Journal of Clinical and Aesthetic Dermatology最新文献

Objective: In patients with moderate-to-severe plaque psoriasis, recent meta-analyses compared efficacies among biologics and time to relapse after treatment withdrawal; however, there was notable heterogeneity in the clinical trials and their criteria used to define relapse. Furthermore, while biologics are effectively grouped into treatment classes based on their mechanisms of action (ie, anti-interleukin (IL)-23 class, anti-IL-17 class), not all biologics should necessarily be grouped into a class effect. For example, the anti-IL-17 class is heterogeneous in their mechanisms of action due to the variety of cytokines and receptors antagonized along with their accompanying gene expression changes in psoriatic disease. Therefore, we performed an in-depth assessment of biologics comprising the anti-IL-17 class and their associated pharmacokinetics (PK). We identified differences in PK parameters that may augment our understanding of how these biologics differ in function and explain variations in time to relapse of psoriatic disease after treatment withdrawal.

Methods: A PubMed literature search was performed and articles screened to only include double-blind, randomized, placebo or comparator-controlled trials. The remaining articles were screened to ensure inclusion of a treatment withdrawal period and to confirm they investigated and defined relapse.

Results: We identified five unique randomized controlled trials that examined time to relapse after treatment discontinuation for anti-IL-17 biologics. Brodalumab, an IL-17RA antagonist, consistently demonstrated the quickest time to relapse, whereas bimekizumab, the first-in-class dual IL-17A and IL-17F antagonist, demonstrated the longest time to relapse.

Limitations: There is heterogeneity in both the criteria for treatment success prior to undergoing treatment withdrawal as well as relapse criteria. The only relapse datapoints shared by all four anti-IL-17 class biologics examined were median time to loss of PASI-75 and PASI-90.

Conclusion: Differences in time to relapse after treatment discontinuation following treatment success can be attributed to both differences in biologic PK properties and mechanisms of action. These results warrant further investigation into the role of IL-17F in the pathogenesis of plaque psoriasis, as targeting this isoform appears to confer synergistic therapeutic benefit compared to targeting the IL-17A isoform alone. Furthermore, the classic understanding of IL-17RA blockade with brodalumab must be revisited as IL-17F was found to partially bind and signal through IL-17RA despite the presence of brodalumab.

Objective: The authors sought to evaluate a flexible, hyaluronic acid (HA) filler, Restylane® Defyne™ (HA_DEF) (Galderma), for combined treatment of chin, nasolabial folds (NLFs), and marionette lines (MLs), in a predefined stepwise order, comparing Down-up (ie, chin first) versus Top-down (NLFs and MLs first) treatment approaches. This postmarketing study complements prior pivotal investigations that demonstrated the safety and effectiveness of HA_DEF treatments of the lower face, by providing a standardized treatment algorithm for combining several treatment areas in the lower face.

Methods: HA_DEF was injected at Day 1 in the first treatment area and at Week 3 in the second area (randomized to either Down-up or Top-down order), with optional touch-up (any area) at Week 6. Assessments included Global Aesthetic Improvement Scale (GAIS), skin firmness, facial harmony, patient satisfaction, and safety until Week 9.

Results: Both approaches achieved similar, favorable results at Week 9, with 100% of patients in both groups (Down-up, n=31; Top-down, n=29) demonstrating aesthetic improvement on the GAIS, improved skin firmness and facial harmony, and natural-looking results. Of patients seeking aesthetic improvement of the submental area, 95% in the Top-down group and 100% in the Down-up achieved improvement. Patient-reported endpoints supported these results, with high satisfaction throughout the study. HA_DEF was well tolerated throughout the study.

Limitations: The results should be considered indicative rather than definitive given the post-marketing design of the study.

Conclusion: Both stepwise approaches may be used for administering HA_DEF when treating the combined areas of chin, NLFs, and MLs.

Cutaneous lupus erythematosus (CLE) may occur independently or in association with systemic lupus erythematosus (SLE). When systemic disease is present, CLE is the first manifestation in nearly one-third of cases. This positions dermatologists as key stakeholders in early detection of systemic disease, underscoring the importance of appropriate screening among this population. Various CLE subtypes carry distinct risks of systemic progression, with acute CLE closely tied to active SLE, subacute CLE conferring moderate risk, and most chronic subtypes (eg, localized discoid lupus) remaining limited to the skin. This review provides a practical, dermatology-focused framework for risk stratification, screening, and comanagement of patients with CLE. To support clinical decision-making and expand awareness, we introduce the "LABS FOR" SLE mnemonic to guide laboratory evaluation and propose an updated visual algorithm that illustrates screening and monitoring practices. We synthesize evidence-based and expert-informed recommendations, including serologic, demographic, clinical, and genetic predictors of systemic involvement. The 2019 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria-requiring antinuclear antibody (ANA) positivity and weighted domain scoring-are reviewed and compared to other diagnostic aids. Additionally, we highlight appropriate ANA testing, the importance of symptom review, and targeted second-line labs. Finally, we discuss collaborative management strategies with rheumatology, including organ-specific therapeutic considerations. By adopting a structured, CLE-informed approach to systemic screening and follow-up, dermatologists can play a critical role in improving outcomes for patients across the lupus spectrum.

