Dermatology practical & conceptual最新文献

Introduction: Psoriasis is a chronic inflammatory disease that may lead to scalp involvement, with a significant impact on patients' quality of life. Although most patients with scalp psoriasis do not experience alopecia, alopecia in the context of psoriasis is a multifaceted issue on which studies are limited.

Objectives: The purpose of this review was to investigate different types of alopecia in psoriasis and the potential mechanisms.

Methods: A thorough literature review was performed, focusing on the relationship between psoriasis and alopecia areata (AA), drug-induced alopecia, and psoriatic alopecia.

Results: Psoriasis and alopecia are related through several pathways. Regarding psoriatic alopecia, in most cases of psoriasis patients with scalp involvement, hair loss is attributed to telogen effluvium. In late-stage lesions, destruction of the hair follicle, perifollicular fibrosis, and free bare hair shafts in the dermis are revealed. However, hair loss in psoriasis is almost always non-scarring and reversible. In drug-induced alopecia, both conventional systemic treatments and biologics may cause hair loss in psoriatic patients. Specific side effects have been reported with TNF-α inhibitors and IL-17 blockers. TNF-α inhibitors may cause several types of alopecia: i) TNF-α inhibitor-associated psoriaticalopecia, ii) TNF-α inhibitor-associated AA, and iii) TNF-α inhibitor-associated lichen planopilaris. In concomitant psoriasis and alopecia areata, there is strong and convincing evidence that patients with psoriasis are at increased risk of developing AA, suggesting a complex interplay of autoimmune mechanisms.

Conclusion: Understanding the types and causes of alopecia in patients with psoriasis is crucial to proper management, thus highlighting the need for more research.

Background: Patients affected by a new variant of endemic pemphigus foliaceus in El Bagre, Colombia have autoantibodies directed against different proteins in the skin and internal organs. In this study we investigated autoantibodies in the intervertebral disk (IVD) and surrounding spinal structures since most patients suffer from back pain.

Methods: We tested autoreactivity using indirect immunofluorescence, reflectance, and confocal microscopy using patient autoantibodies, with both human and bovine tissue as antigen sources. We tested 45 sera from patients and 45 control sera from the endemic area matched by age, sex, demographics, and work activity. Additional mass bone density and trabecular bone score (TBS) were determined in selected cases.

Results: Most of the patient sera revealed polyclonal autoreactivity against previously known and new neural receptors present in the IVD (translamellar cross-bridges of the annulus fibrosus and the nucleus pulposus), neurovascular bundles, and paraspinal neurovascular packages as well as in the anterior and posterior longitudinal ligaments (P<0.001). Patient autoantibodies co-localized with commercial antibodies to MYZAP, desmoplakins I-II, plakophilin-4, and ARVCF (P<0.001). Controls were negative. Triton X-100 and paraformaldehyde allowed us to see the complex morphological 3-dimensional shape of the nerves and receptors. We also found that the patients showed altered microarchitecture of the lumbar spine and low trabecular density, thus suggesting osteoporosis and/ or osteopenia.

Conclusions: The autoantibodies to neural receptors in the IVD and surrounding structures and the osteopenia may contribute to patient back pain. Also, El Bagre-EPF autoantibodies provide a new tool to study the complexity of these neural receptors.

Introduction: Acne vulgaris, affecting around 9.4% of the global population, is a common disorder of the pilosebaceous unit. Approximately 95% of affected individuals develop some degree of scarring, which, along with active acne, contributes significantly to psychosocial morbidity.

Objectives: This study aimed to evaluate the factors influencing acne severity, the development of acne scars, and the severity of scarring in patients with acne vulgaris.

Methods: A cross-sectional study was conducted between May and November 2024 at the dermatology outpatient clinic of Ordu University, Turkey. Demographic data, characteristics of acne lesions, treatment history, and various potential risk factors for acne and scarring were recorded. Acne severity and scar severity were evaluated using standardized grading systems.

Results: A total of 269 patients (175 females, 94 males) were included, with acne scars observed in 71.3%. Younger age, earlier, and adolescent-onset acne were significantly associated with greater acne severity and scarring. Male sex and severe acne further increased the risk and severity of scars. Patients with scarring reported higher emotional stress. Post-lesional hyperpigmentation and erythema predicted more severe scarring. Prior use of topical agents and systemic antibiotics was linked to increased scar risk, while systemic isotretinoin had a protective effect.

Conclusions: Early identification of risk factors and timely intervention may help reduce the burden of acne scarring and improve patients' quality of life. Recognizing predictors of acne severity and scarring can guide clinicians in implementing preventive strategies and optimizing long-term outcomes.

Introduction: Bevacizumab is a humanized monoclonal antibody specifically targeting the vascular endothelial growth factor (VEGF). In addition to cancer and ophthalmology, bevacizumab has other off-label uses. Among these, the treatment of hereditary hemorrhagic telangiectasia and hemangioma can be mentioned.

Objectives: Although there are reports of successful treatments by bevacizumab, there is no systematic review on the topical use of this medication in dermatology. Therefore, this study aimed to investigate this topic.

Methods: A systematic search on topical bevacizumab was done with MeSh-based keywords on online databases of PubMed, Scopus, and Web of Science in December 2022. The records were evaluated, and the eligible articles were selected.

Results: We reviewed related studies, and the disease name, treatment protocol (injection dosage and intervals), outcomes, and complications were summarized for conclusions.

Conclusions: In this study, we systematically reviewed related papers and summarized the use of bevacizumab in dermatology in four categories, including hereditary hemorrhagic telangiectasia, vascular malformation, vascular proliferation, and others (lichen planus, and basal cell carcinoma).

