Dermatology and Therapy最新文献

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.

Introduction: The German national psoriasis registry PsoBest collects long-term data on the effectiveness, safety, and tolerability of systemic treatments for psoriatic disease. Here, we describe patient characteristics and the safety and effectiveness of apremilast for the treatment of psoriatic disease in Germany based on data from PsoBest.

Methods: This was a descriptive analysis of observational data collected from PsoBest using cross-sectional (baseline characteristics) and longitudinal (outcomes, safety) designs. PsoBest recruits patients with moderate to severe plaque psoriasis or psoriatic arthritis who initiate a new systemic psoriasis treatment. Adverse events (AEs) and sociodemographic descriptors were reported for patients exposed to apremilast during the study period (safety cohort). Clinical and patient-reported outcomes were collected 3, 6, and 12 months after the initiation of apremilast monotherapy (outcomes cohort).

Results: From January 15, 2015 to June 30, 2020, 595 registry patients were exposed to apremilast; 417 were treated with apremilast monotherapy. Patients taking apremilast had a higher mean age and higher proportions of comorbidities such as cardiovascular or metabolic disease compared with those taking other nonbiologic systemic or biologic drugs. The most common nonserious AEs were drug ineffectiveness (14.1%), diarrhea (9.4%), nausea (7.1%), and headache (6.1%). The highest incidence rates of nonserious and serious AEs of special interest were for infections and infestations per system organ class (8.03/100 patient-years) and malignant or unspecified tumors (2.50/100 patient-years), respectively. Improvements in Dermatology Life Quality Index, patient-defined treatment benefits (Patient Benefit Index), body surface area, and Psoriasis Area and Severity Index were observed after 3, 6, and 12 months of apremilast treatment.

Conclusions: Patients in routine care treated with apremilast in the German PsoBest registry experienced treatment benefits and improved skin, psoriasis severity, and quality of life. Safety was consistent with the established safety profile. Apremilast is safe and effective for treating moderate to severe psoriatic disease.

Chronic spontaneous urticaria (CSU) is a mast cell-driven disease that affects approximately 1% of the population. Second-generation non-sedating H₁-antihistamines (H1AH) are considered the first-line treatment; however, a substantial proportion of patients remain refractory and require alternative therapeutic approaches, including anti-IgE antibodies or other agents that inhibit mast cell activation and degranulation. Glucagon-like peptide 1 receptor agonists (GLP-1RAs) are widely used for the treatment of type 2 diabetes mellitus and obesity and are known to reduce cardiovascular risk as well as comorbidities such as kidney disease and depression. In addition, GLP-1RAs have been reported to improve several autoimmune and autoinflammatory disorders, including dermatoses such as psoriasis, hidradenitis suppurativa, and atopic dermatitis. Several mechanisms have been proposed to explain the immunomodulatory effects of GLP-1RAs, including their influence on cytokine networks and immune cells, particularly mast cells. We report two female patients, aged 44 and 45 years, with long-standing CSU inadequately controlled on high-dose H1AH, who were initially prescreened for participation in a clinical trial with barzolvolimab. Before trial enrollment, both initiated GLP-1RA therapy (semaglutide or tirzepatide) for metabolic indications. Remarkably, both patients achieved complete resolution of CSU within 3 weeks of GLP-1RA initiation, with remission persisting for over 6 months. These observations suggest a potential immunometabolic mechanism linking GLP-1 signaling and mast cell activation, highlighting a novel therapeutic avenue for antihistamine-resistant CSU.

Introduction: Sleep disturbance is increasingly recognized as a modifier of dermatologic disease, yet its role in hair loss remains underexplored. Hair loss disorders, including alopecia areata (AA), androgenetic alopecia (AGA), telogen effluvium (TE), and scarring alopecias, carry substantial psychosocial burden and involve neuroendocrine and immune pathways sensitive to sleep quality.

Objective: To systematically evaluate associations between sleep disturbances and hair loss across major hair loss subtypes, define shared and subtype-specific mechanisms, and highlight insights relevant to counseling, symptom monitoring, and dermatologic management.

Methods: A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-guided systematic review of PubMed and Scopus identified 291 studies examining sleep disturbances in hair loss. After duplicate removal and screening by two independent reviewers, 29 studies were included. Extracted data included study design, level of evidence, hair loss subtype, sleep measures, mechanisms, and psychosocial correlates.

Results: Overall evidence quality was low to moderate (1 level II, 11 level III, 14 level IV, and 3 level V), with cross-sectional studies predominating (n = 15). AA was most represented (n = 14), followed by AGA (n = 11), TE (n = 3), lichen planopilaris (LPP) (n = 1), and traction alopecia (n = 1). Sleep disturbance was consistently elevated across AA, AGA, TE, and LPP populations, commonly assessed by the PSQI. Mechanistic themes varied by subtype: cytokine activation, hypothalamic-pituitary-adrenal axis dysregulation, and altered clock-genes in AA; circadian misalignment, obstructive sleep apnea-related hypoxia, and hormonal imbalance in AGA; neurogenic inflammation and substance-P pathways in TE; and chronic pruritus and pain in LPP. Psychosocial distress amplified sleep disruption in most subtypes.

Conclusions: Across hair loss disorders, sleep disturbance emerges as a biologically plausible and clinically relevant contributor to disease burden. Although most evidence is observational, converging mechanistic and psychosocial data support a bidirectional relationship between sleep quality and hair loss. Incorporating brief sleep assessments into hair loss care and considering sleep-targeted interventions may improve disease stability and patient well-being. Longitudinal and mechanistic studies are needed to clarify causality and identify therapeutic targets.