Postepy Dermatologii I Alergologii最新文献

Introduction: The concurrent use of tetracyclines and isotretinoin in acne treatment can cause pseudotumor cerebri (PTC). However, topical minocycline (4%) was significantly less systemically absorbed.

Aim: To assess the efficacy and safety of a combination of topical minocycline gel 4% with oral isotretinoin compared to isotretinoin alone in the treatment of acne vulgaris in the Indian population.

Material and methods: This prospective, randomised, comparative study included 60 patients aged ≥ 12 years with acne. Two groups were formed: the Mino-Iso group applied minocycline gel 4% and took 20 mg isotretinoin capsules in the evening, whereas the Iso group took only 20 mg isotretinoin capsules in the evening. The study duration was 12 weeks.

Results: At week 12, the Mino-Iso group showed a significantly greater reduction in inflammatory lesions (-88.5%) than the Iso group (-67.42%) (p < 0.05). The investigator's global assessment (IGA) treatment score was statistically lower and success significantly higher in the Mino-Iso group (p < 0.05 and p = 0.03, respectively). Adverse events (AEs) were reported in 6 and 4 patients in the Mino-Iso and Iso groups, respectively (p = 0.73), all of which were mild in nature and resolved during the study.

Conclusions: The combination of topical gel 4% and oral isotretinoin 20 mg capsule significantly reduced inflammatory lesions, improved IGA scores, and had a higher success rate at week 12 than isotretinoin alone, with similar tolerability. Therefore, this combination can be considered a preferable treatment option for moderate-to-severe acne.

Introduction: Alopecia areata (AA) is an autoimmune disorder causing non-scarring hair loss. AA impacts individuals' quality of life (QoL), affecting emotional wellbeing, self-esteem, and social interactions, and is associated with mental health issues like depression and anxiety. There is a lack of adequate, validated, disease-specific questionnaires to evaluate the quality of life in Polish-speaking patients with AA.

Aim: Formation and validation of the Polish version of the Alopecia Areata Quality of Life questionnaire (AA-QLI).

Material and methods: The original English version of the questionnaire was translated into Polish using a forward and backward translation process according to international standards. The validation was conducted on 21 patients suffering from AA, who completed the questionnaire twice with a 5-day interval. To assess internal consistency of the questionnaire the Cronbach α coefficient was used. The reliability of the Polish version of the questionnaire was evaluated using the intraclass correlation coefficient (ICC).

Results: The Polish version of the AA-QLI questionnaire demonstrated good internal consistency with Cronbach α coefficient of 0.86 for the first completion of the questionnaire. The ICC of 0.93 indicated very good reproducibility of this questionnaire.

Conclusions: The Polish version of the AA-QLI questionnaire showed high internal consistency and reliability, making it a suitable tool for assessing the health-related quality of life in Polish-speaking AA patients.

Introduction: Demodex mites (DM) are pathogenic parasites that in some people cause demodicosis. It is widely discussed which groups of patients are more prone to develop the disease.

Aim: To evaluate the prevalence of DM in a population of solid organ transplant recipients (SOTRs) in comparison to immunocompetent controls.

Material and methods: A total of 225 SOTRs were tested for DM by 2 methods: microscopic evaluation of scrapings of the face and by dermoscopic examination of the face. Additionally, a group of 95 patients, who do not have any immunosuppression history, were asked to volunteer as controls. Every patient in study group was examined for face symptoms and had his medical history reviewed.

Results: The prevalence of positive Demodex test was not significantly different among SOTRs comparing to controls (21 positive results among SOTRs (9.3%) vs. 6 positive controls (6.3%), (p = 0.38)), but there was a numerically higher rate in SOTRs population. Patients treated with tacrolimus had a higher odds ratio of a positive Demodex test when compared to those treated with cyclosporine A (p = 0.046). Skin symptoms were characterized by relatively high negative predictive values (91.0-93.7%). Itch had the best balance between sensitivity and specificity, whereas exfoliation had the highest diagnostic accuracy.

Conclusions: In our study, demodicosis does not occur more often among SOTRs than in the general population. Notably, itch and exfoliation are symptoms of the greatest diagnostic value in demodicosis diagnosis. Patients receiving tacrolimus had a higher prevalence of a positive Demodex test when compared to those treated with cyclosporine A.

Introduction: Psoriasis is a chronic inflammatory skin disease that affects mental health and is often associated with itch.

Aim: To investigate the influence of itch on the symptoms of anxiety, depression, quality of life, and stigmatization in psoriasis patients.

Material and methods: The studied group included 106 adults with psoriasis (34% females; mean age: 42.1 ±13.0 years). Disease severity was evaluated using the Psoriasis Area and Severity Index (PASI). The itch intensity was assessed by a numerical rating scale (NRS) and 4-Item Itch Questionnaire (4-IIQ). Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) questionnaires were utilized to estimate the severity of depression and anxiety, respectively, and so was the Hospital Anxiety and Depression Scale (HADS). Quality of life (QoL) was evaluated using the Dermatology Life Quality Index (DLQI), while stigmatization was studied by the 6-Item Stigmatization Scale (6-ISS).

Results: Psoriasis patients with itch scored significantly higher (p = 0.037) in HADS total score and DLQI (p < 0.001) than those without itch. Itch NRS correlated significantly with the HADS total score (p = 0.027), GAD-7 (p = 0.008), PHQ-9 (p = 0.008), and DLQI (p = 0.001).

Conclusions: Itch significantly impacts the quality of life and well-being of patients with psoriasis.

Introduction: Atopic dermatitis (AD) is a common chronic skin inflammatory disease. The traditional treatment shows limited effect and side effects. Dupilumab is a monoclonal antibody immunotherapy targeting IL-4 and IL-13, which may become a new direction for treating AD.

