Dermatology and Therapy最新文献

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).

Port-wine stain (PWS) is a congenital capillary malformation with a 0.3-0.5% prevalence. This article reviews key techniques and advancements in the diagnosis and treatment of PWS. For assessment, several noninvasive diagnostic techniques were analyzed, including dermoscopy, high-frequency ultrasound, photoacoustic imaging, optical coherence tomography (OCT), laser speckle contrast imaging, the VISIA-CR™ system, and reflectance confocal microscopy. These methods were evaluated on the basis of factors such as vascular morphology (e.g., point, spherical, linear, grid vessels, vessel diameter, vessel wall thickness, etc.), depth of penetration, real-time blood flow monitoring, and quantitative analysis of hemoglobin. However, these noninvasive diagnostic methods share common limitations, such as restricted penetration depth, varying operator dependency, challenges in real-time quantitative analysis, and subjective interpretation in some modalities. In terms of treatment, pulsed dye laser (PDL) therapy remains the clinical gold standard for managing PWS. However, there are now additional options available, including alexandrite laser (755 nm), neodymium-doped yttrium aluminum garnet laser (1064 nm Nd:YAG), and intense pulsed light (IPL), and various other treatment strategies that cater to different characteristics of PWS. Nonetheless, efficacy can be limited by the depth of the blood vessels and individual variability. Photodynamic therapy, which targets the vascular endothelium using photosensitizers, is more effective but also more expensive. Recently, the incorporation of artificial intelligence and deep learning technology holds promise for improving the accuracy of diagnosis and personalization of PWS treatment. This represents a significant direction for future development in this field.

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: Switching biologics within or across classes can improve outcomes for patients with psoriasis who failed to meet their treatment goals on their original therapy. The objective of this study was to identify real-world baseline features which are associated with switching psoriasis therapies following sustained use of a biologic therapy.

Methods: The study was a retrospective analysis of the prospective, multicenter, non-interventional PPD™ CorEvitas™ Psoriasis Registry cohort. Patient sociodemographics, comorbidities, treatment history, disease activity, and patient-reported outcome measures were assessed at baseline visits, along with changes in disease activity and treatment at follow-up visits. Patients were classified at each follow-up visit as either switchers from one biologic therapy to another or non-switchers. Three analytic strategies-logistic regression, random forest, and decision trees-were used to identify features associated with switching.

Results: Patients contributed 14,729 follow-up visits, of which 995 episodes (6.8%) reflected a switch in biologic therapy. In logistic regression models, statistically significant associations with switching were seen for features including body surface area (BSA) involvement at baseline, change in BSA involvement from baseline to follow-up, and addition of at least one non-biologic systemic medication to treatment between baseline and follow-up. In random forest estimations, these three variables along with patient-reported fatigue and quality of life were determined to be most important. Finally, in the decision tree analysis, four subgroups of patients with moderate/severe BSA involvement at baseline in combination with other specific variables were identified as having a > 50% likelihood of switching.

Conclusion: Identification and recognition of these features and combinations thereof can facilitate shared decision-making between clinicians and patients to improve both outcomes of and patient satisfaction with biologic therapy.

Introduction: Patients with moderate-to-severe atopic dermatitis (AD) who discontinue dupilumab need additional therapeutic options. Lebrikizumab's distinct mechanism of action may provide that alternative treatment. We evaluated efficacy and safety of lebrikizumab in adults and adolescents with moderate-to-severe AD previously treated with dupilumab.

Methods: In the open-label ADapt trial, patients who discontinued dupilumab due to inadequate response, adverse events (AEs)/intolerance, or other reasons received lebrikizumab 250-mg every 2 weeks (Q2W) following 500-mg loading dose at baseline/week 2, through week 16, with optional topical therapy. From weeks 16-24, responders (≥ 75% improvement in Eczema Area and Severity Index [EASI 75] or Investigator's Global Assessment score 0/1 with ≥ 2-point improvement from baseline) received lebrikizumab every 4 weeks; inadequate responders continued lebrikizumab Q2W. The primary endpoint was EASI 75 at week 16 in the intent-to-treat population; EASI 75 was also analyzed by reason for dupilumab discontinuation. Secondary and exploratory efficacy endpoints were assessed throughout.

