Dermatology最新文献

Background: Acne is a chronic inflammatory skin disease associated with impaired pilosebaceous unit function, leading to the development of noninflammatory and inflammatory lesions and, in some cases, persistent post-inflammatory erythema, hyperpigmentation, and scarring. Acne pathophysiology is complex, involving altered sebum production and composition, abnormal keratinization, microbiome dysbiosis, and skin inflammation. Conventional therapies, such as topical retinoids, antibiotics, and benzoyl peroxide, are the first-line treatments for mild-to-moderate acne, but antibiotic resistance and local adverse effects can have a negative impact on therapeutic outcomes, leading to a growing interest in alternative strategies for disease management. The use of dermocosmetics is increasingly being recognized as a useful strategy to improve treatment outcomes and patient adherence. In particular, there has been a recent increase in research aiming to identify natural plant-based ingredients with properties that target the multiple pathogenic mechanisms involved in acne but which have less impact on skin barrier function.

Summary: This review provides a summary of the anti-acne properties of the most well-characterized plant extracts and phytocompounds used in dermocosmetic anti-acne products, based on insights gained from in vitro, ex vivo, and in vivo studies. Evidence gained from clinical trials evaluating the effectiveness and safety of topical formulations containing these herbal ingredients is also presented. Finally, several less well-characterized herbal extracts and phytocompounds with promising anti-acne properties are described.

Key messages: Although research is ongoing for many of the anti-acne herbal ingredients identified so far, this review highlights the effectiveness of topical plant-based formulations for reducing lesion counts and disease severity in acne patients, as well as the rebalancing effects of herbal ingredients on sebum composition, microbial diversity, and pilosebaceous unit cell differentiation. Taken together with the antibiofilm, anti-inflammatory, antioxidant, and skin barrier repair properties demonstrated for many of these extracts, current evidence suggests that dermocosmetics with plant-based ingredients show great promise for acne management, either as monotherapies, maintenance treatments, or in combination with conventional drugs.

Introduction: Accurate visualization of nail-matrix psoriasis remains challenging. Ultraviolet-fluorescence dermoscopy (UVF-D) may enhance detection, yet rigorous comparative data are scarce. The aim of this study was to compare the diagnostic yield of UVF-D with standard dermoscopy and naked-eye clinical examination for matrix and bed involvement in nail psoriasis.

Methods: In this single-centre prospective pilot study (March-July 2024), 35 consecutive adults with plaque psoriasis underwent triplicate assessment (clinical, dermoscopy, UVF-D) of all fingernails. Each nail quadrant was scored for matrix-Nail Psoriasis Severity Index (NAPSI) and bed-NAPSI by two blinded dermatologists in randomized order. The study was powered (80%, α = 0.05) to detect a ≥3-point mean difference in matrix-NAPSI between modalities.

Results: UVF-D identified matrix involvement in 550/1,400 quadrants (39.3%) versus 448/1,400 (32.0%) with standard dermoscopy and 441/1,400 (31.5%) clinically (p < 0.001; Kendall's W = 0.42). Mean ± SD matrix-NAPSI scores were 15.7 ± 5.3 (UVF-D), 12.8 ± 5.2 (dermoscopy), and 12.6 ± 4.8 (clinical). Thus, UVF-D detected roughly one additional matrix-affected quadrant for every seven examined and produced a higher matrix-NAPSI, underscoring its added sensitivity over conventional methods.

Conclusions: UVF-D significantly improves visualization of nail-matrix psoriasis versus standard approaches. Larger multicentre studies should validate its diagnostic and longitudinal utility.

Introduction: Pediatric-onset generalized pustular psoriasis (PGPP) is a rare inflammatory disorder characterized by recurrent flares and challenging management. This study aimed to review the clinical features, flare patterns, and treatment options.

Methods: We analyzed PGPP patients diagnosed at Beijing Children's Hospital from 2006 to 2023 who had complete medical record. Data on clinical characteristics, flare numbers, and flare duration were collected through medical record and telephone survey. The flare frequency was calculated by dividing the flare numbers by the years in each age range. Flare duration was categorized as ≤4 weeks or >4 weeks. In addition, we investigated the factors associated with flare frequency in PGPP patients.

