International Journal of Dermatology最新文献

Background: Pemphigus vulgaris (PV) is caused by immunoglobulin G (IgG) autoantibodies targeting desmoglein 3 (Dsg3) and/or desmoglein 1 (Dsg1). While antibody concentration is routinely used to assess disease activity, the role of antibody avidity in PV monitoring has not been elucidated.

Methods: Sixty-three consecutive, newly diagnosed, treatment-naïve patients with PV were enrolled in this retrospective-prospective study. PV severity was assessed using the Pemphigus Disease Area Index (PDAI) and classified as mild (≤ 15), moderate (> 15, ≤ 45), or severe (> 45). Anti-Dsg3 and anti-Dsg1 IgG antibodies' concentration and avidity were determined using conventional and urea-modified enzyme-linked immunosorbent assay (ELISA), respectively. Thirty-three patients were re-evaluated at the beginning of clinical remission. Receiver operating characteristic (ROC) curve analyses were used to determine optimal cut-off values and odds ratios (ORs) for anti-Dsg3 concentration and avidity to distinguish active disease from remission, and mild from moderate-to-severe disease.

Results: Anti-Dsg3 avidity showed a stronger correlation with PDAI (r = 0.474, p < 0.001) than anti-Dsg3 concentration (r = 0.363, p = 0.004). Anti-Dsg1 concentration correlated with PDAI (r = 0.476, p = 0.001), while anti-Dsg1 avidity did not (r = 0.216, p = 0.141). Anti-Dsg3 avidity was a better marker of disease severity than anti-Dsg3 concentration (p = 0.003 vs. p = 0.014). Among 13 patients in remission who were still anti-Dsg3-positive, avidity decreased more significantly than concentration (p = 0.007 vs. p = 0.016). Avidity cut-off of 25.46% distinguished active disease from remission (OR = 3.48), and avidity 35.02% threshold differentiated mild from moderate/severe disease (OR = 6.36).

Conclusions: This is the first study to assess the correlation between PDAI and anti-Dsg3/anti-Dsg1 avidity. Anti-Dsg3 avidity showed the strongest positive correlation with PDAI, announcing the role of antibody avidity as a valuable biomarker in monitoring PV activity.

Introduction: Actinic keratoses (AKs) are ultraviolet (UV)-induced skin lesions that may progress to invasive squamous cell carcinoma. Hyperkeratotic AKs hinder line-field confocal optical coherence tomography (LC-OCT) imaging, limiting assessment of the dermal-epidermal junction (DEJ) and PRO-score, a histopathological index of dermal invasion.

Objective: The aim of this study was to evaluate whether moisturization improves DEJ visualization and PRO-score evaluation in hyperkeratotic AKs using LC-OCT.

Materials and methods: Fifty-nine hyperkeratotic AKs were randomized to receive either 20-min tap water occlusion or 20% salicylic acid ointment (SAO). LC-OCT scans were taken before and after treatment. DEJ visibility, PRO-score (0-3), and confidence in PRO assignment (cPRO) were rated by blinded evaluators.

Results: DEJ visibility significantly increased posttreatment (from 39.0% to 86.4%, p = 0.015), with no significant difference between water and salicylic acid ointment (SAO). Confidence in PRO-scoring also improved (p < 0.001), and 39.1% of lesions with initial scores were reclassified. G2 AKs had higher DEJ visibility than G3 both before and after treatment.

Conclusion: Moisturization enhances LC-OCT evaluation of hyperkeratotic AKs, improving DEJ visualization and diagnostic confidence.

Background: Efficacy cannot be maintained in some psoriasis patients after biological discontinuation. This study aimed to explore predictors of efficacy maintenance after vunakizumab discontinuation in patients with moderate-to-severe plaque psoriasis.

Methods: This post hoc analysis used data from a phase III trial (NCT04839016); 291 patients with moderate-to-severe plaque psoriasis who achieved 100% improvement in Psoriasis Area and Severity Index (PASI) score at Week 52 were enrolled. Efficacy maintenance was defined as patients who maintained PASI 90 or PASI 100 after 20 weeks of vunakizumab discontinuation.

Results: There were 44.7% and 72.5% of patients with PASI 100 and PASI 90 maintenance, respectively. In the multivariate logistic regression model, body mass index (BMI) (odds ratio [OR] = 0.922, p = 0.024) and treatment interruption (OR = 0.550, p = 0.020) were independently associated with a lower possibility of PASI 100 maintenance; however, the association of family history of psoriasis and the first time of PASI 100 achievement with PASI 100 maintenance did not achieve statistical significance. Duration of psoriasis (OR = 0.972, p = 0.049) and treatment interruption (OR = 0.257, p < 0.001) were independently associated with a lower possibility of PASI 90 maintenance. Two nomograms for predicting PASI 90 and PASI 100 maintenance were constructed based on the multivariate models, which disclosed good calibration performance.

Conclusions: PASI 90 and PASI 100 maintenance rates are 72.5% and 44.7% after 20 weeks of vunakizumab discontinuation in patients with moderate-to-severe plaque psoriasis. BMI, treatment interruption, and duration of psoriasis predict a lower possibility of efficacy maintenance after vunakizumab discontinuation.