Journal of Clinical and Aesthetic Dermatology最新文献

Objective: Atopic dermatitis (AD) is a chronic inflammatory skin disease which is associated with a significantly decreased quality of life. Overall, the conventional treatment approaches for moderate to severe AD are prone to relapses. Hence, the exploration of new adjuvant therapies, such as the use of platelet-rich plasma (PRP), is expected to enhance the effectiveness of existing interventions, which remain paramount in improving the quality of life for patients with moderate to severe relapsing AD.

Methods: The literature search primarily focused on original English-language articles on PRP as a therapeutic approach for the management of adult AD. Literature reviews, systematic literature, and meta-analyses were excluded. The databases searched include PubMed/Medline, Science Direct, and Cochrane, up to October 2023. Seven articles were reviewed.

Results: PRP is reported to be used as a therapy for AD in both injectable and topical forms. Various studies showed that PRP could significantly reduce free radical accumulation, proinflammatory mediators, provide healing environment, and restore the metabolic activity disruption. Clinically, PRP therapy was reported to improve clinical symptoms, patient's satisfaction, quality of life, and reduce frequent recurrence. Mild side effects (pain and ecchymosis) due to the injection were reported. Another advantage is that it is safe to be used in pregnant and breastfeeding women.

Limitations: Heterogeneity of methods in preparing PRP and further research with larger scale standardized protocols are warranted.

Conclusion: PRP yields favorable outcomes when used in AD treatment and can serve as an alternative for moderate to severe or refractory AD through its anti-inflammatory and proliferative properties.

Numerous clinical trials have established that various biologic and oral small-molecule therapies are efficacious in patients with psoriasis. However, as there are limited head-to-head trials, healthcare providers may compare results across multiple trials when providing treatment recommendations. Direct comparisons among agents are challenging because psoriasis trials differ in terms of study design, patient population, and data analysis methodologies. Long-term clinical trials present additional challenges because the number of patients enrolled generally declines over time. The missing patient data that might occur, coupled with the specific approach used to substitute or impute that missing data, might introduce bias and skew efficacy results. In this review, we discuss how variations in study design and analytical methodologies affect efficacy outcomes in clinical trials. We also review published trials of biologic and oral small-molecule therapies for psoriasis to illustrate how issues related to missing data and choices in data imputation methodologies can affect the interpretation of efficacy outcomes. Imputation methodologies discussed include nonresponder imputation, modified nonresponder imputation, treatment failure rules, last observation carried forward, modified baseline observation carried forward, and multiple imputation. This review provides a foundation for the healthcare provider's critical evaluation of the psoriasis literature and emphasizes the importance of considering the level of evidence provided in a clinical trial when making treatment decisions.

Background: Cutaneous leishmaniasis is endemic in Iran.

Objective: We sought to investigate the therapeutic outcomes and complications of treatment in patients with cutaneous leishmaniasis.

Methods: This case series enrolled patients with smear-proven cutaneous leishmaniasis who visited our center in Iran from 2018 to 2019.

Results: In total, 36 patients were treated with intralesional meglumine antimoniate, intramuscular meglumine antimoniate, sodium stibogluconate, and amphotericin B. Overall, this treatment was effective in 81.8 percent of patients. Relapse and treatment failure occurred in 6.1 percent and 12.1 percent of patients, respectively. Treatment with intralesional meglumine antimoniate, intramuscular meglumine antimoniate, sodium stibogluconate, and amphotericin B yielded a clearance rate of 80.8 percent, 92.3 percent, 75 percent, and 85.7 percent, respectively. Clearance was associated with a shorter time interval between injections of intralesional meglumine antimoniate (p=0.006) and relapse was associated with a longer time interval between injections (p=0.018). The average number of side effects per patient for intralesional meglumine antimoniate, sodium stibogluconate, intramuscular meglumine antimoniate, and amphotericin B was 0.62, 1.4, 1.6, and 2.8, respectively. The most common side effect of intralesional meglumine antimoniate, intramuscular meglumine antimoniate, and amphotericin B was local pain, arthralgia, and hypokalemia, respectively.

Limitations: Low sample size was the limitation of this study.

Conclusion: The cure rate of intramuscular meglumine antimoniate was higher than amphotericin B, which was higher than the cure rate of sodium stibogluconate. In patients treated with intralesional meglumine antimoniate, reducing the time interval between injections increased the clearance rate and decreased the rate of relapse.

