International Journal of Dermatology最新文献

Neglected tropical diseases (NTDs) affect over a billion individuals worldwide, predominantly in low-income countries in tropical and subtropical areas. These diseases frequently result in chronic and debilitating health conditions that significantly diminish the quality of life, often leading to social isolation. The frequent dermatological manifestations underscore the role of dermatologists in managing NTDs. This editorial highlights the crucial role of dermatologists in diagnosing and treating NTDs, focusing on four key diseases: Monkeypox (Mpox) infection, scabies, leprosy, and leishmaniasis.

Background: Chronic spontaneous urticaria (CSU) exhibits notable responsiveness to omalizumab (OMA). The prognosis and subsequent therapeutic strategies warrant comprehensive exploration in cases exhibiting inadequate responses to OMA.

Methods: We conducted a multicenter retrospective analysis to investigate the 12-month prognosis of patients inadequately responding to three injections of OMA. The endpoints encompassed identifying predictive factors for a favorable prognosis and assessing interventions related to an ameliorated prognostic outlook.

Results: The study involved 48 patients who met the inclusion criteria. After three OMA administrations, therapeutic interventions included the continuation of OMA in 34 patients, systemic corticosteroids in seven patients, and immunosuppressants in 12 patients. After 12 months, 28 of the 48 patients exhibited a good prognosis, whereas the remaining 20 displayed a less favorable prognosis. Good prognostic determinants encompassed the duration of CSU within 51 weeks, the presence of angioedema, IgE levels ≤100 IU/mL pre-OMA, blood eosinophil counts ≥100/mm³ post-OMA, and urticaria control test (UCT) scores ≥5 pre-OMA and ≥6 post-OMA. Following the third OMA injection, the implementation of immunosuppressants presented an association with a good prognosis, while the employment of systemic corticosteroids correlated with an unfavorable prognosis.

Conclusions: More than half of patients inadequately responding to OMA achieved a good prognosis 12 months later. Several clinical variables appear to be predictive of prognosis, and certain therapeutic agents can be associated with prognostic outcomes.

Background: Targeted and immune therapies have recently been associated with the occurrence of multiple cutaneous toxicities, often challenging to differentiate by clinical examination alone without histology. Line-field confocal optical coherence tomography (LC-OCT) is a non-invasive and innovative imaging technique that has been shown to be almost as effective as histology in diagnosing several skin conditions. Our study aimed to assess the effectiveness of LC-OCT in predicting the clinical evolution of early maculopapular eruptions related to antineoplastic targeted therapy and immunotherapy.

Methods: In the period between May 2023 and December 2023, consecutive patients with clinical cutaneous maculopapular reactions caused by oncologic targeted therapy or immunotherapy were enrolled at the dermatologic outpatient clinic of the Fondazione Policlinico A. Gemelli IRCCS, Rome. Patients underwent clinical dermatological examination, video-dermoscopy, LC-OCT, and incisional skin biopsy of a target cutaneous lesion. To investigate the evolutionary pattern of maculopapular lesions (psoriasic eruption, lichenoid eruption, eczematous eruption, bullous eruption), LC-OCT and histopathological images have been compared based on specific characteristics (hyperkeratosis, acanthosis, spongiosis; papillomatosis; lichenoid inflammatory infiltrate; presence of intraepidermal/subepidermal cleavage plan with formation of a bulla).

Results: Eighteen patients were included in this study (11 males, 7 females, median age 64.5). LC-OCT demonstrated an overall concordance with histology of 77.8%, with a Cohen's Kappa of 0.69 (P < 0.0001). Sensitivity exceeded 70%, and specificity was ≥88.2%. The Area Under the Curve (AUC) ranged from 0.9 to 1 for psoriasis and lichenoid eruption and from 0.7 to 0.9 for eczematous and bullous eruption.

Conclusions: LC-OCT appears to be a promising tool for the early differential diagnosis of adverse skin reactions related to targeted therapy and immunotherapy, offering the potential to avoid skin biopsies in fragile cancer patients.

Background: Facial aging, characterized by structural decline and loss of collagen and elastin, has led to increased demand for rejuvenation treatments. Adipose-derived stem cells (ADSCs) have emerged as a promising option, but comparative studies on their application methods are limited.

Objective: Our aim was to compare the efficacy of ADSC combined with microneedling or CO₂ laser for facial rejuvenation.

Methods: Twenty-seven participants were randomized into two groups: Microneedling (MN, n = 14) or CO₂ laser (n = 13). Each group underwent three treatment sessions at 4-week intervals. The ADSC solution was applied to one side and the placebo to the other using a split-face design. We performed objective evaluations (UV spots, brown spots, wrinkles, texture, pores, red areas, and porphyrins) and subjective assessments, including clinical photographs, patient satisfaction scales, and histological analysis of skin biopsies.

Results: The CO₂ laser with the ADSC group showed significantly more significant improvements in UV spots (P = 0.002) and wrinkles (P = 0.002) compared to the MN with the ADSC group. Histological analysis revealed superior elastin fibers and epidermal thickness improvements with CO₂ laser treatment. Patient satisfaction was higher in the CO₂ laser group, with 84.6% reporting complete satisfaction compared to 50% in the MN group.

Conclusions: The combination of CO₂ laser with ADSCs demonstrated superior efficacy for facial rejuvenation compared to MN with ADSCs. This approach improved UV spots, wrinkles, skin structure, and overall patient satisfaction. Further studies with larger cohorts and extended follow-up are needed to confirm long-term efficacy.

A 45-year-old male presented with a 2-year history of erythematous indurated plaques on the right palate and adjacent palatobuccal mucosa, accompanied by dull pain and loosening of the third molar, necessitating extraction. Radiological imaging revealed soft tissue density with cortical bony erosions in the bilateral upper alveolar ridge. A single sub-centimetric right cervical lymph node was palpable. Biopsy showed an upper dermal infiltrate composed of cells with nuclear grooving and abundant eosinophilic cytoplasm. Through this case, we highlight a rare manifestation of a systemic disease.

Background: Keloids, characterized by an aberrant wound-healing process and a highly complex immune microenvironment, pose significant challenges for clinical management. Fibroblasts and vascular endothelial cells (VEC) were identified as the leading cells of keloid development. However, their roles in the keloid immune landscape have yet to be thoroughly elucidated.

Methods: To explore the functional state of cells in the immune landscape of keloids, we conducted a single-cell RNA sequencing analysis on the tissue from three keloid lesions and two specimens of healthy skin. We simultaneously utilized available keloid data from the public database for external validation.

Results: Specific subsets, such as proinflammatory fibroblasts (piF) and VEC, were markedly elevated in lesional skin compared to normal skin. Subsequent differential gene expression and Gene Ontology analyses indicated that these subsets may be involved in shaping the microenvironment. In keloids, there is an increased expression of immune-associated genes (P < 0.05), including TNFRSF6B, HGF, and TGFB3, alongside a decreased expression of inflammatory chemokines in the piF. Moreover, the significant upregulation of immune suppressive genes (P < 0.05), including CD39, CD73, and HIF1A, suggested the potential involvement of VEC as a conditional immune subpopulation in the keloid microenvironment. Immune cell communication analysis revealed preferential enrichment of macrophages and Tregs, highlighting intensified macrophage-centered interactions within the keloid microenvironment.

Conclusion: Our study highlighted the role of piF and VEC in the immune microenvironment of keloids for the first time, providing potential targets for therapeutic development.