Pub Date : 2024-09-27DOI: 10.1007/s40257-024-00894-9
Martim Luz, Tiago Torres
{"title":"Real-World Evidence on Dose Spacing of IL-23 Inhibitors in the Treatment of Psoriasis","authors":"Martim Luz, Tiago Torres","doi":"10.1007/s40257-024-00894-9","DOIUrl":"10.1007/s40257-024-00894-9","url":null,"abstract":"","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":"25 6","pages":"1019 - 1021"},"PeriodicalIF":8.6,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1007/s40257-024-00888-7
Qi Yin, Albert Wolkerstorfer, Oren Lapid, Khatera Qayumi, Murad Alam, Firas Al-Niaimi, Ofir Artzi, Martijn B. A. van Doorn, Ioannis Goutos, Merete Haedersdal, Chao-Kai Hsu, Woraphong Manuskiatti, Stan Monstrey, Thomas A. Mustoe, Rei Ogawa, David Ozog, Tae Hwan Park, Julian Pötschke, Anthony Rossi, Swee T. Tan, Luc Téot, Fiona M. Wood, Nanze Yu, Susan Gibbs, Frank B. Niessen, Paul P. M. van Zuijlen
Background
Intralesional corticosteroid administration (ICA) is a first-line keloid treatment. However, it faces significant variability in current clinical and scientific practice, which hinders comparability of treatment results.
Objectives
The aim of the study was to reach consensus on different aspects of ICA using hypodermic needles in keloids among an international group of dermatologists and plastic surgeons specialized in keloid treatment to provide consensus-based clinical treatment recommendations for all physicians treating keloids.
Methods
The keloid expert panel of 12 dermatologists and 11 plastic surgeons rated 30 statements. Two online e-Delphi rounds were held, both with a response rate of 100%. Fifteen (65%) keloid experts participated in the final consensus meetings. Consensus was defined as ≥ 75% of the participants choosing agree or strongly agree on a 7-point Likert scale.
Results
Consensus was reached on treatment goals, indication for ICA, triamcinolone acetonide (TAC) 40 mg/mL as the preferred corticosteroid administered at a maximum of 80 mg per month and at intervals of 4 weeks, minimizing pain during ICA, the use of 1 mL syringes and 25 or 27 Gauge needles, blanching as endpoint of successful infiltration, caution of not injecting subcutaneously, and the option of making multiple passes in very firm keloids prior to infiltration. Consensus could not be reached on TAC dosing, methods of prior local anesthesia, and location of injection.
Conclusions
This e-Delphi study provides important clinical treatment recommendations on essential aspects of ICA in keloids. By implementing these recommendations, uniformity of ICA in keloid treatment will increase and better treatment results may be achieved.
{"title":"KECORT Study: An International e-Delphi Study on the Treatment of KEloids Using Intralesional CORTicosteroids in Clinical Practice","authors":"Qi Yin, Albert Wolkerstorfer, Oren Lapid, Khatera Qayumi, Murad Alam, Firas Al-Niaimi, Ofir Artzi, Martijn B. A. van Doorn, Ioannis Goutos, Merete Haedersdal, Chao-Kai Hsu, Woraphong Manuskiatti, Stan Monstrey, Thomas A. Mustoe, Rei Ogawa, David Ozog, Tae Hwan Park, Julian Pötschke, Anthony Rossi, Swee T. Tan, Luc Téot, Fiona M. Wood, Nanze Yu, Susan Gibbs, Frank B. Niessen, Paul P. M. van Zuijlen","doi":"10.1007/s40257-024-00888-7","DOIUrl":"10.1007/s40257-024-00888-7","url":null,"abstract":"<div><h3>Background</h3><p>Intralesional corticosteroid administration (ICA) is a first-line keloid treatment. However, it faces significant variability in current clinical and scientific practice, which hinders comparability of treatment results.</p><h3>Objectives</h3><p>The aim of the study was to reach consensus on different aspects of ICA using hypodermic needles in keloids among an international group of dermatologists and plastic surgeons specialized in keloid treatment to provide consensus-based clinical treatment recommendations for all physicians treating keloids.