Journal of Drugs in Dermatology最新文献

Background: DFD-29 (minocycline hydrochloride extended-release capsules, 40 mg) has shown significant therapeutic benefit vs placebo and doxycycline in treating moderate-to-severe rosacea. However, the impact of its use on skin, vaginal, and gastrointestinal microbiota is unknown.

Methods: In this multicenter, randomized, double-blind, placebo-controlled trial, 60 healthy adults were randomized in a 2:1 ratio to receive either DFD-29 (40 mg) orally or a matching placebo once daily for 16 weeks. Microbiological samples were collected from the skin (forehead), vagina, and stool at baseline and weeks 4, 8, and 16 to evaluate changes in normal microbiota species (via culture and 16S rRNA sequencing), in the MIC90 of selected colonized microbial species, and in opportunistic microbiota with DFD-29 vs placebo. Safety was evaluated via analysis of adverse events, vital signs, and laboratory tests.

Results: Thirty-eight adults assigned to DFD-29 and 19 adults assigned to placebo were included in the microbiota evaluable population. There were no significant differences detected in the abundance of microbial species in the skin, stool, or vagina from baseline to week 16 between the DFD-29 and placebo groups. No significant differences were detected in resistance to minocycline between DFD-29 and placebo. There were also no significant differences in the presence of opportunistic microbiota at any time point. No significant safety issues were reported.

Conclusion: Administration of DFD-29 for 16 weeks had no detectable effects on skin, GI tract, or vaginal microflora and was well tolerated in healthy adults, reinforcing its potential as a therapeutic option in moderate-to-severe rosacea.  .

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder associated with many comorbidities, including obesity, diabetes, cardiovascular risk factors, mental health issues, and many more disorders. Current treatments including biologics, topicals, and surgical interventions often fall short in terms of patient satisfaction, demonstrating a need for additional innovative approaches that address HS-related comorbidities.

Objective: This review explores the novel application of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in HS treatment, particularly for patients with comorbid conditions such as metabolic syndrome, diabetes, and obesity. Emphasis is placed on combination therapy and the potential for GLP-1RAs to address both HS symptoms and associated comorbidities, with careful consideration of patient selection.

Methods: A review of emerging evidence and existing literature on GLP-1RAs and their applications for weight loss, metabolic regulation, and anti-inflammatory effects was conducted.

Findings: GLP-1RAs offer dual benefits for HS patients by modulating inflammatory pathways and addressing associated comorbid conditions. Case studies and preliminary data suggest that GLP-1RAs may reduce lesion severity, systemic inflammation, and morbidity, either as monotherapy or in conjunction with existing treatments. However, high-quality randomized controlled trials are indicated to confirm these findings.

Conclusion: GLP-1RAs represent a promising adjunctive or standalone treatment choice for those with HS and its related comorbidities. Further research is needed to establish their safety and efficacy in HS treatment.  .

Objective: Recognizing the risk of atherosclerotic cardiovascular disease (ASCVD) in patients is crucial in clinical practice. Recent studies suggest an association between inflammatory skin diseases and ASCVD. This study evaluates ASCVD risk in inflammatory skin disease patients using a standardized assessment model.

Methods: We used the TriNetX platform to analyze 10-year ASCVD risk in inflammatory skin conditions. Propensity score-matched (PSM) cohorts adjusted for confounders. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression.

Results: Inflammatory skin diseases were associated with elevated ASCVD risk. Hidradenitis suppurativa showed the strongest association (HR 1.32; 95% CI: 1.17-1.48). Elevated risks were also noted for psoriasis (HR 1.21; 95% CI: 1.14-1.28) and atopic dermatitis (HR 1.15; 95% CI: 1.04–1.26). These risks were lower than in diabetes mellitus (HR 2.57; 95% CI: 2.52-2.63).

Conclusion: Patients with hidradenitis suppurativa, psoriasis, and atopic dermatitis exhibit increased ASCVD risk. While lower than in diabetes mellitus, findings highlight the role of dermatologists in ASCVD risk identification and management.  .

Background: Background: The increasing use of long-term, low-dose isotretinoin for acne has raised concerns about a potential association with inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis.

Objective: To evaluate the association between isotretinoin therapy and the risk of IBD using a large real-world database.

Methods: We conducted a retrospective cohort study utilizing the TriNetX network. Patients with acne who received isotretinoin were compared to acne patients who were not exposed to isotretinoin. Propensity score matching (1:1) was performed to balance baseline characteristics. Patients were followed for 6 to 10 years post-exposure. Primary outcomes included incidence of IBD, Crohn's disease, and ulcerative colitis. Secondary outcomes included irritable bowel syndrome (IBS), fecal calprotectin elevation, and elevated lipid levels. Hazard ratios (HRs) were calculated using Cox proportional hazards models.

