Journal of Clinical and Aesthetic Dermatology最新文献

Objective: Chronic pruritus significantly impacts quality of life and remains challenging to manage, particularly in patients unresponsive to systemic therapies. Nemolizumab, a monoclonal antibody targeting the interleukin (IL)-31 receptor, has shown promise in alleviating pruritus across several dermatologic conditions. However, data on its efficacy in treatment-resistant cases, particularly in real-world settings, remain limited. This case series evaluates the efficacy and safety of nemolizumab in patients with treatment-resistant chronic pruritus.

Methods: A multicenter retrospective review was conducted across private dermatology practices and large academic dermatology centers. Patient records were reviewed for demographics, comorbidities, treatment history, and clinical outcomes, including Body Surface Area (BSA), Investigator Global Assessment (IGA), and Peak Pruritus Numerical Rating Scale (PP-NRS). Adverse events were recorded.

Results: Twelve patients (5 with atopic dermatitis, 2 with prurigo nodularis, 3 with chronic pruritus of unknown origin, and 2 with concomitant atopic dermatitis and prurigo nodularis) were included. All had previously failed systemic therapies. Mean baseline BSA was 45 percent (range 5-88%), with mean PP-NRS of 9 (range 6-10). After treatment, mean BSA and PP-NRS decreased to 4 percent (11-fold reduction) and 0.9 (10-fold reduction), respectively. Most (10/12) experienced significant pruritus relief within 24 to 72 hours of nemolizumab initiation. No serious adverse events were noted, including in patients with a history of malignancy or end-stage renal disease.

Limitations: Small sample size, retrospective design, limited follow-up, and absence of a control group.

Conclusion: Nemolizumab demonstrated rapid and substantial efficacy in treatment-resistant chronic pruritus with a favorable safety profile, even in patients with significant comorbidities.

Janus kinase inhibitors (JAKi)-developed to treat inflammatory and immune-mediated diseases-have shown an increased risk of acne development, especially when used to treat dermatologic conditions. There are no treatment guidelines for JAKi-induced acne. Some of the most efficacious treatments for acne vulgaris (AV) are triple combinations, including benzoyl peroxide (BPO), a topical retinoid, and an oral/topical antibiotic. Fixed-dose, triple-combination clindamycin phosphate 1.2%/adapalene 0.15%/BPO 3.1% (CAB) gel has demonstrated good efficacy, safety, and tolerability in Phase 2 and 3 clinical trials of participants with moderate to severe AV. This case report highlights the possible utility of once-daily CAB for JAKi-induced acne. A 15-year-old female patient was administered the oral JAKi upadacitinib (15mg daily) for 16 weeks to treat atopic dermatitis that inadequately responded to dupilumab. The patient had mild preexisting comedonal and inflammatory facial AV prior to JAKi treatment. Over the first few months of JAKi treatment, her acne worsened to moderate/severe inflammatory acne, with erythema and postinflammatory hyperpigmentation. The patient applied CAB gel to the face once daily for approximately 20 weeks with substantial acne improvement and without adverse effects. CAB treatment reduced her acne severity to mild to almost clear, and no significant acne-induced sequelae (scarring, postinflammatory hyperpigmentation, or erythema) were observed. She continues treatment with both CAB and upadacitinib. Treatment guidelines for AV often recommend oral drugs, such as isotretinoin, for moderate-to-severe acne. This case presented here, however, demonstrates that topical CAB gel can treat moderate to severe JAKi-induced inflammatory acne.

Objective: The objective of this study is to determine the likelihood for online consumers seeking hats for sun protection in the United States (US) successfully finding one that meets the recommended criteria for adequate UV protection and whether UPF claims made by these products are reliable indicators of this protection based on materials, structure, and design.

Methods: Online US consumer experience was simulated to identify the top 20 hats targeting consumers seeking sun protection. Specific details were evaluated for the top 20 products identified based on the volume of product occurrences identified as key markers for ultraviolet (UV) protection including the hat style, brim length, UPF claims, presence of ventilation eyelets or mesh, and presence of a reflective undersurface.

