Dermatology and Therapy最新文献

Introduction: The human skin acts as a protective barrier against external pathogens and hosts a diverse microbiome consisting of bacteria, fungi, viruses, and archaea. Disruptions to the skin microbiome can impact immune function, leading to inflammatory and autoimmune conditions. The importance of pH for the microbiome is paramount. Cosmetic skincare products interact with the skin microbiome and skin pH, playing a key role in maintaining microbial balance. Research suggests that products with non-physiological pH levels may disrupt the skin microbiota. Our clinical study aimed to evaluate the effects of low-pH cosmetic products (pH < 5) on the skin microbiome, contributing to improved skin health.

Methods: The clinical study focused on evaluating the skin microbiome diversity following the application for 28 days of four different low-pH cosmetic products (vitamin C, resveratrol, a collagen mask, and a native algae mask) on the forearms of post-menopausal women with skin pH > 5.5.

Results: The diversity of the natural skin microbiome increased consistently throughout the study, evident in both the untreated area and after the application of the Vitamin C Concentrate, Resveratrol Concentrate, Collagen Mask, and Native Algae Mask, as indicated by Shannon's diversity index. The native algae mask notably reduced the Corynebacterium genus and significantly lowered the pH. The skin pH changes corresponded with microbiota stability.

Conclusions: In conclusion, enhanced diversity of the natural skin microbiome was observed over the study duration. None of the investigational products caused significant disruption to the skin microbiome diversity, as evidenced by the stable Shannon's diversity index and relative abundance of specific genera. Notably, the native algae mask significantly decreased the presence of the opportunistic pathogenic Corynebacterium genus, which is likely attributable to a minor reduction in skin pH following extended product use. The findings suggest that the use of low-pH skincare products, like the native algae mask, do not disrupt skin microbiome diversity and may have the potential to positively impact skin microbiome diversity and health by reducing certain pathogenic microbial populations.

Background: Tirbanibulin 1% ointment has been licensed to treat non-hyperkeratotic actinic keratosis (AK) on the face and scalp in adults. Recent evidence suggests that, besides the antineoplastic effect, tirbanibulin may also confer substantial cosmetic benefits to patients.

Methods: We report a single-center retrospective study of patients affected by solar lentigines (SLs) and AKs in the context of field cancerization treated with tirbanibulin 1% ointment.

Results: Among 42 patients, 35% (n = 15) experienced complete clearance of SLs, while partial clearance was observed in 50% (n = 21) of patients. Regarding AKs, complete and partial clearance were observed in 52% (n = 22) and 40% (n = 17) of patients, respectively. Major study limitations are the small sample size and the absence of a control group.

Conclusions: Our results suggest that tirbanibulin 1% ointment may offer the dual benefit of treating AKs while simultaneously lightening aesthetically bothersome and difficult-to-treat lesions like SLs with just 5 days of application.

Introduction: Acne impairs quality of life, often leads to permanent scars, and causes psychological distress. This review aims to update dermatologists on the Federal Drug Administration (FDA)-approved and off-label use of combined oral contraceptives (COC), clascoterone, spironolactone, and emerging hormonal therapies for acne treatment.

Methods: We reviewed current literature on hormonal acne treatments and discussed common patient concerns, barriers to care, and individualized care needs.

Results: Different brands and dosings of COC have generally similar efficacy in treating acne. Dermatologists should discuss contraceptive options and provide individualized shared decision-making with patients based on patient preferences, contraceptive needs, comorbidity profile, access, and cost. Spironolactone is an effective acne treatment with clinical trial data to support its use as a first-line acne treatment for women with acne. Potassium monitoring is of low value for patients on spironolactone unless patients have specific risk factors for hyperkalemia. Clascoterone is a safe and effective topical anti-androgen for the treatment of acne in men and women with limited systemic effects on reproductive hormones.

Conclusion: Hormonal therapies are essential strategies to treat acne. Clinicians should expand the use of existing and emerging hormone therapy as part of their acne treatment strategies.