</p><h3>Methods</h3><p>The keloid expert panel of 12 dermatologists and 11 plastic surgeons rated 30 statements. Two online e-Delphi rounds were held, both with a response rate of 100%. Fifteen (65%) keloid experts participated in the final consensus meetings. Consensus was defined as ≥ 75% of the participants choosing agree or strongly agree on a 7-point Likert scale.</p><h3>Results</h3><p>Consensus was reached on treatment goals, indication for ICA, triamcinolone acetonide (TAC) 40 mg/mL as the preferred corticosteroid administered at a maximum of 80 mg per month and at intervals of 4 weeks, minimizing pain during ICA, the use of 1 mL syringes and 25 or 27 Gauge needles, blanching as endpoint of successful infiltration, caution of not injecting subcutaneously, and the option of making multiple passes in very firm keloids prior to infiltration. Consensus could not be reached on TAC dosing, methods of prior local anesthesia, and location of injection.</p><h3>Conclusions</h3><p>This e-Delphi study provides important clinical treatment recommendations on essential aspects of ICA in keloids. By implementing these recommendations, uniformity of ICA in keloid treatment will increase and better treatment results may be achieved.</p></div>","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":"25 6","pages":"1009 - 1017"},"PeriodicalIF":8.6,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40257-024-00888-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1007/s40257-024-00890-z
Elke Weisshaar
Chronic hand eczema (CHE) is a complex, challenging, and frequently multifactorial skin disease of the hands. It is very common in the general population, especially in certain professions. When hand eczema (HE) persists for longer than 3 months or has a minimum of two relapses per year after initial manifestation with complete clearance, it is considered chronic. In this case, health-related quality of life and the patient’s working life are often impaired. CHE can be considered as an umbrella term because it covers different clinical pictures and etiologies. To date, there is no definite and unique HE classification. Treatment starts with identifying the individual HE etiology paralleled by symptomatic therapy (local and/or systemic and/or ultraviolet phototherapy). Sustainable management of HE requires the identification and avoidance of its triggering factors, from the professional and private environment. This includes ruling out allergic contact dermatitis if any HE persists for more than 3 months despite adequate therapy. Randomized controlled trials investigating the efficacy in HE are lacking for several treatment modalities. Patient education measures of skin protection and prevention complete the multimodal treatment.
慢性手部湿疹(CHE)是一种复杂、具有挑战性且经常由多种因素引起的手部皮肤病。它在普通人群中非常常见,尤其是在某些职业中。如果手部湿疹(HE)持续时间超过 3 个月,或在最初表现为手部湿疹并完全痊愈后每年至少复发两次,则被视为慢性手部湿疹。在这种情况下,与健康相关的生活质量和患者的工作生活往往会受到影响。CHE 可被视为一个总称,因为它涵盖了不同的临床表现和病因。迄今为止,还没有明确而独特的 HE 分类。治疗首先要确定 HE 的病因,同时进行对症治疗(局部和/或全身治疗和/或紫外线光疗)。要对 HE 进行可持续管理,就必须从职业和私人环境中找出并避免诱发因素。这包括在接受适当治疗后,任何 HE 仍持续超过 3 个月的情况下,排除过敏性接触性皮炎的可能性。目前还缺乏对几种治疗方法的有效性进行调查的随机对照试验。皮肤保护和预防方面的患者教育措施完善了多模式治疗。
{"title":"Chronic Hand Eczema","authors":"Elke Weisshaar","doi":"10.1007/s40257-024-00890-z","DOIUrl":"10.1007/s40257-024-00890-z","url":null,"abstract":"<div><p>Chronic hand eczema (CHE) is a complex, challenging, and frequently multifactorial skin disease of the hands. It is very common in the general population, especially in certain professions. When hand eczema (HE) persists for longer than 3 months or has a minimum of two relapses per year after initial manifestation with complete clearance, it is considered chronic. In this case, health-related quality of life and the patient’s working life are often impaired. CHE can be considered as an umbrella term because it covers different clinical pictures and etiologies. To date, there is no definite and unique HE classification. Treatment starts with identifying the individual HE etiology paralleled by symptomatic therapy (local and/or systemic and/or ultraviolet phototherapy). Sustainable management of HE requires the identification and avoidance of its triggering factors, from the professional and private environment. This includes ruling out allergic contact dermatitis if any HE persists for more than 3 months despite adequate therapy. Randomized controlled trials investigating the efficacy in HE are lacking for several treatment modalities. Patient education measures of skin protection and prevention complete the multimodal treatment.