The Journal of dermatological treatment最新文献

Purpose: This review aims to outline the crucial role of IL-36 signaling in inflammatory skin diseases and summarize the therapeutic potential of spesolimab. Our goal is to provide insights into the off-label applications of spesolimab and future directions for its use in treating other challenging skin diseases.

Materials and methods: We conducted a comprehensive literature search across PubMed, Embase, Web of Science, MEDLINE, Scopus, and the Cochrane Library to identify relevant studies. For RCTs, we additionally searched the ClinicalTrials.gov database.

Results: In this review, we examine its off-label applications for conditions such as palmoplantar pustulosis, acrodermatitis continua of Hallopeau, hidradenitis suppurativa, pyoderma gangrenosum, and acute generalized exanthematous pustulosis. This review also explores the role of IL-36 in the pathophysiology of these disorders and discusses how spesolimab may address the limitations of current therapies for refractory cases. Randomized controlled trials and case reports are summarized to highlight the efficacy and tolerability of spesolimab across various inflammatory skin conditions. We highlight the challenges presented by the absence of standardized treatment guidelines and the need for larger clinical trials.

Conclusions: This review underscores the potential of spesolimab to enhance treatment strategies for inflammatory skin diseases.

Purpose: Minoxidil is a routinely used drug in treating multiple hair disorders. This study aimed to investigate the facticity of the temporal increase in the hair shedding amount after topical use of minoxidil.

Materials and methods: We selected 49 patients who used 2% or 5% minoxidil topically to treat androgenetic alopecia for 24 weeks. The amount of hair shedding was recorded every four weeks before and after the treatment. The BASP classification and trichoscopy test results were also recorded before and after the treatment. The relative amount of hair shedding (RAHS) was defined as the recorded number of hair shedding after normalization. The correlation between the maximum RAHS (MRAHS) and the sulfotransferase activity as well as the therapeutic effect was calculated.

Results: A temporary increase in the amount of hair shedding was detected in the first 12 weeks. This increase has a longer duration in patients treated with 2% minoxidil compared to 5%. Its severity was correlated with the improvement of trichoscopy tests only in patients with 5% minoxidil but not in 2%. However, both patients in the 2% and 5% minoxidil groups had a significant association between the MRAHS and the improvement in BASP classification.

Conclusion: The amount of hair shedding increases temporarily after the topical minoxidil use, the level of which is a potential treatment efficacy.

Purpose of the study: Radiation-induced dermatitis (RID) is the most frequent side effect of radiotherapy; however, no effective treatments are currently available. This study investigated the efficacy and safety of an herbal gel for preventing RID and associated symptoms in patients with cancer.

Materials and methods: Cancer patients were randomly assigned 1:1 in an open-label randomized clinical trial. Patients in the prophylactic group received preventative herbal gel treatment (one day before radiotherapy). Patients in the interventional group received herbal gel treatment (upon the development of grade 2 RID). Outcome measures were scored according to the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer. Patient-reported skin symptoms (Skindex-16), quality of life (QLQ-C30), and adverse effects (CTCAE V4.0) were investigated.

Results: Among 71 participants, the prophylactic group showed significant relief with a medium effect size for itching, hurting, and burning or stinging (p < .05, effect size >0.5) compared to the interventional group. No statistically significant difference in the incidence of RID was found (51% in the prophylactic group vs. 53% in the interventional group, p = .91). The prophylactic application of the gel did not affect patient quality of life. No adverse reactions associated with the gel were observed.

Conclusions: Preventative herbal gel treatment can alleviate the radiation dermatitis-related symptoms with good safety, which indicates that gel could be an option for integration in patient care to improve RT in patients with breast, lung, and head and neck cancers.

Objective: Psoriasis is a chronic inflammatory skin disease with significant physical and psychological burden, often associated with comorbidities such as obesity and cardiovascular disease. Current treatments include conventional systemic therapies and targeted biologic and non-biologic therapies, with several limitations related to safety, efficacy, and cost. Roflumilast, a selective PDE4 inhibitor, shows potential as an oral therapy for psoriasis due to its anti-inflammatory effects and favorable safety profile. This study aimed to evaluate the real-world effectiveness and safety of oral roflumilast in moderate-to-severe plaque psoriasis.

