Journal of Clinical and Aesthetic Dermatology最新文献

Objective: Tildrakizumab, an anti-interleukin-23 p19 monoclonal antibody, is approved for the treatment of adults with moderate-to-severe plaque psoriasis. Limited evidence is available regarding the effects of tildrakizumab on patient-reported symptoms and satisfaction. This report describes the secondary endpoints of patient-reported symptoms and treatment satisfaction over 64 weeks in patients with moderate-to-severe plaque psoriasis treated with tildrakizumab in a Phase IV, real-world study.

Methods: In this uncontrolled, open-label study (NCT03718299), patients received tildrakizumab 100 mg at baseline, Week (W)4, and every 12 weeks thereafter to W52, with the final assessment at W64. Patient-reported secondary endpoints included numerical rating scale (NRS) scores for itch, pain, and scaling, and treatment satisfaction measured by 3 rating scales (Treatment Satisfaction Questionnaire for Medication [TSQM], Tildrakizumab Overall Satisfaction, and Patient Happiness with Psoriasis Control instrument) through W64.

Results: Of the 55 patients enrolled, 45 were assessed at W64. Mean NRS scores for itch, pain, and scaling all decreased from baseline beginning as early as W4 with maintenance through W64 (P≤0.001). Treatment satisfaction was positive throughout treatment based on all 3 measures. Mean±SD TSQM domain scores increased from 59.5±17.0 at W4 to 79.5±20.1 at W64 for Effectiveness and from 72.7±18.6 to 81.9±20.5 for Global Satisfaction.

Limitations: The study is small and lacks a comparator arm.

Conclusion: Tildrakizumab treatment improved patient-reported symptoms in patients with moderate-to-severe plaque psoriasis in a real-world setting and was associated with high levels of treatment satisfaction over 64 weeks.

Objective: We sought to correlate the time lag between psoriatic arthritis (PsA) symptom onset and diagnosis to the likelihood and severity of depression, social impairment, and disease impact on quality of life.

Methods: This cross-sectional study conducted by the National Psoriasis Foundation (NPF) surveyed individuals with PsA using patient-reported outcome measures.

Results: The analysis cohort comprised 2,196 patients with PsA. Likelihood of depression progressively increased when time between PsA symptom onset and diagnosis was beyond six months (28.6% <6 months; 29.6% 7-12 months; 38.1% 13-24 months; 35.4% >2 years; p<0.01). Individuals with more than six months delay reported increasingly higher rates of experiencing moderate limitation in social participation (22.9% <6 months; 29.2% 7-12 months; 34.0% 13-24 months; 35.3% >2 years; p<0.001). Unacceptable PsA symptom rates (PsAID score >4) increased with time between PsA symptom onset and diagnosis (74.7% <6 months; 76.4% 7-12 months; 80.8% 13-24 months; 81.6% >2 years; p<0.05). These relationships persisted in body mass index (BMI) and age adjusted models.

Limitations: The study only includes participants who were active members of the NPF, and all data was self-reported.

Conclusion: Our results demonstrate that delays between PsA symptom onset and diagnosis that are greater than six months lead to increased likelihoods of depression, social disengagement, and impaired quality of life, and that longer delays lead to increasingly worse outcomes in these domains.

Objective: We sought to review the biology and clinical benefits of genistein, a plant-derived isoflavone with emphasis on perimenopausal and postmenopausal women. The focus is on assessing its impact on skin health and aesthetics as well as bone density and cardiovascular and metabolic functions.

Methods: This narrative review used PubMed to collect studies relating to the biology and clinical effects of genistein on postmenopausal signs and symptoms, including bone density loss, metabolic issues and symptoms, and skin aging. Articles were selected based on relevance to the scope of genistein's influence on estrogen receptors and their downstream effects. This review included in vitro, in vivo, animal, and human studies.