Results: Among 81,641 isotretinoin-exposed and 1,876,038 unexposed patients, 61,894 matched pairs were analyzed. Isotretinoin use was not associated with increased risk of IBD (HR: 0.88, 95% CI: 0.49–1.57) or ulcerative colitis (HR: 1.05, 95% CI: 0.78–1.41), and was associated with decreased risk of Crohn's disease (HR: 0.69, 95% CI: 0.51–0.94). IBS and fecal calprotectin elevation were not significantly different between groups. Lipid levels in the isotretinoin group were transiently elevated.

Conclusion: Long-term isotretinoin therapy does not increase the risk of IBD in acne patients.  .

Background: There is a notable lack of diversity in dermatologic studies, even concerning conditions that are known to have a higher prevalence in the skin of color (SOC) population, such as hidradenitis suppurativa (HS). This study updates the current literature on SOC representation in dermatology by analyzing the demographics and locations of HS clinical trials from 2020 to 2024, during which there were significant advancements in therapeutics.

Methods: A search of the term "hidradenitis suppurativa" was conducted on the ClinicalTrials.gov website for trials initiated between June 2020 and December 2024.

Results: Five clinical trials totaling 411 participants were included. Caucasian/White participants (n=281, 68.4%) comprised the majority, followed by African American/Black (n=93, 22.6%) participants. In comparison to HS trials from 2008 to 2020, the 5 recent trials between 2020 and 2024 demonstrated a significant (P<0.001) increase (14.9% vs 22.6%, respectively) in the percentage of Black participants. Most US clinical trial sites (n=38, 59.3%) were located in cities with moderate (12.6-49.9%) to high (>50%) Black populations.

Conclusions: The increase in the proportion of Black participants in HS clinical trials from 2008-2020 to 2020-2024 demonstrates a promising outlook for improved representation in HS clinical trials. Nonetheless, an underrepresentation of Black participants in HS clinical trials continues to persist, highlighting the necessity for continued efforts in the inclusion of SOC individuals in clinical research.

Background: Identifying the risk of atherosclerotic cardiovascular disease (ASCVD) is a cornerstone of preventive medical care. Despite its significance, limited research has explored ASCVD risk in individuals with fibrotic skin diseases. This study aims to evaluate the risk of ASCVD in patients diagnosed with fibrotic skin conditions.

Methods: We utilized the TriNetX platform to analyze ASCVD risk associated with fibrotic skin conditions. Propensity score-matched (PSM) cohorts were constructed to adjust for confounding. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression.

Results: Patients with fibrotic skin diseases demonstrated an elevated risk of ASCVD. Scleroderma was most strongly associated with ASCVD risk (HR 2.51 [95% CI: 1.97,3.21]), followed by hypertrophic scar (HR 1.40 [95% CI: 1.20,1.63]). Elevated risks were also observed for morphea (HR 1.36 [95% CI: 1.03,1.08]) and lichen sclerosis (HR 1.30 [95% CI: 1.04,1.62]).

Conclusion: Individuals with fibrotic skin conditions, including scleroderma, hypertrophic scars, morphea, and lichen sclerosis, demonstrate an increased risk of ASCVD. These findings highlight the significance of recognizing fibrotic skin diseases as possible indicators of systemic inflammation.

Hidradenitis suppurativa (HS) is a complex skin condition influenced by both genetic and environmental factors. Increasing evidence points to diet as a key contributor to disease severity through systemic inflammatory pathways. A review of recent literature was conducted to evaluate the relationship between dietary patterns and advancement of HS. Pro-inflammatory diets such as the Western diet, leucine-rich diets, and brewer's yeast were associated with HS exacerbation through mTOR activation and hormonal dysregulations. In contrast, anti-inflammatory agents such as the Mediterranean diet, very low-calorie ketogenic diet, and dairy-free diets showed promising results in mitigating HS flares. Supplementation with vitamin D and zinc also demonstrated clinical improvement in patients with documented deficiencies. Recent research suggests that fasting may help reduce inflammation and ease HS symptoms. This review seeks to synthesize recent literature, offer diet-specific management insights, and identify existing gaps in research and literature regarding diet and HS.

Antibiotics remain a cornerstone in the management of dermatologic conditions such as acne and hidradenitis suppurativa, underscoring the need for responsible antibiotic stewardship. This article explores the “dark side” of antibiotics, highlighting their role in disrupting the gut microbiome, elevating risks for infections like Clostridium difficile, and increasing resistance in Cutibacterium acnes and other microbes. Emerging evidence also links antibiotic use to reduced vaccine efficacy and diminished responses to cancer immunotherapy. To mitigate these risks, dermatologists should prioritize narrow-spectrum antibiotics and incorporate combination topical therapies containing benzoyl peroxide (BPO), such as the triple-combination of clindamycin, adapalene, and BPO, to help curb antibiotic resistance. Prudent antibiotic use, combined with topical regimens utilizing BPO, optimizes treatment outcomes while minimizing systemic adverse effects and resistance. Ongoing education and research are essential to refine prescribing practices that balance therapeutic benefits with long-term patient and public health.