Objective: Skin cancer remains prevalent despite numerous studies reporting the benefits of sunscreen for reducing risk of skin cancer and sunburn. While the risks of not wearing sunscreen are well-documented, there are no effective interventions to promote sunscreen use across populations, and existing interventions have modest outcomes. The current study investigated a novel intervention to increase sunscreen use.

Methods: Participants (n=15) first reported their baseline daily sunscreen use then completed sunscreen sampling and selection procedures that included testing sunscreen samples, choosing preferred sunscreens to take home and sample further, and ultimately selecting a preferred sunscreen to use for the remainder of the study. Participants then self-reported their daily sunscreen use for approximately two weeks (+/-5 days).

Results: All participants increased sunscreen use following intervention.

Limitations: Data were collected between January and May; individuals may increase sunscreen use as temperatures increase (and time outdoors increases). Additionally, the current study relied on self-report of sunscreen use primarily.

Conclusion: Our findings suggest that sampling and election procedures may be an effective strategy to promote sunscreen use. The findings of this study may inform future research examining sunscreen intervention strategies.

HA_RES is a supportive (high G') HA filler with a low degree of water affinity (gel swelling) and modification (<1% BDDE) that has a well-established safety and efficacy profile in the literature, especially for infraorbital hollow (IOH) rejuvenation. To further support the safety of this product, a long-term review of delayed-onset adverse events of interest (DAEIs) related to HA_RES was conducted using reports from a global post-marketing safety surveillance database over the past 23 years. This review demonstrated low reporting frequencies of delayed-onset nodules and inflammatory events, establishing a long-term safety profile for HA_RES that supports its continued use in clinical practice, especially for IOH rejuvenation.

Objective: Epidermolysis bullosa acquisita (EBA) is a rare dermatosis of the mucous membrane and/or skin. Employing biologic treatment modalities, specifically rituximab (RTX), have become pivotal measure in treating patients with blistering diseases. This study aims to summarize the current evidence on the safety and efficacy of RTX in EBA.

Methods: An extensive search was performed in MEDLINE/PubMed, Embase, Scopus, and Web of Science databases until the end of August 19th, 2023. Two independent reviewers screened the papers, and collected data. Two hundred thirty-three studies were screened using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

Results: Thirty-one studies were enrolled. The most common reason of RTX administration in patients with EBA was recalcitrant diseases. Clinical response and disease remission was recorded as 92.7 percent (63 patients) and 73.8 percent (45 patients) of the patients, respectively. A relapse rate of 39.5 percent (15 patients) in the mean follow-up of 23.0 months was reported in the studies. Of the patients, 28.2 percent (11 patients) experienced RTX-related side events, mostly mild and transient infusion reactions.

Conclusion: The results of this systematic review demonstrated that RTX is safe and effective in patients with EBA. This biological treatment modality can be routinely used in managing EBA.

Introduction: Periorificial dermatitis (POD) is a common, chronic, inflammatory facial skin rash that presents as tiny papules and papulopustules with underlying eczematous-like patches, typically confined to the perioral, perinasal, and periorbital areas. There is currently no Food and Drug Administration (FDA)-indicated treatment for POD; however, broad-spectrum antibiotics are efficacious as a treatment option. Broad-spectrum antibiotics negatively impact gut flora and lead to antibiotic resistance. Narrow-spectrum tetracyclines, such as sarecycline, have a low potential for promoting bacterial resistance and gastrointestinal issues.

Objective: We conducted a retrospective chart review in order to evaluate the efficacy of sarecycline in a cohort of patients diagnosed with POD that were treated with sarecycline.

Methods: A review of medical records was completed using an electronic medical record. Inclusion criteria included males and females aged 18 to 95 with a diagnosis of POD, treated with sarecycline with a documented follow-up.

Results: Six patients met inclusion criteria, all of which had shown improvement with no reported side effects. Of the six patients, four were female and two were male and the patient ages ranged from 26 to 58 years old (mean=41 years). The course of therapy ranged from 30 to180 days (median=90 days).

Conclusion: Based on the outcomes, there are many potential benefits to treatment of POD with sarecycline over the alternative tetracycline-class antibiotics. There is a need for more large-scale clinical studies evaluating treatment options for POD. Based on the efficacy and tolerability of sarecycline in large- scale acne studies, sarecycline may be an appropriate novel treatment option for POD and should be explored further.