Journal of Drugs in Dermatology最新文献

Introduction: Benign Familial Pemphigus (Hailey-Hailey Disease [HHD]) is a rare chronic condition, with treatments focusing on managing disease symptoms.

Case presentation: We present a case of a 72-year-old female with refractory HHD. Despite management with standard HHD treatments, such as antibiotics and corticosteroids, the patient's flares persisted. She was started on ruxolitinib 1.5% cream, with improved symptoms.

Discussion: This case demonstrates the difficulties a patient with refractory HHD may experience, and the significance of exploring novel treatment options to improve disease response and patient quality of life.

Conclusion: Ruxolitinib may be an effective treatment option for HHD management, but further investigation is necessary.

Background: The only approved triple-combination acne treatment – clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% (CAB) gel - demonstrated efficacy/safety in 12-week clinical trials. However, real-world treatment may require 6 months for maximum benefits in some cases. Since long-term antibiotic use can lead to resistance in the causative Cutibacterium acnes (C. acnes), this analysis evaluated the effect of long-term CAB use on C. acnes.

Methods: Pooled data from 2 identical, 24-week, single-center, open-label studies evaluated once-daily CAB in participants aged ≥12 years with moderate/severe acne (Investigator's Global Assessment [IGA] of 3/4). Plates inoculated with central forehead swabs were monitored for C. acnes colony formation. Clindamycin susceptibility was assessed via minimum inhibitory concentration (MIC) values using Epsilometer tests; MIC ≥8 μg/mL indicated resistance.

Results: Of 50 participants enrolled, 45 completed the studies. At baseline, C. acnes strains were isolated from 82% (37/45) of participants. After 24 weeks, CAB-treated participants with cultivable isolates decreased by nearly half to 44% (20/45). For susceptible strains isolated at week 24, MIC values remained low (mean, 0.19 μg/mL). Only 1 participant without growth at baseline had cultivable C. acnes at week 24, deemed clindamycin-susceptible. Only the 5 participants (11%) with resistant C. acnes isolates at baseline had resistant isolates at study end, though all 5 had acne improvements at week 24 (IGA decrease, 1-3 points; lesion reductions, 40%-100%).

Conclusions: Long-term CAB gel treatment did not lead to antibiotic resistance development and was efficacious in participants with resistant isolates at baseline, suggesting CAB is well suited for long-term acne treatment.

Background: Recent guidelines within the dermatology literature have indicated that a methotrexate test dose may not be needed for patients at lower risk of toxicity. However, few clinical studies have specifically examined the utility of a test dose with regard to detecting or preventing significant laboratory abnormalities. Other specialties, such as rheumatology, do not mention methotrexate test doses within their guidelines.

Objective: To determine the frequency of laboratory abnormalities in patients initiating low-dose, oral methotrexate with and without a test dose.

Methods: We conducted a retrospective cohort analysis of patients greater than or equal to 18 years of age initiating methotrexate, prescribed by a dermatology or rheumatology provider within the Kaiser Permanente Mid-Atlantic States health plan. A methotrexate test dose was defined as any initial dose less than or equal to 15 mg with one or more laboratory tests within 3 to 10 days after dispensing. Patients were assigned to either the test dose or the non-test dose group. The rate of any grade 2 and higher laboratory abnormality (leukopenia, anemia, thrombocytopenia, elevated aspartate aminotransferase, elevated alanine aminotransferase) over 4 months of treatment was compared between the two groups. For the test dose group, the rate of any grade 2 and higher laboratory abnormality occurring between 3 to 10 days after initial methotrexate dispensing was reported.

Results: 2,575 patients were included; 220 in the test dose group and 2,355 in the non-test dose group, with rheumatology patients making up 91.92% (2,367/2,575). Over 4 months, 6.82% (15/220) of patients in the test dose group had at least one grade 2 or higher laboratory abnormality, compared to 4.34% (91/2,097) in the non-test dose group (P=0.09). Within the test dose group, 2.73% (6/220) of patients had a grade 2 or higher laboratory abnormality occurring between 3 to 10 days after initiating treatment.

