Dermatology and Therapy最新文献

Introduction: Postherpetic neuralgia (PHN) is a chronic neuropathic pain condition that disproportionally affects older adults. First-line oral treatments often yield suboptimal relief and may cause systemic side effects and drug-drug interactions. Effective topical treatments offer the potential to address this significant unmet medical need in PHN. This CASPAR analysis evaluated real-world effectiveness and safety of the high-concentration capsaicin patch (HCCP) in patients with PHN.

Methods: Real-world data were evaluated for a large PHN cohort extracted from the German Pain e-Registry as part of the retrospective, noninterventional, multicohort CASPAR study. Patients received one to four HCCP treatments over 12 months. Patient-reported outcomes included average pain intensity (API), quality of life (QoL), sleep impairment, mood, concurrent pain medications, and safety.

Results: This analysis included 961 patients with PHN (mean age: 63.8 years, female: 69.7%; mean pain duration: 3.3 years) receiving one (n = 187), two (n = 209), three (n = 207), or four HCCP treatments (n = 358). Mean 24-h API decreased from 61.8 at baseline to 46.8 by month 3 (P < 0.001), and to 31.8 at month 12 (P < 0.001). Patients receiving four treatments had the greatest API reductions (63.7 at baseline versus 19.6 at month 12; P < 0.001), whereas improvements were lost in those who discontinued treatment. While ≥ 30% API response rates were similar across treatment groups at month 3 (25.6-30.7% of patients), those receiving additional treatments showed continued improvement, peaking at 99.7% by month 12 after four HCCP treatments. Trends were similar for other patient-reported outcomes, including QoL, sleep, and mood. Concomitant pain medication use decreased over time. Most adverse drug reactions were mild and application site-specific.

Conclusions: HCCP is an effective and well-tolerated topical treatment for patients with PHN, including older adults. After one treatment, improvements were noted in API, QoL, sleep, and mood outcomes, alongside decreased concomitant pain medication use, with progressive improvements following additional treatments. A Graphical Abstract is available for this article.

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: 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: 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: Randomized clinical trials (RCTs) in atopic dermatitis (AD) often exclude older adults and patients with comorbidities, limiting the generalizability of trial findings to real-world populations. Despite the growing use of biologics and Janus kinase inhibitors (JAKis) in clinical practice, the extent to which real-world patients meet RCT eligibility criteria and their associated safety outcomes remains unclear.

Methods: We conducted a retrospective analysis of a large, multicenter international cohort of adolescents and adults with AD treated with biologics (dupilumab, tralokinumab) or systemic JAKis (abrocitinib, baricitinib, upadacitinib) between October 2017 and March 2023 across 16 dermatology centers. Eligibility was defined according to commonly applied RCT criteria. Patients meeting ≥ 1 exclusion criterion were classified as ineligible. Demographic, clinical, and safety outcomes were analyzed.

Results: Among 2154 patients, 514 (23.9%) were ineligible. The most frequent reasons were Eczema Area and Severity Index (EASI) < 16 (67.9%), age ≥ 75 years (21.8%), and cardiovascular disease (13.0%). Ineligibility patterns differed across treatments: patients receiving JAKis were most often ineligible because of EASI < 16 (92.8%), whereas ineligibility among biologic users more commonly reflected also age or cardiovascular comorbidity. Ineligible patients were older, had more non-atopic comorbidities, and had lower measured baseline disease activity. Safety profiles were generally favorable. Among biologic-treated patients, adverse event rates were similar between eligible and ineligible groups. In the JAKi cohort, overall adverse events were more frequent in ineligible patients (52.9% vs. 42.6%; p = 0.051), with acneiform eruption and lipid abnormalities emerging as the most distinct differences. No unexpected safety signals were identified in either treatment group.

Conclusion: Nearly one-quarter of real-world patients with AD would not have met eligibility criteria for pivotal RCTs, yet both biologics and JAK inhibitors demonstrated acceptable safety profiles in these populations. While adverse events were more frequent among ineligible patients receiving JAKis, findings require further investigation to determine their clinical relevance, particularly regarding long-term cardiovascular outcomes.

Background: Alopecia areata (AA), pressure-induced alopecia (PIA), and telogen effluvium (TE) are nonscarring forms of hair loss reported in patients undergoing surgical procedures under general anesthesia (GA). While AA is primarily autoimmune and stress-mediated, PIA arises from prolonged scalp pressure during surgery, and TE is typically triggered by metabolic or physiological stressors that induce a premature transition of anagen hairs into the telogen phase.

Objective: This review aims to explore the emerging evidence linking GA to the onset or exacerbation of these alopecic types.

Methods: Authors review currently available literature found in MEDLINE and Google Scholar databases and present it in a structured way.

Results: Currently available literature supports the existence of a link between GA and AA, PIA, and TE, and proposes several potential mechanisms including immune dysregulation, ischemia, hypoxia, and systemic stress responses on the basis of current findings.

