Dermatology and Therapy最新文献

Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by intense itching, redness, and eczema. It significantly impacts the quality of life of affected individuals, often requiring long-term management strategies. Abrocitinib, an oral Janus kinase 1 (JAK1) inhibitor, is approved for the treatment of moderate-to-severe AD. Phase 2 and phase 3 abrocitinib randomized clinical trials in the JAK1 Atopic Dermatitis Efficacy and Safety (JADE) clinical development program have demonstrated the efficacy and safety of abrocitinib in both adults and adolescents with moderate-to-severe AD. This review article explores the benefit-risk profile of a flexible abrocitinib dosing approach, tailoring dose based on individualized treatment of patients and highlighting the available supportive data from the JADE randomized clinical trials for healthcare professionals as part of joint provider-patient decision making. Dosing flexibility and maintenance with the lowest effective dose is necessary to treat patients according to their individual disease course while minimizing safety risks. Safety data indicate that incidence of treatment-emergent adverse events is reflective of the current dosage, with no carry-over risk from a previous higher dosage. Overall, abrocitinib represents a valuable AD therapy that can be administered according to individual patient needs.Graphical abstract available for this article.

Cutaneous T cell lymphomas (CTCL) are non-Hodgkin T cell malignancies defined by malignant T cell transformation and accumulation in the skin. Limited understanding of CTCL pathogenesis, including the role of the tumor microenvironment, hinders effective treatment. Emerging evidence implicates the skin microbiota as a key modulator of disease, with microbial dysbiosis contributing to progression and representing a novel therapeutic target. This review synthesizes findings from 37 rigorously selected studies, outlining current knowledge of the CTCL-associated microbiome, mycobiome, and virome. It evaluates therapeutic strategies aimed at microbial colonization, emphasizing the potential of modulating host-microbe interactions. Additionally, we provide comprehensive clinical insight into the indications for microbial-modulating strategies of the microbiota in CTCL.

Introduction: Management of atrophic acne scars remains challenging, and conventional treatments often yield suboptimal or inconsistent outcomes. Stromal vascular fraction (SVF), a cell-rich fraction derived from adipose tissue, has recently gained attention as a promising regenerative therapy. Several previous studies have reported benefits of SVF when combined with other treatment modalities; however, its stand-alone efficacy for atrophic acne scars has not been clearly investigated. In addition, molecular evidence supporting the regenerative effects of SVF in acne scar treatment remains limited.

Methods: This randomized, evaluator-blinded, split-face clinical trial was conducted in 14 patients with bilateral facial atrophic acne scars. One side was treated with intradermal SVF injection, while the contralateral side received normal saline (NS). Clinical outcomes were assessed using scar counts, Évaluation Clinique des Cicatrices d'Acne (ECCA) scores, Scar Global Assessment (SGA) scores, and standardized photography at baseline, 5 weeks, and 10 weeks. Skin biopsies were analyzed via immunohistochemistry for markers of epidermal regeneration (cytokeratin 14, cytokeratin 15, p63, integrin β1) and dermal remodeling (collagen I, elastin, vimentin).

Results: At 10 weeks after initial treatment, the SVF-treated side showed a significantly greater reduction in total scar count compared to the NS-treated side (56.4% vs. 13.2%, p < 0.001). Scar subtype analysis revealed that all scar types (ice pick, boxcar, and rolling) responded more favorably to SVF treatment, with large effect sizes (Cohen's d > 0.99). ECCA and SGA scores were also significantly decreased on the SVF-treated side. Immunohistochemical analysis revealed marked upregulation of epidermal progenitor markers and increased deposition of collagen I, elastin, and vimentin in the SVF-treated tissue.

Conclusion: We clinically demonstrated that SVF injection improves atrophic acne scars and simultaneously revealed its regenerative mechanisms involving epidermal and dermal remodeling. This supports the use of SVF as an evidence-based treatment modality for atrophic acne scars.

Trial registration: ClinicalTrials.gov Identifier, NCT07094958.

