in AA patients. This study aims to evaluate the potential increase in atherosclerosis risk among AA patients by measuring CIMT and other associated risk factors.

Methods

A total of 61 patients with AA and 61 healthy controls were included. Anthropometric measurements including height, weight, body mass index, waist circumference, smoking history, and biochemical parameters, including total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and fasting blood glucose levels, were recorded. CIMT was measured bilaterally using ultrasound at three adjacent sites, 10 mm proximal to the carotid bifurcation, with 5 mm intervals. The average of three measurements was used for analysis.

Results

CIMT measurements did not show a significant difference between the two groups. However, the smoking rate, fasting blood glucose levels, and diastolic blood pressure were significantly higher in the AA group compared to the healthy controls.

Conclusions

CIMT, an indicator of subclinical atherosclerosis, was not increased in AA patients. However, the higher diastolic blood pressure and fasting blood glucose levels in the AA group suggest a potential cardiovascular risk that warrants further investigation.

Background

Obesity is a prevalent comorbidity in children with pediatric psoriasis and is known to influence treatment outcomes in adults. In China, secukinumab, an anti-IL-17A biologic, is available for treating pediatric psoriasis. However, the impact of obesity on the effectiveness of secukinumab in children remains unclear.

Objective

To evaluate the effect of obesity on the clinical response to secukinumab in pediatric patients with plaque psoriasis.

Methods

This retrospective cohort study included 70 children with plaque psoriasis treated with secukinumab for at least 52 weeks. Data on demographics, body mass index (BMI), disease duration, prior systemic therapy, and disease severity were collected. Patients were stratified by BMI into a nonobese group (normal: < 85th percentile; overweight: 85th–< 95th percentile) and an obese group (≥ 95th percentile) based on age- and sex-specific percentiles from national pediatric references. Treatment efficacy, measured by PASI100, PASI90, PASI75, and Investigator’s Global Assessment (IGA) 0/1 responses, was assessed at baseline and Weeks 4, 12, 36, and 52, when available. Mixed-effects models and generalized estimating equations were used to analyze the impact of BMI or BMI status on treatment efficacy.

Results

Of the 70 children included, 70.5% and 80.3% achieved PASI100 and PASI90 at weeks 24, respectively, with efficacy sustained through 52 weeks. Nonobese children had significantly higher PASI100 responses compared to obese children at Weeks 12 (69.8% vs. 35.7%) and 24 (76.6% vs. 50.0%, both p < 0.05). After adjusting for confounders, obesity was associated with a reduced likelihood of achieving PASI100 (OR = 0.32, 95% CI 0.13–0.81) and PASI90 (OR = 0.23, 95% CI 0.06–0.83). Higher BMI independently reduced the odds of achieving PASI100 (OR = 0.90, 95% CI 0.81–1.00, p = 0.043).

Conclusion

Secukinumab is effective in treating children with plaque psoriasis; however, obesity and higher BMI negatively impact clinical outcomes.

Background

Challenging diabetic wound is known to be the most complication of diabetes. Besides the conventional treatments, some promising approaches, such as application of human amniotic membrane (HAM) and oxygen therapy, have been proposed to repair the diabetic wounds. In spite of their positive effects, none of these approaches are efficient enough to solve this problem. Therefore, we made an attempt to investigate if a HAM-derived three-dimensional microporous scaffold (HAMS) loaded with oxygen-generating microspheres (OGMs) could effectively promote healing in diabetic rats.

Methods

The diabetic animals were randomly divided into diabetic, D-HAMS, and D-HAMS + OGM groups. Furthermore, nondiabetic untreated rats, i.e., healthy group, were labeled as controls. An annular ischemic 15-mm diameter wound was created in the back of the animals, and HAMS or HAMS + OGM were grafted on the wound of related animals, i.e., D-HAMS and D-HAMS + OGM groups. Stereological, molecular, and tensiometrical assessments were performed 7, 14, and 21 days after surgery.