Specialists in forensic medicine assist in crime scene investigations. The forensic medicine experts include anthropologists, ballistic analysts, entomologists, odontologists, and osteologists. The experts are usually not at the crime scene; they provide an evaluation of evidence that is sent to them. After they complete their assessment of the evidence, they prepare a specialized presentation of their findings: a forensic expert analytical report. The format of the report is variable depending on which forensic expert is writing it; however, there are certain mandatory sections that are included: the chain of evidence, the methods of evidence evaluation, the results of the evaluation of the evidence, and the discussion (including the conclusion) of what the evidence demonstrates. Forensic dermatology is an emerging subfield of medicine. Dermatologists are experts in evaluating the skin, mucosa, hair, and nails. It is anticipated that the demand for forensic dermatology will increase as individuals who currently evaluate crime scenes become aware of the potential benefit of consulting a forensic dermatologist. An illustrative hypothetical forensic dermatology expert analytical report is presented. Like other forensic expert analytical reports, the forensic dermatology expert analytical report has four primary sections. The chain of evidence section is a chronologic documentation that not only identifies the protected care and control of the evidence but also the transfer of the evidence to another individual. The methods section is a comprehensive presentation of the analysis of the evidence; it comprises the majority of an analytical report. The results section provides the information obtained after the evidence has been evaluated; it should be written in plain language, so it is readily able to be understood by not only the other investigators but also the members of the legal profession (including the judge and the attorneys) and the members of the jury. The discussion section includes the opinion of the dermatologist and should be a summary of the investigation findings that puts the analysis of the evidence into context; it can include a conclusion section and should also be written in plain language. Depending on the specific circumstances of the case, the template of the illustrative forensic dermatology expert analytical report can be modified by the dermatologists who is preparing their analytical report. In conclusion, an excellent forensic dermatology expert report will aid both other investigators and the members of the legal system-such as the attorneys, judge, and jury-who are involved in the case. In addition, when the forensic dermatology expert testifies as an expert witness in court, the report will be an asset for the dermatologist.

Introduction: Retinol has a long history of treating skin conditions, including photoaging. However, skin irritation with repeated use of retinol is well documented. The present study assessed the effectiveness of a novel topical formulation, referred to as retinol topical formulation (RTF), to improve the quality of skin health. The RTF was composed of a low dose retinol, a synthetic retinoid ester, a pea peptide, and an antioxidant blend.

Methods: In vitro assessment of RTF on human skin co-cultures (human keratinocytes, melanocytes, and dermal fibroblasts) identified gene expression levels and skin biomarkers after 24 h exposure. An 8-week clinical study was conducted to evaluate once-nightly application of the RTF for short-term and long-term benefits in 30 adult subjects between 35 and 70 years of age (21 female, 9 male). Skin evaluations were conducted via bioinstrumentation (for hydration, transepidermal water loss and elasticity) and at 0, 1-, 2-, 4-, and 8-week self-assessment questionnaires and photo-imaging analysis were performed.

Results: RTF treatment of skin in vitro co-cultures upregulated aquaporin-3, PER1, collagen, and elastin, and downregulated expression of MMP1 and the pigmentation genes TYRP1 and MITF. The clinical assessment significantly improved hydration, transepidermal water loss, and elasticity along with incremental but significant increases in nine skin parameters (hydration, clarity, radiance/glow, smoothness, brightness, texture, appearance of pores, dark spots/hyperpigmentation, and skin tone evenness from baseline) with continuous use over 8 weeks compared to baseline values.

Conclusions: The RTF in vitro analysis showed significant positive changes for several skin biomarkers, and the clinical assessment showed RTF significantly improved the visible signs of dermal aging, without irritation.

Introduction: Chronic hand eczema (CHE) is an inflammatory skin condition characterized by different pathomechanisms, clinical presentations, and prognoses. Treatment is often challenging because of limited approved drugs, and severe CHE is associated with reduced quality of life (QoL) and poor overall health measures in terms of psychological, functional, and occupational challenges. This study aims to describe the real-life management practices of Italian dermatologists who frequently treat patients with CHE, compare these practices with existing guidelines, and propose practical clinical recommendations for the management of these patients.

Methods: An 11-question survey was administered to 14 participating dermatologists to gather their insights on the diagnosis, treatment, and management of CHE. Moreover, a comprehensive literature search was conducted over the previous 10 years as a starting point for discussion among experts.

Results: CHE was the reason for 6.9% of dermatological consultations by the 14 experts. Median time to CHE diagnosis was 12 (range: 2-24) months. Fissuring and itching (85.7% for both) were the most frequently reported signs and symptoms of CHE. The survey highlighted the need for long-term treatment that is effective and well tolerated, with experts emphasizing the importance of improving disease awareness among physicians and patients. Practical clinical approaches were proposed, emphasizing the significance of a thorough medical history and identification of symptoms in the management of CHE. Experts advocated for specifically developed CHE treatment approaches, concentrating on alleviating symptoms and signs, minimizing adverse events/safety issues, enhancing the QoL of patients, and long-term disease control. Findings from this survey were further discussed and compared to recommendations of the available guidelines for the management of CHE.

Conclusions: Managing CHE requires a comprehensive approach that considers both objective clinical factors and subjective patient expectations. Experts emphasized the need for effective and well-tolerated long-term therapies, improved disease awareness, and communication among physicians and patients.

Introduction: Alopecia areata (AA) is a non-scarring autoimmune disease characterized by patchy hair loss. The aim of this study was to validate a novel trichoscopic scoring tool, the Severity TRichoscopy Index for Alopecia Areata (STRIAA), for rapid assessment of AA severity.