Results: According to the current literature, genistein demonstrates efficacy in mitigating menopausal signs and symptoms such as hot flashes, bone density loss and rate of osteoporosis, and skin aging. It shows a protective effect against cardiovascular diseases by improving lipid profiles, weight changes, and reducing low-density lipoprotein cholesterol. It also displays benefits in increasing bone mineral density but has not displayed the side effects commonly associated with estrogen replacement. Regarding skin health, genistein appears to enhance photoprotection, wound healing, elasticity, and hydration, inhibits skin cancer, and reduces wrinkles.

Conclusion: Genistein acts as a selective estrogen receptor modulator (SERM) with benefits across a spectrum of menopausal signs and symptoms, presenting a viable alternative to estrogen replacement in perimenopausal and postmenopausal women. Its utility extends to improving cardiovascular health, bone density, and skin quality, making it a comprehensive treatment option for peri and postmenopausal women.

Objective: We sought to compare the efficacy and safety of encapsulated benzoyl peroxide (E-BPO) cream, 5%, versus vehicle in subjects <65 years of age versus subjects ≥65 with moderate to severe papulopustular rosacea.

Methods: This analysis used pooled results from two 12-week, randomized, vehicle-controlled Phase III trials (NCT03564119, NCT03448939) of E-BPO cream, 5%. These trials included 733 subjects randomized 2:1 to E-BPO or vehicle. The primary endpoints were success in the Investigator's Global Assessment (IGA) score and reduction in mean inflammatory lesion count at Week 12.

Results: Our analysis shows that E-BPO cream, 5%, was significantly superior to vehicle in achieving IGA success and reducing inflammatory lesions in both age groups. IGA success was achieved in 48.3% of subjects who received E-BPO versus 25.4% for vehicle in the intent-to-treat population. The E-BPO and vehicle IGA success percentages for subjects <65 were 45.7% and 23.8%, respectively, and those for subjects ≥65 were 60.0% and 28.1%, respectively. The absolute reduction from baseline in inflammatory lesions was -19.3 for subjects who received E-BPO versus -11.4 for those who received vehicle. The E-BPO and vehicle absolute reduction values for subjects <65 were -19.6 and -11.2, respectively, and 17.5 and -10.4 for subjects ≥65. There were no significant differences in the frequencies of adverse events or cutaneous tolerability.

Limitations: E-BPO was not compared to nonencapsulated BPO.

Conclusion: This combined analysis of results from the two Phase III, randomized, double-blind controlled studies of E-BPO cream, 5%, showed it was efficacious, tolerable, and safe, regardless of age.

Vascular anomalies can be broadly classified as vascular tumors or vascular malformations, depending on the degree of endothelial involvement. These lesions can be subtle and challenging to diagnose in individuals with darker skin tones, which can lead to a delay in treatment. Improving diagnostic accuracy of these lesions may prevent progression and potential adverse outcomes when left untreated. Here, we present a review of common vascular anomalies with a focus on diagnostic considerations in individuals with skin of color.

Background: Striae distensae (SD) is a common cutaneous disorder which appears as linear lesions seen mainly in women. Since previously described in 1889, SD has presented a significant challenge regarding its evaluation and treatment. Carboxytherapy was recently reported as an effective treatment for SD.

Objectives: We sought to objectively compare the clinical effectiveness of carbon dioxide therapy (CDT) as monotherapy versus a combination of CDT and fractional CO₂ laser in the treatment of SD.

Methods: This randomized prospective study included twenty cases with bilateral and symmetrical SD. Each patient was treated with CDT only on the right (Rt) side of the body, while the left (Lt) side received a combination of CDT and fractional C0₂ laser.

Results: Clinical evaluation revealed a clearly significant clinical improvement in SD lesions after both techniques regarding length, width, texture, and pigment changes. Although the Lt side showed slightly better improvement, however no statistically significant difference could be observed between both sides. In the meantime, the objective improvement observed by the 3D camera and histometric analysis correlated with the clinical improvement. Special stains showed collagen deposition which became more compact, dense and better organized, accompanied by evident increase in elastic fibers in a normal linear microfibrillar pattern after treatment on both sides.

