Dermatologic Therapy最新文献

Background: Psoriasis is a chronic inflammatory disease affecting skin and patients’ quality of life. Tildrakizumab is an IL-23p19-inhibitor approved for treatment of moderate-to-severe plaque psoriasis.

Objective: To evaluate the effectiveness of tildrakizumab in daily practice in a heterogeneous cohort of patients with psoriasis often accompanied by comorbid (especially cardiometabolic) diseases.

Methods: We conducted a retrospective analysis at two university outpatient clinics in Germany (April 2018 to June 2024), collecting data on patient characteristics, comorbidities, prior therapies, and treatment response.

Results: The effectiveness analysis included 111 patients with psoriasis treated with tildrakizumab. Median PASI was 12.6 (IQR 11.0–18.6) at baseline and decreased to 6.0 (IQR 1.0–10.4) at Week 4, to 1.8 (IQR 1.0–10.4) at Week 16, and median PASI 0.00 (IQR 0.0–0.0) at Week 76. Median PASI < 3 was achieved by 64.6% at Week 16, 79.7% at Week 52 and 94.4% at Week 76 and PASI < 5 by 83.3% at Week 16, 94.2% at Week 52, and 100% at Week 76. The proportion achieving PASI75, PASI90, and PASI100 at Week 76 was 97.2%, 83.3%, and 58.3%. Patients with arterial hypertension (AHT) showed a lower PASI response compared to those without AHT, starting from Week 28 (p = 0.035) and continuing throughout the follow-up period. However, a detailed analysis indicates that patients with AHT also achieved PASI < 3 at Week 28 and beyond. Furthermore, patients with at least one cardiovascular risk factor (CRF: obesity, dyslipidemia, AHT, or type 2 diabetes mellitus, [46.8%]) demonstrated a less pronounced PASI response at Weeks 16, 28, and 64 compared to patients without such risk factors (p_wk16 = 0.023; p_wk28 = 0.012; p_wk64 = 0.014). Median DLQI at baseline was 16.0 (IQR 9.5–22.0) and improved to 3.0 (IQR 1.0–8.0) at 4–16 weeks.

Conclusion: This analysis confirmed effectiveness of tildrakizumab in a real-world setting, with notable improvements in PASI response observed in a heterogeneous patient cohort and a high level of quality of life improvement. It is noteworthy that patients with AHT and other CRF demonstrated lower treatment responses, indicating that these comorbidities may exert an influence on outcomes.

Pemphigoid diseases are a group of chronic autoimmune blistering skin disorders, with bullous pemphigoid representing the most prevalent subtype. Bullous pemphigoid (BP) primarily affects individuals aged 60–80 years, and its incidence has been steadily rising in correlation with increasing life expectancy and population aging in Western countries. Autoantibodies targeting hemidesmosome proteins (collagen XVII and dystonin-e) at the dermal-epidermal junction activate complement recruiting inflammatory leukocytes that release proteolytic enzymes, degrading structural proteins and causing subepidermal blistering. The current standard treatments for pemphigoid diseases are corticosteroids and classical immunosuppressants. Systemic immunosuppression is not ideal in immunocompromised elderly patients, and more targeted and safer approaches, including dupilumab and omalizumab, are also being investigated. Our current priority is to explore further efficient and safe therapeutic options. Janus kinase (JAK) inhibitors have shown considerable potential as novel treatment options for chronic inflammatory and autoimmune diseases. The JAK inhibitors may offer efficient and safe treatment with rapid symptom improvement and disease control in the management of pemphigoid disorders. This review describes pemphigoid cases, including the rare forms, managed with JAK inhibitors (tofacitinib, baricitinib, upadacitinib, and abrocitinib).

Introduction: Janus kinase (JAK) inhibitors are novel therapies for atopic dermatitis (AD); however, only limited data exist on their effectiveness in patients with previous failures in biological treatment.

Methods: Patients with moderate-to-severe AD and having completed a minimum of 16 weeks of JAK inhibitor therapy were divided into subgroups based on prior dupilumab exposure: those without prior exposure and those whose treatment was discontinued due to lack of efficacy (dupilumab nonresponders [DNR]). Eczema Area and Severity Index (EASI), DLQI, and Itch Numeric Rating Scale (Itch NRS) changes from baseline were assessed in Weeks 16 and 24 (when available). Adverse events during the follow-up were recorded.

