Dermatology and Therapy最新文献

Introduction: Visible light (VL; 400-700 nm) constitutes nearly half of solar radiation and has distinct biological effects on human skin. High-energy visible light (HEVL), particularly blue light (400-490 nm), contributes to erythema, persistent pigmentation, and photoaging. Emerging data also demonstrate synergistic pigmentary interactions between VL and long-wavelength ultraviolet A1 (UVA1). Individuals with skin of colour (SOC) and patients with visible-light-sensitive dermatoses are particularly susceptible to the cutaneous effects of visible light. This review aims to provide an evidence-based overview of VL interactions with skin, the mechanisms driving VL-induced cutaneous changes, and current VL-directed photoprotection strategies, with emphasis on their relevance for SOC populations and visible-light-sensitive dermatoses.

Methods: PubMed and Google Scholar were searched to identify studies addressing VL properties, cutaneous biological effects, and VL-specific photoprotection, including sunscreens, pigments, novel organic filters, antioxidants, and behavioural approaches.

Results: VL, especially blue light, induces oxidative stress, melanogenesis via opsin 3-mediated pathways, and degradation of dermal extracellular matrix. Tinted sunscreens containing iron oxides and pigmentary titanium dioxide provide the most effective and cosmetically acceptable VL protection, reducing HEVL transmission by up to 80-97% and improving clinical outcomes in melasma and other hyperpigmentation disorders. Novel organic UV filters such as TriAsorB™ expand absorbance into the VL spectrum, while adjunctive topical and oral antioxidants may attenuate VL-induced oxidative stress. VL may exacerbate photodermatoses, including autoimmune connective tissue diseases, porphyria, and solar urticaria.

Conclusion: VL is a biologically active and clinically relevant component of sunlight with disproportionate effects in SOC and certain photosensitive dermatoses. Optimal photoprotection requires a multimodal approach integrating UV and VL protection through physical measures, tinted formulations, emerging broad-spectrum filters, antioxidants, and patient-centred photoeducation. Standardised VL-protection labelling and further clinical research are needed to guide future practice.

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: Vitiligo is an acquired disorder of skin pigmentation characterized by impaired melanocyte function and the appearance of well-outlined, white skin spots. Worldwide the incidence ranges between 0.5% and 2%. It has a negative impact on the quality of life of patients causing anxiety, depression, and social stigma. This comprehensive review aims to consolidate the current evidence concerning vitiligo treatment with oral Janus kinase (JAK) inhibitors.

Methods: Three databases (PubMed, Medline, and Embase) were searched to identify all articles discussing vitiligo treatment with oral JAK inhibitors up to April 2025.

Results: We identified 217 articles encompassing vitiligo treatment with the JAK inhibitors baricitinib, tofacitinib, upadacitinib, ritlecitinib, ruxolitinib, prebocitinib, and povorcitinib.

Limitations: The data primarily stem from observational studies, case reports, case series, pilot studies, reviews, and meta-analyses. The establishment of treatment protocols necessitates more extensive and well-controlled studies.

Conclusions: Oral JAK inhibitors could present an effective and safe option for patients with vitiligo; however. there is a need for further long-term studies and more data about treatment procedures.

Introduction: There is increasing evidence suggesting that ultraviolet-induced fluorescence dermoscopy (UVFD) may enhance the diagnostic accuracy of various skin entities. This study aimed to evaluate the utility of UVFD for visualizing the discriminative features of the most common non-pigmented tumors of the face, including basal cell carcinoma (BCC), dermal nevus (DN), sebaceous hyperplasia (SebH), and seborrheic keratosis (SebK).

Methods: A total of 181 lesions were examined using polarized dermoscopy (PD) and UVFD. For assessment, established dermato-oncologic criteria for PD, as well as previously defined and newly observed features for UVFD, were used.

Results: The most common UVFD findings in BCCs were dark silhouettes (84.48%), interrupted follicle patterns (54.83%), arborizing vessels (54.83%), and well-demarcated borders (41.93%). DNs exhibited dark silhouettes (72.72%), interrupted follicle patterns (66.66%), and well-demarcated borders (54.54%). SebHs presented with punctate pink central fluorescence (43.63%) and 2-3 central plugs with or without fluorescence (36.36%). SebK showed well-defined borders (70.96%), white-blue fluorescence at the ridge edges (41.93%), and an interrupted follicle pattern (41.93%). Several UVFD features were indicative of specific entities, such as black globules, which are characteristic of BCC, central plugs or punctate pink central fluorescence (SebH), and white-blue fluorescence at the ridges or warty surface (SebK). However, other findings, such as an interrupted follicular pattern or absence of follicular fluorescence, were common across lesions and did not allow for differentiation.

Conclusion: The study offers new insights into the presentation of non-pigmented facial lesions under UVFD, with several features indicative of particular entities. Incorporating this method into daily practice may improve diagnostic accuracy and reduce unnecessary biopsies.

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: Plaque psoriasis (PsO) is an inflammatory skin disease that can impair quality of life. Tildrakizumab, an anti-IL-23 p19 monoclonal antibody, offers a treatment option for patients eligible for systemic therapy or phototherapy, but real-world results have not been comprehensively analyzed. This systematic review and meta-analysis evaluated real-world effectiveness, quality-of-life impact, and safety of tildrakizumab for treatment of moderate-to-severe plaque PsO, alone and relative to guselkumab and risankizumab.