</p></div>","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":"25 6","pages":"909 - 926"},"PeriodicalIF":8.6,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11511713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Background</h3><p>For patients with psoriasis, discontinuation of biologics following remission has become more common in daily practice.</p><h3>Objective</h3><p>We aimed to identify predictors and construct a predictive model for time to relapse following withdrawal from biologics.</p><h3>Methods</h3><p>This 12-year, multicenter, observational cohort study was performed in six dermatology centers between February 2011 and February 2024. We identified biological treatment episodes in patients with moderate-to-severe psoriasis and included only treatment episodes in which a clinical response (≥ 50% reduction in Psoriasis Area and Severity Index score [PASI 50] from baseline) was achieved and the patient withdrew from biological therapy with a well-controlled status (PASI < 10 and ≥ 50% improvement in PASI from baseline). The primary outcome was time to relapse, which was defined as the period from the last biologic administration to relapse. An extended multivariate Cox proportional hazards analysis (Prentice–Williams–Peterson Gap time model) was used to predict relapse and generate a predictive model.</p><h3>Results</h3><p>This study screened 1613 biological treatment episodes, and 991 treatment episodes were enrolled. The time to relapse decreased significantly as the number of previous withdrawals from biological treatment increased (<i>p</i> < 0.001). Similarly, the time to relapse decreased significantly as the number of previous biologics used increased (<i>p</i> < 0.001). The maximum PASI improvement during biological treatment decreased and the PASI score at withdrawal of biological treatment increased in parallel as the number of prior withdrawals from biologics increased. The time to relapse following withdrawal was longest for interleukin (IL)-23 inhibitors (IL-23i), followed by the IL-12/23i, IL-17 inhibitors (IL-17i), and tumor necrosis factor-α inhibitors. After adjustment, multivariate Cox regression identified the following significant predictors of relapse following withdrawal: the mechanisms of action of biologics (hazard ratio [HR] for IL-17i vs IL-12/23i, 1.59; HR for IL-23i vs IL-12/23i, 0.60), number of previous withdrawals from biological treatment (HR 1.23; 95% confidence interval [CI] 1.13‒1.33), time to achieve PASI 50 (HR 1.01; 95% CI 1.00‒1.02), maximum PASI improvement on biologics (HR 0.98; 95% CI 0.98‒0.99), and PASI at the end of therapy (HR 1.03; 95% CI 1.01‒1.05). The model had good predictive and discriminative ability.</p><h3>Conclusions</h3><p>These results have the potential to help physicians and patients make individualized treatment decisions; information on the risk of relapse of psoriasis at specific timepoints following the withdrawal of biologics is particularly valuable for patients considering discontinuation of biologics or as-needed biologic therapy. However, the benefit and risk of repeated withdrawals of biologics should be carefully weighed, as the treatment efficacy and duratio
背景对于银屑病患者来说,缓解后停用生物制剂在日常实践中已变得越来越常见。方法这项为期 12 年的多中心观察性队列研究于 2011 年 2 月至 2024 年 2 月期间在六个皮肤病中心进行。我们确定了中度至重度银屑病患者的生物制剂治疗疗程,并仅纳入取得临床应答(银屑病面积和严重程度指数[PASI 50]评分比基线降低≥50%)且患者在良好控制的状态下(PASI < 10且PASI比基线改善≥50%)退出生物制剂治疗的疗程。主要结果是复发时间,即从最后一次使用生物制剂到复发的时间。采用扩展多变量 Cox 比例危险度分析(Prentice-Williams-Peterson Gap 时间模型)预测复发,并生成预测模型。随着以前退出生物治疗次数的增加,复发时间明显缩短(p <0.001)。同样,随着之前使用生物制剂次数的增加,复发时间也明显缩短(p <0.001)。随着之前停用生物制剂次数的增加,生物制剂治疗期间的最大 PASI 改善程度降低,而停用生物制剂时的 PASI 评分也同时增加。白细胞介素(IL)-23抑制剂(IL-23i)的停药后复发时间最长,其次是IL-12/23i、IL-17抑制剂(IL-17i)和肿瘤坏死因子-α抑制剂。经调整后,多变量 Cox 回归确定了以下显著的停药后复发预测因素:生物制剂的作用机制(IL-17i 与 IL-12/23i 的危险比 [HR],1.59;IL-23i 与 IL-12/23i 的危险比 [HR],0.60)、之前退出生物制剂治疗的次数(HR 1.23;95% 置信区间 [CI] 1.13-1.33)、达到 PASI 50 的时间(HR 1.01;95% CI 1.00-1.02)、生物制剂治疗的最大 PASI 改善(HR 0.98;95% CI 0.98-0.99)以及治疗结束时的 PASI(HR 1.03;95% CI 1.01-1.05)。结论这些结果有望帮助医生和患者做出个体化治疗决策;停用生物制剂后特定时间点的银屑病复发风险信息对于考虑停用生物制剂或按需使用生物制剂治疗的患者尤其有价值。然而,应仔细权衡反复停用生物制剂的益处和风险,因为随着停药次数的增加,治疗效果和缓解持续时间都会缩短。
