Dermatology and Therapy最新文献

Introduction: Alopecia areata incognita (AAI) represents a distinct subtype of alopecia areata (AA), characterized by profound hair shedding and diffuse thinning. Despite being initially described in 1987, AAI remains underdiagnosed, with limited published reports. This comprehensive review aims to consolidate the current evidence concerning AAI pathogenesis, clinical presentation, trichoscopic and histopathologic attributes, differential diagnoses, and available treatment modalities.

Methods: PubMed searches were performed to identify all articles discussing AAI published up to September 2024.

Results: We identified 28 articles encompassing AAI epidemiology, pathogenesis, clinical presentation, trichoscopic findings, histopathologic characteristics, diagnosis, and treatment options.

Limitations: The data primarily stem from observational studies, case reports, case series, and a pilot study. The establishment of diagnostic criteria and treatment protocols necessitates more extensive and well-controlled studies.

Conclusion: Alopecia areata incognita is a distinctive form of AA, sharing similarities with telogen effluvium (TE) and showing potential associations with androgenetic alopecia (AGA). It has an acute onset and results in sudden diffuse hair loss. While diagnostic challenges persist, combining clinical, trichoscopic, and histopathologic evaluations aids in accurate identification. AAI typically responds favorably to topical steroids and has a better prognosis than other subtypes of AA.

Introduction: Plaque-type psoriasis affects the genital area in 7-42% of patients, and can impose significant quality of life (QoL) impairments. In this case, systemic treatment is recommended regardless of the affected body surface area. This real-world study compared treatment effects and patient-reported outcomes (PROs) between patients with and without genital lesions, undergoing apremilast treatment for 6 ± 1 months.

Methods: Secondary analyses were conducted using data from the observational, retrospective, cross-sectional APPRECIATE study. Adult patients with plaque-type psoriasis who initiated apremilast during the previous 6 ± 1 months were consecutively recruited in seven European countries between May 2016 and November 2019. At the time of study inclusion (T1), clinical and PROs were assessed by physician/patient questionnaires. Baseline data were collected retrospectively from medical records.

Results: This study included 482 patients: 108 with genital psoriasis (GenPso+) and 374 without genital lesions (GenPso-). The GenPso+ group had higher disease burden at baseline. For patients receiving ongoing treatment at T1, there was significant improvement in disease severity and marginally significant improvement in QoL impairments, independent of genital involvement. Satisfaction with medication and patient benefits also did not differ between groups.

Conclusion: This study further established the value of apremilast as a systemic treatment for patients with psoriasis, including those with genital involvement.

Trial registration: The APPRECIATE study was registered at  https://clinicaltrials.gov/  with the number NCT02740218.

Introduction: Psoriasis (PsO) is a common dermatological condition. Psoriasis severity is commonly characterized by percentage body surface area (BSA) affected, with < 3% BSA considered mild disease and 3-10% moderate disease. Treatment options for and knowledge of clinical practice patterns in patients with mild PsO are limited. Here, we use real-world data to characterize patients diagnosed with mild and moderate PsO and their clinical management.

Methods: Data were derived from the Adelphi Real World PsO Disease Specific Programme™, a cross-sectional survey of dermatologists and adult patients with PsO in the USA, between December 2021 and March 2022. Dermatologists reported demographic and clinical details. Patients reported treatment satisfaction and quality of life using patient-reported outcome measures. Patients were stratified by physician-reported severity at diagnosis (mild/moderate) and compared using bivariate analyses.

Results: Out of 389 patients, 18.5% were diagnosed with mild PsO. The majority were female, white, and employed. Patients diagnosed with moderate PsO had higher body mass index (p = 0.002) and longer disease duration (p = 0.041). Only 22.0% of patients diagnosed with mild PsO had BSA < 3% at diagnosis, and 48.1% of patients diagnosed as moderate PsO had BSA < 10%. BSA improvement following initiation of current treatment was higher among patients diagnosed with moderate PsO (p < 0.001). Those diagnosed with moderate PsO more commonly had involvement of the elbows (p = 0.003), legs (p = 0.002), knees (p < 0.001), soles (p = 0.035), and back (p = 0.004) at diagnosis. Cracked skin, redness, and tender skin (p < 0.001 for all) were more common among those diagnosed with moderate PsO. Both groups mostly received topical agents; however, those diagnosed with moderate PsO more commonly received systemic (p < 0.001) or biologic (p = 0.002) treatment. Patients diagnosed with moderate PsO had lower EQ-5D-5L (p = 0.014) and treatment satisfaction (p = 0.007) scores.

Conclusion: These findings suggest that physicians routinely underestimate PsO severity, resulting in possible undertreatment, suboptimal outcomes, and quality-of-life impairments for patients with milder severity PsO.

Introduction: A systematic literature review and network meta-analysis (NMA) were conducted to compare the short-term efficacy of lebrikizumab to other biologic and Janus kinase (JAK) inhibitor monotherapies approved for moderate-to-severe atopic dermatitis in adults and adolescents.