Results: Among the 86 patients enrolled, primary reasons for stopping dupilumab were inadequate response (n = 48, 55.8%), AEs/intolerance (n = 14, 16.3%), and other reasons (n = 24, 27.9%). Fifty-nine patients (68.6%) completed week 16; 52 patients (60.5%) completed week 24. At weeks 16 and 24, respectively, response rates were 57.4% (35/61) and 60.0% (33/55) for EASI 75; 53.2% (25/47) and 61.5% (24/39) for Pruritus Numeric Rating Scale ≥ 4-point improvement; and 83.0% (44/53) and 83.0% (39/47) for Dermatology Life Quality Index ≥ 4-point improvement. Most treatment-emergent AEs were mild/moderate. Serious AEs and discontinuations due to AEs were reported by 2 (2.3%) and 5 (5.8%) patients, respectively. Of the 10 patients who discontinued dupilumab due to eye-related events, facial dermatitis, or inflammatory arthritis, none reported similar events with lebrikizumab.

Conclusion: Results suggest that lebrikizumab provides meaningful improvements in skin clearance, itch, and quality of life in dupilumab-experienced patients with moderate-to-severe AD, with a safety profile consistent with other lebrikizumab phase 3 trials.

Trial registration: ClinicalTrials.gov identifier, NCT05369403.

Introduction: Atopic dermatitis (AD) is a complex disease with clinical heterogeneity. Nemolizumab is a novel interleukin (IL)-31 receptor alpha inhibitor that has demonstrated efficacy in managing moderate-to-severe AD. However, there are no head-to-head trials that compare nemolizumab with other anti-IL-4/13 monoclonal antibodies (mAbs). To support clinical decision-making, the comparative efficacy and safety of nemolizumab versus other advanced systemic therapies, in combination with topical treatments, were estimated using network meta-analyses (NMAs).

Methods: Randomized controlled trials (RCTs) investigating advanced systemic therapies for moderate-to-severe AD in adolescents (12-17 years) and adults (≥ 18 years) were identified through a systematic literature review (searches conducted 31 March 2025, CRD42023492392). The trial results were analyzed in fixed- and random-effects Bayesian NMA models. Outcomes included ≥ 75% improvement in the Eczema Area Severity Index (EASI-75), an Investigator's Global Assessment (IGA) score of 0 or 1 (IGA success), treatment-emergent adverse events, and discontinuations due to adverse events. Analyses for all endpoints were conducted at week 16. This publication presents a targeted comparison of licensed anti-IL mAbs.

Results: Twenty-two RCTs were included in the NMA. When measuring response through EASI-75 and IGA success, no statistically significant differences were observed between nemolizumab and all other anti-IL mAbs in CsA-experienced adults or CsA-naïve adolescents. In CsA-naïve adults, only lebrikizumab demonstrated statistically superior efficacy against nemolizumab. Nemolizumab demonstrated a comparable safety profile with other available treatments.

Conclusions: The results of this study suggest that compared with other anti-IL mAb therapies for the treatment of moderate-to-severe AD, nemolizumab has similar efficacy in achieving EASI-75 and IGA success, and a comparable safety profile. This is in addition to nemolizumab's well-demonstrated efficacy in improving itch. Nemolizumab may be particularly beneficial in clinical settings where patients and physicians are seeking to manage AD with a well-tolerated therapeutic.

Introduction: Psychodermatology studies the connection between skin and mental health and is especially relevant in older adults, where visible skin changes and aging often reflect psychological well-being. This is an understudied area in dermatology.

Methods: This narrative review examined literature on the current concepts and management strategies of geriatric psychodermatology. Research databases such as MEDLINE, PubMed, Springer, Google Scholar, and others were investigated, with a total of 131 papers identified. No publication date limits were included.

Results: There is a complex and fascinating relationship between the skin and the brain often referred to as the "skin-brain axis." Common psychodermatologic disorders in the elderly include obsessive-compulsive and related disorders, delusional infestation, and psychogenic pruritus, and these are often difficult to diagnose and manage in the elderly. We also summarize secondary dermatoses from anxiety, depression, stress, and dementia in the elderly. Comprehensive geriatric assessment extends beyond physical health and includes dermatologic, psychiatric, cognitive, and psychosocial domains. Comprehensive care requires collaboration among dermatology, psychiatry, and geriatrics, often incorporating both pharmacologic and non-pharmacologic approaches. We also describe dermatologic signs of elder abuse, dementia complicating psychodermatoses, and review treatment strategies of these conditions.

Conclusion: Psychocutaneous dermatology is a relevant and understudied area that dermatologists should familiarize themselves with. Multidisciplinary care including pharmacologic and non-pharmacologic strategies are often required for the management of these patients.

