American Journal of Clinical Dermatology最新文献

Background: Ritlecitinib, an oral selective inhibitor of Janus kinase 3 and the TEC family of kinases, has recently been approved for the treatment of severe alopecia areata, but real-world data are still limited.

Objective: The aim was to evaluate the effectiveness and tolerability of ritlecitinib 50 mg/day after 24 weeks in patients with severe alopecia areata in clinical practice.

Methods: We performed an Italian observational, retrospective, multicentre study with 24 weeks of follow-up. Patients ≥ 12 years of age with severe alopecia areata (Severity of Alopecia Tool [SALT] ≥ 50) and a disease duration ≥ 6 months who were candidates for systemic therapy were enrolled. Ritlecitinib 50 mg/day was administered according to national guidelines. The primary endpoint was to evaluate the achievement of SALT ≤ 20 at week 24. Secondary endpoints included achievement of SALT ≤ 10; mean change in SALT; trichoscopic improvement; quality of life; psychological impact; efficacy in eyebrows, eyelashes, and nails; and safety profile.

Results: A total of 102 patients were included. At week 24, 40.2% of patients achieved SALT ≤ 20, with a greater response in adolescents (48.6%) than in adults (21.9%). The mean SALT score decreased from 86.2 ± 18.5 to 40.8 ± 37.1. Significant improvements were observed in trichoscopic signs and quality of life. The treatment was also effective on eyebrows, eyelashes, and nails. Adverse events were mild (e.g., acne, headache). Ritlecitinib had to be discontinued in only one case of severe anaemia.

Conclusions: In this multicentre real-world study, ritlecitinib 50 mg/day was an effective and well-tolerated treatment option for severe alopecia areata.

Background: Vitiligo is a multi-factorial autoimmune skin disorder often triggered by environmental exposures. Although the exposome has gained attention, no systematic review has fully assessed its role in vitiligo.

Objective: We aimed to evaluate evidence linking exposomal factors to vitiligo onset and progression, focusing on quantifiable associations and study quality.

Methods: A systematic search of PubMed and Embase (inception to 25 August, 2024) followed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines and was registered in PROSPERO (CRD42024529828). Eligible studies reported associations between environmental exposures and vitiligo onset, flares, or progression. Observational studies, case series, clinical trials, and pharmacovigilance reports were included. Findings were synthesized narratively.

Results: Of 8377 records, 496 studies met inclusion criteria. Drug-associated vitiligo, particularly from immune checkpoint inhibitors, was the most robustly supported association (7-25% in patients with melanoma). Phenol-based chemicals were consistently linked to melanocyte toxicity. Coronavirus disease 2019 infection modestly increased risk (hazard ratio ≈ 1.11), while vaccination did not. Other factors such as stress (n = 113), trauma, sunburn, smoking, diet, and sleep were frequently cited but supported by lower-level evidence. Study heterogeneity, a lack of standardized outcomes, and the predominance of observational designs limited meta-analysis and causal inference.

Conclusions: These findings highlight the environmental triggers of vitiligo onset and progression. Drugs, chemicals, and infections are key triggers; lifestyle factors require further study.

Background and objective: Symptomatic dermographism (SD), the most common chronic inducible urticaria subtype, manifests as strip-shaped, pruritic wheals after skin friction. Conclusive data on its associated factors are limited, and direct comparisons between individuals with and without SD remain scarce. We aimed to identify factors associated with SD internationally.

Methods: The PREVALENCE-D (Prevalence Estimation of Dermographism) study was an international cross-sectional survey conducted from 2021 to 2024 across 19 countries. An expert-designed questionnaire diagnosed SD and assessed potential associated factors. SD participants were defined as those who self-reported chronic recurrent urticarial dermographism with itch. Factors associated with SD were identified by comparing participants with and without SD.

Results: Of 68,513 participants, 3101 had SD (female 73.3%). Their mean age was 40.2 ± 16.2 years. Key factors associated with SD included atopic dermatitis (adjusted odds ratio [aOR] 4.20, 95% confidence interval [CI] 3.62‒4.88) and allergic rhinitis (aOR 2.11, 95% CI 1.88‒2.37). Participants with at least one atopic condition (allergic rhinitis, atopic dermatitis, or asthma) were significantly more likely to have SD (aOR 2.70, 95% CI 2.47‒2.95). Those with all three atopic conditions had a further increased likelihood of SD (aOR 7.75, 95% CI 5.31‒11.29). Other associations included working and older age groups, female sex, dyslipidemia, and thyroid disease.

