American Journal of Clinical Dermatology最新文献

Background

Ethnic differences of the clinicopathological characteristics in many immune-mediated skin diseases have been reported, including psoriasis vulgaris (PV). However, the ethnic differences of pustular psoriasis have been less studied.

Objective

The aim of this study was to compare the differences in epidemiology, genetic background, clinical manifestations, treatment patterns and responses among Asian and non-Asian patients with pustular psoriasis, including generalized pustular psoriasis (GPP) and acrodermatitis continua of Hallopeau (ACH).

Methods

This systematic review was based on a comprehensive search of Cochrane, PubMed, and Embase databases from earliest available date to 31 December 2024, and all studies reporting on patients with either GPP or ACH irrespective of study design. Studies with study size below five patients or those focusing on quality of life or economic aspects were excluded. In each publication, the ethnic composition, demographics information, disease course and manifestation, as well as genetic mutations, treatment type and response were collected if available.

Results

Of 2187 screened studies, 141 studies were included, with the majority being cohort studies. Compared with other ethnicities, East Asians with GPP carried more null IL36RN mutations, while AP1S3 mutations seemed absent in Asians. Phenotypically, Asians had younger onset age, bimodal age distribution, less family history of PV, and more scalp/nail involvement. In Asians, absence of coexisting PV was associated with severe disease. GPP with PV had shorter pre-pustular duration among Asians than non-Asians. Use of acitretin appeared higher and more effective among East Asians compared with other populations. In ACH, Asians mostly carried homozygous null IL36RN mutations and had younger onset age, more multi-digit involvement, persistent treatment course, and more coexisting GPP than Europeans. Biologics use was less common in Asia in both GPP and ACH than in Europe and the US.

Conclusions

This systematic review underscores notable ethnic differences in genetic profiles, clinical features, and therapeutic responses in GPP and ACH. The diagnosis of GPP and ACH may differ across studies and the true impacts of ethnicities on these differences remain to be confirmed. Nonetheless, the results from this study enhance our understanding of the heterogeneous characteristics of GPP and ACH, highlighting the necessity of incorporating ethnic differences into the diagnosis, genetic testing, and management strategies for patients with GPP and ACH.

Pyoderma gangrenosum (PG) is a rare, ulcerative, neutrophilic dermatosis that can be challenging to diagnose. Diagnosis of PG is clinical due to a lack of specific histopathologic, immunologic, or imaging findings associated with the disease, although several clinical frameworks exist to guide diagnosis. However, misdiagnosis of PG is frequent and leads to increased patient morbidity and mortality. This article highlights common mimickers of PG and offers clinical pearls to aid in accurate diagnosis with the goal of decreasing diagnostic delay and misdiagnosis and improving patient outcomes.

Vulvovaginal itching is a common yet often under-recognized condition affecting women across all age groups. Despite its prevalence, many dermatologists receive minimal training in vulvar diseases, leading to delayed diagnoses and prolonged discomfort for patients. This review explores the broad spectrum of causes, including infections, inflammatory conditions, neuropathic disorders, and systemic illnesses. The complexity of vulvovaginal pruritus often requires a multidisciplinary approach to accurately diagnose and treat. Contributing factors such as hormonal changes, personal hygiene practices, and environmental exposures must also be considered. Treatment strategies typically begin with lifestyle modifications and topical therapies, such as corticosteroids and antifungals, but can extend to systemic medications and biologics for resistant cases. Additionally, nonpharmaceutical options such as sitz baths and psychological interventions can be crucial for managing chronic symptoms. However, there remains a significant gap in research, particularly regarding the characterization of female-specific pruritus and its long-term impact on quality of life. Despite some advances, the available studies largely focus on isolated causes rather than the holistic nature of the condition. Further research is urgently needed to develop comprehensive, evidence-based guidelines for diagnosing and treating vulvovaginal itching, a condition that has a profound effect on both physical and emotional well-being.

Hidradenitis suppurativa is a chronic inflammatory condition characterized by recurrent abscesses, nodules, tunnels, and scarring. Fluctuations in disease activity are common during pregnancy, and more than half of women with hidradenitis suppurativa report experiencing post-partum flares. Both treatment efficacy and safety of the woman and fetus or infant must be considered when developing a treatment plan for pregnant and lactating women with hidradenitis suppurativa. Although certain commonly used hidradenitis suppurativa medications, such as tetracyclines and spironolactone, are contraindicated during pregnancy, there are still various medical therapies, including topicals, systemic antibiotics, metabolic modulators, and biologics, as well as procedural therapies that may be utilized during pregnancy. This paper aims to provide an updated evidence-based review of the management of hidradenitis suppurativa in pregnancy with an emphasis on safety data.