{"title":"Predicting the Time to Relapse Following Withdrawal from Different Biologics in Patients with Psoriasis who Responded to Therapy: A 12-Year Multicenter Cohort Study","authors":"Yu-Huei Huang, Sung Jen Hung, Chaw-Ning Lee, Nan-Lin Wu, Rosaline Chung-yee Hui, Tsen-Fang Tsai, Chang-Ming Huang, Hsien-Yi Chiu","doi":"10.1007/s40257-024-00887-8","DOIUrl":"10.1007/s40257-024-00887-8","url":null,"abstract":"<div><h3>Background</h3><p>For patients with psoriasis, discontinuation of biologics following remission has become more common in daily practice.</p><h3>Objective</h3><p>We aimed to identify predictors and construct a predictive model for time to relapse following withdrawal from biologics.</p><h3>Methods</h3><p>This 12-year, multicenter, observational cohort study was performed in six dermatology centers between February 2011 and February 2024. We identified biological treatment episodes in patients with moderate-to-severe psoriasis and included only treatment episodes in which a clinical response (≥ 50% reduction in Psoriasis Area and Severity Index score [PASI 50] from baseline) was achieved and the patient withdrew from biological therapy with a well-controlled status (PASI < 10 and ≥ 50% improvement in PASI from baseline). The primary outcome was time to relapse, which was defined as the period from the last biologic administration to relapse. An extended multivariate Cox proportional hazards analysis (Prentice–Williams–Peterson Gap time model) was used to predict relapse and generate a predictive model.</p><h3>Results</h3><p>This study screened 1613 biological treatment episodes, and 991 treatment episodes were enrolled. The time to relapse decreased significantly as the number of previous withdrawals from biological treatment increased (<i>p</i> < 0.001). Similarly, the time to relapse decreased significantly as the number of previous biologics used increased (<i>p</i> < 0.001). The maximum PASI improvement during biological treatment decreased and the PASI score at withdrawal of biological treatment increased in parallel as the number of prior withdrawals from biologics increased. The time to relapse following withdrawal was longest for interleukin (IL)-23 inhibitors (IL-23i), followed by the IL-12/23i, IL-17 inhibitors (IL-17i), and tumor necrosis factor-α inhibitors. After adjustment, multivariate Cox regression identified the following significant predictors of relapse following withdrawal: the mechanisms of action of biologics (hazard ratio [HR] for IL-17i vs IL-12/23i, 1.59; HR for IL-23i vs IL-12/23i, 0.60), number of previous withdrawals from biological treatment (HR 1.23; 95% confidence interval [CI] 1.13‒1.33), time to achieve PASI 50 (HR 1.01; 95% CI 1.00‒1.02), maximum PASI improvement on biologics (HR 0.98; 95% CI 0.98‒0.99), and PASI at the end of therapy (HR 1.03; 95% CI 1.01‒1.05). The model had good predictive and discriminative ability.</p><h3>Conclusions</h3><p>These results have the potential to help physicians and patients make individualized treatment decisions; information on the risk of relapse of psoriasis at specific timepoints following the withdrawal of biologics is particularly valuable for patients considering discontinuation of biologics or as-needed biologic therapy. However, the benefit and risk of repeated withdrawals of biologics should be carefully weighed, as the treatment efficacy and duratio","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":"25 6","pages":"997 - 1008"},"PeriodicalIF":8.6,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-15DOI: 10.1007/s40257-024-00889-6
