Dermatologic Therapy最新文献

Background. Rapid efficacy is an important item to psoriasis patients. Risankizumab, a humanised immunoglobulin G1 monoclonal antibody that inhibits IL-23, has demonstrated early and sustained efficacy in patients with moderated-to-severe psoriasis. Effectiveness data in real world, particularly regarding short-term response, however, are scarce. Objective. To explore the short-term effectiveness of risankizumab in patients with moderate-severe psoriasis in normal clinical practice. Methods. This was an observational, retrospective, multicentre study carried out at thirteen hospitals in Valencia, Spain. It was conducted on a sample of adult outpatients over 18 years of age, diagnosed with moderate-to-severe psoriasis who received at least one subcutaneous injection of 150 mg of risankizumab. Psoriasis Area and Severity Index (PASI) was used to assess the short-term (4 weeks) effectiveness of risankizumab. Results. One hundred and sixteen patients (63.8% men) with a mean age (standard deviation (SD)) of 50 (16) years were included in the study. 90.6% were overweight or obese, and 22.7% were biologic-naïve. The mean (SD) PASI score decreased from 11.9 (7.2) at the baseline to 3.3 (2.7) at week 4, with a median (SD) PASI score reduction of 8.6 (2.3) (p < 0.05). The absolute PASI score of <2 was reached by 52.6% of patients. Overall, PASI scores of 75, 90, and 100 were achieved in 56%, 37.1%, and 25.9% of patients, respectively, at week 4. PASI 90 was achieved by a significantly higher proportion of naïve patients than biologic-experience failure patients (59.3% vs. 30.3%; p = 0.01). Conclusion. This study, which reflects our initial risankizumab experience in a real-life setting, seems to show quick effectiveness in psoriasis treatment after one single dose. This trial is registered with NCT04862286.

Introduction. Increasing microbial resistance to conventional pharmaceuticals calls for nonpharmaceutical treatments of vaginitis. This systematic review summarizes the efficacy of the antiseptic agent boric acid (BA) as a treatment option for microbial vaginitis in comparison to conventional therapies and proposes clinical recommendations. Materials and Methods. PubMed and Embase were searched for “boric acid” and “microbial vaginitis.” A protocol was registered on PROSPERO (CRD42020160146). Inclusion criteria included clinical trials, observational and interventional studies, including case series/reports. Exclusion criteria included in vitro and animal studies, non-English language, and no BA treatment outcome. Primary outcomes included microbial, clinical, and complete cure. Secondary outcomes included adverse events, relapse/reinfection rates, evidence levels, microorganisms, treatment regimens, and follow-up time. Data were extracted to a predefined Excel sheet. Results. Of 195 identified unique articles, 54 were retrieved and 41 met our inclusion criteria. Heterogeneity precluded the conduction of a meta-analysis. Conclusion. An average cure rate of 76% was found for vulvovaginal candidiasis BA treatment. Recurrent bacterial vaginosis was controlled with BA and 5-nitroimidazole with promising results. Maintenance BA was equal to maintenance oral itraconazole therapy in vulvovaginal candidiasis and bacterial vaginosis in a retrospective study. Prolonged BA monotherapy cured three of six recurrent Trichomonas infections. Adverse events (7.3%) were typically mild and temporary. Based on our findings and the rising antimicrobial therapy resistance, we suggest intravaginal BA 600 mg/day for 2 weeks for (recurrent) vulvovaginal candidiasis and 600 mg/day for 2-3 weeks for recurrent bacterial vaginosis. Rare resistant Trichomonas infections can be treated with BA 600 mg × 2/day for months and in combination with oral antimicrobials. We suggest a maintenance regimen of BA 600 mg × 2/week for recurrent vulvovaginal candidiasis. In case of resistant bacterial vaginosis, we suggest BA 600 mg × 2-3/week. Data on maintenance therapy and BA treatment of bacterial vaginosis and trichomoniasis are however limited.

Introduction. Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent painful or suppurative lesions due to follicular occlusion. Biologics and other treatment modalities such as surgical excision are commonly used in the treatment of severe HS. However, despite the frequent use of biologics and surgical interventions in the treatment of patients with HS, an assessment of their combined effects is lacking. This systematic review aims to qualitatively analyze the efficacy of combined biologic and surgical treatment for HS. Methods. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed. The databases PubMed (MEDLINE), Embase, Cochrane (CENTRAL), ClinicalTrials.gov, MedRxiv.org, and the International Clinical Trial Registry were searched from inception until May 1, 2023. Results. A total of 1,145 studies were screened, with eight studies included for data extraction. Patients receiving combined biologic and surgical treatment showed greater improvement in the severity measurements of HS, including HS Impact Assessment, HS Physician Global Assessment, HS Sartorius Score, International Hidradenitis Suppurative Severity Score, HS recurrence rate, and Dermatology Life Quality Index. However, three studies reported a prolongation of wound healing with combined biologic and surgical treatment. Conclusion. Our systematic review highlights the additive effects of using biologics and surgery together to treat HS compared to either treatment alone. However, when both treatment modalities are used simultaneously, the potential risk of prolonged wound healing must be considered. Due to the limited number and heterogeneity of the included studies, more clinical trials are needed to establish diagnostic conclusions.

