Dermatology最新文献

Background: Maintaining homeostasis in the upper pilosebaceous unit in acne-prone skin has emerged as the primary goal for effective and long-term acne management.

Summary: In this review, we describe advances in acne research that have helped redefine the strategic targets for new topical acne treatments, providing the basis for new therapeutic strategies that may allow this goal to be achieved.

Key messages: First, we describe the results of studies analyzing apparently uninvolved skin from individuals with acne, using sequential skin surface biopsies. These studies led to the identification of subclinical lesions, referred to as microcomedones, as the root of all subsequent acne lesions, and thus clinically non-lesional acne skin as the strategic target for new acne therapies. We then describe the concept of the comedo switch, in which exposure of progenitor cells in the pilosebaceous unit to comedogenic factors in acne-prone skin leads to the formation of microcomedones. Previously considered as an "inert plug", the microcomedone rather appears to be "an egg" that can grow into acne lesions.

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.

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: Ehlers-Danlos syndromes (EDS) represent a group of heritable connective tissue disorders characterized by skin hyperelasticity, joint hypermobility and generalized tissue fragility. Many patients remain undiagnosed years after initial symptoms and an accurate diagnosis is difficult despite all efforts. Currently, Germany lacks a patient registry and a specialized EDS centre.

Methods: In early 2020, a dermatological-orthopaedic EDS outpatient service was established at the University Hospital of Cologne. Medical records of all patients presenting in 2020 were retrospectively analysed.

Results: Forty-three adults were examined. Fifteen patients were diagnosed with EDS (different types), 13 with hypermobility spectrum disorder, and 1 with likely Loeys-Dietz syndrome (LDS) based on patient history and a suspicious variant in the gene TGFBR1. Excluding hypermobile EDS (6 patients), molecular confirmation was achieved in a total of 4 of 9 patients. The combination of symptomatic generalized hypermobility and skin manifestations was diagnostic in more than two-thirds of the EDS patients. Arterial involvement (aneurysms, dissection and rupture) and distinctive cutaneous signs (thin translucent skin with haematomas) indicated vascular EDS and LDS in altogether 3 patients.

Conclusion: With the present analysis, we discuss our diagnostic approach in patients with a suspected diagnosis of EDS in order to raise awareness of this rare group of genodermatoses and review recent developments in EDS nosology.

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common cause of chronic liver disease. Patients suffering from psoriasis are at an increased risk of developing MASLD. Psoriasis and MASLD share a pro-inflammatory cytokine milieu; however, it is still unclear whether these conditions are related through shared metainflammatory processes or shared comorbidities such as obesity, diabetes, insulin resistance, and metabolic syndrome. The aim of our study was to better characterize the anthropometric and metabolic profile of psoriatic patients with MASLD.

Methods: We conducted a prospective, single-center, cross-sectional study between June 2014 and August 2017. Recruitment was restricted to adult patients with psoriasis. Blood analysis, liver ultrasonography, and a FibroScan were performed. Blood investigations, baseline anthropometric measurements, and components of fatty liver disease (hepatic ultrasound, FibroScan) were assessed.

Results: A total of 100 patients were recruited, of which, 43% (65.1% men, n = 28) were diagnosed with MASLD. The mean BMI was significantly higher in MASLD than in non-MASLD (27.7 kg/m2 vs. 30.1 kg/m2, p =< 0.001). The mean waist circumference in MASLD patients was significantly higher than in non-MASLD patients (105.6 cm vs. 97.2 cm, p = 0.005). There was no significant difference between the mean age of both patient groups (50.4 vs. 47.3 years, p = 0.26). Psoriatic arthritis was more prevalent in MASLD than in the non-MASLD group (14.3% vs. 1.8%, p = 0.004). Biochemical analysis revealed significantly higher C-peptide level in patients with MASLD compared with patients without MASLD (2.5 vs. 1.6 ng/mL, p = 0.036). Moreover, MASLD patients were found to have a lower HDL level and higher glycemia, triglyceridemia, cholesterol, and LDL levels than non-MASLD patients. A total of 16.3% of patients with MASLD had fibrosis stage ranging from F2 to F4 based on liver stiffness measurement compared with only 10.6% of patients without MASLD.

Discussion: We identified parameters which were more prevalent in patients with psoriasis having MASLD, specifically a high BMI, elevated triglyceride levels, decreased HDL levels, and an elevated level of C-peptide. Patients with psoriasis and MASLD were more likely to suffer from comorbid psoriatic arthritis, despite having similar psoriasis disease severity as measured by PASI.

Conclusion: This study highlights the importance of screening patients with psoriasis for MASLD to prevent the progression to liver fibrosis.

Introduction: Cutaneous malignant melanoma (CMM) is the most lethal form of skin cancer worldwide. The precise prediction of lymph node metastasis is critical for personalized treatment and improved patient outcomes. However, no prior study has employed interpretable machine learning techniques to predict lymph node metastasis in CMM. This study aimed to utilize interpretable machine learning to integrate multidimensional data from the Surveillance, Epidemiology, and End Results (SEER) database - encompassing clinical characteristics, pathological information, and biomarkers of CMM - to construct various predictive models for lymph node metastasis.