Objective: DFD-29 is a low-dose modified formulation of minocycline 40mg that has demonstrated efficacy and safety in patients with rosacea. We report the effect of DFD-29 on patient-reported assessments of disease severity and quality of life (QoL) from two clinical trials in patients with moderate-to-severe rosacea.

Methods: MVOR-1 (NCT05296629) and MVOR-2 (NCT05343455) were 16-week, randomized, double-blind, active- and placebo-controlled Phase III trials that compared the impact of oral DFD-29 (EMROSI, Journey Medical Corporation), doxycycline 40mg, and placebo in adults aged 18 years or older with moderate-to-severe rosacea. Changes in QoL were exploratory endpoints that were evaluated at baseline and Weeks 2, 4, 8, 12, and 16 using the Rosacea-Specific Quality of Life (RosaQoL) questionnaire and the Dermatology Life Quality Index (DLQI).

Results: Among randomized subjects, 288 completed MVOR-1 (DFD-29, n=117; doxycycline, n=98; placebo, n=73) and 296 completed MVOR-2 (DFD-29, n=115; doxycycline, n=113; placebo, n=68). In both trials, DFD-29 significantly improved QoL versus placebo (p<0.05) as assessed by RosaQoL and DLQI over 16 weeks. In MVOR-2, DFD-29 was also significantly superior to doxycycline in improving least squares mean RosaQoL scores at Week 12 (p=0.034). In MVOR-1, patients reported superior improvements in DLQI scores with DFD-29 versus doxycycline (p<0.05) at Weeks 4, 8, and 12.

Limitations: RosaQoL and DLQI were exploratory endpoints.

Conclusion: These data suggest that DFD-29 may be useful in improving QoL in patients with moderate-to-severe rosacea.

Objective: This study aims to assess the regression rate of basal cell carcinoma (BCC) in excision specimens following diagnostic biopsies obtained from patients in a veterans affairs facility.

Methods: A retrospective review of biopsy-proven BCC excision cases was conducted. All included biopsy and corresponding excision reports were reviewed to determine the margin status of specimens. Proportion of residual carcinoma cases and regression rate of the tumor were determined.

Results: Regression rate of BCC was estimated to be 47%. The most prevalent subtype was nodular BCC (46%), and the most prevalent location was the head. Tumors located on the trunk and upper extremities were more likely to regress, and those on the head were less likely to regress (p<0.05). Punch biopsy technique was associated with significantly lower regression rate (p<0.01). The time interval between the biopsy and excision and age were not significantly different between regressed and non-regressed tumors. Neither of sexes and neither of tumor subtypes had significantly different regression rates as compared to the general study population.

Limitations: The limitation of our study is that the data may not be generalizable due to our unique study population.

Conclusion: BCC is a tumor with the potential to regress. However, definitive management resides in complete surgical excision, which will most likely remain the mainstay of treatment in the near future.

Background: Skin cancer is the most common cancer faced by adults in the United States. Melanoma, while a less common subtype of skin cancer compared to basal cell and squamous cell carcinomas, is associated with greater rates of metastases, mortality, and morbidity, and its rate of incidence is projected to increase. Primary care physicians (PCPs) can play an important role in skin cancer detection and in the decision to refer a patient to a dermatologist. Technologies such as the elastic scattering spectroscopy (ESS) device (DermaSensor, Inc.), a handheld, noninvasive assistive tool, may help in the evaluation of a skin growth and improve appropriate referral decision making.

Methods: A total of 50 malignant and 50 benign lesions were assessed by each of the 118 physicians (board-certified internal and family medicine physicians), yielding 5,900 malignant and benign lesion assessments without the device and 5,900 with the ESS device. Physicians were also surveyed regarding their confidence in their management decision.

Results: The study met the primary endpoint; the area under the receiver operating characteristic (AUROC) of the PCPs aided with the device was 0.671 (95% confidence interval [CI]: 0.611-0.732) compared with the AUROC unaided by the device of 0.630 (95% CI: 0.582-0.678), a significant increase (p=0.036). When asked whether the device would provide value to their decision making, 91.5% of respondents either agreed or strongly agreed.