Aim: This study was to explore the clinical curative effect of dupilumab in the treatment of children with AD, and its influence on the quality of life (QoL) of children.

Material and methods: 54 children with AD, who were treated in the outpatient and inpatient departments of the hospital from August 2023 to July 2024, were included in this study. These children were treated with dupilumab, and their clinical curative effect as well as QoL were evaluated through relevant scales as well as the IgE, eosinophil counts, and Th2 cytokine levels.

Results: After treatment, Eczema Area and Severity Index (EASI) score was 8.8 ±4.5, Scoring Atopic Dermatitis (SCORAD) score was 15.1 ±8.4, and itching Numeric Rating Scale (NRS) score was 1.1 ±0.7. Compared with those before treatment, the scores of 25.4 ±6.2, 38.6 ±10.3, and 6.9 ±2.2 were highly decreased with differences being statistically significant (p < 0.05). Only 3 cases had an Investigator's Global Assessment (IGA) ≥ 3, which was greatly reduced than that before treatment (p < 0.05). 5 cases had the adverse reaction of conjunctivitis after treatment, Patient-Oriented Eczema Measure (POEM) score was 4.8 ±1.6, and Dermatology Life Quality Index (DLQI) was scored as 3.3 ±1.8. These were observably lower than those before the patients were treated, exhibiting significant differences (p < 0.05). There were significant reductions in IgE levels, eosinophil count, Th2 cytokines (IL-4 and IL-13), and thymus and activation-regulated chemokine (TARC) after treatment (p < 0.05).

Conclusions: Dupilumab could effectively treat children with AD and improve their QoL, so it had a clinical application value.

Introduction: The prevalence of biochemical hyperandrogenemia (BHA) in female acne varies across studies. While certain phenotypic features may suggest hormonal evaluation, clinical predictors of BHA are unclear. Furthermore, the predictors of treatment outcome remain inconclusive, and despite common belief, no strong evidence links BHA to treatment resistance.

Aim: To identify determinants of BHA and treatment response in female acne.

Material and methods: Female acne patients who underwent hormonal tests (androstenedione, DHEAS04, E2, FSH, LH, free testosterone, prolactin, SHBG, TSH, total testosterone, and 17-OHP) from January 2020 to September 2022 were analysed for associations of clinical parameters with BHA, PCOS, and treatment resistance.

Results: Among 86 females (mean age: 24, range: 14-41), acne categories were as follows: persistent (46.5%), adult-onset (26.7%), recurrent (19.8%), and adolescent (7%). Clinical and BHA rates were 65.1% and 70.9%, respectively. The most common elevated hormones were 17-OHP (65%) and androstenedione (40%). Hirsutism and truncal acne were associated with BHA. High DHEAS04 and menstrual irregularity were linked to the persistent category, and 17-OHP elevation was related to a chronic course. PCOS prevalence (17.4%) was associated with high DHEAS04, Free Androgen Index, TT, low E2, and hirsutism. Persistent/recurrent acne and hirsutism were associated with treatment failure.

Conclusions: The persistent course and prolonged duration of acne in females, combined with hirsutism and truncal location, are associated with BHA. Patients without androgenic signs may have BHA, and PCOS diagnosis can be established through appropriate referral. Treatment response does not correlate with hormone levels; however, prolonged duration/persistent course and hirsutism predict poorer outcomes.

Introduction: Hereditary angioedema (HAE) significantly affects patients' quality of life due to its life-threatening potential and the unpredictability of attacks.

Aim: To determine strategic goals to reduce the frequency of attacks and improve the quality of life by evaluating the attack triggers, attack management strategies, and medication use attitudes of HAE patients treated in our clinic.

Material and methods: Patients who were followed up in our clinic with a diagnosis of HAE in 2022-2023 were included in the study. Patient data were obtained by retrospective scanning of file records.

Results: The analysis included 23 HAE patients with an average age of 34.7 years, predominantly female (60.9%). In the patients' family history, there was a high prevalence of HAE (95.7%) and HAE-related death (73.9%). The median duration of HAE diagnostic delay was 9 years (0-50). A significant positive correlation was found between patient age and the duration of diagnostic delay (r = 0.575; p = 0.004). The majority of patients were aware of acute attack triggers and contraindicated medications (91.3%, 70%, respectively). Gastrointestinal, facial, and limb symptoms were common, with emotional stress identified as the leading trigger. The median monthly attack frequency was 6 (1-10), with nearly half experiencing more frequent episodes. Response times to on-demand treatment for icatibant were less than 30 min in 52.2% of patients. Despite experiencing frequent attacks, many patients exhibited pharmacophobia, leading to reluctance towards second-line long-term prophylactic (LTP) therapy.

Conclusions: The high frequency of attacks in our patients was related to the lack of use of LTP agents and personal life stress. Despite severe attacks and a family history of HAE-related deaths, pharmacophobia to LTP was common, with pharmacophobia resulting from side effects of second-line LTP agents. Our findings highlight the need for our patients to have access to psychosocial support programs and first-line LTP agents.

Dupilumab has revolutionized atopic dermatitis (AD) treatment, but concerns arise about its potential link to cutaneous T-cell lymphomas (CTCL). This review explores CTCL occurrence post-dupilumab therapy in AD and its potential therapeutic effects. A case study of a 76-year-old patient with severe AD treated with dupilumab, developing erythroderma revealing mycosis fungoides (MF), underscores the need to understand associated mechanisms and risk factors for safe dupilumab use. This case also highlights the utility of the high-frequency ultrasound in monitoring cutaneous manifestations in patients with MF.