Dermatology and Therapy最新文献

Introduction: Hand eczema and psoriasis present overlapping clinical features, complicating diagnosis and treatment selection. Traditional diagnostic methods rely on clinical assessment, patient history, allergy testing, and histopathology. However, recent advancements in molecular diagnostics offer promising alternatives. Accurate diagnosis is crucial for optimal therapy selection, particularly in occupational dermatology, where hand eczema is a common occupational disease.This study aims to assess the effectiveness of molecular diagnostics in distinguishing hand eczema from psoriasis, analyze disease severity and chronicity, and evaluate therapeutic changes and health-related quality of life (HrQoL) over a 2-year period.

Methods: A long-term cohort study was initiated in November 2020, enrolling 287 patients with suspected occupational skin disease. Molecular classification based on gene expression (CCL27 and NOS2) was performed on skin biopsies. Data collection included physician global assessment (PGA), Quality of Life in Hand Eczema Questionnaire (QOLHEQ), and Dermatology Life Quality Index (DLQI). Statistical analyses employed Cohen's kappa, χ² tests, Wilcoxon signed-rank tests, and 95% confidence intervals.

Results: Of 272 patients assessed via molecular diagnostics, 38.9% had clinically unclear diagnoses, with over 95% of these clarified through molecular classification. Dermatological and molecular diagnoses showed low agreement. Disease severity and chronicity significantly decreased over 2 years. Use of systemic therapies increased, while overall corticosteroid usage declined. HrQoL improved significantly, with DLQI scores decreasing by 50%.

Conclusions: Molecular diagnostics significantly enhance diagnostic accuracy for hand dermatoses, leading to targeted treatment adjustments. The observed therapy shift correlated with improved disease outcomes and HrQoL. As specialized systemic treatments emerge, precise diagnostic tools will be essential for optimizing patient care and reducing the burden of occupational skin diseases.

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disease often requiring continuous therapy. The objective with the ECZTEND trial was to assess the long-term safety and efficacy of tralokinumab treatment.

Methods: ECZTEND was a multicountry, open-label, 5-year extension trial conducted from September 2018 to July 2024 in patients (≥ 12 years) with moderate-to-severe AD who had received up to 1 year of tralokinumab treatment in a parent trial. Patients were eligible regardless of previous randomization (tralokinumab or placebo) or treatment response in the parent trial. The primary endpoint was the number of treatment-emergent adverse events (TEAEs) through week 268. Key secondary endpoints were Investigator's Global Assessment (IGA) and Eczema Area and Severity Index (EASI) through week 248.

Results: In total, 1672 patients were enrolled (4466.2 patient-years of exposure; median 2.6 years). Overall, 68.4% of patients (n = 1143) completed the trial period they consented to; 7.1% (n = 117) discontinued owing to lack of efficacy; and 4.2% (n = 72) owing to adverse events. The TEAE incidence rate was 114.3/100 patient-years with a pattern consistent with that observed in the parent trials albeit at lower rates. The majority (> 97%) of TEAEs were nonserious and of mild or moderate severity. Most (> 80%) were assessed as not related to tralokinumab by the investigator and resolved by the end of the trial. Common TEAEs (≥ 5%) included nasopharyngitis, atopic dermatitis, coronavirus infection, upper respiratory tract infection, conjunctivitis, and headache. The proportions of patients with IGA 0/1 and EASI-75/EASI-90 increased during the first 16 weeks and then remained stable through week 248 at ≥ 50% for IGA 0/1 and EASI-90, and ≥ 80% for EASI-75.

Conclusions: Long-term tralokinumab treatment for up to 6 years (parent trials plus ECZTEND) in patients ≥ 12 years with moderate-to-severe AD was well tolerated and maintained long-term efficacy. A graphical abstract is available for this article.

Trial registration: Clinicaltrials.gov listing: NCT03587805 (ECZTEND).

Introduction: Sensitive skin (SS) is a common clinical condition characterized by exaggerated sensory responses such as burning, stinging, itching, and irritation to otherwise nonpathological stimuli, most frequently affecting the face. The underlying mechanisms remain incompletely understood, particularly with regard to the role of the skin microbiome.

Methods: This study investigated the facial skin microbiota in Vietnamese adults with SS and examined its associations with clinical symptoms and skin physiological parameters. A total of 75 participants were enrolled, including 45 with SS and 30 with nonsensitive skin (NSS). Clinical assessment included evaluation of subjective symptoms, symptom regularity, time of symptom onset, trigger factors, and objective measurements of skin pH, sebum, hydration, transepidermal water loss (TEWL), erythema, and melanin index. Bacterial communities were profiled using 16S rRNA gene sequencing targeting the V3-V4 region.