Methods: Prospective cohort study at a single center in Portugal including adults with moderate-to-severe psoriasis treated with oral roflumilast 500 mcg once daily.

Results: Among fifty-eight patients (baseline median PASI 13.7 ± 5.5), 63.0% achieved PASI < 5, 47.8% PASI < 3, and 21.7% PASI < 1 by week 24 (mNRI). Weight loss occurred in 53.4%, with a mean reduction of 6 kg ± 4.3. Mild gastrointestinal symptoms were common but rarely caused discontinuation. No serious adverse events were reported.

Conclusion: Roflumilast demonstrated real-world effectiveness and a favorable safety profile in moderate-to-severe plaque psoriasis. Additional benefits, including weight loss and no need for laboratory monitoring, make it a promising treatment option, particularly for patients with comorbidities or limited access to biologic therapies.

Purpose: This study aimed to investigate the effectiveness and safety of a new monopolar radiofrequency device equipped with a 5 cm² tip, against fine wrinkles around the eyes and cheeks.

Materials and methods: This multicentered, prospective pilot study involved treating participants with mild-to-moderate wrinkles on both periorbital areas and cheeks using the monopolar radiofrequency device for one session. One and four months after treatment, wrinkle reduction, overall esthetic improvement, adverse events, and vital signs were evaluated.

Results: The study involved 13 participants (age: 35-62 years) and on a five-point scale, periorbital wrinkles showed a significant reduction at 4 weeks (0.96 ± 0.65) and 16 weeks (1.04 ± 0.59). On a five-point scale, cheek wrinkles also decreased at weeks 4 and 16 (1.00 ± 0.55 and 1.12 ± 0.64, respectively). On a five-point scale (range: -1-3), overall global esthetic improvement was rated by the participants at weeks 4 and 16 to be 2.23 ± 0.80 and 2.31 ± 0.61, respectively. Adverse events were not observed during the follow-up.

Conclusion: A single session using the new monopolar radiofrequency device equipped with a 5 cm² tip safely and effectively improves mild-to-moderate periorbital and facial wrinkles.

Background: Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) not only regulates cholesterol metabolism and cardiovascular disorder but also modifies inflammatory response and autoimmunity.

Objective: This study investigated the relation of PCSK9 to clinical features and treatment outcomes in psoriasis patients.

Methods: One hundred and five psoriasis patients who initiated systemic treatment due to moderate-to-severe disease condition were enrolled. Baseline characteristics and treatment response after 12-week treatment were collected. Their serum samples before treatment initiation were collected and sent to PCSK9 detection by enzyme-linked immunosorbent assay. Serum PCSK9 was also detected in 30 healthy subjects.

Results: PCSK9 level was 2-fold times in psoriasis patients vs. healthy subjects. PCSK9 could predict psoriasis risk with AUC of 0.777. By optimum cutoff value of 179 ng/ml, PCSK9 had the best predictive potential for psoriasis risk. PCSK9 quartile was positively correlated with BMI, hyperlipemia history, PASI, and sPGA. However, PCSK9 quartile was not correlated with PASI 75 response, PASI 90 response, or sPGA 0/1 response at week 12.

Conclusion: PCSK9 is upregulated and correlated with severe disease condition, but fails to predict treatment outcomes in psoriasis patients.

Purpose: The Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II) was developed to enhance the methodological rigor of clinical practice guidelines (CPGs), aiming to generate trustworthy recommendations for various clinical scenarios. Despite its importance, there exists a gap in the quality of CPGs pertaining to Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (SJS-TEN). The aim of the study was to evaluate SJS-TEN CPGs to shed light on areas for enhancing SJS-TEN guidelines' quality.

Materials and methods: A systematic review was conducted to identify SJS-TEN CPGs from January 2011 to December 2023 across bibliographic and guideline databases, as well as dermatology association websites. Four reviewers employed the AGREE II instrument to appraise the quality of eligible CPGs. Subsequently, AGREE II domain scores were calculated and their recommendations mapped.