Hemali Shah, Rose Parisi, Eric Mukherjee, Elizabeth J. Phillips, Roni P. Dodiuk-Gad
Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the most severe cutaneous adverse reactions that are typically drug-induced in adults. Both SJS and TEN have high morbidity and mortality rates. SJS/TEN imposes clinical challenges for physicians managing patients suffering from this condition, both because it is rare and because it is a rapidly progressing systemic disease with severe cutaneous, mucosal, and systemic manifestations. Although many cases of SJS/TEN have been reported in the literature, there is no consensus regarding diagnostic criteria or treatment. Significant progress has been made in understanding its genetic predisposition and pathogenesis. This review is intended to provide physicians with a comprehensive but practical SJS/TEN roadmap to guide diagnosis and management. We review data on pathogenesis, reported precipitating factors, presentation, diagnosis, and management SJS/TEN focusing on what is new over the last 5 years.
{"title":"Update on Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: Diagnosis and Management","authors":"Hemali Shah, Rose Parisi, Eric Mukherjee, Elizabeth J. Phillips, Roni P. Dodiuk-Gad","doi":"10.1007/s40257-024-00889-6","DOIUrl":"10.1007/s40257-024-00889-6","url":null,"abstract":"<div><p>Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the most severe cutaneous adverse reactions that are typically drug-induced in adults. Both SJS and TEN have high morbidity and mortality rates. SJS/TEN imposes clinical challenges for physicians managing patients suffering from this condition, both because it is rare and because it is a rapidly progressing systemic disease with severe cutaneous, mucosal, and systemic manifestations. Although many cases of SJS/TEN have been reported in the literature, there is no consensus regarding diagnostic criteria or treatment. Significant progress has been made in understanding its genetic predisposition and pathogenesis. This review is intended to provide physicians with a comprehensive but practical SJS/TEN roadmap to guide diagnosis and management. We review data on pathogenesis, reported precipitating factors, presentation, diagnosis, and management SJS/TEN focusing on what is new over the last 5 years.</p></div>","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":"25 6","pages":"891 - 908"},"PeriodicalIF":8.6,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40257-024-00889-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13DOI: 10.1007/s40257-024-00892-x
Nicolas G. Quan, Remie Chrabieh, Mona Sadeghpour, Lucinda L. Kohn
Acne fulminans (AF) is a severe form of inflammatory acne commonly associated with adolescents. It is characterized by an abrupt onset of painful nodules and plaques and can progress to suppurative, ulcerative, and hemorrhagic lesions. AF can be associated with systemic symptoms such as fever, arthralgia, and bone pain. The etiology of AF is unknown but it has been linked to the use of certain medications and has been rarely found in autoinflammatory syndromes. In previous years, there have been reports of <200 cases in the literature; however, AF may be more common in clinical practice than reported. The most common presentation of AF is seen in adolescents starting isotretinoin therapy. Diagnosis of AF is determined based on its clinical findings. The main purpose of this article is to provide clinicians with a practical approach to treating AF. Current evidence for its treatment is limited to case reports and case series. The mainstay treatment of AF is a combination of prednisone and isotretinoin. It is important to taper or discontinue any exacerbating or precipitating medications such as isotretinoin, antibiotics, or androgens when AF is identified. Along with treatment of AF, it is important to treat associated scarring. Early identification and treatment of AF in adolescents is crucial to minimize both acute symptoms and long-term scarring, and further research is needed to determine optimal management.
