Postepy Dermatologii I Alergologii最新文献

Introduction: Prurigo nodularis (PN) is a chronic pruritic and inflammatory skin disorder and dupilumab is currently the only biologic agent approved in China for the treatment.

Aim: To evaluate the efficacy and safety of dupilumab in managing moderate to severe PN through a retrospective study of 76 patients.

Material and methods: A retrospective analysis was conducted of clinical and laboratory data from PN patients who received regular dupilumab treatment for 52 weeks at the Dermatology Department of the Second Affiliated Hospital of Soochow University between March 2021 and June 2023. Assessments were made at baseline (week 0), and at weeks 4, 8, 16, 26, and 52 using prurigo nodule counts, Investigator's Global Assessment (IGA) scores, Pruritus Numeric Rating Scale (NRS) scores, and Dermatology Life Quality Index (DLQI) scores to evaluate clinical symptoms and pruritus. Adverse events occurring post-treatment were also recorded to assess the drug's safety and efficacy.

Results: A total of 76 patients with moderate to severe PN were included in this study. By week 52, there were significant reductions in prurigo nodule counts, IGA scores, NRS scores, and DLQI scores. Prurigo nodule counts decreased from a baseline of 74.64 ±33.45 to 2.3 ±0.9, IGA scores from 3.53 ±0.54 to 0.54 ±0.33, NRS scores from 7.65 ±2.27 to 1.01 ±0.65, and DLQI scores from 18.46 ±4.53 to 1.55 ±0.68, with all differences being statistically significant (p < 0.05). Seven patients experienced injection site reactions, and 2 patients developed facial erythema, which resolved either spontaneously or with symptomatic treatment. No other adverse events were reported.

Conclusions: Dupilumab effectively reduces the number of PN, improves IGA scores, alleviates pruritus, and enhances quality of life in patients with moderate to severe PN, with a high safety profile.

Introduction: Psoriasis is a chronic multi-systemic inflammatory disease. Anti-tumor necrosis factor (TNF) agents such as adalimumab, infliximab, etanercept are effectively used for treatment. The increased risk of infection, especially tuberculosis is a major concern for patients receiving TNF inhibitor therapy.

Aim: The aim of this study was to evaluate frequency and risk of tuberculosis in psoriasis patients using anti-TNF therapy over a 16-year period.

Material and methods: This study is based on data from the Turkish Psoriasis Registry (PSR-TR) and digital records of the Medical School of the Bezmialem Vakif University. Patients with tuberculosis were recorded and the details of the treatment they received were explored.

Results: We detected 3 patients with pulmonary tuberculosis and 1 patient with tuberculosis peritonitis in spite of isoniazid chemoprophylaxis. The common feature of these patients was a history of etanercept treatment.

Conclusions: We concluded that psoriasis patients receiving TNF inhibitor therapy are at risk of tuberculosis infection despite isoniazid prophylaxis and contrary to the literature it looks like those patients treated with etanercept may be at greater risk for tuberculosis than patients treated with other TNF inhibitor agents.

Introduction: Hidradenitis suppurativa (HS) is an immune-mediated, autoinflammatory skin disease with different clinical manifestations. Traditional clinical examination may not assess HS true extent, while high-frequency ultrasound can detect subclinical lesions, influencing severity assessments.

Aim: To compare the clinical severity of HS with the ultrasonography-based staging, and explore relationships between demographic data, risk factors and clinical phenotypes.

Material and methods: An ongoing pilot study included 98 patients of the Bulgarian HS Expert Centre. Informed consent and epidemiological data were collected. Patients were categorized into disease duration groups (short/long) and classified by phenotype. Clinical severity was assessed through Hurley, IHS4, and HS-PGA staging systems and by ultrasound using SOS-HS, US IHS4, and US HS-PGA scales.

Results: The study cohort was predominately male (74.5%) with a mean age of 36.69 years, average disease duration of 7.6 years and prevalence of the regular phenotype (53%). Age and disease duration correlated with Hurley stage (p < 0.05), but not with SOS-HS severity. Comorbidities correlated with disease duration (r = 0.256, p = 0.01), and the follicular-furunculous phenotype was associated with the females (p = 0.04). Clinical and ultrasound assessments showed strong correlations, although ultrasound showed higher severity scores (r = 0.42 to 0.92, p < 0.05), as well as significant differences across the phenotypes.

Conclusions: HS is often underestimated due to delayed diagnosis and atypical presentations. Combining clinical and ultrasound assessments can provide more accurate staging. A multidisciplinary approach in expert centres can enhance diagnosis, treatment and monitoring.

Introduction: Asthma-chronic obstructive pulmonary disease overlap (ACO) patients are categorized as those with persistent airflow limitation and features of asthma and chronic obstructive pulmonary disease (COPD).

Aim: This study aimed to identify ACO subgroups based on atopy, bronchodilator response (BDR), and eosinophil count.

