American Journal of Clinical Dermatology最新文献

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.

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.

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.

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.

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.

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.

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.