Acne keloidalis nuchae (AKN) is a condition that involves chronic inflammation of the hair follicles on the occipital scalp and posterior neck that often progresses to keloid-like plaques. AKN has most commonly been reported to affect postpubertal males of African descent. The cause of AKN has not been definitively described; however, it is likely an inflammatory response to trauma or infection of the scalp. AKN is associated with chronic scalp folliculitis, hidradenitis suppurativa, folliculitis decalvans, acne mechanica, keratosis follicularis spinulosa decalvans, cutis verticis gyrata, metabolic syndrome, acanthosis nigricans, and hypothyroidism. Treatment for AKN begins with topicals, antibiotics, and intralesional steroid injections. Refractory cases are treated with laser and surgery. Isotretinoin, cryotherapy, phototherapy, electrosection, and radiotherapy have also been effective in treating AKN but are less commonly used. In this review, we describe the existing understanding of AKN with a focus on comorbid conditions and available treatment options.

Background. In patients with stage III melanoma carrying BRAF mutations, the risk of melanoma recurrence is relatively high even after complete resection of the primary melanoma and regional lymph nodes. Methods. We collected data from patients with stage III cutaneous and acral melanoma who received adjuvant trametinib combined with dabrafenib from three cancer centres in China between August 2019 and December 2022. Results. A total of 55 patients were included in this study. The one-year recurrence-free survival (RFS) rate was 79.8% (95% CI 73.6–86.0%). The one-year RFS rate was 79.8% (95% CI 72.8–86.8%) in the cutaneous melanoma subgroup, while the one-year RFS rate was 74.1% (95% CI 58.0–90.2%) in the acral melanoma subgroup. Six (46.2%) patients experienced recurrence during adjuvant therapy; 7 (53.9%) patients recurred after completion of the regimen. At the time of the first recurrence, distant metastasis occurred in 10 patients, local recurrence occurred in 2 patients, and one patient experienced both distant metastasis and local recurrence. Conclusions. This study confirmed the good tolerability and short-term benefits of adjuvant therapy with dabrafenib and trametinib in Chinese patients with stage III melanoma with BRAF V600 mutation.

Background. Despite the availability of numerous therapies, keloid treatment remains a challenging clinical issue. Intralesional triamcinolone has been established as an effective corticosteroid treatment for keloids, while sporadic reports suggest the efficacy of intralesional verapamil. This study aimed to evaluate the safety and efficacy of bevacizumab as an adjuvant therapy for keloid treatment. Methods. This randomized controlled trial involved 38 patients diagnosed with keloid according to clinical criteria. The study compared the effects of intralesional triamcinolone combined with bevacizumab injections with intralesional triamcinolone alone. Patients were randomly assigned to either the combination treatment group, which received intralesional triamHEXAL® (20 mg/ml, every two weeks for three months) plus Avastin® (2.5 mg/ml, every two weeks for two months), or the single treatment group, which received intralesional triamHEXAL® alone. The Vancouver Scar Scale (VSS) was used for serial photographic records of scar evaluation, with differences in VSS scores considered the primary outcome, and changes in height and patient satisfaction visual analog score (VAS) were secondary outcomes. Results. A total of 38 patients participated, with a mean age (SD) of 35.32 (14.02) years and 50% male. No significant differences in age, BMI, disease duration, gender, causing, family history, or site were observed between the two groups. The single treatment group exhibited a mean reduction of 0.60 (95% CI: (−1.18, −0.01); P = 0.045) in pigmentation score and a mean decrease of 1.37 (95% CI: (−2.68, −0.07); P = 0.039) in total score compared to the combination treatment group after three months of treatment. There was a significant reduction in keloid height in the combination group after the end of the treatment (P = 0.024). No significant differences in side effects were observed between the two groups. Conclusion. Our study demonstrates that bevacizumab can be considered an effective and safe adjuvant therapy option for keloid treatment, suggesting its potential as a promising treatment for the management of keloids. This trial is registered with IRCT20131119015455N5.