Results: In total, 241 patients were included; 148 received upadacitinib (99 dupilumab-naïve, 49 post-dupilumab failure), 47 were with baricitinib (32 dupilumab-naïve, 15 post-dupilumab failure), and 46 received abrocitinib (35 dupilumab-naïve, 11 post-dupilumab failure). At Week 16, an EASI-75 response in the upadacitinib group was achieved in 86% naïve versus 82% DNR patients, 91% naïve versus 73% DNR patients in the abrocitinib group, and 81% naïve versus 67% DNR in the baricitinib group. Itch NRS ≥ 4-point reduction was achieved in 82% naïve versus 76% DNR patients on upadacitinib, 83% naïve versus 91% DNR patients on abrocitinib, and 72% naïve versus 40% DNR patients on baricitinib.

Conclusion: In conclusion, our retrospective analysis suggests that previous dupilumab failure did not significantly affect the short-term effectiveness of JAK inhibitor therapy for AD.

Objective: To investigate the effectiveness and safety of 4 MHz monopolar radiofrequency in enhancing facial wrinkles.

Methods: A prospective experimental study was conducted involving 62 facial skin aging patients treated at the Medical Cosmetic Dermatology Department of Shangqiu First People’s Hospital between June 2022 and December 2022. These patients received treatment using a 4 MHz monopolar radiofrequency device. Patients with facial skin aging underwent Fitzpatrick facial wrinkle grading and VISIA image acquisition at baseline, immediately after treatment, and 30- and 90-days post-treatment; adverse events were also recorded.

Results: After administering noninvasive radiofrequency treatment to 62 patients with facial skin aging, 41 demonstrated significant improvement 90 days post-treatment, with 17 classified as effective and 4 as ineffective. The overall clinical effectiveness rate was 93.55%. Ninety days following radiofrequency therapy, Fitzpatrick facial wrinkle grading was repeated for the patients with facial skin aging. Fifteen patients were classified as Grade I, 28 as Grade II, and 19 as Grade III, revealing significant differences before and after treatment (χ² = 16.1, p = 0.013). Adverse reactions were limited to mild erythema and edema, and no complications such as postinflammatory hyperpigmentation, epidermal burns, fat atrophy, or scarring, were observed in any patients.

Conclusion: The application of monopolar radiofrequency for facial rejuvenation is safe, effective, and associated with minimal adverse reactions.

Background: Antiacne dermocosmetics are effective supportive care for managing mild-to-moderate acne. Exploration of the microcomedone ecosystem can provide insights into specific targets for antiacne products.

Objective: To analyze changes in infra-clinical acne lesions in subjects using a formulation containing Silybum marianum fruit extract (SMFE) to manage mild-to-moderate facial acne.

Methods: A controlled, randomized, open-label study was conducted in adults and adolescents with predominantly retentional acne lesions: the test group received the SMFE-based product, and the control group received a hydrating skincare product. After evaluating the clinical efficacy of the study product, a multiomics approach was used to assess metabolome, lipidome, and microbiome changes in the microcomedone ecosystem. Two-dimensional ultrastructural imaging was also performed on extracted microcomedones.

Results: After 2 months of twice-daily application of the study product, acne lesion severity was effectively reduced in the test group (N = 20) compared to the control group (N = 20). Ultrastructural imaging clearly showed alterations in microcomedones in the test group, which, together with evidence of decreased levels of several cellular components, demonstrated the comedolytic effect of the product. Specific changes also occurred at the microbiota and lipid levels: compared to controls, the relative abundance of Malassezia globosa fungi significantly decreased (p < 0.05), along with the levels of some proinflammatory lipids. These lipolytic fungi could be key targets of the antiacne product.

Conclusion: Our integrative analysis demonstrated that the SMFE-based product acts on the four main pillars of acne: hyperkeratosis, skin dysbiosis, hyperseborrhea, and proinflammatory lipids.

Trial Registration: ClinicalTrials.gov Identifier: NCT05640388

Background: Botulinum toxin-A (BoNT-A) injection is a widely used cosmetic procedure in Korea to improve calf contours; however, a standardized protocol has yet to be established. While other BoNT-A formulations have been studied for calf contouring, the efficacy and safety of Inco-BoNT-A (IncoBoNT-A) specifically for this purpose remain unclear.

Objective: This prospective case series study aimed to evaluate the effectiveness and safety of IncoBoNT-A for calf contouring.