{"title":"A Practice Approach to Acne Fulminans in Adolescents","authors":"Nicolas G. Quan, Remie Chrabieh, Mona Sadeghpour, Lucinda L. Kohn","doi":"10.1007/s40257-024-00892-x","DOIUrl":"10.1007/s40257-024-00892-x","url":null,"abstract":"<div><p>Acne fulminans (AF) is a severe form of inflammatory acne commonly associated with adolescents. It is characterized by an abrupt onset of painful nodules and plaques and can progress to suppurative, ulcerative, and hemorrhagic lesions. AF can be associated with systemic symptoms such as fever, arthralgia, and bone pain. The etiology of AF is unknown but it has been linked to the use of certain medications and has been rarely found in autoinflammatory syndromes. In previous years, there have been reports of <200 cases in the literature; however, AF may be more common in clinical practice than reported. The most common presentation of AF is seen in adolescents starting isotretinoin therapy. Diagnosis of AF is determined based on its clinical findings. The main purpose of this article is to provide clinicians with a practical approach to treating AF. Current evidence for its treatment is limited to case reports and case series. The mainstay treatment of AF is a combination of prednisone and isotretinoin. It is important to taper or discontinue any exacerbating or precipitating medications such as isotretinoin, antibiotics, or androgens when AF is identified. Along with treatment of AF, it is important to treat associated scarring. Early identification and treatment of AF in adolescents is crucial to minimize both acute symptoms and long-term scarring, and further research is needed to determine optimal management.</p></div>","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":"25 6","pages":"967 - 974"},"PeriodicalIF":8.6,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1007/s40257-024-00883-y
Elisabeth V. Goessinger, Philippe Gottfrois, Alina M. Mueller, Sara E. Cerminara, Alexander A. Navarini
Psoriasis, a chronic inflammatory skin disease, affects millions of people worldwide. It imposes a significant burden on patients’ quality of life and healthcare systems, creating an urgent need for optimized diagnosis, treatment, and management. In recent years, image-based artificial intelligence (AI) applications have emerged as promising tools to assist physicians by offering improved accuracy and efficiency. In this review, we provide an overview of the current landscape of image-based AI applications in psoriasis. Emphasis is placed on machine learning (ML) algorithms, a key subset of AI, which enable automated pattern recognition for various tasks. Key AI applications in psoriasis include lesion detection and segmentation, differentiation from other skin conditions, subtype identification, automated area involvement, and severity scoring, as well as personalized treatment selection and response prediction. Furthermore, we discuss two commercially available systems that utilize standardized photo documentation, automated segmentation, and semi-automated Psoriasis Area and Severity Index (PASI) calculation for patient assessment and follow-up. Despite the promise of AI in this field, many challenges remain. These include the validation of current models, integration into clinical workflows, the current lack of diversity in training-set data, and the need for standardized imaging protocols. Addressing these issues is crucial for the successful implementation of AI technologies in clinical practice. Overall, we underscore the potential of AI to revolutionize psoriasis management, highlighting both the advancements and the hurdles that need to be overcome. As technology continues to evolve, AI is expected to significantly improve the accuracy, efficiency, and personalization of psoriasis treatment.