Conclusions: Atopic dermatitis and allergic rhinitis emerged as the strongest correlates of SD, especially those with all three atopic conditions. Thus, allergic comorbidities should be assessed in SD patients. Further research is needed to clarify the pathophysiological relationship between these conditions and SD. [Graphical abstract available online].

Muslim patients may participate in religious and cultural practices that can affect their dermatologic health and influence their preferences regarding care and treatment. In this narrative review, we explore these topics and present culturally sensitive strategies for improving patient care for Muslim communities. We performed a literature review and identified articles published between 2005 and 2025 pertaining to the dermatological health and care of Muslim patients. We first discuss several key religious and cultural topics that can influence Muslim patients' perspectives on and participation with dermatological care, including views on contraception, modesty, divine will, and use of traditional medicines. Next, we summarize some specific religious and cultural prohibitions and observances than can affect dermatologic care, including tenets surrounding medications that contain animal products and the practice of fasting during the holy month of Ramadan. Lastly, we outline some key dermatoses associated with specific religious practices dermatologists should be aware of to enhance diagnostic accuracy and ensure timely, appropriate care. Importantly, we outline some key recommended clinical practices for providing evidence-based, culturally responsive dermatological care that respects patients' privacy, dignity, and spiritual values. Culturally competent dermatologic practice requires that clinicians understand health conditions and behaviors associated with religious and cultural practices and can employ clinical communication strategies that respect and incorporate patients' personal preferences. Enhanced awareness of the unique cultural and religious factors affecting dermatologic health in Muslim communities can help dermatologists foster trust and provide more effective, patient-centered care.

Psoriasis is a chronic, immune-mediated inflammatory disease with substantial impact on quality of life. While biologic therapies targeting interleukin (IL)-23 and IL-17 have set new efficacy and safety benchmarks, currently available oral agents offer limited potency or tolerability. There remains an unmet need for an oral therapy that combines the convenience of oral administration with the efficacy and safety of biologic agents. Icotrokinra, a first-in-class, orally administered macrocyclic peptide that selectively targets the IL-23 receptor (IL-23R), has been evaluated across phase 2 and 3 clinical trials in moderate-to-severe plaque psoriasis. This review aimed to provide an overview of icotrokinra in psoriasis, based on a literature search up to December 2025 using PubMed and supplemented by conference abstracts, industry communications, and ClinicalTrials.gov. In the phase 2b FRONTIER-1 trial, icotrokinra demonstrated a clear dose-response relationship, with sustained efficacy through 52 weeks in the FRONTIER-2 long-term extension. In the pivotal phase 3 ICONIC-ADVANCE-1 and ICONIC-ADVANCE-2 studies, icotrokinra was superior to placebo in achieving the primary endpoints of Investigator's Global Assessment (IGA) score 0/1 (clear or almost clear skin) and ≥ 90% improvement in the Psoriasis Area and Severity Index (PASI90) at week 16, and demonstrated greater efficacy than deucravacitinib at week 24, while maintaining a favorable safety profile. Long-term results from ICONIC-LEAD confirmed durable efficacy through 52 weeks, while ICONIC-TOTAL demonstrated consistent outcomes in scalp, genital, and palmoplantar psoriasis. Adverse events were mostly mild and comparable to placebo, with no new safety signals or pharmacokinetic concerns. Icotrokinra is the first oral IL-23R antagonist to achieve high and durable levels of skin clearance with a favorable safety profile, highlighting the potential of selective oral IL-23R blockade with minimal off-target or drug-drug interaction potential, thereby overcoming key limitations of oral small molecules.

Background: Involvement of the head-and-neck area in atopic dermatitis (AD) is common, associated with reduced quality of life, and suggested as an independent criterion for moderate-to-severe AD. The effectiveness of systemic therapies for AD specifically in the head-and-neck area remains underexplored.

Objective: The objective was to evaluate the effectiveness of approved anti-inflammatory systemic therapies for AD in the head-and-neck area through a systematic review and meta-analysis.