Material and methods: From 2021 to 2024, we conducted a retrospective study on patients with asthma and/or COPD who underwent BDR testing. An ACO diagnosis required persistent airflow limitation, a history of asthma before the age of 40 or significant BDR, and at least one minor criterion. Patients were grouped by atopy status, BDR presence, and eosinophil count. We compared demographic, laboratory, spirometry, and medication data across subgroups.

Results: The study included 109 ACO patients with a mean age of 49.5 ±10.7 years. Atopic ACO patients showed a higher increase in FEV₁ after inhalation of 400 µg of salbutamol or the equivalent (ΔFEV₁BDR) and higher total IgE levels than non-atopic patients (200 ml vs. 100 ml, p = 0.034; 211 IU/ml vs. 60 IU/ml, p = 0.002). Eosinophil counts were higher in the BDR-positive group (360/µl vs. 195/µl, p = 0.047). High eosinophilic ACO patients also had elevated IgE levels (323 IU/ml vs. 80 IU/ml, p = 0.001). BDR-positive and eosinophilic groups demonstrated better spirometric results. Atopic ACO patients used more leukotriene receptor antagonists, while BDR-negative ACO patients used antimuscarinics.

Conclusions: Higher ΔFEV₁BDR in atopic ACO indicates they may respond better to bronchodilators. Elevated eosinophil counts in BDR-positive patients support their classification and suggest less severe disease progression.

Introduction: Artificial intelligence in medicine has increased enormously in recent years.

Aim: To evaluate the effectiveness of ChatGPT-4 in answering common patient queries about hidradenitis suppurativa.

Material and methods: A group of 31 physicians and 30 patients suffering from hidradenitis suppurativa independently evaluated and compared the quality, empathy, and satisfaction of the ChatGPT-4's and the dermatologist's responses to patient queries, in a single-blind study, without any information about answers' sources beforehand to minimize bias. Additionally, on the last page of the questionnaire, without the possibility of returning to assess the answers, the question was asked "Given that AI can answer your questions more accurately and empathetically than a doctor, who would you rather receive an answer from, the doctor or the AI".

Results: For each variable, patients as well as medical doctors rated the answers generated by ChatGPT-4 significantly better than the answers provided by the dermatologist (p < 0.00001 for each variable). Moreover, when asked which of the two answers patients would prefer to receive, they chose the answers generated by ChatGPT-4 out of an average of 88.33% of the questions. Among 30 patients, in the last question 21 people answered that, despite the lower quality and empathy, they would prefer to get an answer from a medical doctor.

Conclusions: Our study revealed that despite ChatGPT-4's responses being rated better than the physician's, patients still prefer medical doctors as a source of information. Thus, AI will not replace physicians soon, although we should undoubtedly learn to live and cooperate with it.

Introduction: TIM-3 gene polymorphisms strongly influence familial asthma susceptibility.

Aim: This study investigates the genetic association of polymorphisms at rs9313441, rs511898, and rs953569 loci in the T cell immunoglobulin and mucin domain protein 3 (TIM-3) with familial asthma aggregation.

Material and methods: Thirty asthma patients admitted to our hospital, diagnosed between December 2021 and December 2022, served as probands. We analysed three generations of direct blood relatives, dividing them into three groups (Generation I, II, III), each comprising 30 individuals. Data collected included demographic and high-risk asthma factors like gender, age, ethnicity, body mass index, and histories of asthma, allergies, and smoking. We compared these non-genetic factors across groups and conducted unilateral direct sequencing to determine allele and genotype frequencies at key loci.

Results: The rs511898 locus showed no significant difference in the CC/CT genotype and allele distribution among the groups; however, the TT genotype was significantly more frequent in Generations I and II compared to Generation III (p < 0.05). At the rs953569 locus, the AA genotype was significantly more prevalent in Generation III than in the other groups (p < 0.05). The rs9313441 locus revealed a significantly higher frequency of the AG genotype in Generation III compared to the other two groups (p < 0.05), with no significant differences in GG and AA genotypes.

Conclusions: There are distinct differences in TIM-3 gene expression across familial lines of asthma patients, and specific genotypes correlate with increased genetic susceptibility to asthma. Direct sequencing of these susceptibility genes aids in early identification and provides a foundation for targeted diagnosis, treatment, and preventive measures in familial asthma.

Vitiligo is a chronic autoimmune disorder linked to systemic inflammation, oxidative stress, and metabolic dysregulation, including metabolic syndrome (MetS). This review examines the shared mechanisms underlying vitiligo and MetS, highlighting oxidative stress, pro-inflammatory cytokines, and lipid dysregulation as central contributors. A systematic analysis of 23 studies found association between vitiligo and MetS, though variations exist based on the disease type, severity, and duration. Emerging therapies, such as statins and thiazolidinediones demonstrate potential for managing vitiligo and its metabolic risks by targeting oxidative and inflammatory pathways. While animal and in vitro studies show promise, clinical outcomes are inconsistent, with safety concerns limiting systemic treatments.