Results: Participants with SS exhibited significantly higher erythema and TEWL across all sex and age subgroups, as well as elevated skin pH in female and middle-aged participants (p < 0.05). Alpha and beta diversity metrics did not differ significantly between SS and NSS groups. However, differential abundance analysis using Analysis of Compositions of Microbiomes with Bias Correction (ANCOM-BC) identified 53 bacterial genera with significant compositional differences, indicating subtle community restructuring. A total of 32 genera, including Peredibacter, Enterobacter, and Marmoricola, were enriched in SS, whereas Streptococcus, Escherichia-Shigella, and Weissella were depleted. Correlation and stratified analyses further revealed genus-level associations with skin physiological parameters, clinical symptoms, anatomical locations, symptom regularity, and time since symptom onset.

Conclusions: SS is associated with subtle but distinct alterations in facial skin microbiome composition, in parallel with measurable changes in skin physiological parameters related to barrier function and reactivity. The results indicate associations between microbial composition, skin physiological parameters, and clinical characteristics in the SS phenotype, and offer a population-specific microbiome reference for Vietnamese facial skin.

Introduction: Psoriasis and obesity often occur together, with up to 50% of patients with psoriasis being classified as obese. This increases systemic inflammation, cardiovascular risk, and disease severity while reducing the efficacy of biologic treatments. Despite this overlap, dermatology lacks obesity-specific guidance. This review evaluates lifestyle, pharmacological (glucagon-like peptide 1 receptor agonists [GLP-1 RAs] and tirzepatide) and surgical strategies, as well as clinic-level algorithms, to inform dermatological practice.

Methods: We performed a narrative synthesis of epidemiology, randomized trials, real-world studies, and guideline recommendations. Our focus was on the pathophysiology and the efficacy of GLP-1 RAs and tirzepatide, providing a practical algorithm pathway for triage, pharmacotherapy escalation, and referral criteria to a multidisciplinary unit.

Results: Although there are no psoriasis-specific guidelines for obesity treatment, the strong link between the two conditions and the poorer therapeutic response observed in obese patients make addressing excess weight essential for people with psoriasis. The proposed algorithms emphasize universal lifestyle counseling and dermatology-led management for patients with a BMI (body mass index) < 35 kg/m² and without major metabolic complications. GLP-1 RAs are considered the first-line treatment, given the available scientific evidence about their efficacy in terms of weight loss and management of comorbidities, as well as their safety profile. If weight loss with these drugs is insufficient, the next proposed treatment step is tirzepatide. Bariatric surgery, including bypass procedures, should be reserved for patients with a BMI ≥ 40 kg/m², or with a BMI ≥ 35 kg/m² when earlier measures have failed and/or comorbidities are not adequately controlled.

Conclusion: Dermatologists should integrate obesity assessment and patient-centered interventions into psoriasis care. A structured, multidisciplinary approach could meaningfully enhance dermatological, metabolic, and cardiovascular outcomes in patients with psoriasis and obesity.

Introduction: Collagen peptides are widely used to support skin health, but the immunological mechanisms mediating such effects remain unclear. So, this study investigated the effects of bioactive collagen peptide (BCP) supplementation on facial wrinkles, skin biophysical properties, and systemic levels of transforming growth factor-beta (TGF-β) and Klotho in sedentary middle-aged women.

Methods: This randomized controlled trial included 119 healthy, sedentary women, aged 35-55 years who were randomly assigned to control, Col 2.5 g, or Col 10 g groups. Daily oral supplementation for 12 weeks consisted of either 2.5 g/day or 10 g/day of BCP (Peptpure^®), or participants were allocated to a non-supplemented control group.

Results: Supplementation with 10 g/day of BCP significantly reduced the number (p < 0.0002) and length (p < 0.0424) of wrinkles. Both collagen groups improved skin elasticity (p < 0.0321 for 2.5 g; p < 0.0065 for 10 g) and hydration (p < 0.0471 for 2.5 g; p < 0.0037 for 10 g). Plasma TGF-β levels were significantly elevated in the 2.5 g group (p < 0.0026) and 10 g group (p < 0.0001) compared with controls, as well as Klotho levels for both collagen groups (p < 0.0016 and p < 0.0001, respectively).

Conclusions: A 12-week course of Peptpure^® BCP supplementation improved facial skin health, underlined by increased systemic levels of TGF-β and Klotho, suggesting activation of regenerative and antiaging pathways.

Trial registration: ClinicalTrials.gov identifier: NCT06971029.

Introduction: Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss. Ritlecitinib, an oral JAK3/TEC family kinase inhibitor, inhibits cytokines that may be involved in humoral and cellular immunity and is approved to treat severe AA in patients aged ≥ 12 years. This sub-study of a phase 3 study evaluated primary immune responses to the meningococcal groups A, C, Y, and W-135 oligosaccharide diphtheria CRM₁₉₇ conjugate (MenACWY-CRM) vaccine and secondary immune responses to tetanus toxoid booster (Tdap) in patients with AA receiving ritlecitinib.

Methods: Adult participants in the ALLEGRO-LT study (NCT04006457) receiving open-label ritlecitinib 50-mg once-daily for ≥ 6 months were eligible. Participants received a single-dose of 0.5-mL Tdap booster alone or in combination with a single dose of 0.5-mL MenACWY-CRM vaccine. Blood samples were collected at baseline pre-vaccination and 1 month post-vaccination.