Chronic spontaneous urticaria (CSU) is a debilitating inflammatory skin disorder characterized by recurrent wheals and/or angioedema lasting beyond 6 weeks without identifiable triggers. Recent advances have shifted the understanding of CSU from a historically idiopathic condition to one increasingly recognized as an immune-mediated disease with distinct endotypes, including type I (autoallergic) and type IIb (autoimmune). This narrative review synthesizes contemporary insights into CSU pathophysiology, endotype classification, and systemic manifestations, while highlighting the substantial impact on quality of life, sleep, and psychological health. Advances in biomarker research, including total serum immunoglobulin E (IgE) levels, basophil activation tests (BAT), and eosinophil counts, support progress toward personalized treatment approaches. Therapeutically, management of CSU has evolved from empirical symptom control with H1 antihistamines toward mechanism-based precision medicine. Omalizumab remains the established second-line therapy, and dupilumab received US Food and Drug Administration (FDA) approval in 2025 for antihistamine-refractory disease. In parallel, several targeted therapies are under investigation, including Bruton's tyrosine kinase (BTK) inhibitors, anti-KIT antibodies, and Janus kinase (JAK) inhibitors. These therapeutic mechanisms may offer sustained benefit, though long-term outcomes require validation through controlled trials. Integration of psychological interventions, such as cognitive behavioral therapy combined with pharmacotherapy, underscores the need for holistic patient care. Despite these advances, challenges remain in biomarker validation, sequencing of new therapies, and bridging clinical trial evidence with real-world practice. Future directions include refining endotype-driven personalized care, conducting long-term real-world studies, and developing cost-effective, globally accessible treatment strategies to optimize patient outcomes.

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin condition requiring long-term management to maintain remission and prevent relapse. Appropriate use of topical anti-inflammatory medications is an important factor in improving symptoms in patients with AD. This study aimed to investigate the treatment methods for maintaining remission and application of anti-inflammatory topical therapy.

Methods: This observational study was conducted in October 2022, using medical claims data from DeSC Healthcare Inc., linked with survey data collected from users of kencom®, a health promotion application. Eligible patients were adults aged ≥ 19 years with a confirmed AD diagnosis and prescription history. The survey evaluated (1) the actual treatment situation during the remission maintenance phase; and (2) instructions, actual status and adherence for application of anti-inflammatory topical therapy.

Results: A total of 626 patients who answered the kencom® survey and met eligibility criteria were included. Of these, 42.3% were instructed to stop medication once eczema improved, while 34.2% were instructed to continue during remission. Regarding instructions for the amount applied, the most common response was "No specific instructions" (44.2%), followed by "Fingertip-unit (FTU)" (27.2%). In actual practice, "FTU" was the most common amount (42.2%). Regarding application area, the most frequent instruction and actual practice were "Apply only to areas with eczema with remaining inflammation" at 52.6% and 62.5%, respectively, followed by "Apply not only to the eczema or remaining inflamed areas but also the surrounding areas" at 24.0% and 37.2%. Regarding the application method, "Apply thinly" was the most common instruction and actual practice at 32.7% and 48.4%, respectively. Treatment adherence rates were generally high, at over 60%.

Conclusion: Guidance from healthcare professionals has a crucial role in the proper use of topical therapies for AD. It is essential to ensure that topical medications are used properly to help patients achieve their treatment goals.

Introduction: Despite the expanding range of approved systemic therapies for atopic dermatitis (AD) and psoriasis (PSO), data on patient preferences remain limited. It is largely unknown whether patients wish to initiate systemic treatment, which route of administration (oral versus subcutaneous) they prefer, or what factors drive their treatment preferences. This study evaluated the desire for systemic therapy among systemic treatment-naïve patients with AD or PSO, including disease-specific influencing factors and preferences for administration routes (subcutaneous injections vs. tablets).

Methods: Eligible patients with AD or PSO were recruited at two German university hospitals. Questionnaires collected demographic and clinical data, including disease severity, pruritus and pain intensity, quality of life (QoL) impairment, and desire for systemic therapy. Data analysis comprised Mann-Whitney U tests (between-group comparisons), and Spearman correlations (factors influencing therapy desire).

Results: From 253 recruited patients, systemic treatment-naïve patients with moderate-to-severe disease severity exclusively using topical therapies were selected (56 with AD, 63 with PSO); 77.8% of patients with PSO and 67.9% of patients with AD desired systemic therapy, mainly for superior efficacy, QoL improvement, and pruritus reduction. Administration preferences differed significantly (PSO 57.1% injections; AD 73.7% tablets; p < 0.005). The desire for systemic therapy moderately correlated with pain intensity (ρ = 0.422, p < 0.001) and QoL impairment (ρ = 0.379, p < 0.005) in AD and with male sex in PSO (ρ = 0.347, p < 0.005).

