Journal of Dermatology最新文献

Psoriasis is increasingly regarded as a systemic inflammatory disease rather than a condition confined to the skin. It is commonly associated with comorbidities such as metabolic syndrome, cardiovascular disease, and hepatic disorders. Among these, fatty liver is one of the most frequently observed hepatic comorbidities in psoriasis patients; however, the prognosis of patients with both psoriasis and fatty liver has not been fully elucidated. This is a single-center retrospective study aimed at elucidating the characteristics of Japanese patients with psoriasis comorbid with fatty liver and identifying predictive factors for advanced liver fibrosis. A total of 89 psoriasis patients were enrolled in this study, including 64 with psoriasis vulgaris, 24 with psoriatic arthritis (PsA), and 1 with generalized pustular psoriasis. All patients underwent abdominal computed tomography to assess the presence of fatty liver. We compared clinical and laboratory parameters between patients with fatty liver and those without. Psoriasis patients with comorbid fatty liver were significantly younger and had higher body mass index (BMI), psoriasis and area severity index scores, serum C-reactive protein, alanine aminotransferase, aspartate aminotransferase, hemoglobin A1c, and triglyceride levels, and prevalence of diabetes mellitus (DM) compared to those without fatty liver. Other than them, in patients with PsA, the higher frequency of multiple biologic switches was found. Among patients with fatty liver who met the diagnostic criteria for metabolic dysfunction-associated steatotic liver disease (MASLD), those with comorbid DM exhibited a significantly higher Fibrosis-4 index compared to those without DM. The exploratory analysis of predictive factors for high-risk liver fibrosis in patients with psoriasis and MASLD identified age ≥ 57 years, BMI ≥ 24.8, and comorbid DM as significant risk factors. In conclusion, psoriasis patients with comorbid fatty liver and components of metabolic syndrome, such as obesity and DM, should be considered for referral to a hepatology specialist.

SDR9C7-nonsyndromic epidermal differentiation disorder (nEDD) is a form of ceramide synthesis disorder that is known to confer susceptibility to dermatophytosis. Recurrent widespread tinea corporis developed in a SDR9C7-nEDD patient with homozygosity for the Japanese founder variant (c.826C>T, p.Arg276Cys) during apremilast treatment to improve ectropion. Ceramide analysis of the stratum corneum revealed decreased protein-bound ceramides, indicating skin barrier dysfunction. Based on previous studies of decreased Irf4 mRNA in Sdr9c7^−/− mice, IRF4 transcription factor-dependent IL-17 production, and the importance of IL-17A/F in mucocutaneous immunity against Candida albicans, we examined the expression of each molecule using immunofluorescence and found for the first time decreased IRF4 and IL17-A/C/F (which were further decreased by apremilast treatment) in SDR9C7-nEDD epidermis. Although further studies are needed to clarify an evaluation of cytokine profiles in SDR9C7-nEDD, which may have immune profiles different from the previously reported IL-17-dominant immune profiles in the major forms of ichthyosis, these findings might have contributed to susceptibility to dermatophytosis in this patient, and it is suggested that the use of apremilast should be avoided in SDR9C7-nEDD.

Minocycline, a semisynthetic tetracycline, is widely used to treat inflammatory skin diseases such as acne and rosacea. Despite its favorable safety profile, it may cause various adverse effects, including hypersensitivity reactions. We describe the case of a 20-year-old male who developed delayed-onset symptomatic dermographism following oral minocycline treatment (100 mg/day) for acne. One week after starting treatment, the patient developed pruritic, evanescent, linear wheal-like lesions at multiple sites, without angioedema or systemic symptoms. Lesions resolved spontaneously within two weeks of drug withdrawal. An oral challenge test with escalating doses of minocycline, up to a cumulative total of 100 mg initially, showed tolerance; however, symptoms recurred after nine consecutive days at the therapeutic dose, confirming causality. Symptoms resolved following drug discontinuation and a 2-day course of oral cetirizine. To evaluate cross-reactivity, prick and intradermal tests with doxycycline were negative, and a 10-day oral doxycycline challenge was uneventful, indicating no cross-reactivity. Symptomatic dermographism is the most common form of chronic inducible urticaria, but its association with minocycline is rare. The underlying immunopathogenesis remains unclear, potentially involving mast cell activation or superantigen-like effects. This case underscores the importance of prolonged drug rechallenge in identifying rare delayed adverse reactions such as minocycline-induced late-onset symptomatic dermographism and supports the safe use of doxycycline as an alternative.