Methods: We conducted a systematic literature search in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) indentifying studies reporting response to systemic anti-inflammatory therapies for AD in the head-and-neck region. Searches were conducted in the databases PubMed, EMBASE, and Web of Science from inception through June 2025. The primary outcomes were mean percentage change of Eczema Area and Severity Index (EASI) for the head-and-neck region (EASI-HN), and proportion of patients achieving 75% improvement of EASI for the head-and-neck region (EASI75-HN). Meta-analyses were performed where data permitted.

Results: In total, 22 publications, encompassing 32 unique studies and 11,372 patients in total, met the inclusion criteria. Of the 22 included publications, eight were post hoc analyses of randomized controlled trials (RCTs), and 14 were observational real-world studies. Across studies, the mean reductions of EASI-HN after 16 weeks of treatment ranged from 59% (dupilumab 300 mg every 2 weeks (Q2W) without topical therapy) and 67% (lebrikizumab 250 mg Q2W without topical therapy) to 80% (upadacitinib 30 mg once daily (QD) without topical therapy) and 85% (dupilumab 300 mg Q2W with concomitant topical therapy). EASI75-HN after 16 weeks of treatment ranged from 20% (baricitinib 2 and 4 mg QD) to 66% (upadacitinib 30 mg QD). Evidence for the conventional systemic therapies, cyclosporine and methotrexate, was limited and not readily comparable to the other treatments.

Conclusions: In this systematic review, biologics and Janus kinase inhibitors (JAKis) were effective in treating AD in the head-and-neck region, achieving treatment responses comparable to those observed in other body regions. Further research providing direct comparison between therapies are warranted.

The concept of a therapeutic window of opportunity, defined as the period from symptom onset during which treatment initiation yields the most favorable patient outcomes, is applied in routine clinical practice across a range of inflammatory conditions. It has become an increasingly important area of interest in hidradenitis suppurativa (HS), a disease in which recurrent inflammation and accumulating damage can lead to irreversible destruction of skin architecture. Biologic therapies, aiming to suppress the inflammatory burden and prevent disease progression, are currently only permitted in moderate to severe HS. However, as there is no consensus definition of moderate disease, physicians may face uncertainty about when to consider or switch biologic therapy. To identify the boundaries of the window of opportunity within HS, global HS experts have developed frameworks for defining moderate HS and disease progression. It is proposed that prompt medical treatment should be administered to patients with moderate HS, defined as patients with inadequate control of HS symptoms on conventional therapies, or one inflamed skin tunnel (draining/non-draining), or four or more inflammatory lesions (including inflammatory nodules and abscesses) involving two or more anatomic areas. Furthermore, the proposed definition for disease progression is the development of one or more new tunnel(s) and/or the extension of existing tunnels, or development of one or more persistent HS lesions in an anatomical region not previously affected, or any increase in the number of persistent HS lesions in an affected anatomical region. The proposed frameworks aim to provide practical advice to physicians and support targeting the window of opportunity during routine clinical practice.

Atopic dermatitis (AD) is one of the most frequent conditions treated by dermatologists. The therapeutic options for moderate-to-severe AD are rapidly expanding with the introduction of biologics and Janus kinase inhibitors (JAKis). There are currently three oral JAKis approved for the treatment of AD, namely abrocitinib, baricitinib and upadacitinib. Although JAKis are rapidly effective for treating AD and its symptoms, they require careful patient selection and monitoring due to a side-effect profile which includes an increased risk of major adverse cardiovascular events (MACE) and malignancies, especially in patients with pre-existing risk factors. The aim of this article is to provide practical recommendations on how to prescribe, monitor and manage potential adverse reactions of systemic JAKis for AD, and to assist dermatologists in navigating various scenarios that can be encountered in clinic.

Solid organ transplant recipients (SOTRs) experience a significantly elevated risk of skin cancer, primarily due to the immunosuppressive and carcinogenic effects of anti-rejection medications. Both incidence and mortality are substantially higher than in the general population, necessitating a tailored approach to prevention, surveillance and management. This comprehensive review synthesises the field of transplant dermatology and highlights key advancements. Recent epidemiological studies are explored, comparing incidence rates with those in the general population and other immunosuppressed groups. We also review the significance of risk factors, including those shared with the general population and those unique to SOTRs. Current prevention strategies are discussed, with a focus on the evidence behind chemoprophylactic agents. We also summarise current guidelines regarding screening and management of skin cancer in SOTRs. While the general approach to skin cancer in SOTRs has remained similar over the past decades, a broad range of consensus statements are now available, providing clearer guidance for clinicians managing these high-risk patients.