Journal of Clinical and Aesthetic Dermatology最新文献

Scalp psoriasis is a chronic immune skin disease affecting up to 80 percent of patients with psoriasis. Treatments include topical steroids, keratolytics, tar, anthralin, vitamin D analogs, and retinoids. However, treatment can be difficult due to the presence of hair. Roflumilast 0.3% cream was approved in 2022 for the treatment of chronic plaque psoriasis, including intertriginous areas. Here, we present the case of a 28-year-old female patient with scalp psoriasis, who had previously trialed both topical and systemic treatments for her disease without success. Use of once daily roflumilast 0.3% cream resulted in rapid scalp psoriasis clearance, with results seen as early as Day 3 and complete clearance by Day 5 of treatment without adverse events or tolerability concerns.

Objective: Melasma is an acquired pigmentary disorder for which tranexamic acid (TA) injection has shown promising results in earlier studies. This study aimed to evaluate the effectiveness and safety of intradermal TA as an adjuvant therapy for melasma in individuals with Fitzpatrick Skin Type IV-V.

Methods: We conducted a double-blind, randomized, split-face controlled trial of 34 female patients with melasma. All subjects were randomized to receive either 10mg of intradermal TA or placebo injection on the right or the left side of their face. The primary outcome was improvement of melasma lesions assessed by modified Melasma Area and Severity Index (mMASI) score and mexameter examination which includes Melanin Index (MI) and Erythema Index (EI). Measurements were done at baseline and every two weeks for 12 weeks. Additionally, side effects of therapy and subject satisfaction assessment with patient global assessment (PtGA) were also documented.

Results: This study showed the reduction of mMASI score was larger and faster in intervention group compared to control group whereas the reduction of MI and EI was not significantly different between both groups. The majority of subjects did not experience any serious side effects. The subjects in the treatment group also reported significantly higher proportion of very good response compared to control group.

Limitations: This was a single-center study with a small sample size and the inability to control confounding variables.

Conclusion: Based on our results, intradermal TA injection appears to be an effective and safe adjuvant therapy for melasma in individuals with Fitzpatrick Skin Type IV-V.

A key strategy for pain management in dermatologic procedures is the use of local anesthesia, yet the injection itself often causes significant discomfort. This article explores evidence-based strategies to minimize pain during anesthetic administration in office-based dermatologic settings. Techniques discussed include buffering and warming lidocaine, selecting the optimal needle gauge, orienting the bevel properly, as well as adopting advanced injection methods such as subdermal bleb formation and parallel needle insertion. Additional methods like tactile distraction, hand stabilization, and psychological engagement are also emphasized. Together, these approaches enhance patient comfort, procedural efficiency, and overall satisfaction with dermatologic care.

Background: Actinic keratosis (AK) is a common dermatologic condition that can progress to squamous cell carcinoma if left untreated. Field therapy plays a critical role in managing both visible and subclinical lesions within sun-damaged skin.

Objective: The author sought to provide one nurse practitioner's perspective on the evolving role of field therapy in AK management, emphasizing patient-centered care, real-world challenges for all advanced practice providers (APPs), and personal experience.

Methods: This commentary reflects clinical observations, patient interactions, and the author's own experience undergoing multiple field therapies, including topical 5-fluorouracil, imiquimod, tirbanibulin, and photodynamic therapy. Emphasis is placed on treatment selection, education, and adherence strategies.

Results: Field therapy is effective when personalized to the patient's lifestyle, skin type, and preferences. Empathetic counseling and tailored treatment regimens improve outcomes and satisfaction. Newer therapies such as tirbanibulin and daylight photodynamic therapy offer promising options with improved tolerability.

Conclusion: APPs are uniquely positioned to lead in early AK treatment and prevention. Combining clinical expertise with patient education and empathy enhances the impact of field therapy. The author's dual perspective as a provider and patient offers valuable insight into the real-world application of evidence-based dermatologic care.

Acrodermatitis continua of Hallopeau (ACH) is a rare pustular psoriasis variant that presents as sterile pustules on the hands and feet with a relapsing course. This condition is not easily treated, but literature shows some cases are successfully controlled with biologics such as etanercept, adalimumab, secukinumab, and ustekinumab. Mixed connective tissue disease (MCTD) is a type of autoimmune disease and is rarely seen in the pediatric population. It is characterized by overlapping features of various autoimmune disorders, often involving scleroderma, systemic lupus erythematosus, polymyositis, and other organ dysfunction. MCTD is typically diagnosed with lab testing to indicate the presence of specific autoantibodies to a nuclear matrix protein, such as ribonucleoprotein. This communication emphasizes the importance of revisiting diagnoses in patients with persistent, refractory skin conditions and highlights the need for comprehensive evaluation in the presence of evolving or atypical presentations, especially when autoimmune diseases are suspected. Steps for diagnostic workup and treatment may provide clinical benefits to patients and serve as a reference for other clinicians. The course of treatment for ACH and MCTD in the pediatric and adolescent population is discussed.

