Archives of Dermatological Research最新文献

Merkel cell carcinoma (MCC) is an aggressive skin malignancy with rising incidence. Prior studies suggest sociodemographic factors influence outcomes, but data in the immunotherapy era are limited. This study evaluates the association between sociodemographic characteristics and MCC presentation, treatment, and survival in the immunotherapy era. We conducted a retrospective population-based cohort study using National Cancer Database data from 2016 to 2020 to evaluate associations between sociodemographic factors, disease presentation, treatment, and survival in MCC during the immunotherapy era. We observed differences in presentation, treatment, and outcomes by race, insurance status, and socioeconomic status. Black patients had 1.52-fold higher odds of presenting with stage II disease (95% CI 1.09–2.12) and 1.41-fold higher odds of stage III/IV disease (95% CI 1.25–1.59) compared to White patients, along with longer median treatment delays (25.5 vs. 19.7 days, p < 0.05). Shorter time-to-treatment was independently associated with improved survival (HR 0.89; 95% CI 0.83–0.95). Overall treatment rates were high (97.41%), but uninsured patients had higher amputation rates (1.47% vs. 0.37%, p < 0.001) and were twice as likely to receive no treatment (5.88% vs. 3.13%, p < 0.001) versus privately insured patients. Five-year survival differed across SES quartiles (45.99% vs. 55.09% for lowest vs. highest, p < 0.001). In multivariable analysis adjusting for age, sex, stage, comorbidity, and treatment, only SES remained an independent predictor of survival, with the highest quartile showing a 17% lower mortality risk (adj-HR 0.83; 95% CI 0.71–0.96). In conclusion, SES was the strongest independent predictor of survival (adj-HR 0.83 for highest vs. lowest quartile) in this national MCC cohort, with additional differences by race, insurance, and geography in disease presentation and treatment patterns. These findings highlight the importance of considering sociodemographic factors in managing MCC in the immunotherapy era.

Hair loss, medically known as alopecia, has a profound effect on the psychological disposition of those who suffer from it, making it a topic of great importance to improve treatment and understand hair biology. This paper will look into baldness’s biological and genetic causes in the quest to give an all-inclusive overview of the classifications and detection techniques. A note on the conventional treatments, including Minoxidil and Finasteride, and innovative therapies, like platelet-rich plasma and stem cell therapy, is also considered. Moreover, the paper discusses technological advancements that play an essential role in early diagnosis, including scalp dermoscopy, trichoscopy, and digital imaging. The rationale behind using machine learning (ML) techniques like Convolutional Neural Networks (CNNs), Support Vector Machines (SVMs), and Self-Regulated Networks like RegNet-64 is their automation capacity in baldness detection and classification. A comparative analysis of these models has further disclosed and revealed their strengths and weaknesses in both clinical and research settings. This review of the prior literature will emphasize the mighty role of Artificial Intelligence (AI) and ML in improving diagnostic precision, facilitating timely interventions, and enhancing patient outcomes in managing hair loss. Comparative analysis of such models has revealed more and further disclosed and exposed their strengths and weaknesses in both clinical and research settings. In this review of earlier literature, the mighty role of AI and ML will be highlighted to improve diagnostic precision, allowing for timely interventions and, thus, improved patient outcomes in managing hair loss.

Psoriasis is a chronic, immune-mediated skin disease characterized by keratinocyte stress and cytokine-driven inflammation. Glycoprotein 96 (gp-96), a heat shock protein 90 paralog located in the endoplasmic reticulum, plays a critical role in the folding of Toll-like receptors and may contribute to the amplification of inflammatory responses. This study investigated serum gp-96 levels in patients with psoriasis compared to healthy controls and explored potential associations with clinical features. A total of 44 psoriasis patients and 44 healthy individuals were enrolled in a prospective case-control study. Serum gp-96 concentrations were quantified using ELISA. Patients’ demographic and clinical data, including PASI scores, nail and joint involvement, and treatment modalities, were collected. Serum gp-96 levels were significantly higher in psoriasis patients than in healthy controls (median 15.92 vs. 9.33 ng/mL, p < 0.001). However, gp-96 levels did not correlate significantly with PASI score, age, disease duration, or other clinical variables. ROC analysis revealed that serum gp-96 has good diagnostic performance in distinguishing psoriasis patients from controls, with an AUC of 0.83 and an optimal cut-off value of 11.57 ng/mL (sensitivity and specificity: 77.3%). A borderline association with nail involvement was observed, suggesting a potential link between gp-96 levels and localized keratinocyte stress. These findings suggest that gp-96 may be a promising diagnostic biomarker in psoriasis, independent of disease severity, and could play a role in the pathogenesis of the disease through its involvement in ER stress and innate immune activation. Further studies with larger cohorts and tissue-level investigations are warranted to validate these results and explore the therapeutic potential of targeting gp-96 in psoriatic disease.