{"title":"Image-Based Artificial Intelligence in Psoriasis Assessment: The Beginning of a New Diagnostic Era?","authors":"Elisabeth V. Goessinger, Philippe Gottfrois, Alina M. Mueller, Sara E. Cerminara, Alexander A. Navarini","doi":"10.1007/s40257-024-00883-y","DOIUrl":"10.1007/s40257-024-00883-y","url":null,"abstract":"<div><p>Psoriasis, a chronic inflammatory skin disease, affects millions of people worldwide. It imposes a significant burden on patients’ quality of life and healthcare systems, creating an urgent need for optimized diagnosis, treatment, and management. In recent years, image-based artificial intelligence (AI) applications have emerged as promising tools to assist physicians by offering improved accuracy and efficiency. In this review, we provide an overview of the current landscape of image-based AI applications in psoriasis. Emphasis is placed on machine learning (ML) algorithms, a key subset of AI, which enable automated pattern recognition for various tasks. Key AI applications in psoriasis include lesion detection and segmentation, differentiation from other skin conditions, subtype identification, automated area involvement, and severity scoring, as well as personalized treatment selection and response prediction. Furthermore, we discuss two commercially available systems that utilize standardized photo documentation, automated segmentation, and semi-automated Psoriasis Area and Severity Index (PASI) calculation for patient assessment and follow-up. Despite the promise of AI in this field, many challenges remain. These include the validation of current models, integration into clinical workflows, the current lack of diversity in training-set data, and the need for standardized imaging protocols. Addressing these issues is crucial for the successful implementation of AI technologies in clinical practice. Overall, we underscore the potential of AI to revolutionize psoriasis management, highlighting both the advancements and the hurdles that need to be overcome. As technology continues to evolve, AI is expected to significantly improve the accuracy, efficiency, and personalization of psoriasis treatment.</p></div>","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":"25 6","pages":"861 - 872"},"PeriodicalIF":8.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40257-024-00883-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-03DOI: 10.1007/s40257-024-00884-x
Xiaolin Zhang, Yiqun Jiang
Alopecia areata is a common autoimmune disorder characterized by non-scarring hair loss on the scalp or other hair-bearing surface. In recent years, Janus kinase (JAK) inhibitors have shown promise in the treatment of alopecia areata by disrupting the signaling pathways involved in immune-mediated hair follicle damage. However, some patients with alopecia areata exhibit insufficient responses to JAK inhibitors. This review aims to explore the predictive factors for poor responses to JAK inhibitors in patients with alopecia areata and to discuss alternative treatment strategies in such cases. Patients with a longer duration of the current episode and higher baseline severity are at an increased risk of inadequate JAK inhibitor responses. Oral administration rather than topical application, and extended treatment durations, correlate with a favorable response. Notably, the poor response to JAK inhibitors in alopecia areata may be related to the amount and functional depletion of regulatory T cells resulting from an augmented T helper-2-type immune response. For patients with poor responses to JAK inhibitors, treatment adjustments may include increasing the dosage, extending the treatment duration, combination therapies, or switching to alternative JAK inhibitors. For patients with atopic comorbidities or psychological problems, it is important to select corresponding treatment options to optimize patient outcomes. Further research is needed to establish more reliable predictors and improve overall patient care.
斑秃是一种常见的自身免疫性疾病,其特征是头皮或其他生发表面出现非疤痕性脱发。近年来,Janus 激酶(JAK)抑制剂通过破坏参与免疫介导的毛囊损伤的信号通路,在治疗脱发症方面显示出前景。然而,一些斑秃患者对JAK抑制剂的反应不足。本综述旨在探讨脱发症患者对JAK抑制剂反应不佳的预测因素,并讨论此类患者的替代治疗策略。当前病程较长、基线严重程度较高的患者对JAK抑制剂反应不佳的风险较高。口服而非局部用药以及延长治疗时间与良好反应相关。值得注意的是,斑秃患者对 JAK 抑制剂的不良反应可能与 T 辅助细胞-2 型免疫反应增强导致的调节性 T 细胞数量和功能耗竭有关。对于对JAK抑制剂反应不佳的患者,治疗调整可包括增加剂量、延长疗程、联合治疗或改用其他JAK抑制剂。对于有特应性合并症或心理问题的患者,必须选择相应的治疗方案,以优化患者的治疗效果。我们需要进一步开展研究,以确定更可靠的预测指标,并改善对患者的整体护理。