Results: A total of 109 patients with PGPP were included in the study, with a follow-up duration ranging from 1.90 to 22.80 years. The median age of onset was 6.00 years, with a higher prevalence in males (73, 66.97%). Most patients (55, 50.46%) experienced their first flare between the ages of 7 and 12 years. A total of 45 patients (41.28%) had history of psoriasis vulgaris, 16 (14.68%) had history of acrodermatitis continua of Hallopeau, and 4 (3.67%) had history of psoriatic arthritis. Respiratory infection was the most common trigger, affecting 35 patients (32.11% of cases). The annual flare frequency was 0.68. The frequency and duration of flares showed a decreasing trend with increasing age. Earlier onset age is associated with a higher flare frequency. Before 2020, conventional therapies were most commonly used, with acitretin used in 67 patients (61.47%). Following 2020, secukinumab became the most often used medication (44 patients, 40.37%).

Conclusion: PGPP exhibits a trend toward flare decrease with age, yet recurrence remains common. Earlier onset age may be associated with higher flare frequency. At present, biologic agents are the main treatment. These findings provide new insights into PGPP.

Background: Rosacea is a prevalent, chronic inflammatory skin disorder increasingly affecting middle-aged individuals worldwide. Characterized by facial erythema, flushing, papules, pustules, and telangiectasia, rosacea arises from complex, dysregulated immune responses with chronic inflammation and vascular instability. Given its multifactorial nature, treatment approaches focus on managing symptoms and often require a multidisciplinary strategy that integrates targeted skincare, topical and systemic therapies, and physical modalities to address the condition's diverse clinical manifestations, subtypes, and severity effectively. Validated conventional treatments, like metronidazole and azelaic acid, offer symptom relief to varying extents; however, many patients find these therapies insufficient, leading to a growing interest in alternative therapies.

Summary: Dermocosmetic products containing natural ingredients, particularly botanicals, are gaining in popularity, driven not only by their reported anti-inflammatory properties and perceived favorable tolerability, but also because they often appear to align with the personal values and beliefs of many individuals, and offer a more holistic approach to care. This review provides an up-to-date summary of advancements in the use of botanical ingredients for the management of rosacea. By exploring both well-studied botanicals and emerging plant extracts, this review highlights the growing role of natural adjunctive treatments in rosacea care.

Key messages: Emerging clinical evidence suggests that plant-based ingredients may help alleviate rosacea symptoms by modulating inflammation, regulating keratinization, and supporting vascular health, thereby promoting skin restoration, vessel stability, and reduced sensitivity.

Introduction: An acne-specific questionnaire Quality of Life Relevance-Acne (QOLRELEVANCE-ACNE) was developed to evaluate health-related quality of life based on the most relevant topics for acne patients. The aim of the present study was to undertake an international validation of the QOLRELEVANCE-ACNE questionnaire and to propose a severity grading system for its scores.

Methods: Patients with acne were asked to fill in the QOLRELEVANCE-ACNE and Dermatology Life Quality Index (DLQI) questionnaires. Global acne severity was assessed independently by both dermatologists and patients. Cronbach's alpha was used for assessment of internal consistency of the QOLRELEVANCE-ACNE questionnaire. Spearman rank correlation was used to study convergent validity and test-retest reliability of the QOLRELEVANCE-ACNE questionnaire. DLQI severity banding system and global acne severity grades were applied to develop variants of the scoring system for the QOLRELEVANCE-ACNE questionnaire.

Results: The results of 726 patients with acne across seven countries (Bulgaria, Ukraine, Greece, Spain, Sri Lanka, Croatia, and Malta) were analysed. Cronbach's alpha was 0.94 for the entire QOLRELEVANCE-ACNE questionnaire, 0.90 for the socioemotional, 0.88 for the symptoms, and 0.76 for the stigma and suicidal thoughts domains. The QOLRELEVANCE-ACNE questionnaire showed high test-retest reliability (r = 0.96, p < 0.001) and strong correlation with DLQI scores (r > 0.6, p < 0.001 in all countries). The following grading system of the QOLRELEVANCE-ACNE questionnaire scores was accepted: total scores <20 indicate a mild effect, scores from 20 to 30 indicate a moderate effect and scores >30 indicate a severe effect on a patient's life.

