Journal of Drugs in Dermatology最新文献

We, as dermatologists, are exceedingly lucky.  We can watch our patients improve before our eyes. In clinical practice, we don't often track a quantitative metric to gauge success but rather measure the success of our treatment by the appearance of our patients' skin.

Acne vulgaris is an extremely common dermatologic condition. Individuals with acne present not only to dermatologists, but also to internists, family medicine physicians, pediatricians, estheticians, and beauty counters alike in search of a treatment. The diagnosis of acne is relatively straightforward, leading many to believe that acne is a simple condition. However, the pathophysiology of acne is anything but simple. Decades of research has ultimately revealed a complex interaction of pathogenic factors that lead to acne. This includes sebum production, C. acnes colonization, inflammation, and follicular hyperkeratinization. Understanding each of these features has been fundamental to the development of anti-acne medications. Topical agents are often used as an initial therapy given their safety and efficacy. While some topical therapies have been used for decades, new creams, gels, and lotions continue to be added to the list of approved acne treatments. Given the number of topical acne products on the market, we present an updated review of the current landscape of topical acne treatments and how each choice functions mechanistically to fight against acne. J Drugs Dermatol. 2024;23:10(Suppl 1):s4-11.

The skin microbiome is essential for skin barrier function because it inhibits pathogen colonization, and decreased microbiome diversity correlates with increased Staphylococcus aureus (S. aureus) burden and atopic dermatitis (AD) severity. Managing S. aureuss-driven AD in clinical practice remains problematic due to complications such as AD exacerbation, impetigo, abscesses, and invasive infections. This project used a modified Delphi process comprising face-to-face discussions followed by a blinded vote to define 5 final consensus statements. A panel of 6 pediatric dermatologists developed a consensus on S. aureus-driven AD exacerbation, challenges in current treatments for AD with secondary bacterial infections, and new developments to improve patient care and outcomes. The panel's 5 consensus statements provide recommendations for dermatologists, pediatricians, and healthcare providers treating patients with secondary infected AD. These recommendations underscore the importance of recognizing and managing S. aureus skin infection in AD clinical practice and promoting antibiotic stewardship to mitigate resistance. The panel defined a significant unmet need for a single topical AD therapy effective against all symptoms, including pruritus, S. aureus-driven AD exacerbation, infection, and inflammation, across AD severity levels. J Drugs Dermatol. 2024;23(10):825-832. doi:10.36849/JDD.8240.

Janus kinase inhibitors (JAKis) have recently emerged in the arsenal of tools to treat dermatological conditions. However, there are some concerns regarding these treatments due to their boxed warning. Here we discuss the safe and effective use of JAKs for the treatment of a wide variety of dermatologic conditions. We will also discuss monitoring guidelines. J Drugs Dermatol. 2024;23(10):852-856. doi:10.36849/JDD.8073.

Background: Inflammatory dermatologic conditions suitable for topical treatments benefit from a hydrating vehicle that improves the skin barrier without irritation.

Objective: This research was designed to assess skin barrier effects and aesthetic attributes of the vehicle for topical roflumilast cream (vehicle) vs a currently marketed ceramide-containing moisturizing cream (moisturizer).

Methods: This was a single-site, randomized, intraindividual, double-blind, controlled study conducted over 17 days. Patients (aged 18 years or older) with mild, symmetric asteatotic eczema of the lower extremities were enrolled to receive lower leg applications of the vehicle on one leg and moisturizer on the other. The primary efficacy endpoint was a change in transepidermal water loss (TEWL) from baseline to day 15. Secondary efficacy endpoints included change from baseline in TEWL at other study visits, change from baseline in hydration as assessed via corneometry, and patient- and investigator-rated assessments of the products. Safety and tolerability were also assessed.

Results: A total of 40 patients enrolled in the study. The primary efficacy endpoint was met for both treatments. A statistically significant difference in TEWL on day 1 favored the moisturizer, but no difference was seen between vehicle and moisturizer at any other timepoint. Both vehicle and moisturizer also met the secondary efficacy endpoint of change from baseline in hydration.

Limitations: The sample size was small.

Conclusions: The vehicle for roflumilast cream performed similarly to a leading, currently marketed, dermatologist-recommended, ceramide-containing moisturizer across all patient- and investigator-rated assessments of efficacy, tolerability, and aesthetic properties in patients with mild asteatotic eczema. J Drugs Dermatol. 2024;23(10):834-840. doi:10.36849/JDD.7958  .

Background: Primary hyperhidrosis (PHH) is a disorder of excessive sweating caused by aberrant cholinergic signaling. Sensitive skin (SS) is a condition of subjective cutaneous hyperreactivity to innocuous stimuli, impacting 40% to 70% of the population. SS is exacerbated by sweat, stress, and heat, suggesting that cholinergic stimulation may contribute to SS flares.

Objective: To survey PHH sufferers to assess hyperhidrosis (HH) and SS symptom burden.

Methods: An International Review Board (IRB)-exempt survey was disseminated by the International Hyperhidrosis Society. A predictive classification model for SS was built using random forest machine learning algorithms.

Results: Of the 637 respondents with PHH, 89% reported SS; and there was a significant association between HH and SS severity scores. Importantly, SS occurred on body sites affected and unaffected by HH. Predictive modeling designated Sensitive Scale-10 (SS-10), a validated questionnaire to gauge SS severity, to be the most helpful in predicting SS in this cohort.

Limitations: Self-reported data.

Conclusion: These data are the first to propose and support a relationship between SS and HH. SS occurred with greatest frequency at HH-afflicted body sites, but also occurred on unaffected sites, suggesting that sweat is not the sole causative link. Future work can explore cholinergic signaling as a potential link between these conditions. Screening HH patients for SS may be warranted. J Drugs Dermatol. 2024;23(10):882-888. doi:10.36849/JDD.8461.