Results: Although 90 percent of hats marketed for use in the sun made UPF claims, there was a 60 percent probability of finding a hat that conformed to stringent UPF standards for hats set forth by UK and Australian testing standards for UPF claims to be made by hats to be used for sun protection factoring in materials, structure, and design.

Conclusion: Given the lack of conformity for UPF testing and 33 percent of hats failing to meet criteria for adequate sun protection based on materials, structure, and design, UPF claims for hats sold in the US online are not a reliable indicator for sun protection. Recommendations for hats for UV protection should focus on crown coverage, circumferential brim with length of at least 2.75", materials with minimal disruption, and not UPF claims.

Objective: The goal of this study was to examine the relationship between psoriasis and occupational organic dust exposure among United States (US) adults 20 to 79 years of age.

Methods: We merged two, two-year cycles (2009 to 2010 and 2011 to 2012) of data from the National Health and Nutrition Examination Survey (NHANES). Of 10,990 participants, 483 were excluded due to incomplete data, resulting in a cohort of 10,507 individuals. We utilized STATA/SE 18.0 for multivariable logistic regression analyses.

Results: Among individuals with psoriasis, the prevalence of organic dust exposure was 32 percent compared to 22 percent with organic dust exposure among those without psoriasis. There was a significant association between psoriasis and organic dust exposure among patients ages 20 to 79 years after adjusting for potential confounding variables (adjusted odds ratio [AOR]: 1.68; 95% confidence interval [CI]: 1.19-2.36; p=0.004). There was significant organic dust exposure among female participants with psoriasis (p=0.040), and increased rates of exposure among adults with psoriasis ages 40 to 59 years (p=0.038) and adults with psoriasis ages 60 to 79 years (p=0.034). There was a higher percentage of psoriasis participants with over fifteen years of organic dust exposure (43%) compared to those without psoriasis (23%) (p=0.038).

Limitations: Limitations include the possibility of recall bias due to self-reporting and inability to control for psoriasis severity.

Conclusion: Organic dust exposure was significantly associated with psoriasis in this study. These results remained significant when examining female subgroups, ages 40 to 59 years, and ages 60 to 79 years. There was also a statistically significant presence of psoriasis among individuals with occupational organic dust exposure of fifteen years or more.

Introduction: In 2023, the American Academy of Allergy, Asthma, and Immunology (AAAAI)/American College of Allergy, Asthma, and Immunology Joint Task Force (JTF) updated their guidelines for management of atopic dermatitis from their last update in 2012. The American Academy of Dermatology (AAD) also updated their own guidelines from 2014 for the diagnosis, assessment, safety, and efficacy of treatments in 2024. In this review, we outline the key changes from the prior guidelines and highlight the major differences between the two recommendations.

Results: The majority of the guidelines and recommendations are similar in their overall recommendations with small stylistic differences including application frequency and combination of therapies. Key differences between the two recommendations include topical PDE-4 Inhibitors, topical JAK Inhibitors, systemic JAK inhibitors, azathioprine, methotrexate, and mycophenolate. The final difference between the AAD and JTF guidelines is that AAD categorizes evidence and comments on the certainty of association for each group of comorbidities, while JTF makes general statements regarding comorbidities.

Objective: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with systemic inflammation and reports of increased prevalence and risk of inflammatory arthritis. Despite this, there is a lack of tools to assess musculoskeletal (MSK) symptoms in patients with HS. This quality improvement initiative aims to evaluate MSK symptom severity and impact in patients with HS using the International Dermatology Outcome Measures (IDEOM) Musculoskeletal Questionnaire (MSK-Q).

Methods: Over 20 months, the IDEOM MSK-Q was distributed to 115 patients with HS receiving care at a single dermatology clinic. Demographic and clinical data were collected at all visits. The IDEOM MSK-Q is a 9-item tool scored on a 10-point scale, with subscores evaluating MSK symptom severity, impact on quality of life, and fatigue in the past week.