Conclusions: Most topically treated patients with moderate-to-severe AD or PSO desire systemic therapy, with distinct disease-specific administration preferences.

This Summary of Research provides an overview of the results of a phase 3 study that assessed the efficacy and safety of apremilast in Japanese patients with moderate to severe palmoplantar pustulosis (PPP) who had not responded to topical treatment (NCT05174065). Patients were randomized to apremilast or placebo for 16 weeks, after which patients randomized to placebo transitioned to apremilast through 52 weeks. This study showed that apremilast significantly improved PPP clinical severity, symptoms, and patient-reported quality of life compared with placebo after 16 weeks of treatment. The benefits of apremilast were maintained or further improved over 52 weeks of treatment. The most common side effects (experienced by > 10% of patients) included diarrhea, nasopharyngitis, nausea, soft stool, and headache, and were consistent with previous studies of apremilast. Side effects were mainly mild to moderate. The results from this phase 3 study support apremilast as a systemic oral treatment option for patients with PPP with inadequate response to topical treatment, for whom treatment options are limited.

Rosacea is a common, chronic, inflammatory disease of the skin, which predominantly (but not exclusively) affects the centrofacial region. Clinical features may include transient or persistent facial erythema, recurrent flushing, telangiectasia, papules, pustules, phymatous changes, and ocular disturbances. These can lead to significant physical and psychological burden and discomfort, which adversely affects a patient's quality of life (QoL). While current guidelines provide recommendations on treatment initiation and modification, there is a lack of information for long-term management and maintenance. The Rosacea-Expert Advice on Combined and Holistic approaches (REACH) group is an international group of experienced dermatologists, brought together to address these shortcomings. This paper summarizes discussions from three REACH Global Scientific Committee (GSC) meetings, with the objective to simplify the rosacea management pathway and ensure that healthcare professionals are aware of rosacea triggers, pathogenesis, risk factors, comorbidities, chronicity, patient satisfaction, monitoring, and treatment options. The REACH GSC developed a rosacea management pathway as a backbone for this publication-to advise on each step, including pitfalls to avoid, patient discussions to conduct, tools and guidelines to employ, and clinical factors to consider. Being able to discern all the clinical features of rosacea specific to each patient is imperative, from recognizing overriding signs and symptoms to understanding potential comorbidities and assessing impact on QoL. Clear and sensitive communication regarding these elements, and what outcomes are achievable, will help to optimize therapeutic management and foster a sense of patient empowerment and disease control. For patients, being able to engage in their own long-term care of symptoms, signs, and flares is critical. Deepening the understanding of the condition as a chronic, yet eminently manageable one, will help empower patients with rosacea and their dermatologists alike. The REACH GSC project was initiated and funded by Galderma.

Over the past two decades, numerous highly effective biological treatments have been developed for patients with moderate-to-severe psoriasis. As a result of more effective therapies, treatment goals have shifted from a 50% to a 90% reduction in psoriasis area and severity index. Although randomized controlled trials provide some insight, they often include only a subset of patients, have short durations, and do not compare different treatments. Many patients respond well to these new treatments; however, some do not respond at all, whereas others experience a loss of effectiveness after an initial response. No definitive guidelines on the best time to start treatment or on how to choose the most suitable treatment for an individual patient have yet been established. Furthermore, it remains uncertain whether optimal treatment or specific therapy reduces the risk of developing comorbidities. Real-world data have revealed adverse effects, such as tuberculosis reactivation with tumor necrosis factor inhibitors, worsening of inflammatory bowel disease with interleukin-17 inhibitors, and potential cardiovascular events associated with particularly interleukin-12/23 inhibition. Studies from both clinical trials and real-world settings have also shown that patients with high body mass index, smokers, older individuals, and those with prior biological treatments tend to have poorer treatment outcomes. Recently, studies have indicated that genetic markers such as HLA-C*06:02, initial treatment response, and post-initiation drug concentration levels can predict treatment response. The integration of genetic markers, clinical data, and advanced technologies may aid in developing more personalized treatment plans for patients in the future.