Methods: The NMA included randomized, double-blind, placebo-controlled monotherapy phase 2 and 3 trials of biologics (lebrikizumab 250 mg every 2 weeks [Q2W], dupilumab 300 mg Q2W, and tralokinumab 300 mg Q2W) and JAK inhibitors (abrocitinib 100/200 mg daily, baricitinib 2/4 mg daily, and upadacitinib 15/30 mg daily) at approved doses. Efficacy outcomes included the proportions of patients achieving Eczema Area and Severity Index (EASI) improvement, an Investigator Global Assessment of 0 or 1 (IGA 0/1), and a ≥ 4-point improvement in pruritus/itch numeric rating scale score at 12 weeks (abrocitinib) or 16 weeks (other treatments). Itch was also assessed at week 4. A Bayesian NMA employing baseline risk-adjusted random effects models was used to estimate treatment differences.

Results: Twenty-two monotherapy studies involving 8531 patients were included in the NMA. By week 12/16, lebrikizumab had superior odds of achieving IGA 0/1 and itch improvement compared to baricitinib and tralokinumab; similar odds to dupilumab, abrocitinib, and upadacitinib 15 mg; and inferior odds to upadacitinib 30 mg. Additionally, lebrikizumab had a higher probability of improving EASI than baricitinib 2 mg; similar probability to baricitinib 4 mg, tralokinumab, dupilumab, abrocitinib, and upadacitinib 15 mg; and lower probability than upadacitinib 30 mg daily. At week 4, lebrikizumab had superior odds of improving itch compared to tralokinumab; similar odds to baricitinib, dupilumab, and abrocitinib 100 mg; and inferior odds to abrocitinib 200 mg and upadacitinib.

Conclusion: Among biologics, lebrikizumab was comparable to dupilumab and superior to tralokinumab in improving response rates at week 16. Upadacitinib 30 mg was the only JAK inhibitor with superior response rates compared to lebrikizumab.

Introduction: Seborrheic dermatitis (SD) is a common, chronic inflammatory skin condition affecting sebaceous gland-rich areas of the skin. The multifactorial etiology of SD involves sebocyte activity, skin microbiome dysbiosis, and immune factors. Various treatment options exist for management of SD.

Methods: A PubMed search conducted on November 1, 2024 using the terms "seborrheic dermatitis" and "treatment" (restricted to 2019-2024) yielded 389 results, from which relevant papers and additional references were included in this review.

Discussion: Topical antifungals, topical corticosteroids, and topical calcineurin inhibitors are first-line treatments for SD; however, long-term use of each of these may be limited by varying side effects. Roflumilast foam is a newly approved topical with potential to become a first-line treatment. Myriad systemic treatments exist as second- and third-line treatments for cases of moderate-to-severe and/or recalcitrant SD. Procedural interventions of varying efficacy exist.

Conclusions: The treatment of SD requires an individualized approach, utilizing a range of topical, systemic, and procedural interventions. The advent of new treatments like roflumilast foam offers novel, well-tolerated, and safer options than what has been available in the past.

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disease with a substantial impact on patients' quality of life (QoL). This study aimed to characterize the burden of moderate-to-severe AD in the Portuguese population, focusing on patients' QoL and socioeconomic activities while describing their treatment patterns and healthcare resource use.

Methods: This multicenter, cross-sectional, and non-interventional study in eight Portuguese referral AD centers recruited patients over 12 years old, seeking first-time AD care. Patients over 16 years old were analyzed, and data on demographics, clinical characteristics, treatment patterns, healthcare resource utilization, and burden of disease via patient-reported outcomes (PROs) were collected.

Results: With a predominantly White cohort, a mean age of 30.0 years, and balanced gender distribution, the study highlighted the significant impact of moderate-to-severe AD on patients' QoL, with a mean Dermatology Life Quality Index score of 15.19. High levels of itch, lesional skin severity, sleep disturbance, and pain contributed to the substantial burden of disease. Productivity was impaired in 40.0% of patients and daily activities were disrupted in 50.0%. Average body surface area involvement was 45.82%, with a mean of 6.49 AD flares in the previous year. Dermatologists played a pivotal role in the patient journey, contributing significantly to the diagnosis (55.9%) and referral process (70.9%). Treatment patterns highlighted a historical reliance on topical therapies and an evolving landscape with post-visit inclusion of advanced therapies such as dupilumab (38.5%), conventional immunosuppressants like cyclosporine (31.2%), and baricitinib (6.8%).

Conclusion: This study unveils the intricate landscape of moderate-to-severe AD in Portugal, highlighting a substantial unmet need for optimal disease management. The role of dermatologists is crucial, yet limited adoption of advanced therapies in the face of significant disease burden prompts critical reflection.