Introduction: Psoriasis is a chronic systemic inflammatory disease that requires long-term treatment strategies to maintain sustained disease control. Treatment persistence is an important real-world indicator of therapeutic effectiveness and tolerability. Guselkumab, an IL-23 inhibitor, has shown favorable persistence in several studies, but extended long-term data remain limited.

Objectives: To assess 3- and 5-year drug survival rates of guselkumab in patients with moderate-to-severe plaque psoriasis and to examine the relationship between persistence and clinical variables such as PASI, BMI, prior biologic exposure, and involvement of difficult-to-treat areas.

Methods: This was a multicenter retrospective observational study conducted across 14 dermatology centers in Italy. Adult patients with moderate-to-severe plaque psoriasis who started guselkumab were included. Data collected included demographics, clinical history, disease severity, comorbidities, and treatment details. Drug survival was analyzed using Kaplan-Meier curves and Cox proportional hazards models.

Results: A total of 247 patients were included. At three years, 80.2% of patients remained on guselkumab, and at five years, 72.8% continued treatment. Persistence was not significantly influenced by BMI, PASI, or age. However, prior biologics exposure was associated with a higher risk of discontinuation (hazard ratio (HR): 1.84; P=0.0208), especially in those previously treated with IL-17 inhibitors (HR:2.14; P=0.0150). The involvement of difficult-to-treat areas did not significantly affect persistence, although a trend toward reduced discontinuation was observed in patients with genital involvement (P=0.0539).

Conclusions: Guselkumab demonstrated high long-term persistence in real-world clinical practice. Drug survival remained consistently high across various subgroups, with prior IL-17 inhibitor exposure being the main predictor of decreased persistence.

Introduction: The recurrent/traumatized melanocytic nevus (RTMN) refers to melanocytic lesions that reappear following incomplete removal or trauma to a previous nevus, often presenting clinically and dermoscopically similar to melanoma, which complicates differential diagnosis. Histologically, RTMN exhibit melanocytic proliferation and scar tissue from prior trauma or excision. PRAME (preferentially expressed antigen in melanoma) immunohistochemistry (IHC) is emerging as a diagnostic tool for distinguishing between nevi, melanoma, and nevus-associated melanomas. However, its role in RTMN has not yet been established.

Objectives: This study aimed to evaluate the expression of PRAME in RTMN, specifically in the melanocytic and fibroblastic components, to explore its potential diagnostic utility.

Methods: A series of 22 RTMN cases from the Pathology Unit of the University of Campania Luigi Vanvitelli Hospital were reviewed. PRAME IHC was performed on formalin-fixed, paraffin-embedded tissue, and staining was evaluated in three compartments: junctional melanocytic, intradermal melanocytic, and fibroblastic scar tissue.

Results: PRAME IHC showed no positivity in the junctional or intradermal melanocytic components of any case. However, five out of 22 cases (22.7%) demonstrated PRAME positivity in the fibroblastic component, which was statistically significant (P=0.0169).

Conclusions: This study suggests that PRAME IHC is negative in the melanocytic components of RTMN, distinguishing it from melanoma. However, PRAME positivity in the fibroblastic scar component warrants careful interpretation to avoid diagnostic pitfalls. These findings emphasize the importance of considering the histological context when using PRAME as a diagnostic marker in RTMN.

Introduction: Atypical network is a dermoscopic criterion that helps in the diagnosis of melanoma. Despite its importance, the interpretation of atypical networks varies widely among experts.

Objective: This study examined the impact of viewing the whole lesion versus viewing foci of pigment network (i.e., snippets) in isolation from within the lesion on expert classification of pigment network in dermoscopic images.

Method: Six dermoscopy experts, blinded to the diagnosis, each evaluated a total of 92 images (80 nevi and 12 melanomas) for the presence of typical versus atypical pigment network. While 57% of images had consistent classification of the network between whole lesion and snippets, 43% shifted the network classification between the snippet to the whole lesion view. Melanomas were more prone than nevi to intra-rater discrepancy between whole lesion and snippets (54.2% vs. 41.7%; odds ratio (OR): 1.65; 95% confidence interval (CI): 1.11-2.47). The inter-observer agreement was higher for the snippet view (65.22%) than for the whole lesion view (55%).

Results: These findings suggest that both the objective morphology of the pigment network and the subjective interpretation of the network in context with other features within the lesion influence expert classification of pigment network.

Conclusion: Factors such as the variability in the distribution, thickness, and color of network lines, overall pattern, and other dermoscopic structures likely contributed to the classification changes.

Introduction: The use of brodalumab in patients with psoriasis who have failed other biologic drugs is an underexplored topic.

Objectives: To evaluate the safety and the efficacy of brodalumab in a subgroup of psoriasis patients who already failed anti-IL23 or anti-IL12/23 treatment.

Methods: Using the Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI), we retrospectively evaluated a cohort of 23 patients with psoriasis who underwent a change in therapy with brodalumab exclusively following primary or secondary therapeutic failure of anti-IL-23 or anti-12/23 drugs.

Results: The mean PASI decreased significantly following the introduction of brodalumab after four weeks of treatment, continuing to decrease at 16 and 36 weeks, reaching the nadir at 52 weeks (baseline PASI baseline: 14.6 ± 9.2 vs. 52 weeks PASI: 1.1 ± 1.8; P<0.001). Sixty-three point six percent of patients reached PASI 100 just after 16 weeks. The same trend of improvement was also observed for the DLQI. The adverse effects observed in our study population were generally mild.

Conclusions: Our results are in line with the current literature and suggest that patients who have failed therapy with IL-23 or IL-12/23 inhibitors may benefit from switching to brodalumab, which could be considered a good choice for patients who need a rapid resolution of the inflammatory skin condition.