Conclusion: Simultaneous international validation of the QOLRELEVANCE-ACNE questionnaire confirmed its convergent validity, internal consistency and test-retest reliability. A grading system of the QOLRELEVANCE-ACNE questionnaire scores was accepted.

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory debilitating disorder showing ethnic heterogeneity in its clinical presentation and associated comorbidities. However, data on East Asian populations remain scarce.

Methods: We conducted a retrospective analysis of clinical records for patients with HS diagnosed between 2006 and 2022 at two tertiary referral hospitals in Taiwan. Age- and sex-matched reference individuals without HS (3:1 ratio) were randomly selected from dermatology outpatients. Association between comorbidities and HS were analyzed using conditional logistic regression, while logistic regression identified predictors for lesion distribution and disease severity.

Results: A total of 512 patients with HS and 1,536 reference individuals were identified. Comorbidities independently associated with HS were obesity, smoking, and diabetes. Men had 4.2 times the odds of developing gluteal lesions but only 0.5 times the odds of axillary or inguinal involvement compared to women. Current smokers had 2.8 times the odds of gluteal involvement but 0.6 times the odds of having axillary lesions. A significant association was observed between obesity and axillary involvement. Advanced disease (Hurley stage II and III) was significantly associated with male sex, smoking, and axillary involvement.

Conclusion: Our study highlights distinct lesion distribution in East Asian patients with HS. Male sex and active smoking could predict for gluteal involvement, while female sex and obesity for axillary involvement. Independent risk factors for advanced disease were male sex, smoking, and axillary involvement.

Introduction: Many treatments for multiple actinic keratoses (mAKs) have been proven effective in clinical trials. However, there is a lack of evidence regarding the long-term impact of therapies on disease progression in patients with mAKs. This study aimed to investigate the long-term clinical trajectory of mAKs patients undergoing repeated topical interventions and to evaluate the clinical effectiveness of these treatments and patients' adherence to an extended follow-up protocol in a real-world setting.

Methods: We conducted a prospective follow-up of a cohort comprising 81 treatment-naïve mAKs patients from 2012 to 2023. Patients received examinations and, when necessary, interventions every 6 months. Instances of treatment cycle discontinuation and refusals to continue with specific therapies were systematically recorded. Descriptive statistics alongside the Student's t test were employed to evaluate improvements in the Physician Global Assessment (PGA) scores following treatment with the same medication.

Results: The average total number of medical examinations and treatments administered per patient was 23.0 ± 0.4 and 16.1 ± 2.4, respectively. Annually, the average number of examinations and treatments per patient was 1.9 ± 0.1 and 1.3 ± 0.2, respectively. We completed 539 (41.6%) treatment cycles using photodynamic therapy with red light and methyl aminolevulinate (MAL-PDT), 182 (14.0%) with diclofenac plus hyaluronate (DHA), 97 (7.5%) with imiquimod (IMI), 101 (7.8%) with 5-fluorouracil (5-FU), 25 (1.9%) with FU, and 353 (27.2%) with cryosurgery. PGA values indicated a statistically significant reduction following each treatment at the 30-day post-treatment mark; however, these values exhibited an increase by the 6-month follow-up visit. The rates of treatment cycle discontinuation were as follows: 28.0% with MAL-PDT, 22.0% with DHA, 27.8% with IMI, 22.8% with 5-FU, and 24.0% with FU. Refusal rates for subsequent treatment cycles with the same drug were documented as 32.7% for MAL-PDT, 17.6% for DHA, 24.7% for IMI, 21.8% for 5-FU, 20.0% for FU, and 12.2% for cryotherapy. Throughout the study duration, 223 cases of squamous cell carcinoma (SCC), 46 cases of basal cell carcinoma (BCC), and 4 malignant melanomas (MMs) emerged on the face or scalp, along with 71 SCCs, 64 BCCs, and 8 MMs in other body regions.

Conclusion: Immunocompetent patients with mAKs require lifelong follow-up accompanied by repeated treatment cycles, as the clearance rates, regardless of the degree achieved after a single treatment cycle, tend to be temporary. These patients are at a heightened risk of developing skin tumors.