Results: Overall, 17 participants received Tdap vaccination, of whom 13 also received meningococcal vaccination. At month 1 post-vaccination, 62.5% (10/16) of participants exhibited a tetanus booster response. All participants (16/16) achieved anti-tetanus antibody levels of 1.0 IU/mL and 0.1 IU/mL; 50% (8/16) showed a > fourfold increase from baseline. For the MenACWY-CRM vaccine, 20% (1/5) and 40% (2/5) of participants achieved human serum bactericidal activity titer for serogroup C ≥ 1:8 and ≥ 1:4, respectively. The geometric mean titer of antibodies for serogroup C increased from baseline (n = 12) to month 1 (n = 11). In total, three adverse events (AEs) occurred in three participants. No vaccine-related AEs, serious AEs, or permanent discontinuations due to AEs were reported.

Conclusions: Primary and secondary immune responses to the meningococcal and tetanus vaccines were observed in patients with AA during chronic ritlecitinib therapy, although the study was limited by the small sample size. The vaccines were well tolerated, no vaccine-related AEs were reported, and there was no exacerbation of underlying disease.

Trial registration: ClinicalTrials.gov identifier, NCT04006457.

Introduction: Psoriasis is a chronic inflammatory disease associated with multiple systemic comorbidities and reduced quality of life. Risankizumab, an interleukin (IL)-23 inhibitor, has demonstrated efficacy in achieving rapid and sustained skin clearance in moderate-to-severe psoriasis. However, its impact on chronic subclinical inflammation is less understood. Conventional clinical assessments like Psoriasis Area and Severity Index (PASI), Investigator's Global Assessment (IGA), and Body Surface Area (BSA) focus on evaluating visible symptoms and are limited in capturing underlying disease activity. Optical coherence tomography (OCT), a non-invasive imaging modality, offers real-time assessment of structural and vascular changes, providing valuable insights beyond the skin surface.

Methods: This sub-analysis of a prospective, single-center exploratory study included 22 patients with moderate-to-severe psoriasis treated with risankizumab. Clinical assessments (PASI, IGA, BSA) were conducted at baseline and weeks 2, 4, 16, 28, 40, and 52. OCT imaging performed at baseline and weeks 4, 16, and 52 evaluated epidermal thickness and vascular parameters (e.g., vessel density and diameter) in lesional and perilesional skin.

Results: By week 16, mean (95% confidence interval [CI]) PASI score decreased from 16.3 (11.6-21.1) at baseline to 3.5 (1.8-5.2), and BSA involvement from 24.7% (16.1-33.3) to 5.2% (1.9-8.4) (both p < 0.001). By week 52, 86.7%, 73.3%, and 40.0% of patients achieved PASI 75, 90, and 100, respectively, and 93.3% achieved IGA 0/1. OCT showed lesional reductions in epidermal thickness (- 37.4%), vessel density (- 26.6% Δ area under the curve [AUC]), and vessel diameter (- 59.5% ΔAUC) over the 52-week period. Notably, vascular changes also occurred in uninvolved perilesional skin.

Conclusion: Risankizumab improved both clinical and OCT parameters over 52 weeks, emphasizing the importance of long-term therapy with benefits extending beyond visible improvement. OCT emerged as a valuable tool for assessing deep (vascular) treatment response, thereby supporting a more comprehensive understanding of therapeutic outcomes in psoriasis.

Introduction: Facial hyperpigmentation is a condition that often shows limited response to treatment. Thiamidol is a proven human tyrosinase (hTyr) inhibitor. However, evidence from randomized controlled trials evaluating the effectiveness of Thiamidol in reducing facial hyperpigmentation remains limited.

Methods: This study is the first and largest randomized, double-blind, vehicle-controlled trial to evaluate the effectiveness of 0.2% Thiamidol cream in the treatment of facial hyperpigmentation in both sexes. A total of 200 participants with facial hyperpigmentation were randomized to either a Thiamidol cream or a vehicle cream group for 12 weeks. Blinded physicians assessed participants' scores on the modified Melasma Area and Severity Index (mMASI) using standardized photographs, with physician and patient global assessments and digital color analysis performed at weeks 4, 8, and 12.

Results: Of the 200 participants enrolled, 196 completed the study. The Thiamidol group showed significantly greater reductions in their mMASI scores (indicating improvement) than the vehicle group at all time points: the reduction from baseline were 11.8% vs 5.4% at week 4, 27.9% vs 13.6% at week 8, and 36.1% vs 16.1% at week 12 (all P < 0.001). The physician global assessments indicated slight to moderate improvement at weeks 8 and 12 (P < 0.001 and P = 0.001, respectively). The patient global assessments and digital color analysis showed no significant differences between groups. We found no statistically significant differences between the groups in the improvement of freckles or solar lentigines. No significant adverse events were reported in either group.

Conclusion: We found Thiamidol to be effective, well tolerated, and suitable for both sexes in the treatment of facial hyperpigmentation. These findings support its potential for broader clinical application in cosmetic dermatology.

Trial registration: ClinicalTrials.gov (NCT03926845).