Dermatology and Therapy最新文献

Introduction: Atopic dermatitis (AD) involving special areas such as the hands, head and neck, and genital region poses important therapeutic challenges owing to distinct barrier fragility, environmental exposure, and mixed Th1/Th2/Th17 activation. These sites often drive treatment escalation despite limited overall body surface involvement. Evidence on the real-world effectiveness of upadacitinib in these anatomical locations remains limited.

Methods: A retrospective, observational multicenter study was conducted across five Spanish dermatology departments (November 2024 to November 2025). Adults and adolescents with moderate-to-severe AD and involvement of at least one special area treated with upadacitinib (15 or 30 mg) for ≥ 16 weeks were included. Disease severity was assessed using the Eczema Area and Severity Index (EASI), body surface area (BSA), pruritus numeric rating scale (NRS), Dermatology Life Quality Index (DLQI), Investigator's Global Assessment (IGA), and local 0-4 Physician Global Assessment (PGA). Minimal disease activity (MDA) was defined as EASI ≤ 3 plus pruritus-NRS 0-1. Descriptive statistics were applied. Distribution-shift plots were used to analyze categorical changes in special areas.

Results: Overall, 57 patients were included (mean age 47.9 ± 17.6 years, 59.6% women). Facial/neck, hand, and genital involvement were present in 73.7%, 61.4%, and 21.1% of patients, respectively; 31.9% had ≥ 2 special areas affected. Upadacitinib induced rapid improvement, with EASI decreasing from 18.9 to 2.7 at week 16 and 2.4 at week 52. MDA was reached by 61% at week 16 and 69% at week 52. Special-area PGA improved markedly across all sites.

Conclusions: Upadacitinib provided rapid, sustained, and clinically meaningful improvement in AD involving special areas, supporting its use in anatomically sensitive areas.

Introduction: Hidradenitis suppurativa (HS) is a highly disabling chronic inflammatory disorder affecting up to 1% of the Spanish population. It is a complex disease that requires significant resources and imposes a considerable economic burden. The aim of this study was to assess the economic burden of diagnosed HS in Spain both at patient and population level.

Methods: The study was conducted from a societal perspective using a bottom-up, prevalence-based approach. We evaluated publicly financed direct healthcare costs (consultations, diagnostic tests, inpatient admissions, surgery, comorbidities, treatment), direct nonhealthcare costs (formal and informal care, out-of-pocket expenses), and indirect costs (absenteeism and productivity loss) incurred by patients diagnosed with HS. A sensitivity analysis was conducted to test the uncertainty of the model.

Results: The mean annual cost of treating all severities of patients with HS in Spain was €39,535.10. The largest cost components across all categories were informal care (46.05%), treatment (18.24%), out-of-pocket expenses (12.76%), loss of work productivity (10.82%), and surgery (5.62%). Moderate and severe patients cost 64.05% (€34,221.92) and 170.53% (€56,432.77) more than mild patients (€20,860.35), respectively. Assuming a prevalence of 1% and a diagnostic rate of 10%, the total economic burden of diagnosed HS in Spain was estimated at €1587 million.

Conclusions: HS has a significant economic impact on patients, their families, the healthcare system, and wider society. This is particularly evident among patients with moderate-to-severe HS. To reduce the economic burden and improve quality of life, efforts should be made to prevent the disease from progressing and to ensure that patients remain in the milder stages.

Introduction: Clinical guidelines recommend against routine use of systemic corticosteroids in atopic dermatitis (AD) due to associated adverse effects. Real-world adherence to these guidelines is unclear.

