Journal of Clinical and Aesthetic Dermatology最新文献

Objective: Oral Janus kinase inhibitors (JAKi) are effective in managing moderate-to-severe atopic dermatitis (AD), but concerns regarding venous thromboembolism (VTE) risk persist, particularly in female patients with overlapping risk factors such as oral contraceptive pill (OCP) use and nicotine exposure (primarily smoking). We evaluated VTE events in this population using data from the abrocitinib clinical trial program.

Methods: We reviewed the Phase II and Phase III clinical trial data (JADE program) for abrocitinib in AD, focusing on VTE incidence in female patients with documented OCP use and nicotine exposure to contextualize thromboembolic risk.

Results: VTE events were rare. Nonfatal VTE incidence was low, with dose-specific incidence rates less than 1.0 per 100 patient-years (PY). Among female patients taking OCPs and current or former smokers, no VTEs occurred (0 of 78). In the overall active study group, most VTEs arose in patients with multiple baseline risk factors (eg, obesity, immobilization, prior thrombosis). Discontinuation due to VTE-related adverse events was infrequent (n=7, 0.13/100 PY) in the overall study group. No VTE-related deaths were reported. Comparative rates were consistent with or lower than background risk in AD populations with similar demographics.

Limitations: This review is limited by the lack of publicly available patient-level data, possible underreporting of lifestyle risk factors, inability to quantify total nicotine exposure, small sample size, and unmeasured confounding variables.

Conclusion: VTE events in female patients with AD treated with abrocitinib, including those taking OCPs and with nicotine exposure, were rare and generally associated with multiple concurrent risk factors for VTE. No VTE events were noted in female patients treated with abrocitinib who were taking OCPs and with history of smoking/nicotine exposure. These findings may help contextualize VTE risk in real-world treatment decisions.

Objective: Prurigo nodularis (PN) is a chronic inflammatory dermatologic condition characterized by symmetrically distributed, intensely pruritic, hyperkeratotic nodules. This review aims to explore the role of the central and peripheral nervous systems in PN, focusing on the pain cascade pathway and its implications for novel therapeutic approaches.

Methods: A review of the literature on PN and the pathophysiology of the pain cascade was performed. Original and review articles published before April 1, 2025, were evaluated for relevance.

Results: The pathophysiology of PN involves repetitive scratching that leads to skin thickening and an exaggerated immune response, with key roles played by eosinophils, helper T (Th) cell 2 cytokines (interleukin [IL]-4, IL-13, IL-31), and neuroimmune interactions that perpetuate the itch-scratch cycle and the pain cascade. Management requires a multimodal approach including behavioral strategies, topical corticosteroids, intralesional therapies, and phototherapy. Systemic treatments, ranging from immunosuppressants and neuromodulators to targeted biologics, are often necessary due to the refractory nature of PN. Monoclonal antibodies such as dupilumab and nemolizumab, which target specific cytokine pathways, have significantly advanced treatment options. Ongoing trials with emerging agents emphasize the importance of immunomodulation in transforming PN care and guiding future therapies.

Conclusion: PN is a chronic dermatologic condition that severely impacts quality of life. Emerging research into its pathophysiology indicates immune and neuronal dysregulation. Recent therapeutics have changed the standard of care for patients with PN. Continued future research into pathophysiology and the pain cascade can inform development of additional novel therapeutics.

Objective: We aimed to evaluate the safety and efficacy of a serum containing plant adaptogens (MYS) compared to a moisturizing lotion (ML) pre- and post-laser treatment.

Methods: A double-blind, split-face controlled study enrolled women with mild-to-moderate photodamaged skin. Participants were randomized to twice-daily application of MYS and ML to one side of their face and ML only to the opposite side two weeks prior to and 10 days following a single, non-ablative fractional laser treatment. Tolerability and global skin healing were assessed immediately post-procedure and on Days 1, 2, 4, 7, and 10. Global skin quality (the total sum of scores for erythema, dullness, rough skin texture, pores, and uneven pigmentation) was calculated at baseline, Week 2 (pre-procedure/skincare only), and Day 10 (post-procedure).

Results: Fifteen participants completed the study (mean age: 52 years). Significantly less dryness occurred on the MYS vs. the ML side of the face on Days 1 and 2 (p=0.05 and p=0.001, respectively), with less erythema on the MYS vs. the ML side (29% vs. 17%) on Day 2. Significant improvements occurred in global skin healing on the MYS vs. the ML side of the face on Days 1, 2, and 4 (p=0.04, p=0.003, and p=0.003, respectively) and in global skin quality at Week 2 and Day 10 (p=0.03 and p=0.001, respectively). All adverse events were temporary and related to the procedure.