{"title":"Predictors and Management of Inadequate Response to JAK Inhibitors in Alopecia Areata","authors":"Xiaolin Zhang, Yiqun Jiang","doi":"10.1007/s40257-024-00884-x","DOIUrl":"10.1007/s40257-024-00884-x","url":null,"abstract":"<div><p>Alopecia areata is a common autoimmune disorder characterized by non-scarring hair loss on the scalp or other hair-bearing surface. In recent years, Janus kinase (JAK) inhibitors have shown promise in the treatment of alopecia areata by disrupting the signaling pathways involved in immune-mediated hair follicle damage. However, some patients with alopecia areata exhibit insufficient responses to JAK inhibitors. This review aims to explore the predictive factors for poor responses to JAK inhibitors in patients with alopecia areata and to discuss alternative treatment strategies in such cases. Patients with a longer duration of the current episode and higher baseline severity are at an increased risk of inadequate JAK inhibitor responses. Oral administration rather than topical application, and extended treatment durations, correlate with a favorable response. Notably, the poor response to JAK inhibitors in alopecia areata may be related to the amount and functional depletion of regulatory T cells resulting from an augmented T helper-2-type immune response. For patients with poor responses to JAK inhibitors, treatment adjustments may include increasing the dosage, extending the treatment duration, combination therapies, or switching to alternative JAK inhibitors. For patients with atopic comorbidities or psychological problems, it is important to select corresponding treatment options to optimize patient outcomes. Further research is needed to establish more reliable predictors and improve overall patient care.</p></div>","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":"25 6","pages":"975 - 986"},"PeriodicalIF":8.6,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acne scarring is a common sequela of acne vulgaris, which seriously affects facial esthetics. The treatment options for acne scars vary depending on the development stage, color, type, and location of scarring. The objective and precise assessment of acne scars is a prerequisite for treatment, and it is also an important means of monitoring the treatment effect. The traditional methods to evaluate the types and severity grade of acne scars are primarily based on subjective assessment by physicians, which lacks objectivity and accuracy. Novel noninvasive skin imaging techniques, such as skin surface imaging analysis systems, dermoscopy, reflectance confocal microscopy (RCM), high-frequency ultrasound (HFUS), optical coherence tomography (OCT), and multiphoton tomography (MPT), provide new tools for the rapid and objective assessment of acne scars. This article reviews the progress of skin imaging techniques in the diagnosis, classification, and efficacy evaluation of acne scars.
{"title":"Advances in the Application of Noninvasive Skin Imaging Techniques in Acne Scars","authors":"Xiaoli Ning, Lingfan Jiang, Ruixing Yu, Yujun Sheng, Mengmeng Li, Hongfei Ouyang, Jingkai Xu, Yong Cui","doi":"10.1007/s40257-024-00882-z","DOIUrl":"10.1007/s40257-024-00882-z","url":null,"abstract":"<div><p>Acne scarring is a common sequela of acne vulgaris, which seriously affects facial esthetics. The treatment options for acne scars vary depending on the development stage, color, type, and location of scarring. The objective and precise assessment of acne scars is a prerequisite for treatment, and it is also an important means of monitoring the treatment effect. The traditional methods to evaluate the types and severity grade of acne scars are primarily based on subjective assessment by physicians, which lacks objectivity and accuracy. Novel noninvasive skin imaging techniques, such as skin surface imaging analysis systems, dermoscopy, reflectance confocal microscopy (RCM), high-frequency ultrasound (HFUS), optical coherence tomography (OCT), and multiphoton tomography (MPT), provide new tools for the rapid and objective assessment of acne scars. This article reviews the progress of skin imaging techniques in the diagnosis, classification, and efficacy evaluation of acne scars.</p></div>","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":"25 5","pages":"823 - 835"},"PeriodicalIF":8.6,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-05DOI: 10.1007/s40257-024-00881-0
Luis F. Andrade, Zaim Haq, Parsa Abdi, Sarah G. Brooks, Veronica Voronina, Michael J. Diaz, Gil Yosipovitch
{"title":"Association of Cardiovascular Disease and Chronic Spontaneous Urticaria: A Case–Control Study","authors":"Luis F. Andrade, Zaim Haq, Parsa Abdi, Sarah G. Brooks, Veronica Voronina, Michael J. Diaz, Gil Yosipovitch","doi":"10.1007/s40257-024-00881-0","DOIUrl":"10.1007/s40257-024-00881-0","url":null,"abstract":"","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":"25 5","pages":"849 - 851"},"PeriodicalIF":8.6,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}