Introduction: Non-transient erythema (NTE) is a major feature of rosacea, but its clinical evaluation is subject to human investigator variability. The angiopoietin-TIE2 receptor tyrosine kinase pathway plays a key role in regulating vascular homeostasis, but was previously overlooked as a target for rosacea therapy. Angiopausin® is a patented plant-based ingredient identified through a molecular phytotherapy screening program as a positive inducer of the angiopoietin-TIE2 pathway, which is the "gatekeeper of vascular quiescence." The objective of this preliminary study was to compare traditional clinical NTE scoring methods with a novel algorithm-assisted approach (AAREA®) aimed at both assessing erythema and exploring the potential scientific interest of analyzing erythema regression patterns in patients with rosacea treated with topical Angiopausin.

Methods: Data were obtained from the regular follow-up of patients with mild-to-moderate rosacea, monitored as part of the real-world "homeostasis in chronic facial dermatosis" registry cohort. Patients were managed exclusively with Angiopausin (applied twice daily) for up to 64 weeks. Facial redness was evaluated clinically using the global investigator erythema assessment (IEA) score and compared to data generated using the algorithm-assisted approach using an ANOVA with post hoc Tukey tests.

Results: Forty-four patients (9 men, 35 women) were included (average follow-up: 29 ± 3 weeks per patient). Reductions in total IEA scores were observed at week 4 (W4; p < 0.05) and through W8 to W64 (p < 0.001). Decreases in individual scores were also observed for flushing, NTE and edema (W4 to W64: p < 0.001), and telangiectasia (W8 to W32; p < 0.001). A high level of agreement (R2 = 0.9566) was observed between the clinical IEA scores and the algorithm-assisted approach. The algorithm-assisted approach also provided quantitative data on redness area and intensity, detected early reductions in NTE, and identified distinctive NTE regression patterns.

Conclusion: This study demonstrated the real-world effectiveness of targeting the angiopoietin-TIE2 pathway for managing rosacea, with topical Angiopausin resulting in significant and long-lasting reductions in NTE and other vascular manifestations. It also highlighted how advances in rosacea therapy can be studied by profiling the clinical effects of treatments using artificial intelligence. The AAREA tool provided valuable data for clinical scoring and research into understanding rosacea pathogenesis.

Introduction: Pruritus exerts a substantial negative impact on the quality of life of patients, yet comprehensive evaluations of its global disease burden remain limited. This study assessed the temporal trends in the burden of pruritus at global, regional, and national levels from 1990 to 2021.

Methods: Data were extracted from the Global Burden of Disease 2021 database. Trends in age-standardized rate (ASR) of incidence, prevalence, and disability-adjusted life years (DALYs) associated with pruritus were analyzed across geographic regions, sociodemographic index (SDI) levels, sex, and age groups. Further analyses included decomposition analysis, assessment of social inequalities, frontier analysis, and Bayesian age-period-cohort modeling.

Results: In 2021, the global ASR of incidence, prevalence, and DALYs due to pruritus were 767.02 (95% uncertainty interval [UI]: 685.95-861.45), 986.45 (95% UI: 883.65-1,090.80), and 10.42 (95% UI: 5.05-19.04) cases per 100,000 population, respectively. Corresponding estimated annual percentage changes were 0.35 (95% confidence interval [CI]: 0.34-0.36), 0.36 (95% CI: 0.35-0.37), and 0.36 (95% CI: 0.35-0.38). The burden was highest among females, elderly people, and populations in Southeast Asia and middle SDI regions. Population growth represented the primary driver of the increased burden. Over time, high SDI regions experienced a progressive rise in burden, while low SDI regions demonstrated closer alignment with burden control targets. Future projections indicate a substantial increase in incidence, particularly among patients aged over 60 years.

Conclusion: An upward trend in the global burden of pruritus was observed between 1990 and 2021, mainly caused by population growth. Moreover, the global incidence of pruritus will increase significantly in future. Public health management strategies need to pay particular attention to women, the elderly, Southeast Asia, the middle and high SDI region, and some countries with overly rapid growth rates, such as China, India, and Myanmar.