Conclusion: Twice-daily application of a serum containing plant adaptogens before and after non-ablative fractional laser treatment demonstrated significant reductions in dryness and erythema, and improvements in global skin healing and skin quality compared to ML.

Objective: Although systemic hormonal therapies (spironolactone, oral contraceptives) are clinically effective for the treatment of acne vulgaris (AV) in female patients, perceived safety concerns have contributed to the growing interest in topical hormonal AV therapies.

Methods: We searched PubMed using the terms "topical," "antiandrogen," "hormonal," "clascoterone," "spironolactone," and "acne vulgaris."

Results: The majority of articles identified related to clascoterone and topical spironolactone. Clascoterone cream 1% was approved in 2020 by the US Food and Drug Administration (FDA) for patients with AV aged 12 years or older based on two Phase III randomized controlled trials (RCTs) in 1440 patients (722 randomized to clascoterone) and an open-label extension study; other evaluations included a Phase IIa pharmacokinetic study and a Phase IIb RCT. Six clinical studies-mostly small, randomized trials-reported 193 patients treated with topical spironolactone as 5% cream, 5% gel, 2% solution, and 1% nanogel, and 1 RCT evaluated topical flutamide gel in 27 patients. The efficacy and safety of topical spironolactone and flutamide are supported by limited data with some conflicting results; neither agent is approved by the FDA and both must be compounded extemporaneously with no supporting pharmacokinetic data.

Limitations: Clinical studies of topical spironolactone are limited by the small number of patients and wide range of formulations evaluated.

Conclusion: Available evidence supports the use of clascoterone cream 1% and suggests potential benefits and limitations of topical spironolactone in patients with AV; however, for topical spironolactone, pharmacokinetic studies and large-scale RCTs are needed to better characterize both efficacy and safety profiles.

Atopic dermatitis (AD) is the most common chronic inflammatory skin condition and typically presents with pruritus, xerosis, eczematous lesions, and lichenification. Treatment options vary depending on severity; however, core management involves trigger avoidance, daily skin care, and anti-inflammatory therapies. Dupilumab, a monoclonal antibody that blocks interleukin-4 (IL-4) receptor α, is approved for the treatment of moderate-to-severe AD in patients aged 6 months or older. While this approval represents a significant advancement in AD therapy, the full extent of its side effect profile continues to emerge. Herein, we report two cases of refractory AD in which dupilumab therapy was limited by conjunctivitis and paradoxical worsening of cutaneous symptoms. We present these cases to describe the presentation, clinical progression, and management of dupilumab-associated adverse reactions in AD treatment, thereby contributing to a deeper understanding of its side effect profile. Notably, these cases demonstrate the successful use of nemolizumab as a therapeutic alternative in the setting of dupilumab intolerance.

Background: Photodynamic therapy (PDT) is an effective field treatment for actinic keratoses (AKs). It is an ideal option for patients who prefer a minimally invasive procedure conveniently administered in their physician's office. Anecdotal clinician insights suggest that it may not be used at the same rate year-round.

Objective: This study investigates whether PDT and cryosurgery usage is affected by season and geographic location in the United States.

Methods: The data source is an aggregate of closed and open United States medical procedural claims (Common Procedural Code [CPT] and Healthcare Common Procedure Coding System [HCPCS]) from a broad selection of commercial payers and Centers for Medicare & Medicaid Services (CMS) from 2015 to 2022. Patient records associated with cryosurgery and PDT CPT codes were extracted. A total of 79.1 million patients from 50 states and 4 territories between 2015 to 2022 were included in the analysis. The data were further stratified using meteorologically defined seasons and geographic locations.

Results: PDT utilization is affected by season and geographic location. Procedural claims peak during cooler months and decrease during warmer months, particularly where seasonal changes are more drastic. This trend repeats throughout the study period, including the COVID-19 pandemic. In contrast, use of cryosurgery remains unchanged.

Limitations: The dataset does not capture claims from all commercial payers and CMS.

Conclusion: To our knowledge, this study provides the first evidence of PDT seasonal usage patterns across the nation. This pattern could be attributed to several factors and the findings could serve as a learning opportunity for clinicians to reevaluate their approach in treating AKs.