Conclusion: CDT demonstrated efficacy and safety as a minimally invasive modality for management of SD, as it induces collagen remodeling and better organization of elastic fibers with minimal side effects and downtime.

Objective: We sought to examine possible differences in BCC characteristics and treatment patterns between two matched cohorts of Hispanic White and non-Hispanic White individuals.

Methods: In this single institution, retrospective matched cohort study, data from patients with biopsy proven BCC from June 2005 to May 2022 was collected. Demographic, BCC, and treatment characteristics were compared between Hispanic White and non-Hispanic White individuals using a Wilcoxon rank-sum test, for continuous and ordinal variables, and Fisher's exact test, for categorical variables.

Results: A total of 604 individuals with a diagnosis of biopsy-proven BCC were matched in a 1:1 fashion by age (± 0 years) and sex, based on self-identified ethnicity as Hispanic or non-Hispanic. Since all patients self-identified as White race, the two cohorts were labeled Hispanic White (n=302) and non-Hispanic White (n=302). The most frequent location for BCC was in the H area, 129 [42.7%] White Hispanic group vs 132 [43.7%] White non-Hispanic group (p = 0.87). In both Hispanic White and non-Hispanic White groups, the predominant subtype of BCC was the nodular (149 [50.2%] vs 164 [54.7%], p = 0.25). The median BCC pre-operative size in the Hispanic White group was 0.9 cm, whereas in the non-Hispanic White group, it was 1.0 cm (p = 0.004). Furthermore, the MMS defect size in the Hispanic White group had a median of 1.3 cm, while in the non-Hispanic White group, it was 1.6 cm (p < 0.001).

Limitations: Retrospective design, single-center study, and self-reported race and ethnicity.

Conclusion: Both groups had similar demographics, tumor features, treatments, and post-operative complications. Notably, preoperative lesion and MMS defect sizes were larger in non-Hispanic Whites than in Hispanic Whites, contrary to expectations. Despite assumptions of poorer skin cancer outcomes among Hispanics, our findings indicate increased sizes in non-Hispanic Whites. Given the diversity in genetics and clinical traits within ethnicities, especially Hispanics, more research is needed for precise insights into disease outcomes across diverse backgrounds.

Objective: Hyaluronic acid (HA) has become a commonly used ingredient in topical moisturizing products; however, limitations of delivery of HA to only the surface of skin have hindered leveraging the full capacity of HA for skin rejuvenation. Here, we aimed to evaluate the clinical benefits of a multi-weight HA plus antioxidant complex-based lotion with SPF 30 compared to a single-weight HA plus ceramide-based lotion with SPF 30.

Methods: A double-blind comparative study was conducted on 70 female subjects, aged 25 to 65 years with mild-to-moderate facial dryness and visible fine lines and wrinkles, divided evenly into two groups (n=35 per group). Clinical grading of the face, including dryness, roughness, and fine lines, was assessed after once-daily application for up to eight weeks.

Results: Daily use of the multi-weight HA plus antioxidant lotion demonstrated significant improvements in all clinical grading assessments (dryness, roughness, and fine lines) as early as Week 2 compared to baseline. Statistically significant improvements in visible dryness, roughness, and fine lines were greater for the multi-weight HA plus antioxidant lotion compared to the single-weight HA plus ceramide-based lotion.

Limitations: The overall small sample size.

Conclusion: This study showed the enhanced improvement in dryness, roughness, and fine lines following daily utilization of a novel multi-weight HA plus antioxidant complex-based lotion compared to a single-weight HA plus ceramide-based lotion. These improvements may be attributed to the ability of multi-weight HAs to moisturize the skin surface and penetrate the upper surface layers of the skin, combined with the added benefits of key antioxidants.