Methods: We constructed six machine learning models to predict lymph node metastasis using clinical, pathological, and biomarker data from 2,448 patients with CMM in the SEER database. These models comprise a support vector machine, random forest (RF), XGBoost, LightGBM, adaptive boosting, and gradient boosting decision tree. The primary influential factors were identified using Gaussian Naive Bayes and gradient boosting algorithms. Shapley additive explanations (SHAP) analysis facilitates visual interpretation in individual patients. Model performance was evaluated based on accuracy, sensitivity, specificity, Brier score, and area under the receiver operating characteristic curve (AUC).

Results: The RF algorithm exhibited the highest predictive performance with an AUC of 0.897, accuracy of 0.821, sensitivity of 0.876, specificity of 0.765, and Brier score of 0.086. The primary influential variables were T stage, chemotherapy, ulceration, pretreatment lactate dehydrogenase (LDH) levels, and radiation therapy. SHAP analysis confirmed a significant association and highlighted the critical function of (LDH) as a predictive biomarker.

Conclusion: This study successfully established an accurate predictive model for lymph node metastasis in patients with CMM using machine learning techniques, offering a significant reference to aid clinician treatment decisions.

Introduction: Limited data are available on the effectiveness and safety of dimethyl fumarate (DMF) for the treatment of moderate-to-severe psoriasis in real-world clinical practice. The objectives were to assess the effectiveness and safety of DMF in patients with moderate-to-severe plaque psoriasis in Switzerland.

Methods: Data from 28 adults enrolled in the Swiss Dermatology Network for Targeted Therapies registry who started DMF treatment as first line or subsequence therapy at registry entry and had ≥3 months of follow-up were analysed. No missing imputation was performed.

Results: The median Psoriasis Area and Severity Index (PASI) decreased from 9.3 to 2.0 (p = 0.0136) and 2.3 (p = 0.0156) after 6 and 12 months of DMF treatment, respectively. At month 6, 61.5%/61.5%/15.4% of patients achieved a PASI <5/<3/<1 and at month 12, 75.0%/50.0%/37.5%. The proportions of patients achieving a PASI 75/90/100 response were 62.5%/25.0%/12.5% at month 12. At 12 months, median body surface area affected decreased from 10.3% to 1.5% (p < 0.01). The most common adverse events were abdominal pain (50.0%) and flushing (35.7%), which occurred in the first 3 months.

Conclusion: In a real-world setting, DMF significantly improves the severity and extent of disease in patients with moderate-to-severe psoriasis for up to 1 year with a safety profile consistent with previously published data on fumarates.

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disease with lifelong consequences for patients' well-being. Quality-of-life tools such as Dermatology Life Quality Index (DLQI) and Patient-Oriented Eczema Measure (POEM) assess disease burden at a specific time point but do not capture long-term life course impairment. The cumulative life course impairment (CLCI) model describes the multidimensional, cumulative effects of a chronic condition over an individual's life course, influencing their trajectory and fulfilment. Two instruments to assess CLCI were recently developed. The CLCI-R assesses retrospective, irreversible cumulative damage since disease onset, while the CLCI-P identifies patients at risk of future life course impairment. Both tools measure the psychosocial impact of chronic skin disease over time, extending beyond conventional cross-sectional quality-of-life measures. This study aimed to quantify the extent of CLCI in adult patients with moderate-to-severe AD seen at an academic medical centre.

Methods: A cross-sectional study was conducted at Singapore General Hospital among 82 adults with moderate-to-severe AD. Participants completed CLCI-R and CLCI-P questionnaires, while Eczema Area and Severity Index (EASI), DLQI, POEM, Itch, and sleep Visual Analogue Scale (VAS) scores were collected in the same visit. Spearman's correlation, Mann-Whitney U tests, and multiple linear regression were used to analyse associations and predictors of CLCI.

Results: The mean CLCI-R score was 29.4 ± 1.9, with no significant difference between moderate and severe AD (p = 0.907), indicating substantial retrospective impairment in both. CLCI-P scores were significantly higher in severe AD patients (Mean: 28.4 ± 5.5 vs. 15.9 ± 2.0; p = 0.007), highlighting greater future impairment's association with severe disease. CLCI-P correlated significantly with DLQI (r = 0.611) and disease severity (r = 0.489). In multivariable analysis, greater prospective impairment was associated with higher DLQI, CLCI-R, and disease duration ≥21 years.

Conclusion: This study underscores the substantial cumulative burden faced by patients with AD, particularly in those with longer disease duration and more severe disease. Integrating CLCI into dermatology assessments may help identify patients at higher risk of life course impairment and offers an opportunity to mitigate future cumulative burden with treatment.

Introduction: Hidradenitis suppurativa is a chronic inflammatory disease of the apocrine gland-bearing areas frequently misdiagnosed or underdiagnosed. Its true prevalence is still unknown and there is an ongoing interest in this matter. The current study was a part of the Global Hidradenitis Suppurativa Atlas (GHiSA) initiative that is actively involved in better understanding the epidemiological characteristics of HS.

Methods: This study was a multicenter study in 2 tertiary care hospitals in Bucharest. After obtaining consent, data from 796 healthy accompanying adults were included. A validated screening questionnaire was used before the clinical examination of the screening-positive and randomly selected screening-negative participants, respectively.

Results: The prevalence of hidradenitis suppurativa in Bucharest, Romania was 0.75% (95% confidence interval: [0.35%-1.63%]).

Conclusion: There aren't any data available regarding the prevalence of hidradenitis suppurativa in Romania and the current report is the first paper addressing the prevalence of HS in the capital of Romania, Bucharest.