Methods: This retrospective cohort study evaluated US healthcare claims using Optum's Clinformatics Data Mart Database. We included two cohorts: exposure and diagnosis-based cohorts. Index was defined as the date of first systemic corticosteroid use post-AD diagnosis in the exposure cohort (AD diagnosis must have occurred within 6 months preceding index) or as the date of the first AD diagnosis in the diagnosis-based cohort. Follow-up began on index and continued until end of available data, health insurance discontinuation, death, or systemic corticosteroid discontinuation (exposure cohort) or initiation (diagnosis-based cohort). Patients were aged ≥ 12 years with diagnosed AD between 2017 and 2024 and had continuous health insurance enrollment ≥ 1 year before and after index. Patients were excluded if they had other immune-mediated inflammatory diseases within the 6 months preceding index or had history of malignancy, organ transplant, or HIV/AIDS. Systemic corticosteroid exposure duration was categorized as short term (≥ 1 day to < 30 days), medium term (> 1 month to ≤ 3 months), or long term (continuous/intermittent use for > 3 months). Categorization was informed by expert recommendations and observed prescription patterns. Exposure duration and treatment patterns were assessed in the exposure cohort. Prevalence of systemic corticosteroid use within 6 months post-AD diagnosis was evaluated in the diagnosis-based cohort.

Results: The exposure cohort included 29,994 patients; 67.7% had short-term use, 8.5% had medium-term use, and 23.9% had long-term use. Intramuscular systemic corticosteroids accounted for 20.0% of prescriptions; 80.0% received oral systemic corticosteroids. The diagnosis-based cohort included 80,647 patients; the prevalence of systemic corticosteroid use in AD was 20.0%.

Conclusions: In the USA, systemic corticosteroids remain widely prescribed. These findings highlight the critical need for broader adoption of effective corticosteroid-sparing therapies in patients with AD.

Sun tattoos, also referred to as patterned sunburn lines, have recently emerged as a visible consequence of uneven ultraviolet (UV) exposure, increasingly shared on social media platforms, particularly by adolescents and young adults. These patterns arise from partial photoprotection by clothing, accessories, or stickers and reflect acute UV-induced inflammation and DNA damage. Although often trivialized or aestheticized online, repeated sunburns contribute to cumulative photodamage, photoaging, pigmentary disorders, and increased risk of skin cancer. This commentary examines sun tattoo lines from a behavioral dermatology perspective, highlighting how digital trends and social reinforcement may influence sun-exposure behaviors. Beyond their biomedical significance, these conspicuous lesions carry psychosocial implications and offer an opportunity for therapeutic intervention through patient education. We discuss the clinical relevance of recognizing sun tattoo lines as markers of risky UV behavior and propose their use as practical visual tools to reinforce photoprotection strategies in routine dermatologic care. Addressing such emerging behaviors requires integrating clinical prevention, patient counseling, and targeted public health communication within contemporary dermatology practice.

Introduction: Remibrutinib, an oral, highly selective, Bruton's tyrosine kinase (BTK) inhibitor, has shown efficacy and favorable safety in pivotal global phase 3 studies in patients with chronic spontaneous urticaria (CSU). This 52-week safety study evaluated the effect of remibrutinib in Japanese patients with CSU.

Methods: BISCUIT, a phase 3 (NCT05048342), open-label, single-arm study, investigated the safety and efficacy of remibrutinib 25 mg twice-daily as an add-on medication in Japanese patients with CSU who remain symptomatic despite treatment with H₁-antihistamines. The primary endpoint was the proportion of patients with ≥ 1 adverse events (AEs).

Results: Overall, 71 Japanese patients (mean age 43.5 years) had a median remibrutinib exposure of 52.1 weeks; 87.3% of patients reported ≥ 1 AE, and all events were mild or moderate in severity. COVID-19 (19.7%) and headache (12.7%) were the most common AEs. Three serious AEs, unrelated to remibrutinib, were reported. No deaths occurred during the treatment period. At week 12, mean change from baseline in weekly Urticaria Activity Score (UAS7) and weekly Itch/Hives Severity Scores was - 18.1, - 8.0, and - 10.1, respectively; responses appeared to occur as early as week 1 and appeared to be sustained until week 52. Additionally, 53.6% of the patients had well-controlled disease (UAS7 ≤ 6) and 30.4% had complete absence of itch and hives (UAS7 = 0) at week 52.

Conclusion: Remibrutinib showed a favorable safety profile and a meaningful improvement in CSU symptoms (itch and hives) at week 12, with fast improvement as early as week 1 that was sustained up to week 52, supporting its potential as an effective oral BTK inhibitor for Japanese patients with CSU.