Conclusions: When initiating methotrexate in dermatology and rheumatology patients, the use of a test dose may be of limited value in detecting or preventing significant laboratory abnormalities. These findings provide support for evolving guidelines and consensus statements in dermatology regarding methotrexate test dose use.  .

Background: Roflumilast is a topical phosphodiesterase-4 inhibitor FDA-approved for treating plaque psoriasis and atopic dermatitis. Line-field confocal optical coherence tomography (LC-OCT) is a novel non-invasive imaging method utilized to evaluate skin in vivo.

Objective: This study uses LC-OCT (Damae Medical, France) to visualize the effects of 0.3% roflumilast versus vehicle on healthy skin in vivo.

Methods: Three subjects (mean age: 26 years) with healthy skin applied roflumilast (right forearm) and vehicle (left forearm) daily for seven days. LC-OCT imaging was performed at multiple intervals: before cream application (T0A), after application (T0B), 15 minutes (T0C), 1 hour (T0D), 8-12 hours (T0E), 24 hours (T0F), 7 days (T7), and 7 days after the last application (T14). A dermatopathologist evaluated changes in morphology, and an AI algorithm calculated the changes in stratum corneum (SC) and epidermal thickness.

Results: At T0B, both creams showed a hyperreflective layer above the SC, which diminished over time. Roflumilast-treated skin exhibited increased dermal-epidermal junction (DEJ) demarcation, more organized keratinocytes, and a reduction in hyperreflective material. The algorithm showed increased SC thickness in both arms until T7, but only roflumilast's SC thickness continued increasing until T14, while the vehicle-treated arm decreased. Epidermal thickness increased in both arms but reversed at T14.

Conclusion: LC-OCT visualized roflumilast's effects on healthy skin, including reduced hyperreflective material consistent with mottled pigmentation and normalized keratinocyte organization, suggesting the effects it has on healthy skin. The AI algorithm showed lasting effects on SC thickness, even after discontinuation of treatment.

Background: Nicotinamide (niacinamide) is the water-soluble form of vitamin B3. Nicotinamide plays a crucial physiological role as a catalyst for various molecular reactions in the body and is a common over-the-counter supplement. In dermatology, oral nicotinamide has a long history of diverse applications. Oral nicotinamide mitigates ultraviolet-induced immunosuppression, serves as adjunctive therapy for blistering skin disorders, reduces inflammation and sebum in acne vulgaris, and has been used for pruritic disorders. Recent studies indicate that terminal metabolites of nicotinamide may contribute to vascular inflammation and elevate the risk of cardiovascular disease, particularly at doses exceeding therapeutic recommendations of 500 mg. Given the wide range of applications of nicotinamide in dermatology, we aim to investigate the effects of oral nicotinamide on cardiovascular health.

Methods: A review of the literature was conducted to assess the dermatological benefits of oral nicotinamide as well as its potential cardiovascular risks, particularly at high doses. Evidence from clinical trials and meta-analyses was evaluated to synthesize current knowledge on its safety and efficacy.

Results: Oral nicotinamide has demonstrated significant benefits in dermatological practice, including reducing the incidence of non-melanoma skin cancers in immunocompetent individuals and improving outcomes in various inflammatory skin conditions. However, recent evidence suggests that increased serum levels of nicotinamide's terminal metabolites N1-methyl-2-pyridone-5-carboxamide and N1-methyl-4-pyridone-3-carboxamide leads to increased risk of major adverse cardiovascular effects.

Conclusion: While oral nicotinamide remains a valuable option in dermatological practice, clinicians should exercise caution in prescribing this at high doses due to the potential cardiovascular risks.

Background: DermmunityTM is a Los Angeles-based community service program established in 2020 at the University of Southern California Department of Dermatology to provide dermatologic education to local underserved communities.

Methods: This study characterized the impact of Dermmunity through retrospective analysis and a prospective survey given over a one-year period (2023-2024).