Conclusion: The ESS device improved PCP accuracy in managing lesions suggestive of melanoma and increased their sensitivity for all skin cancers and melanoma. Participating internal medicine and family medicine physicians reported increased confidence in their assessments with the device. The ESS device can improve PCP decision making when managing lesions suggestive of melanoma.

Objective: Acne vulgaris is a major health and social concern for many adolescents and adults. The goal of this study was to further assess the efficacy and safety of a United States Food and Drug Administration cleared light-emitting diode (LED) therapy (Omnilux Clear, GlobalMed Technologies) for treating adolescents and adults with mild-to-moderate facial acne. The device is a wearable facial mask designed for home use that simultaneously emits light in red (633 nm) and blue (415 nm) wavelengths.

Methods: The study enrolled male (n=15) and female (n=15) patients aged 14 to 45 years old. Patients were required to have an Investigators Global Assessment (IGA) score of 2 (mild) or 3 (moderate). Patients applied the treatment at home 4 times weekly, never more than once daily, and allowed 24 hours between treatments. The primary efficacy endpoints were the change from baseline in inflammatory and noninflammatory lesion counts, and the proportion of patients achieving a ≥1-grade reduction in IGA scores from baseline. Other assessments included quality of life and tolerability questionnaires.

Results: After 7 weeks, there were significant reductions in inflammatory and noninflammatory lesion counts (for each, p<0.0001) and most patients (86%) achieved ≥1-grade reduction in IGA scores, meeting study success criteria. The few reported adverse events were mild and transient.

Limitations: The primary limitation of this study was the open-label study design.

Conclusion: These results provide strong support for this wearable LED device for the safe and effective home treatment of adolescents and adults with mild-to-moderate acne.

Objective: The authors sought to evaluate the feasibility, educational outcomes, and cost-savings of free dermatologic screenings at local farmers' markets and a church in Oklahoma City, Oklahoma.

Methods: We piloted six free skin cancer screenings at farmers' markets and a church in Oklahoma. Exposed areas were examined by dermatology residents under supervision of a board-certified dermatologist. Suspicious lesions were referred. Pre- and postscreening surveys assessed knowledge, sunscreen use, and barriers to care. Demographics and ZIP codes were collected. Follow-up was conducted at 6 months. We estimated cost savings per screening using published visit costs and Internal Revenue Service (IRS) mileage rates. Statistical analysis included paired t-tests, analysis of variance (ANOVA), and chi-square tests (p<0.05).

Results: Among 411 adults, 40 participants (9.7%) had notable lesions, including 7 confirmed basal cell carcinomas and 23 actinic keratoses. Awareness of risk-reducing practices and lesion recognition increased significantly postcounseling (both p<0.0001). The most reported barrier to dermatology was lack of perceived need. Estimated cost savings per participant was $156.70, totaling $64,403.70 across all participants.

Limitations: Limitations include reliance on self-reported survey data, incomplete follow-up among referred participants, and lack of histopathologic confirmation for all findings.

Conclusion: This study shows the feasibility and cost-effectiveness of free skin screenings when paired with local farmers' markets, which often provide complimentary spaces for nonprofit organizations. These low-cost models may enhance earlier detection and awareness in communities with limited access.

Objective: Populations with skin of color remain under-represented in dermatology clinical trials. Here, we first evaluated the efficacy of a serum and sunscreen regimen, containing 2-mercaptonicotinoyl glycine (2-MNG, Melasyl^TM), a new ingredient that quenches melanin precursors, on improving facial dyschromia in women with skin of color.

Methods: This open-label study completed with 60 female participants, aged 25-70 years old, from diverse racial/ethnic backgrounds with skin phototypes IV-VI and presenting with mild to moderate hyperpigmentation and skin roughness. After completing a 1-week washout period, all participants used a 2-MNG-containing serum and sunscreen SPF30 regimen for 12 weeks. Evaluations included clinical assessments, quality of life questionnaires, plus imaging at several time points.

Results: After 2 weeks of treatment, dermatological assessments showed significant improvement in skin brightness and radiance in all participants. At Week 4, we observed significant reduction in dyschromia and hyperpigmentation. Expert grading and clinical imaging also demonstrated significant improvement in skin smoothness and pores appearances. By Week 12, all participants perceived a significant improvement in quality of life: from feeling less unattractive to decreasing the use of camouflage to cover up skin concerns. Lastly, skincare regimen was overall well tolerated by all participants.

Limitations: This study evaluated the 2-MNG containing skincare regimen efficacy and did not specifically address the effectiveness of individual ingredients, nor include a comparison to a gold standard treatment.

Conclusion: Overall, our results demonstrate that a 2-MNG-containing serum and sunscreen SPF30 regimen effectively reduces the appearance of facial dyschromia, while improving skin texture and quality of life among women with skin of color.