Trial registration: Trial Registration: NCT05048342.

Introduction: Psoriasis is a chronic inflammatory skin disease associated with significant physical and psychological burden. Tildrakizumab, an interleukin-23 p19 inhibitor, has demonstrated efficacy in treating moderate-to-severe plaque psoriasis both in clinical trials and real-world setting. However, limited data are available on the impact of the effective treatment of psoriasis on the psychological health of patients. The aim of this study was to assess changes in psychological well-being, as well as clinical and quality-of-life outcomes, in patients with moderate-to-severe plaque psoriasis treated with tildrakizumab in routine clinical practice in Italy.

Methods: This was an interim analysis (IA) of a 52-week multicenter, prospective, observational study. Adults with moderate-to-severe plaque psoriasis initiating tildrakizumab were enrolled. Endpoints focused on well-being and psychological health and included changes, from baseline to week 28, in Depression, Anxiety, and Stress Scale-21 (DASS-21) scores, Dermatology Life Quality Index (DLQI), European Social Survey (ESS) items, and World Health Organization-Five Well-Being Index (WHO-5). Effectiveness was also monitored via Psoriasis Area and Severity Index (PASI), and safety via treatment-emergent adverse event reporting.

Results: A total of 115 patients were included (mean age 52.5 years, 60.8% male), 102 receiving ≥ 1 dose of tildrakizumab and completing DASS-21 evaluations at baseline and week 28. At week 28, improvements were observed in DASS-21 subscales [depression (- 2.6, 95% CI - 2.0 to - 1.0), anxiety (- 2.3, 95% CI - 2.0 to - 1.0), and stress (- 3.4, 95% CI - 4.0 to - 2.0)], accompanied by marked PASI reduction (- 13.7, 95% CI - 12.8 to - 10.1). DLQI, ESS, and WHO-5 scores also improved. Adverse events were generally mild or moderate, with no unexpected safety signals.

Conclusion: In this real-world IA, tildrakizumab was observed to improve the psychological well-being of patients, reflected by a reduction in all items of the DASS-21 scale and, in parallel, confirmed its effectiveness in managing physical symptoms of psoriasis, establishing its role in the holistic management of psoriasis.

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting the pilosebaceous unit and is linked to several comorbid disorders as well as an economic impact burden. Variations in clinical presentation, comorbidities and healthcare delivery across regions necessitate localised guidelines. This consensus aims to provide evidence-based, expert-driven recommendations tailored to the United Arab Emirates (UAE) healthcare context to standardise and improve HS management.

Methods: A three-phase modified Delphi methodology was employed to develop consensus statements among 14 experts based in the UAE. A comprehensive literature review informed the development of 61 draft statements covering diagnosis, classification, comorbidities, treatment and multidisciplinary care. Statements achieving ≥ 80% agreement in two rounds of voting were included. Final recommendations reflect expert consensus and current best evidence.

Results: A total of 58 consensus statements were adopted. Key recommendations address clinical diagnosis on the basis of lesion type and anatomical location, the use of Hurley staging and International Hidradenitis Suppurativa Severity Score System (IHS4) for severity assessment, and the need for screening for metabolic and inflammatory comorbidities. Treatment guidance includes lifestyle modifications, the use of topical and systemic antibiotics, hormonal therapy, biologics and surgical options, based on disease severity. Supportive care, including pain management, psychological support and multidisciplinary coordination, was emphasized. A management algorithm was developed for practical application.

Conclusions: This consensus provides the first UAE-specific guidelines for HS diagnosis and management. It supports a comprehensive, stepwise and multidisciplinary approach to reduce disease burden and improve patient outcomes. Adoption of these recommendations is expected to harmonise clinical practice and foster improved quality of care for patients with HS in the UAE.

Introduction: Microbiome-modulating therapies including prebiotics, probiotics, and postbiotics have been increasingly investigated as adjuncts or alternatives for managing acne vulgaris through effects on the gut-skin axis, inflammation, and barrier function. The objective of this systematic review is to characterize the safety and efficacy of oral and topical prebiotics, probiotics, and postbiotics in managing acne vulgaris.