While patient-reported outcome measures (PROMs) provide valuable clinical insights and can complement clinician-reported outcome measures, their use can be limited by completion time and integration barriers. Although item response theory-based Patient-Reported Outcomes Measurement Information System (PROMIS) measures offer advantages, their content validity in skin disease remains unclear. This study evaluates the content validity (i.e. relevance, comprehensibility, and comprehensiveness) of a profile of PROMIS scales among patients with acne, atopic dermatitis, psoriasis, hidradenitis suppurativa, and alopecia areata. Cognitive debriefing interviews were conducted among English-speaking adults with dermatologist-confirmed acne, atopic dermatitis, psoriasis, hidradenitis suppurativa, or alopecia areata. Participants were recruited from Brigham and Women’s Hospital dermatology clinic and National Eczema Association from January 5, 2024, to July 19, 2024. Among 30 participants, mean age was 37.3 years. PROMIS scales ‘Anxiety’, ‘Satisfaction with Participation in Discretionary Social Activities’, ‘Ability to Participate in Social Roles and Activities’, ‘Satisfaction with Social Roles and Activities’, ‘Pain Intensity’ demonstrated sufficient relevance (> 85% items relevant). Scales for ‘General Life Satisfaction’ (77.3%), ‘Depression’ (84.4%), ‘Social Isolation’ (80.0%), ‘Itch Severity’ (83.3%) did not meet this threshold. Comprehensibility and comprehensiveness were high across scales. Some reported seven-day recall may not capture disease fluctuations; and insufficient coverage of romantic relationships, body image, and treatment satisfaction. In this cohort of participants with chronic skin disease, several PROMIS scales demonstrated acceptable content validity, providing insight into suitability for use. Further research evaluating additional measurement properties (e.g., construct validity, responsiveness) is needed.

Systemic sclerosis (SSc) and morphea are fibrosing skin conditions with limited treatment options and often unpredictable responses. Interleukin-17 (IL-17), a pro-inflammatory cytokine, has emerged as a potential target given its complex role in fibrosis. Early studies of brodalumab have suggested potential improvement in SSc skin scores, though results remain preliminary and unpublished. Secukinumab has shown benefit in several case reports involving morphea and stiff skin syndrome. However, concerns remain about long-term safety, including cardiovascular risks and rare cases of drug-induced scleroderma-like illness. In this narrative review, we summarize the current clinical and translational literature on IL-17 blockade in fibrosing skin disease, including two phase II trials and five case reports published between 2019 and 2024. Across these studies, IL-17 inhibitors were associated with improvements in skin thickening, disease activity, and quality-of-life scores in select patients. We also explore the immunologic rationale for IL-17 inhibition and its interplay with TGF-β and fibroblast activation. While current data remain limited, IL-17 blockade shows early promise as a targeted therapy for fibrosing skin disease. Further investigation is needed to clarify patient selection criteria, validate long-term efficacy, and ensure safety. As our understanding of immune-mediated fibrosis deepens, IL-17 inhibitors may offer a novel therapeutic approach for patients with refractory or progressive skin fibrosis.

Metal contact allergies have consistently ranked among the most prevalent contact allergies globally. However, trends in the allergies vary by region. This study aimed to assess the prevalence and trends of contact allergies to metals in the baseline series over the past decade. It also sought to identify factors associated with the metal allergies comparing to those without metal allergies. We analyzed patch test data for the metallic allergens—nickel, cobalt, and chromium, —collected from January 2013 to December 2022. The rate of all metal contact allergies decreased. Nickel emerged as the most prevalent allergen (21.7%), followed by chromium (9.6%), and cobalt (7.9%). Notable associated factors for metal contact allergies include female sex, occupational exposure, and a history of suspected metal contact allergy. Concomitant positive reactions were most frequently observed with the combinations of nickel and cobalt. A decline in metal contact allergy prevalence in Thailand, correspond to rising popularity in various novel metal substitutes; plastic, resin or natural materials. Dermatologists should also keep track of contact allergy to those metal substitutes.

Acne vulgaris affects approximately 9.4% of the global population and disproportionately burdens individuals with skin of color (SOC) through persistent postinflammatory hyperpigmentation (PIH) and acne scarring. Conventional therapies primarily target inflammatory lesions but have limited efficacy for pigmentary sequelae. Energy-based devices (EBDs) have emerged as valuable adjuncts, yet most available evidence is derived from studies in lighter skin phototypes. This narrative review evaluates the efficacy, safety, and clinical considerations of EBDs for acne and its sequelae in SOC, with a focus on Fitzpatrick skin types IV–VI. We reviewed clinical trials, case series, and systematic reviews investigating ablative and non-ablative lasers, picosecond lasers, radiofrequency (RF), intense pulsed light (IPL), and combination therapies, assessing outcomes such as acne clearance, acne scar remodeling, PIH improvement, and adverse events. Fractional non-ablative lasers and long-wavelength Nd: YAG devices consistently demonstrated improvements in acne scars and pigmentation, with mostly self-limited PIH, although studies were small (n < 50) and short-term. Picosecond lasers showed promise for both acne scarring and pigmentary disorders with low complication rates, while RF microneedling improved acne scar texture with minimal pigmentary risk due to its chromophore-independent mechanism. IPL and LED therapies yielded modest lesion reductions but variable patient satisfaction. Across modalities, PIH was the most frequent adverse event, typically transient but more common with higher fluence or higher density settings. The current evidence base is limited by small sample sizes, underrepresentation of SOC populations, particularly Black and Afro-Caribbean patients, and a lack of standardized outcome measures. EBDs represent valuable adjuncts for acne and acne scarring in SOC when conservative parameters and tailored protocols are used, with RF microneedling and longer-wavelength lasers appearing most favorable. Larger, SOC-inclusive randomized trials are urgently needed to establish evidence-based guidelines and ensure equitable, safe, and effective acne care.