Results: At baseline, 79.14 percent of patients reported joint symptoms, with 33.91 percent rating joint pain ≥7/10. Fatigue was also prevalent (47.82% rating ≥7/10). Higher HS severity was significantly correlated with greater MSK symptom burden, with the greatest impact reported in work and/or school activities and daily physical activities. Follow-up assessments suggested symptom improvement with systemic treatment, though statistical significance was not achieved.

Limitations: This study has a small sample size and limited follow-up duration.

Conclusion: Our analysis shows substantial MSK symptom burden and fatigue among patients with HS. The IDEOM MSK-Q may be a valuable tool for assessing MSK symptoms and impact, supporting further development and validation in the HS population.

Background: Glutathione, a potent antioxidant, has gained attention for its skin-lightening effects, leading to ethical debates. Social media influence has popularized its use in various skincare products such as under-eye creams, face masks, sunscreens, and moisturizers. Despite its popularity, scientific research on topical glutathione is limited.

Objective: To perform a review of existing literature on the safety and efficacy of topical glutathione.

Methods: A PRISMA-guided systematic review was conducted using PubMed and MEDLINE databases with search terms "glutathione" AND "topical" AND "skin" OR "dermatology." From 446 articles, only clinical trials on topical glutathione were included, excluding reviews, animal studies, and research on oral or intravenous glutathione. Five clinical trials met the inclusion criteria.

Results: Studies suggest glutathione may improve hyperpigmentation and provide antioxidant advantages. A glutathione amino acid precursor (GAP) blend increased the glutathione reduced monomers (GSH) oxidized dimers glutathione disulfide (GSSG) ratio, a surrogate measure for oxidative damage repair capacity. S-acyl glutathione 2% cream significantly reduced ultraviolet-induced erythema (p=0.0003). A 2% oxidized glutathione lotion decreased the melanin index (p<0.05), total epidermal water loss (TEWL) (p<0.05), and wrinkles (p<0.01). Combination creams with glutathione also showed benefits, though tolerability was varied. Safety data is limited and warrants further exploration.

Conclusion: Topical glutathione shows promise for dermatological applications. Further randomized controlled trials are necessary to fully evaluate its efficacy in hyperpigmentation, TEWL, skin elasticity, and ultraviolet (UV) damage. Additionally, ethical considerations regarding its use as a skin-bleaching agent must be addressed to avoid reinforcing structural racism and healthcare disparities.

Alopecia areata (AA) is an immune-mediated, nonscarring hair loss with established associations with various autoimmune conditions, including inflammatory bowel disease. The following case describes a 38-year-old White male patient with Crohn's disease who developed rapidly-progressive alopecia areata during treatment with infliximab. Despite discontinuation of infliximab and aggressive treatment with corticosteroids and tofacitinib, the patient progressed to alopecia universalis within six months. Concurrently, the patient's Crohn's disease required escalation to colectomy with ostomy placement due to inadequate response to vedolizumab. Following his colectomy, the patient continued treatment with tofacitinib and demonstrated dramatic improvement in his AA, achieving complete hair regrowth within one year and maintaining remission two years after discontinuation of all immunosuppressive therapies. This case illustrates potential mechanistic connections between alopecia areata and Crohn's disease through shared inflammatory pathways involving interferon-γ and JAK signaling. The temporal relationship between the patient's colectomy and remission of his alopecia areata suggests a gut-immune axis mechanism, where addressing the primary intestinal inflammatory source may have influenced a remote autoimmune manifestation. This case highlights the potential for targeting primary inflammatory sources to achieve broader immunologic benefits in patients with concurrent autoimmune conditions.

Squamous cell carcinoma (SCC) is the second most common type of skin cancer following basal cell carcinoma (BCC). Risk factors for the development of SCC include exposure to ultraviolet light (UV) and non-UV-related risk factors, such as chronic wounds, Marjolin ulcers, and human papillomavirus (HPV) infection. In this case report, we report an interesting case of the development of SCC in the palm of a patient with an extensive history of Lyme disease.