Dermatology and Therapy最新文献

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.

Introduction: Patient education initiatives for atopic dermatitis (AD) improve medication adherence, treatment satisfaction, severity of disease, and quality of life. An international survey was conducted to better understand the journey of diagnosis and treatment, unmet needs, and educational preferences of patients and caregivers for children diagnosed with AD residing in the US, Europe, Japan, and the Gulf region.

Methods: A cross-sectional, anonymous, multilingual online survey was conducted from December 2024-January 2025. Eligible individuals were aged ≥ 18 years and either a patient diagnosed with AD by a medical professional or a caregiver for a child ages 6-12 years with AD.

Results: Of the 1103 survey participants (68% adult patients; 32% caregivers), 56% were from the US, 25% from Europe, 13% from the Gulf region, and 6% from Japan. Over half (61%) found it easy or very easy to find information on AD; however, responses indicated an interest in improved content of available AD education. Almost half (46%) indicated it would be beneficial to have a list of questions to take to their doctor's appointment, 42% wanted more information about AD triggers, and 40% wanted a way to communicate the impact of AD to their doctor. For new medications, participants wished to understand safety, mechanism of action, duration of treatment, and the possibility of freedom from symptoms.

Conclusion: Patient and caregiver education in AD is essential for improving disease management and often-compromised quality of life. While access to disease information was reasonably high, there is a clear opportunity to improve and refine AD education content and provide actionable, patient-centered tools.

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.

Introduction: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease frequently associated with other immune-mediated inflammatory diseases (IMIDs), such as systemic lupus erythematosus (SLE) and psoriasis. Although advanced therapies have improved HS outcomes, many patients continue to experience suboptimal control, particularly when managing concurrent comorbidities. Combination therapy with biologics and small molecules may offer an effective strategy in select complex cases.

Methods: We present three female patients with moderate-to-severe HS and systemic comorbidities (two with paradoxical palmoplantar psoriasis, one with SLE) who were treated with a combination of secukinumab and upadacitinib. All had previously failed at least two conventional systemic therapies. Secukinumab 300 mg was initiated first, followed by the addition of upadacitinib (15-30 mg) after 5-6 months.

Results: The combination achieved significant improvement in HS activity and complete or near-complete resolution of comorbid conditions. Treatment was well tolerated, with no discontinuations or adverse events reported over 3-6 months of follow-up.

Conclusion: Our findings suggest that dual targeted therapy may represent a viable approach for patients with refractory disease and multiple immune-mediated conditions, warranting further investigation in larger cohorts.

Copper (Cu) and zinc (Zn) are trace elements required for a multitude of physiological processes, including wound healing, and there has been a long history of including both metal ions in topical skin repair formulations. Wound healing involves complex and dynamic cellular mechanisms in the main phases of platelet hemostasis, inflammation, granulation tissue formation, re-epithelialization, and extracellular matrix remodeling. This process is influenced by the balance in the skin's commensal microbiota, and the risk of microbes becoming pathogenic through migration and colonization of the deeper tissues. We examine the antimicrobial effects of Cu/Zn versus their roles in the innate immune response that prevents the invasion and proliferation of microorganisms and in the cellular mechanisms that promote wound healing. Cu/Zn modulates macrophage polarization, promoting the transition from the pro-inflammatory M1 phenotype to the pro-healing M2 phenotype, which is critical for tissue repair. Both elements also act as cofactors that modulate the activities of important growth factors, mediators, and enzymes, including antioxidant enzymes, such as superoxide dismutase, which have a role in the innate immune response to pathogens and protect cells from oxidative damage, reducing inflammation and promoting healing. These divalent ions stimulate angiogenesis, and the Cu/Zn combination can also modulate integrin expression in keratinocytes, which are needed for re-epithelialization, supporting cellular mobility and differentiation, and enhancing the healing process. The synergistic roles of Cu/Zn in preventing infection while stimulating the skin's natural immune defenses encourage efficient tissue repair after injury. Topical Cu/Zn-containing formulations therefore hold promise for improving wound management.