Results/discussion: From 2020 to 2024, Dermmunity reached 406 participants. Faculty and trainees led lectures on dermatologic health topics including how to access a dermatologist. Survey results demonstrated most participants were female (85.6%), Hispanic/Latinx (74.8%), and insured (88.2%). The largest age group were 35–44-year-olds (33.1%), and the most common highest education level was high school (39.8%). Most respondents found the information presented useful (92.3%), and half (50.9%) felt it would affect their skincare practices. Despite over half having prior skin, hair, or nail conditions, 61.3% had never seen their primary doctor for dermatologic issues. Less had been to a dermatologist (43.7%), nearly a third citing challenges accessing a dermatologist (30.5%). After presentations, the majority felt educated on when to see a dermatologist (79.5%), and 74.3% reported knowing how to schedule an appointment.

Limitations: Small sample size and non-response bias.

Conclusion: Community outreach programs like Dermmunity increase the dermatologic knowledge of participants' and their confidence in when and how to access a dermatologist. Findings highlight how community-based educational outreach can bridge gaps to care in underserved communities and help improve health equity.

Background: While caffeine has been proposed to stimulate hair growth, its safety and efficacy remain unclear. This systematic review evaluates the effects of caffeine interventions on hair loss and growth outcomes.

Methods: A systematic review of seven databases, including PubMed, Medline, and Embase, was conducted in August 2023. Original studies investigating caffeine's effects on hair loss were included. Study quality was assessed using the National Institute of Health Study Quality Assessment Tools. Outcomes of interest included caffeine intervention types and their effects on hair growth.

Results: Of 587 citations, nine studies met the inclusion criteria: five randomized controlled trials, three prospective cohort studies, and one twin-twin cohort study. Most studies investigated topical caffeine; one assessed oral caffeine intake. Topical caffeine consistently demonstrated hair growth or reduced hair loss with minimal adverse effects. However, none of the studies used tattooed or marked scalp areas for hair counts.

Conclusions: Caffeine appears to be a safe and promising potential treatment for hair loss. Topical caffeine shows potential as a therapeutic option, though further large-scale randomized controlled trials with standardized outcome measures are needed.

Background: Rotation flaps are reliable pillars in reconstructive surgery that provide excellent cosmesis. They allow the recruitment of adjacent tissue with similar characteristics and redistribute tension vectors along an arcuate path to achieve low tension closure. They also readily conform to relaxed skin tension lines, resulting in good cosmesis.

Objective: To review the principles and designs of rotation flaps and provide reproducible examples for practical application by the reconstructive surgeon.

Materials and methods: Various named and anatomic site-specific rotation flaps were selected to demonstrate their versatility, and surgical pearls are provided to achieve optimal results.

Conclusions: Understanding the principles of rotation flaps is critical to reconstructive surgeons. Proper design, adequate undermining, strategic placement of standing cone deformities, and appreciation of pivotal restraint are necessary for the successful execution of rotation flaps. Mastering the application of rotation flaps will add to a surgeon's armamentarium and allow their application to other anatomic sites.  .

Background: The objective of this survey was to obtain feedback and insights from United States dermatology healthcare professionals on their perceptions of sunscreens.

Methods: This cross-sectional survey study launched online via the Dermsquared® platform to US dermatology healthcare professionals (HCPs) comprised questions evaluating perceptions of sunscreen (eg, formulation, usage, active safety and efficacy, misinformation, and perceptions on sunscreen access). "Strongly agree" and "agree" responses were analyzed together and "strongly disagree" and "disagree" responses were analyzed together. The relationships between groups were evaluated using the chi-square test of independence (P<0.05).

Results: A total of 723 HCPs were surveyed. Most (98%) agreed that the "best sunscreen is the one that patients will consistently use." Significantly more dermatologists than physician assistants and nurse practitioners (P<0.05) agreed with this, and 99% of HCPs agreed that sunscreen helps lower skin cancer risk. Most HCPs (99%) agreed that sunscreens offering a better application and aesthetic experience are likely to be used by patients more often. Significantly more HCPs agreed that chemical/organic actives offer a better application experience than physical/inorganic actives compared with those who responded neutral or disagreed, and most HCPs agreed that both sunscreen types were safe and effective. Social media and social media influencers were believed to be the greatest source of misinformation for patients.

Conclusion: The dermatology HCPs in this survey strongly support sunscreen use and believe that FDA-approved sunscreens are effective and safe. The social media findings highlight a continued need to improve education on sunscreen use and increase counseling from clinicians on sun protection behaviors.