Methods: MEDLINE® and Embase were searched on November 16, 2023, along with meeting abstracts (2021-2023) and bibliographies of previous reviews, for English-language real-world studies of tildrakizumab (singly or comparative) in adults with chronic moderate-to-severe plaque PsO. Outcomes included effectiveness (Psoriasis Area and Severity Index [PASI], Physician's Global Assessment [PGA], body surface area percentage [%BSA] affected), Dermatology Life Quality Index (DLQI), and safety (adverse events [AEs], serious AEs [SAEs], treatment-related AEs [TRAEs], or withdrawals due to AEs [WDAEs]). Meta-analyses were performed at 12-16, 24-28, and 36-52 weeks.

Results: Of 6982 records screened, 37 studies (45 publications) were analyzed. Tildrakizumab-treated patients experienced 78-87% improvement from baseline to 36-52 weeks across mean absolute PASI (12.81 [95% confidence interval 11.69, 13.92] to 1.62 [1.03, 2.20]), %BSA (16.21% [13.72%, 18.70%] to 3.27% [1.26%, 5.28%]), PGA (3.18 [2.89, 3.47] to 0.70 [0.08, 1.33]), and DLQI (14.59 [12.32, 16.87] to 1.83 [0.84, 2.82]), with low rates of AEs, SAEs, TRAEs, and WDAEs. Benefits and safety of tildrakizumab were similar to guselkumab and risankizumab.

Conclusion: Tildrakizumab demonstrated effectiveness, with reduction from moderate-to-severe to mild disease and improved DLQI scores, without notable safety concerns, for up to 1 year in this real-world meta-analysis. Although real-world data must be interpreted cautiously because of heterogeneity and potential bias, these findings align with randomized trial results, further supporting the use of tildrakizumab in clinical practice.

Introduction: Treatment adherence is crucial for managing chronic diseases, including plaque psoriasis. In Bulgaria, patients with plaque psoriasis can receive treatment with reimbursed biologics, such as guselkumab, if they meet National Health Insurance Fund (NHIF) requirements. These requirements include stringent disease criteria and a complex administrative process. The objective of this analysis is to assess the proportion of patients adhering to the guselkumab administration schedule, as specified in the summary of product characteristics (SmPC), after the first continuation of the NHIF treatment approval period (approximately 48 weeks).

Methods: This was a prospective, multicenter, single-country, noninterventional study. The primary endpoint was the proportion of patients adhering to the guselkumab administration schedule as outlined in the SmPC after the first continuation of the NHIF treatment approval period. Secondary endpoints included evaluating guselkumab's safety and efficacy, as well as patient profile.

Results: This study included 39 female and 61 male patients with plaque psoriasis, with a mean age of 51.5 years. Overall, 95% of enrolled patients adhered to the guselkumab dosing regimen (i.e., received all seven doses) at 50 weeks after study initiation. Treatment with guselkumab led to a rapid and sustained reduction in Psoriasis Area and Severity Index (PASI) scores, with 84.4% of patients achieving PASI 90 and 42.7% reaching PASI 100 by the final visit. Significant improvements were also observed in absolute PASI, body surface area (BSA), and Dermatology Life Quality Index (DLQI) scores, indicating marked disease control and enhanced quality of life across the study period. There were ten adverse events during the study, and no new safety signals for guselkumab were identified.

Conclusions: Bulgarian patients treated with guselkumab adhered well to treatment in this study, with an adherence rate comparable to that observed in randomized clinical trials and higher than the drug survival rates reported in real-world studies. This may be owing, in part, to the existing patient support programs specific to Bulgaria. Treatment with guselkumab in real-life clinical practice in Bulgaria was well tolerated and effective in reducing signs and symptoms of plaque psoriasis, consistent with the overall efficacy and safety profile demonstrated in randomized controlled trials.

Introduction: Combined platelet-rich plasma and hyaluronic acid (PRP-HA) offers a promising nonsurgical technique for tissue regeneration through synergistic efficacy and longevity effects. This study aims to investigate PRP-HA's efficacy and safety for neck rejuvenation.

Methods: This 32-week prospective trial enrolled 30 Thai participants with mild-to-moderate neck aging. Treatment consisted of three monthly intradermal PRP-HA injections to the anterior neck surface, with follow-ups at 2 weeks, and 1, 2, 3, and 6 months posttreatment completion. Assessment included skin firmness, elasticity, biometric parameters, pain scores, and adverse effects.

Results: Of 29 completing participants, neck skin firmness improved 54% from baseline at 3-month posttreatment completion, increasing to 65% at 6 months (p < 0.0001). While gross elasticity initially improved at 1 month posttreatment (p = 0.0217); it subsequently declined. The 6-month follow-up showed substantial reductions in melanin and erythema (p < 0.01). Sustained improvements were observed in hydration through study completion (p < 0.01). Sebum levels decreased significantly after the first two treatments and at 3 months posttreatment (p < 0.05). No significant changes appeared in skin texture, wrinkles, and brightness. Most participants reported 51-75% improvement after the third treatment, maintaining through 6 months. No severe adverse effects were reported.

Conclusions: PRP-HA demonstrates safe and effective improvements in neck skin firmness, hydration, and pigment and sebum regulation, with benefits lasting 6 months after three treatment sessions. However, variable effects on elasticity and modest results on wrinkles, texture, and brightness warrant further controlled trials to further elucidate and confirm its rejuvenative properties on the neck.

Trial registration: This trial is registered under the Thai Clinical Trials Registry (TCTR20230212003).