Methods: Twenty Korean women (mean age: 35.55 ± 7.37) received 75–100 U of IncoBoNT-A per calf muscle (total 150–200 U for both calves), administered intramuscularly using a 30G 0.5-inch needle. Evaluations were conducted at baseline and at 1, 3, and 6 months postprocedure. Changes in muscle size were measured via ultrasound and tape, supplemented by clinical photographs. Observer evaluations (PGAIS, Merz scales for female Asian calf) and participant satisfaction (SGAIS) were assessed at each visit, along with body weight monitoring and daily activity assessments.

Results: Both calf circumference (measured by tape) and muscle thickness (measured by ultrasound) at 2 fixed locations declined over time, with significant reductions at each visit compared to baseline. The PGAIS and SGAIS scores demonstrated consistent clinical improvement and patient satisfaction. The Merz scale indicated a shift from “severe” and “very severe” to “mild” and “moderate” ratings over time. Notably, weight gain was associated with less reduction in calf circumference.

Conclusions: A single dose of 150–200 U IncoBoNT-A is safe and effective for calf contouring. Unlike facial wrinkle treatment, weight management may be essential for achieving optimal results in calf contouring with BoNT-A.

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that significantly impacts patients’ quality of life, particularly in relation to sexual health. Sexual dysfunction and erectile dysfunction are frequently reported among individuals with HS. However, the relationship between disease severity and sexual health outcomes remains unclear. This systematic review aims to explore the impact of HS on sexual dysfunction in both males and females, examining the physical and psychological factors involved.

Methods: A systematic literature search was conducted in PubMed, Medline (OVID), and Web of Science using keywords related to HS and sexual health, including “sexual dysfunction,” “sexual desire,” “erectile dysfunction,” “impotence,” and “infertility.” Studies were screened for relevance, and those that examined sexual health outcomes in HS patients were included. Thirteen studies met the inclusion criteria and were analyzed qualitatively due to the heterogeneity of the outcome measures. Nonrandomized studies were evaluated using the Newcastle-Ottawa Scale to assess methodological quality.

Results: The review found that sexual dysfunction was prevalent in HS patients, with rates ranging from 42% to 71.8%. Female patients consistently reported higher levels of sexual distress, while male patients experienced erectile dysfunction at significant rates, as measured by the FSFI and IIEF. Importantly, worsening disease severity did not consistently correlate with increased sexual dysfunction, suggesting that factors such as pain, odor, and psychological distress may have a greater influence.

Conclusion: This review demonstrates that HS significantly impacts sexual health, though the severity of HS does not always correlate with worsening sexual dysfunction. Psychological factors, pain, and genital involvement appear to play a more prominent role. Future research should focus on addressing both the psychological and physical aspects of sexual dysfunction in HS patients and explore the underlying mechanisms linking HS to infertility.

Introduction: Hematological disorders are often associated with dermatological conditions due to immune dysregulation and the use of polypharmacy. Such dermatological manifestations have the potential to impair quality of life and may also result in morbidity and mortality. Furthermore, in some instances, it may be necessary to modify the treatment regimen.

Methods: This study retrospectively evaluated dermatological consultations for patients in a hematology clinic, assessing clinical and demographic data, dermatological diagnoses, and the effects on hematological treatment and prognosis.

Results: The data from 434 consultations involving 304 patients were subjected to analysis, with the most prevalent hematological diagnoses being acute myeloid leukemia, multiple myeloma, and myelodysplastic syndrome. The majority of consultations (70.7%, n = 307) were inpatient, while the remainder were outpatient. The most frequently observed dermatological conditions were infections (37.3%) and drug reactions (15.7%). In 39.4% (n = 171) of cases, dermatological findings led to modifications in systemic treatment, primarily due to infections and drug reactions. Among these patients, 19 required modifications to their hematological treatment regimen. A diagnosis was reached through clinical examination in 74.9% of patients. In other cases, additional diagnostic procedures were necessary, including dermoscopy, histopathology, and microbial examination. The in-hospital mortality rate was 2.3% (n = 7). Only one death was directly associated with a dermatological condition: toxic epidermal necrolysis in a patient receiving brentuximab vedotin.

Conclusion: The results of this study highlight the importance of dermatological assessment in patients with hematological conditions. It is also crucial for clinicians to be more aware of the potential dermatological manifestations, including infections and drug reactions, that may occur in these patients.