Limitations: Despite existing evidence, significant gaps remain in understanding the associations between various forms of alopecia and GA, owing to a lack of high quality, structured research.

Conclusions: There is a possible link between GA and various forms of alopecia, although further research to clarify the relationships, identify at-risk individuals, and inform perioperative hair loss management strategies is needed.

Obesity is a major global health concern characterized by excessive fat accumulation, which significantly increases the risk of numerous comorbidities. While lifestyle modifications and pharmacotherapy are commonly employed, bariatric surgery is recognized as a highly effective treatment option. These procedures alter gastrointestinal anatomy, restricting food intake and modifying nutrient absorption, thereby reducing hunger and increasing satiety. Beyond weight reduction, bariatric surgery can improve or resolve obesity-related conditions, including type 2 diabetes, hypertension, sleep apnea, and dyslipidemia. In addition to obesity, patients undergoing bariatric surgery frequently present with diverse skin disorders, such as hidradenitis suppurativa, psoriasis, necrobiosis lipoidica, skin tags, acanthosis nigricans, striae, keratosis pilaris, hyperhidrosis, plantar hyperkeratosis, intertrigo, pseudoacanthosis nigricans, lymphedema, bacterial infections, and confluent and reticulated papillomatosis. Bariatric surgery has been reported to improve or resolve conditions such as acanthosis nigricans, confluent and reticulated papillomatosis, necrobiosis lipoidica, hidradenitis suppurativa, psoriasis, hirsutism, skin tags, intertrigo, keratosis pilaris, and pebble fingers. Conversely, it may precipitate or exacerbate other conditions, including xeroderma, sporotrichosis, prurigo pigmentosa, bowel-associated dermatitis-arthritis syndrome, pellagra, disseminated intravascular coagulation, purpura, vasculitis, panniculitis, and alopecia. The relationship between obesity, weight loss, and skin health in patients undergoing bariatric surgery is complex, involving mechanisms such as inflammation, hormonal alterations, and mechanical stress on the skin. This study aims to investigate the effects of bariatric surgery on the progression and development of skin disorders, evaluating both potential improvements and the emergence of new conditions postoperatively. In summary, bariatric surgery exerts multifaceted and sometimes conflicting effects on skin health.

Introduction: Psoriasis is an immune-mediated chronic inflammatory skin disease with a prevalence in Spain of between 2.3% and 2.7%. One-third of patients present with moderate to severe psoriasis (Pso). This article aims to retrospectively describe the characteristics of patients with Pso, as well as severity, patterns of treatment, quality of life (QoL), and associated direct healthcare resources utilized in routine clinical practice in Spain.

Methods: The SUMMER project is an ambispective, non-interventional, multicenter study including adult patients with a diagnosis of Pso. In the retrospective phase, data were extracted from patients' electronic medical records. Data on disease severity scores (PASI and BSA) and impact on quality-of-life impact (DLQI) were captured by natural language recognition processors.

Results: Of 10,874 patients with a diagnosis of psoriasis identified from five participating sites, 2734 did not meet inclusion criteria; a total of 8140 patients were included. Mean age (SD) was 57.7 (16.1) years and 51.3% were male. Most patients had plaque psoriasis (91.5%) and lesions in visible areas (70.8%). The most common comorbidities were dyslipidemia (32%), hypertension (25.6%), and anxiety (18.5%). On the basis of thresholds of PASI (5%) and BSA (3%), psoriasis was not controlled in 17.1% and 37.2% of the patients, respectively, and 25.1% of patients were receiving biological treatments. Between 2017 and 2022, ustekinumab showed the highest persistence rate, especially when used as first-line treatment. There was a tendency to prescribe guselkumab and risankizumab most commonly as second- and third-line therapies. DLQI scores showed that Pso had a moderate or higher impact on QoL for 38.0% of patients.

Conclusions: The results show how patients with moderate-severe psoriasis are managed in routine clinical practice in Spain. Between 17% and 37% of patients with Pso are not on the appropriate therapeutic target. Almost a quarter of patients required biological treatments to control the disease.

Psoriasis is a chronic inflammatory skin disease characterized by well-demarcated erythematous plaques with silvery scales that affects 2-3% of the global population. Beyond its dermatological manifestations, psoriasis has recently been recognised as a significant cardiovascular risk factor, patients with psoriasis have an approximately 50% increased relative risk of major cardiovascular events compared with the general population. This review examines the complex relationship between psoriasis and cardiovascular disease, exploring the epidemiological evidence, underlying pathophysiological mechanisms, clinical implications and therapeutic considerations. The inflammatory milieu characteristic of psoriasis, involving T cell activation, cytokine dysregulation and systemic inflammation, creates a pro-atherogenic environment that accelerates cardiovascular disease development. Understanding the mechanisms of cardiovascular risk is crucial for clinicians managing psoriatic patients, as it necessitates comprehensive risk assessment and preventive strategies beyond traditional dermatological care.