Background

Tapinarof cream 1% is an aryl hydrocarbon receptor agonist approved by the US Food and Drug Administration to treat atopic dermatitis (AD) in patients down to age 2 years.

Objective

The aim of this study was to evaluate the safety and pharmacokinetics of tapinarof cream 1% once daily (QD) in adolescents and children with extensive AD under maximal usage conditions.

Methods

Patients with a validated Investigator Global Assessment scale for Atopic Dermatitis™ (vIGA-AD™) score ≥ 3 and body surface area (BSA) involvement ≥ 25% (ages 12–17 years) or ≥ 35% (ages 2–11 years) were enrolled into three age cohorts (2–6, 7–11, and 12–17 years) and received tapinarof cream 1% QD for 4 weeks.

Results

Overall, 36 patients (12 per cohort) were enrolled; mean BSA affected was 42.8% (range 26.0–90.0) and mean Eczema Area and Severity Index (EASI) score was 23.8. At baseline, 28 patients (77.8%) had a vIGA-AD™ score of 3 (moderate). No-to-minimal tapinarof systemic exposure was observed (25% of post-treatment plasma samples were below the quantifiable limit of a highly sensitive assay [< 50 pg/mL]). Mean maximum plasma concentration (C_max) was 2.44 ng/mL, and median time to C_max was 2.9 h. Eight patients (22.2%) reported treatment-emergent adverse events (TEAEs), which were mild or moderate; only one patient discontinued due to two unrelated TEAEs. One case of mild folliculitis and no contact dermatitis occurred. Tapinarof was well tolerated, including on sensitive skin and extensor/flexural surfaces.

Conclusion

Tapinarof cream exhibits highly favorable safety and pharmacokinetics in adolescents and children down to age 2 years with extensive AD.

Trial Registration

ClinicalTrials.gov: NCT05186805.

Background

Nail psoriasis (NP) affects up to 90% and 86% of patients with cutaneous psoriasis and psoriatic arthritis, respectively, with a significant impact on quality-of-life. The Nail Psoriasis Severity Index (NAPSI) is infrequently used in clinical practice owing to its labor-intensive nature and variable interobserver reliability.

Objective

The objective of this study was to assess performance and inter-reader agreement between artificial intelligence (AI)-determined NAPSI scores and dermatologist-assigned scores.

Methods

This cross-sectional study used clinical images of psoriatic fingernails captured retrospectively at a specialized nail clinic in New York City. A convolutional neural network (CNN) model was trained and utilized for NAPSI classification of psoriatic fingernail clinical images, with seven dermatologist nail experts scoring identical images. The primary outcome was the interclass correlation coefficient (ICC), using a one-way analysis of variance (ANOVA) fixed effects model for the single-rater absolute agreement, between the average NAPSI score determined by the dermatologists and the AI.

Results

In total, 240 images of psoriatic fingernails were included. The ICC for overall NAPSI, matrix (NAPSIm), and bed (NAPSIb) scores among the dermatologists were 0.43 (95% confidence interval [CI] 0.33–0.55), 0.56 (95% CI 0.46–0.67), and 0.53 (95% CI 0.43–0.65), respectively. Comparing the AI algorithm-assigned NAPSI, NAPSIm, and NAPSIb scores with the average dermatologist-assigned scores, ICCs were 0.81 (95% CI 0.74–0.86), 0.75 (95% CI 0.65–0.82), and 0.81 (95% CI 0.74–0.86), respectively.

Conclusions

We found an excellent correlation between AI-derived NAPSI scores and dermatologist-assigned scores, underscoring the potential of CNNs to improve accuracy and reliability in NAPSI scoring. The limitations of this study include the small sample size, undetermined CNN diagnostic accuracy, incomplete data, and potential racial/ethnic minority group underrepresentation.