Methods: Anonymized images from 340 patients were scored by two independent raters who analyzed four scalp areas (vertex, occipital, and left and right parietal) for trichoscopic signs: black dots, yellow dots, exclamation mark hairs, broken hairs, and short vellus hairs. Scores (0-3) were assigned according to the number of trichoscopic signs per area, resulting in a total STRIAA score out of 60.

Results: STRIAA showed high interrater reliability (Cronbach's alpha 0.99) and significant correlation with the Severity of Alopecia Tool (SALT) score (p < 0.001). Yellow and black dots were significantly associated with the SALT score.

Conclusions: The STRIAA provides a rapid and comprehensive assessment of AA severity, complementing current assessment tools in clinical practice.

Introduction: Psoriasis is characterized by aberrant keratinocyte activity and immune cell infiltration, driven by immune-mediated pathways. MicroRNAs (miRNAs) play crucial roles in regulating these processes, offering insights into disease mechanisms and therapeutic targets.

Objectives: This study aimed to investigate changes in circulating miRNAs in psoriasis patients undergoing risankizumab therapy, an anti-IL-23 monoclonal antibody, to understand its impact on disease pathogenesis and treatment response.

Methods: Plasma samples from 12 psoriasis patients were collected before (T0) and after 1 year (T1) of risankizumab treatment and analyzed using small RNA sequencing. Findings were validated in a separate cohort of 23 patients using quantitative real-time PCR (qRT-PCR). T-regulatory cell (Treg) numbers and pro-inflammatory cytokine levels were also assessed.

Results: Significant clinical improvement was observed in all patients after 1 year of treatment, accompanied by increased Treg counts and reduced levels of pro-inflammatory cytokines. Twenty-four miRNAs exhibited differential expression post-treatment; 9 were downregulated and 15 upregulated. Notably, miR-200a-3p showed a significant correlation with baseline Psoriasis Area Severity Index (PASI), indicating its potential as a severity marker. Risankizumab therapy also decreased peripheral blood levels of IL-23, IL-1β, and IL-8.

Conclusions: This study identifies specific circulating miRNAs, including miR-200a-3p, as potential biomarkers for monitoring treatment responses in psoriasis patients. The findings underscore the therapeutic efficacy of risankizumab in modulating miRNA profiles and immune pathways associated with psoriasis pathogenesis. Overall, these results provide new insights into the mechanisms of risankizumab action and highlight miRNAs as promising candidates for personalized medicine approaches in psoriasis management.

Introduction: Chronic urticaria (CU) is frequently a debilitating skin condition characterized by recurrent and spontaneous wheal and flares with significant impact on quality of life. This systematic review examines the impact of CU on sexual health.

Methods: A systematic review using PubMed, Embase, Web of Science, and Cochrane library databases was conducted for articles on sexual health in chronic urticaria.

Results: The database search produced 741 articles, of which 14 articles met inclusion criteria. Study design, patient demographics, disease characteristics, measures used to assess sexuality or sexual function, and study results were independently extracted for each article by two researchers. Any discrepancies were resolved to consensus by a third reviewer. Sexual dysfunction was common in patients with CU and its severity is associated with increased disease activity and poor disease control.

Conclusion: Sexual dysfunction is common in patients with CU, and it negatively affects their quality of life (QoL), body image, sleep quality, and mental health. Incorporating sexual health assessments into CU trials will allow for valuable insights into efficacy of study medications on this important QoL domain. Increased awareness of sexual impairment in CU is needed to provide comprehensive care.

Introduction: Secukinumab has proven to be effective and safe in psoriasis (PsO), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) in the phase 3 studies. However, data on real-world practice is limited.

Methods: This study is an ongoing, multicenter, 2-year observational study that focuses on patients with moderate to severe plaque PsO, active PsA, or AS receiving secukinumab. The aim of this study is to present baseline data for the entire study population.

Results: A total of 127 patients were enrolled, with 101 having PsO, 12 with PsA, and 14 with AS. Among the patients, approximately 54.0% were male. The mean body mass index ranged from 25.0 to 27.4 kg/m² across all groups. Patients with PsO had the longest disease duration with an average of 11.0 years, followed by AS (3.0 years) and PsA (1.0 year). Previous biologic therapy was observed in 6.9-8.1% of patients. Baseline disease severity scores revealed moderate to severe disease. In the PsO group, the mean Psoriasis Area and Severity Index score was 16.1. For patients with PsA, the mean Tender Joint Count was 9.1, and the mean Swollen Joint Count was 6.7. In the AS group, the mean Bath Ankylosing Spondylitis Disease Activity Index score was 4.6, and the mean Ankylosing Spondylitis Disease Activity Score was 3.7.

Conclusion: The study demonstrates disease durations, disease activity, and treatment history in Thai patients that were generally consistent with previous randomized controlled studies. Long-term data on the efficacy and safety of the treatment will be presented in future publications.