Results and conclusions: Seven eligible SJS-TEN CPGs reviewed, originating from Europe, North America, Asia, and an authorship Group. The highest AGREE II domain scores were observed in scope and purpose (mean: 63%, standard deviation [SD]: 23.195%) and clarity of presentation (mean: 70%, SD: 14.5%). Conversely, the lowest score was noted in the applicability domain (mean: 28%, SD: 17.44%). Only two guidelines by the British Association of Dermatologists (28.6%) met the 'recommend' level. Recommendations from all CPGs were compared in tabular form.

Background: Data directly comparing targeted narrowband ultraviolet B (NB-UVB), 308-nm excimer laser, and 308-nm excimer lamp for vitiligo are limited.

Objectives: We compared the efficacy and safety of these three modalities in vitiligo.

Methods: In this retrospective study, we reviewed the medical records of vitiligo patients at the Photodermatology Clinic, Siriraj Hospital. Patients received either targeted NB-UVB (group A), a 308-nm excimer laser (group B), or a 308-nm excimer lamp (group C), administered two to three times per week for at least 3 months. Photographs taken before and after therapy were evaluated. The primary outcome was repigmentation, graded on a five-tier scale: poor (0-25%), fair (26-50%), good (51-75%), very good (76-90%), and excellent (91-100%). The secondary outcome was treatment-related adverse events.

Results: No statistically significant differences in efficacy were observed among the three groups, indicated by a very good to excellent response in 42.4% (group A), 17.6% (group B), and 29.4% (group C). Although group A showed higher response rates at 3 and 6 months, differences were not significant. Adverse effects were significantly more frequent in group C.

Conclusions: All three devices demonstrated comparable efficacy and promoted rapid repigmentation. However, the excimer lamp had the highest rate of adverse effects.

Objective: To investigate the efficacy and safety of 308-nm excimer laser therapy with or without fire needle therapy in patients with stable acral vitiligo.

Methods: A retrospective study was conducted to review patients with stable acral vitiligo treated between January 2020 and October 2024. In addition to topical halometasone cream, patients received either 308-nm excimer laser therapy alone (laser group) or a combination of 308-nm excimer laser and fire needle therapies (combination group) for three months. Vitiligo Area Scoring Index (VASI), physician global assessment (PGA), pain during treatment, and side effects were compared between the groups.

Results: A total of 62 patients (32 in the laser group and 30 in the combination group.) were included. The mean age was 34.2 ± 9.8 years, with 39 (62.9%) males. Baseline characteristics were comparable between the two groups. Patients in both groups experienced a reduction in VASI scores (0.06 ± 0.74 and 0.16 ± 0.14 in the laser and combination groups, respectively). Compared with the laser group, the combination group showed significant improvement in lesion appearance, but reported mild pain (p < 0.001). Both groups experienced mild skin reactions, which resolved quickly after treatment.

Conclusions: Combination therapy with 308-nm excimer laser and fire needle is a safe and effective approach for stable acral vitiligo.

Purpose: To evaluate the burden of chronic spontaneous urticaria (CSU) compared with atopic dermatitis (AD) and psoriasis (PSO).

Methods: This retrospective, cross-sectional study used real-world data from adult respondents from the 2019 US National Health and Wellness Survey (NHWS). Outcome measures included the 36-item Short-Form Survey version 2 (SF-36v2; mental and physical component summary [MCS and PCS] scores), Work Productivity and Activity Impairment (WPAI), and healthcare resource utilization (HCRU).

Results: Among 74,994 respondents (CSU N = 371; AD N = 549; PSO N = 2061), mean (standard deviation [SD]) age at data collection was 41.7 (14.0), 48.4 (16.3), and 51.4 (16.6) years for CSU, AD, and PSO, respectively. Mean (standard error [SE]) MCS and PCS scores were lower (worse) among respondents with physician-diagnosed CSU vs. AD and PSO, respectively: MCS: 41.3 (0.6) vs. 44.8 (0.5) vs. 45.3 (0.2); PCS: 42.1 (0.5) vs. 47.8 (0.4) vs. 47.7 (0.2); all p < 0.001. Respondents with CSU reported higher (p < 0.001) work and activity impairment and HCRU vs. respondents with AD or PSO.

Conclusion: After adjusting for confounders, respondents with CSU experienced higher humanistic and economic burden compared with respondents with AD or PSO, indicating a need for new treatments and improved clinical management.