Introduction: Atopic dermatitis (AD) is a chronic, inflammatory skin disease with a hallmark symptom of pruritus. We developed Worst Pruritus Numeric Rating Scale (NRS)-a single-item, patient-reported outcome measure-to assess itch severity in clinical trial populations of adults with moderate-to-severe AD. The objective of this study was to evaluate the psychometric properties of Worst Pruritus NRS and determine its appropriateness for use in clinical trials assessing the efficacy of treatments among adults with moderate-to-severe AD.

Methods: We used data from a subset of 267 participants in a phase 2 clinical trial of rocatinlimab (NCT03703102; N = 274) to confirm reliability, validity, and ability to detect change in Worst Pruritus NRS. We estimated and confirmed a meaningful within-patient change (MWPC) threshold using anchor- and distribution-based methods.

Results: All intraclass correlation coefficients (ICCs) were ≥ 0.86, providing robust evidence for test-retest reliability. Evidence supported construct validity, including known-groups validity (all P < 0.0001). There were moderate, positive correlations between scores on Worst Pruritus NRS and supportive measures at week 16, including Dermatology Life Quality Index (DLQI) question 1 (itch item) (r = 0.78), DLQI (r = 0.66), Eczema Area and Severity Index (EASI) (r = 0.50), Investigator's Global Assessment (IGA) (r = 0.46), Body Surface Area of Involvement (BSA) (r = 0.40), and SCORing Atopic Dermatitis (SCORAD) itch item (r = 0.97). On average, patients with better DLQI question 1 scores, EASI, and IGA classifications achieved better (i.e., lower) scores on Worst Pruritus NRS at week 16 (P < 0.0001). Ability to detect change was supported with moderate-to-strong and positive correlations between Worst Pruritus NRS change scores and changes in supporting measures. MWPC estimates confirmed the commonly applied 4-point threshold value and a range of 3 to 4 points as indicative of meaningful within-patient change.

Conclusions: Worst Pruritus NRS is a reliable and valid patient-reported outcome measure to assess itch severity in clinical trial settings among adults with moderate-to-severe AD.

Introduction: Dermocosmetics are widely used to complement dermatologic care, yet context-specific guidance remains limited for populations with Fitzpatrick skin types III-V. We convened a national expert panel to generate transparent, reproducible recommendations across ten common clinical scenarios.

Methods: Egyptian dermatologists participated in round 1 (national survey, n = 601) and round 2 (expert panel, n = 16), both with anonymous ratings and inter-round feedback, using the RAND/UCLA appropriateness method (median bands 1-3/4-6/7-9; disagreement index (DI) = interpercentile range (IPR)/IPR adjusted for symmetry (IPRAS); DI > 1.0 = disagreement). Per-item outputs included median, P30, P70, IPR (30-70), asymmetry Index (AI), IPRAS, DI, and final category (appropriate/uncertain/inappropriate). We additionally benchmarked classifications against prior consensus, guidelines, and key evidence frameworks.

Results: Across ten vignettes and 30 ingredients (30 ingredients × 10 scenarios = 300 items; multiple raters per item in round 1), 158 (52.7%) items were appropriate (median ≥ 7; DI ≤ 1.0), 135 (45.0%) were uncertain, and 7 (2.3%) were inappropriate. Photoprotection had the highest appropriateness across scenarios (broad-spectrum/tinted SPF), with a small number of DI-flagged uncertain exceptions. Hydration/barrier agents (e.g., hyaluronic acid, peptides, ceramides) were appropriate in stress-aging, post-laser, and post-procedure care. Pigment modulators (tranexamic acid, arbutin, niacinamide, vitamin C, glabridin) were appropriate in melasma/post-inflammatory hyperpigmentation and chronic sun-induced pigmentation. Classical retinoids were inappropriate for postpartum/breastfeeding and immediate post-procedure; lower-irritancy retinoid esters were context-dependent. Botanicals showed inconsistent support. Panel disagreement (DI > 1.0) declined from 38.3% in round 1 to 15.7% (47/300) in round 2. Patterns largely aligned with prior consensus; visible-light-mitigating photoprotection and timing-specific retinoid use were emphasized for darker phototypes.

Conclusion: We provide a transparent, regionally relevant framework for dermocosmetic ingredient selection. Sun protection and barrier support are foundational; pigment modulators are scenario-specific; retinoids require selective use; botanicals remain adjunctive.