Background: While Janus kinase inhibitors (JAKi) show excellent outcomes in Phase2b/3 trials for alopecia areata (AA), they do have potential side effects due to their immunosuppressive nature and other effects on the JAK-STAT pathway. These side effects can be mitigated by adherence to lab monitoring.

Objective: The authors sought to analyze patients, using JAKi, to manage symptoms of AA, to determine frequency of lab monitoring and check for adherence to the recommended rate of every three months.

Methods: A retrospective chart review was conducted by first identifying all patients diagnosed with AA at a specialty hair clinic in an academic dermatology department between January 2021 and May 2024. Each patient chart was reviewed for past and current use of any known oral JAKi. Fifty-seven patients were identified to meet our inclusion criteria and all of their charts were reviewed. The primary outcome is the average time between lab monitoring dates for each patient. The hypothesis was formulated after the data collection in the form of whether patients were being adherent to lab monitoring protocol.

Results: Most patients were non-adherent to the lab testing frequency standard. Significant differences were found in blood test times between adherent and non-adherent patients and between non-adherent and extremely non-adherent patients with p-values less than 0.01 for both sets.

Conclusion: Patients with AA undergoing JAKi treatment are not adhering to the recommended lab monitoring frequency. New tactics to improve adherence need to be taken.

Background: Both primary and secondary psychodermatoses are prevalent and dermatologists can play a pivotal role in their managment. We sought to understand dermatologists' training, comfort, and concerns for prescribing psychotropic medication for these condtions.

Methods: We surveyed 49 dermatologists at the University of Utah, querying demographic variables, training enviroment, exposure to psychotropic medication use in training, current prescribing comfort, and current prescribing patterns. Associations between questionnaire responses and dermatologist demographics and training patterns were evaluated using ordinal logistic regression.

Results: Across the 42 collected surveys, most had limited exposure to psychotropic medication and psychodermtoses managment in residency, most were encouraged to refer these patients to psychiatry, and lack of training on use and side effects were the most commonly cited reasons for not prescribing psychotropic medications. Having more faculty who advocated for psychtropic medication use and training during residency on psychodermatoses were associated with greater prescribing comfort (OR=6.77, 1.54-29.8 and OR=6.09, 1.80-20.6 respectively).

Conclusion: Most dermatologists surveyed had limited exposure and training using psychotrophic medications for psychodermatoses. Lack of training and experience with these medications was a significant factor affecting prescribing comfort, highlighting the improtance of expanded residency training on the use of psychotrophic medications and the managent of primary and secondary dermatoses.

Background: Lately, there has been a growing demand for the utilization of complementary and alternative medicines (CAMs) with dermatological applications. This is true despite limited RCT-level studies on such agents. This presents a barrier for dermatologists and fellow clinicians in counseling patients who may be using or are tempted to use these CAM modalities. This review highlights CAM agents used by patients for applications in cosmetic and surgical dermatology, exploring their efficacy and toxicity profiles.

Methods: A comprehensive review was conducted on the effectiveness of several CAMs utilized in cosmetic and surgical dermatology by patients. A literature search was performed using PubMed, Embase, Google Scholar, Web of Science, and Cochrane.

Results: Most CAM agents studied had statistically insignificant results, and for CAM agents that had significant results in efficacy, the studies were questionable due to flawed randomization, lack of proper blinding, faulty data analysis, poor study design, suggestion of bias, small sample size, and limited clinical application.

Conclusion: CAM agents have promising potential in dermatologic use; however, more RCT-level studies are needed. A study design that either emphasizes a comparison between the CAM agent and conventional therapy, or the CAM agent with or without conventional therapy should be incorporated in future studies. As of now, dermatologists should be cognizant of bias in published studies demonstrating the effectiveness of certain CAM agents, as well as the possible adverse effects.

Objective: This review examined studies published during the past two decades in which lasers were used to treat acne vulgaris. Its aim was to assess the mechanism, efficacy, and safety of lasers as a treatment modality for this vexingly common and potentially disfiguring condition.

Methods: PubMed searches were performed to identify articles published through December 2023 that discuss the use of lasers for the treatment of acne vulgaris.

Results: Various lasers, including visible light, infrared, fractional ablative CO₂ lasers with isotretinoin, and two 1726-nm lasers approved by the United States Food and Drug Administration, show efficacy in treating acne vulgaris. Studies vary widely in their design, characteristics, and methodological rigor.

Limitations: The available literature on using lasers to treat acne is limited by variability in study design, short-term follow up, and small sample sizes.

Conclusion: Lasers have demonstrated efficacy as primary or adjunctive treatment modalities for acne vulgaris in certain clinical scenarios. Larger randomized, controlled, double-blinded studies with sufficiently long follow-up periods and standardized objective measurements are needed to substantiate the efficacy of lasers in treating acne vulgaris.