Results

It was found that compared to the diabetic group, both HAMS and HAMS + OGM transplantations caused a significant increase in the wound closure rate; the volumes of the newly generated epidermis and dermis; the density of the epidermal basal cells, fibroblasts, and blood vessels; the number of proliferating cells; and collagen deposition as well as biomechanical properties of healed wound, and these improvements were more apparent in the D-HAMS + OGM-group. In addition, the transcripts of Tgf-β, bFgf, and Vegf genes were notably upregulated in both the treated groups compared to those in the diabetic one and were greater in the D-HAMS + OGM group. This is while expression of Tnf-α, Il-1β, and Hif-1α as well the numerical densities of neutrophils and macrophages dropped more significantly in the D-HAMS + OGM group compared to those of the other diabetic groups.

Conclusion

In general, we found that the transplantation of HAMS loaded with OGM has more effect on diabetic wound healing.

Background

The prognostic value of the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and red blood cell distribution width (RDW) in cutaneous squamous cell carcinoma (cSCC) remained underevaluated.

Objective

We assessed preoperative systemic inflammatory markers (SIMs) in predicting survival outcomes of cSCC.

Method

This single-center retrospective study included newly diagnosed cSCC who underwent wide excision between 2000 and 2022. SIMs’ cutoff values were determined. Survival analyses for disease-free survival (DFS), distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS) were performed.

Results

A total of 334 patients were included. Higher NLR, PLR, and RDW significantly correlated with more Brigham and Women’s Hospital (BWH) staging high-risk factors. Cutoffs were 2.88 for NLR, 2.93 for LMR, 156.24 for PLR, and 16% for RDW. Elevated NLR, PLR, RDW, and reduced LMR were significantly associated with worse DFS, DMFS, DSS, and OS (all p < 0.01). Focusing on BWH stage T2b/T3, NLR and LMR remained strong predictors of DFS, DMFS, and DSS. In multivariate analysis, NLR and LMR were independently associated with DFS, LMR with DMFS, and PLR and RDW with DSS.

Conclusions: Preoperative SIMs are valuable prognostic markers in cSCC, aiding in predicting recurrence, metastasis, and mortality.

Objective

To summarize and analyze the clinical diagnosis and patient management of immune drift in psoriasis.

Methods

Review the cases of psoriasis patients in the Peking University Third Hospital dermatology inpatient room from 2022 to 2023 and analyze three patients who developed eczema on hands and feet after treatment with biological agents. Review databases such as PubMed, Medline, and Embase databases to summarize the cases of immune drift induced by biological therapy for psoriasis reported in the literature.

Results

A total of 57 patients were included in the literature search combined with the 3 patients reported in this article for discussion. In previous studies, the biologics involved include the following: adalimumab (22 cases), infliximab (5 cases), etanercept (6 cases), ixekizumab (7 cases), secukinumab (10 cases), ustekinumab (15 cases), and guselkumab (3 cases). Among them, 8 patients experienced immune drift reactions to more than one biological agent. Among these patients, the proportion of male patients is 54%, and the proportion of female patients is 46%, with the age being (42.5 ± 24.5) years. The time from the initiation of biologic therapies to the onset of eczematous rash varies from 4 days to 22 months. The main manifestation included erythema, papules with exudation or scales, and the affected areas include the scalp, face, neck, trunk, and limbs. In previous studies, 47 patients reported laboratory indicators, of which 23 (48.9%) had elevated eosinophils and 9 (19.1%) had elevated IgE levels. A total of 10 patients reported biopsy results, all of which were consistent with eczema. Previous studies have reported 34 cases of treatment outcomes. Among them, 23 cases stopped using their original biologics and were changed to other types of biologics or small-molecule drugs, or treated with systemic glucocorticoids, cyclosporine, and methotrexate. In addition, 11 cases continued to use their previous biologics, of which 8 patients improved after topical glucocorticoids treatment and 3 cases did not receive any treatment and improved. Among the 3 patients reported in this article, 2 had elevated serum total IgE and 1 had elevated eosinophils. The three patients all stopped using previous biologics and improved after treatment with other types of biologics or systemic glucocorticoids and immunosuppressants.

Conclusions

Biologic therapy plays an important role in the treatment of psoriasis, but their