Photoaging is the consequence of chronic exposure to solar irradiation, encompassing ultraviolet (UV), visible, and infrared wavelengths. Over time, this exposure causes cumulative damage, leading to both aesthetic changes and structural degradation of the skin. These effects manifest as rhytids, dyschromia, textural changes, elastosis, volume loss, telangiectasias, and hyperkeratosis, collectively contributing to a prematurely aged appearance that exceeds the skin’s chronological age. The hallmarks of photoaging vary significantly by skin phototype. Skin of color tends to exhibit dyschromia and features associated with “intrinsic” aging, such as volume loss, while white skin is more prone to “extrinsic” aging characteristics, including rhytids and elastosis. Moreover, susceptibility to different wavelengths within the electromagnetic spectrum also differs by skin phototype, influencing the clinical presentation of photoaging, as well as prevention and treatment strategies. Fortunately, photoaging—and its associated adverse effects—is largely preventable and, to some extent, reversible. However, effective prevention and treatment strategies require careful tailoring to an individual’s skin type. In this review, we summarize molecular mechanisms underlying photoaging, examine its clinical manifestations, outline risk factors and prevention strategies, and highlight recent advancements in its treatment.

Background

There are limited data on clinical outcomes and prognosis factors for bullous pemphigoid (BP) at long-term follow-up.

Objective

We aimed to investigate the clinical outcomes and prognostic factors in BP patients.

Methods

This retrospective study was performed between January 1, 2009 and December 31, 2023 in Shandong Province, China. The primary outcomes were the rates and predictive factors of mortality, complete remission off-therapy (CROT), and relapse by Cox proportional hazards models or logistic regression analyses. Nomograms for BP mortality and CROT were also described.

Results

Of the 1063 BP patients enrolled, 45 were excluded due to loss to follow-up. The cohort comprised 1018 BP patients to analyze. A total of 344 (33.8%) patients died, with cumulative 1-, 3-, and 5-year mortality rates of 22.8%, 31.2%, and 34.5%, respectively. Increased age at onset (HR = 1.08), body surface area (BSA) involvement 10–30%, BSA involvement > 30% (HR = 7.19; HR = 9.84, respectively), double-positive IgG and C3 on DIF (HR = 1.37), and systemic corticosteroid in combination  with immunosuppressants treatments (HR = 0.50) were associated with mortality. A total of 321 (31.5%) patients achieved CROT. Cumulative CROT rates at 1, 3, and 5 years were 10.9%, 32.9%, and 47.5%, respectively. Shorter diagnosis delay time (HR = 1.01), baseline anti-BP180 antibody < 50 IU/mL (HR = 1.48) and systemic drugs other than corticosteroid treatment (HR = 1.68) were associated with CROT. Predictive models demonstrated outstanding performance in classifying mortality at 1, 3, and 5 years (AUCs 0.83, 0.86, 0.88), but moderate classification for CROT (AUCs 0.67, 0.62, 0.63). A total of 749 (73.6%) patients experienced relapses.

Conclusions

This study, the first large cohort to examine long-term outcomes in BP patients, identifies risk factors for mortality and CROT, offering key insights for clinicians to improve prognosis and reduce relapse rates.

Background

Tralokinumab, a first-in-class and second biologic approved for treating moderate-to-severe atopic dermatitis in adolescents and adults, has demonstrated consistent efficacy and safety across multiple clinical trials.

Objective

We aimed to assess the real-world effectiveness and safety of tralokinumab by performing a systematic review and meta-analysis on the real-world evidence of tralokinumab.

Methods

We systematically searched PubMed and EMBASE from inception until 28 July, 2024 for observational studies describing the effectiveness and safety of tralokinumab for the treatment of atopic dermatitis. The primary outcome was the proportion of patients achieving a ≥75% improvement in the Eczema Area and Severity Index (EASI-75) after 16 weeks and secondary outcomes included the proportion of patients achieving EASI-50 and EASI-90 and the proportion of patients experiencing adverse events.

Results

Nineteen unique studies encompassing 911 bio-naïve and bio-experienced patients with atopic dermatitis treated with tralokinumab were included. After 16 weeks of treatment, 82%, 59% and 26% of patients achieved EASI-50, EASI-75 and EASI-90, respectively, and the proportion of patients developing conjunctivitis was 3.2%.

Conclusions

Tralokinumab demonstrates strong effectiveness and good tolerability in real-world settings, with a high proportion of patients achieving a clinical response and adverse events being observed only infrequently.