Methods: We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review of randomized controlled trials, cohort studies, and case-control studies evaluating oral and topical prebiotics, probiotics, and postbiotics for acne vulgaris from inception to August 2025 in PubMed, Embase, Web of Science, and Cochrane. Inclusion criteria comprised clinical studies reporting on safety and/or efficacy of topical and/or oral prebiotic, probiotic, and postbiotic therapy in patients with acne vulgaris.

Results: In total, 33 studies evaluating 2112 total patients were included, with treatment durations of 4-25 weeks; 5 prebiotic, 24 probiotic, and 7 postbiotic studies were included, with 2 studies comparing prebiotics and probiotics and 1 study comparing prebiotics and postbiotics against each other. Safety was favorable across all modalities with no serious adverse events reported. Pooled mean total lesion reductions were -37.2% for prebiotics, -45.2% for probiotics, and -49.5% for postbiotics, versus -37% for controls.

Conclusions: Prebiotic, probiotic, and postbiotic therapies appear to be safe and associated with clinically meaningful lesion reductions in acne. They may increase tolerability and add additional efficacy to standard acne treatments including topical and oral antibiotics and retinoids. Probiotics currently have the strongest evidence base, while prebiotics and postbiotics are promising adjuncts. Larger, standardized randomized trials are needed to clarify comparative efficacy, optimal formulations, and durability.

Pediatric psychodermatology is an emerging field that is uniquely tailored to the developmental, emotional, and psychosocial needs of children with psychocutaneous conditions. This review aims to synthesize the current literature on the presentation and management of psychodermatologic conditions in children. We discuss the current treatment landscape for these conditions in the pediatric population, including pharmacologic, behavioral, and integrative interventions. Effective management of psychodermatologic conditions in children begins with early identification with developmentally sensitive screening tools. Additionally, prompt management of conditions using a practical treatment regime that addresses both cutaneous disease and psychological distress will improve outcomes for children. Further research and awareness of these conditions, when combined with continued clinician education and structural interventions, will lead to improved outcomes for this population.

Introduction: Psoriasis involving special or high-impact areas (scalp, nails, palms/soles, genitalia) is associated with a disproportionate functional and psychological burden that is often underestimated by conventional severity scores and remains challenging to treat effectively. This study compared the real-world efficacy and safety of three interleukin (IL)-23p19 inhibitors-risankizumab, guselkumab, and tildrakizumab 200 mg-in patients with moderate-to-severe plaque psoriasis with involvement of high-impact sites.

Methods: This multicenter retrospective study included 670 patients treated for at least 52 weeks across 37 Italian dermatology centers. Patients received risankizumab (n = 254), guselkumab (n = 177), or tildrakizumab 200 mg (n = 239) according to approved regimens. Effectiveness was assessed using Psoriasis Area Severity Index (PASI) and site-specific Physician's Global Assessment (PGA) scores (scalp, nails, palms/soles, genitalia) at weeks 4, 16, 36, and 52. Safety was evaluated through reported adverse events.

Results: Risankizumab demonstrated the fastest and most pronounced reduction in PASI, achieving PASI90 and PASI100 responses in 89.6% and 82.1% of patients at week 52, respectively. Tildrakizumab 200 mg showed a slower onset but comparable long-term efficacy, particularly in nail and palmoplantar psoriasis. At week 52, complete nail clearance (fn-PGA = 0) was achieved in 90.0% of patients treated with risankizumab, 76.7% with tildrakizumab, and 66.7% with guselkumab. Palmoplantar and genital psoriasis showed near-complete resolution across all treatment groups by week 52. Scalp involvement improved markedly with all agents, with lower residual disease observed with risankizumab. All treatments were well tolerated, with infrequent and predominantly mild adverse events and no major safety concerns.

Conclusion: In real-world clinical practice, IL-23p19 inhibitors provide high and sustained efficacy in psoriasis affecting high-impact sites. Risankizumab offers faster and deeper responses, while tildrakizumab 200 mg represents an effective long-term option, particularly in patients with higher BMI or more treatment-resistant disease. These findings support a personalized approach to biologic selection based on disease localization, patient characteristics, and therapeutic goals.