Medicolegal exposure is a pervasive challenge in both dermatology and dermatopathology. Despite advancements in diagnostic and therapeutic technology, malpractice litigation continues to affect clinicians and laboratories. Errors can occur at multiple stages, from biopsy technique and clinical judgment to histopathologic interpretation and patient follow-up. This article seeks to examine the medicolegal landscape affecting dermatologists and dermatopathologists, identify recurring sources of litigation, and provide practical strategies to minimize legal risk while upholding high standards of care. The majority of malpractice cases in dermatology and dermatopathology do not stem from gross negligence but from miscommunication, documentation lapses, sampling errors, and system-level failures. Common issues include delayed melanoma diagnosis, failure to recognize aggressive nonmelanoma skin cancers, incomplete biopsies, mismanaged follow-up, and inadequate documentation of informed consent. Systemic pressures such as managed care, private equity ownership, and unrealistic patient expectations further amplify exposure risk. Complete elimination of malpractice risk is impossible. However, dermatologists and dermatopathologists who practice meticulous clinicopathologic correlation, document decision-making, communicate clearly, and maintain professional boundaries within corporate systems can significantly reduce exposure.

Objective: We aim to review current treatment strategies for cutaneous lupus erythematosus (CLE) and highlight emerging therapies, evolving outcome measures, and practical considerations that may inform future management of this clinically heterogeneous disease.

Methods: We conducted a narrative review of the literature using PubMed to identify relevant clinical trials, observational studies, and mechanistic investigations related to CLE treatment. Emphasis was placed on studies published within the past 15 years. Expert opinion from dermatology and rheumatology was incorporated to contextualize evolving therapies and their application in clinical practice.

Results: Current management of CLE follows a stepwise framework, with antimalarials and immunosuppressants forming the foundation of systemic therapy. However, many patients experience refractory disease, especially in chronic or hypertrophic subtypes. Advances in the understanding of CLE pathogenesis have led to the development of targeted biologics and small molecule agents that modulate Type I interferon signaling, B- and T-cell activation, and inflammatory cytokine pathways. Novel tools such as Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI-A) and the Investigator Global Assessment for Cutaneous Lupus (CLA-IGA-R) are being validated to standardize disease assessment, while RNA tape sampling and real-world electronic health record (EHR)-based algorithms are enhancing research precision. Emerging therapies, such as belimumab, anifrolumab, litifilimab, deucravacitinib, and enpatoran, demonstrate promise in both clinical trials and real-world settings.

Limitations: As a narrative review, this study is limited by the lack of systematic inclusion criteria and formal quality assessment of individual studies.

Conclusion: Ongoing therapeutic innovation, guided by mechanistic insights and strengthened by the development of standardized outcome measures, is transforming the CLE landscape and advancing the goal of precision-based, durable disease control.

Intramuscular triamcinolone acetonide (IMT) has been used for the past 60 years, but a recent survey of 800 dermatologists showed that 55% use it rarely or not at all, primarily because of fear of adverse events. With a unique mechanism of action vs. other systemic corticosteroids, a relatively low dose, and short half-life, IMT can produce a long-term clinical anti-inflammtatory effect. This paper presents an argument for the efficacy of IMT with proper, safe use. In addition, this paper will discuss many of the clinical conditions for which IMT can be effective.

Background: The purpose of this meeting was for an expert panel to analyze current literature and provide updated consensus statements regarding the optimal management, safety, and efficacy of oral antibiotics in acne vulgaris (AV).

Methods: A thorough literature search was conducted across PubMed, Scopus, and Google Scholar to identify English-language original research articles evaluating the use of oral antibiotics for AV. An expert panel of 8 dermatologists, specializing in the management of AV, convened to assess the findings and develop statements regarding oral antibiotics for AV. Each statement was approved through a modified Delphi process, and a strength of recommendation was assigned based on the Strength of Recommendation Taxonomy (SORT) criteria.

Results: A total of 544 articles regarding the safety, efficacy, and management of oral antibiotics for AV were identified through the literature search. Following a rigorous screening process, 17 articles were deemed relevant to the research questions and provided to the panelists for review prior to the roundtable discussion. The panel reached unanimous agreement on 10 consensus statements and recommendations, assigning seven a strength of A, one a strength of B, and two a strength of C.

Conclusion: The expert panel concluded that oral antibiotics can be used in the treatment of moderate-to-severe AV, oral antibiotics should be combined with topical treatments, and duration of use should be determined based on individualized patient care. Tetracyclines are recognized options for AV therapy, with sarecycline considered a preferred option for AV due to its targeted mode of action, unique ribosomal binding properties, narrow spectrum of antibiotic activity, lower bacterial resistance risk, and overall better tolerability. Additionally, tetracyclines should be avoided in pregnancy and in young children.