Atopic dermatitis (AD) is a common chronic inflammatory skin condition that significantly impairs patients' quality of life as a result of intense itching and persistent eczematous lesions. Although AD has a multifaceted etiology-including genetic predisposition, environmental triggers, barrier dysfunction, and dysregulated immune responses-interleukin-4 (IL-4) has a recognized central role in its pathogenesis. This narrative review explores the role of IL-4 in the pathophysiology of AD, its contribution to the atopic march, and the therapeutic impact of IL-4 inhibition. IL-4 plays a critical role in skin barrier dysfunction, dysbiosis, pruritus, and inflammation, all of which contribute to the debilitating symptoms of AD. Moreover, IL-4 is implicated in other atopic conditions, such as asthma, allergic rhinitis, and food allergies, underscoring its role beyond AD and its importance in the atopic march. Recent advances in targeted therapies, particularly IL-4/IL-13 signaling inhibitors, have changed AD management. Dupilumab, an IL-4 receptor antagonist, has demonstrated significant efficacy in reducing AD symptoms and enhancing patient outcomes in both children and adults. In addition to symptomatic relief, suppressing IL-4 signaling may also offer potential for disease modification, altering AD's progression and possibly preventing the onset of other atopic conditions. This review highlights the crucial role of IL-4 as a therapeutic target in AD. By understanding the role of IL-4 in AD pathogenesis and exploring the therapeutic implications of targeting IL-4 pathways, this work can contribute to guide future research concerning treatment approaches and also emphasize the need for early and targeted interventions to mitigate disease impact and ultimately improve patient quality of life.

Introduction: Primary results of the JADE DARE trial (NCT04345367) demonstrated that abrocitinib was superior to dupilumab in reducing the signs and symptoms of moderate-to-severe atopic dermatitis (AD). This post hoc analysis evaluated the efficacy and safety of abrocitinib in patients with moderate-to-severe AD who were responders or nonresponders to dupilumab using various definitions of response.

Methods: Data included dupilumab-treated patients from JADE DARE who switched to abrocitinib 200 mg when enrolled in the ongoing JADE EXTEND trial (NCT03422822). For this analysis, various response criteria at Week 26 of JADE DARE were defined post hoc based on Investigator's Global Assessment (IGA), Eczema Area and Severity Index (EASI), Peak Pruritus Numerical Rating Scale (PP-NRS), and Dermatology Life Quality Index (DLQI) scores or responses. Efficacy was analyzed at Week 12 of JADE EXTEND based on patients' fulfillment of the various response criteria at Week 26 of JADE DARE. EASI scores and percentage changes from baseline in EASI and PP-NRS at Week 26 in JADE DARE were compared with the corresponding scores and percentage changes at Week 12 in EXTEND. Safety was assessed.

Results: Of 365 dupilumab-treated patients in JADE DARE, 316 were enrolled in JADE EXTEND and 312 received abrocitinib 200 mg. Most dupilumab responders for IGA, EASI, PP-NRS, and DLQI at DARE Week 26 maintained their responses 12 weeks after switching to abrocitinib, while a considerable proportion of IGA, EASI, PP-NRS, or DLQI dupilumab nonresponders gained response after switching to abrocitinib. Lower EASI scores and greater percentage changes from baseline in EASI and PP-NRS scores were observed with abrocitinib at EXTEND Week 12 than with dupilumab at DARE Week 26. No new safety signals were observed.

Conclusion: Abrocitinib 200 mg may be an effective treatment option for patients with moderate-to-severe AD who do not achieve an optimal response with dupilumab treatment.

Clinical trial registration: Clinicaltrials.gov: NCT04345367 (JADE DARE) and NCT03422822 (JADE EXTEND).

Introduction: Patients with psoriasis (PsO) and permanent spinal cord injuries (SCI) resulting in paraplegia and tetraplegia may experience a higher rate of infections compared to patients with PsO without SCI. It can result in further challenges for therapeutic management with immunosuppressants (biological and non-biological treatments). Thus,  we aimed to evaluate the rate of infections in patients with PsO and SCI treated with systemic immunosuppressants.

Methods: This multicenter, retrospective observational study enrolled patients with PsO and traumatic SCI undergoing systemic immunosuppressive treatments for at least 5 years. All patients were evaluated by experienced, board-certified dermatologists and neurologists. Demographic and clinical data were collected.

Results: We enrolled 23 patients with SCI (16 with paraplegia and 7 with tetraplegia) treated with methotrexate (MTX) and different biologics (tumor necrosis factor (TNF) inhibitors (i) and interleukin (IL)-17i/IL-23i). Globally, patients with SCI treated with MTX displayed higher rates of infection compared to those treated with biologics. Patients with paraplegia had lower rates of infection compared to patients with tetraplegia during anti-psoriatic therapies (p < 0.05). Those treated with TNFi had greater rates of infection than those treated with IL-17i/IL-23i (p < 0.001). Patients with psoriatic arthritis (PsA) experienced a significant diagnostic delay and clinical monitoring of PsA severity was challenging.

Conclusion: In patients with moderate-to-severe PsO and concurrent traumatic SCI, dermatologists should consider using IL-17i/IL-23i as first-line therapy.