The Journal of dermatological treatment最新文献

Onychomycosis is a prevalent fungal infection of the nail unit that disproportionately affects individuals with diabetes, often presenting with increased severity and a higher risk of complications such as impaired mobility, secondary bacterial infection, and ulceration.

Objectives: This review examines the pathophysiological relationship between diabetes and onychomycosis, appraises the safety and efficacy profiles of current antifungal therapies, and outlines key considerations in selecting appropriate treatment regimens. It addresses pharmacokinetics, hepatic and renal considerations, and drug-drug interactions, while emphasizing the emerging role of topical therapies and the importance of a patient-centered approach.

Results: Early and accurate diagnosis utilizing mycological and molecular techniques such as fungal culture, histopathology, and polymerase chain reaction is essential to guide effective management in this high-risk population and mitigate adverse outcomes. Timely intervention is critical to reduce morbidity and prevent long-term complications. Topical and oral antifungals should be considered for mild to moderate and moderate to severe onychomycosis, respectively. The use of oral agents can be complicated by comorbidities and polypharmacy which heighten the risk of contraindications and drug-drug interactions. Therapeutic success in this population relies not only on appropriate drug selection but also on antifungal stewardship and patient adherence to prescribed regimens.

Conclusions: In view of the expanding aging population and increasing comorbidity burden, physicians should remain cognizant about diagnosing and treating onychomycosis in diabetic patients. An interdisciplinary approach to management is advisable.

Objectives: To evaluate the clinical characteristics and therapeutic outcomes of ulcerated infantile hemangioma (IH) and identify prognostic factors of ulcerated IH.

Methods: A single-center retrospective study recruiting patients with ulcerated IH between 2008 and 2023 was conducted. Clinical features and treatment response were analyzed to identify prognostic factors of ulcerated IH and differences in outcomes between early versus late pediatric dermatology referral.

Results: A total of 85 patients with ulcerated IH were included. Hemangiomas in the head and neck (H&N) and anogenital regions had an earlier presentation and occurrence of ulceration. Large hemangiomas or ulcers, combined/mixed IH, lip hemangiomas, and positive microbial growth were significant prognostic indicators for longer healing time, more complications and recurrence of ulceration. Cheek hemangiomas, focal IH and later onset ulceration were associated with less scarring and complications. Early referrals before ulceration had less ulcer recurrence (odds ratio [OR] = 0.139; 95% confidence interval [CI]: 0.028-0.693] and secondary complications (OR = 0.081 [95% CI: 0.019-0.348]). Prophylactic topical timolol maleate 0.5% was effective in reducing scar formation (OR = 0.06 [95% CI: 0.005-0.75]) and shortening follow-up duration (P = 0.044). Combination therapy with oral propranolol and pulsed dye laser was the mainstay of treatment (74%). Maintenance laser after ulcer resolution was associated with less ulcer recurrence (OR = 0.27 [95% CI: 0.075-0.96]).

Conclusion: Early referral of high-risk cases to a pediatric dermatology center before ulceration is crucial. Prophylactic topical timolol before ulceration and maintenance laser therapy after ulcer resolution can improve outcomes.

Background: Psoriasis is a chronic inflammatory disease affecting about 2% of the global population, with moderate-to-severe forms requiring systemic treatment for successful disease management. By targeting the interleukin (IL)-23p19 subunit of IL-23, the master cytokine of psoriasis pathogenesis, guselkumab, tildrakizumab, and risankizumab offer improved risk-benefit profiles.

Objective: While randomized clinical trials (RCTs) provide controlled data, real-world evidence (RWE) offers insights into the performance of these therapies in diverse patient populations, including those with comorbidities or difficult-to-treat areas affected. With RWE on these inhibitors constantly emerging, a comprehensive overview and expert interpretation are essential for providing key insights into psoriasis management in clinical practice.

Methods: This review, therefore, examined RWE on the effectiveness and safety of IL-23p19 inhibitors compared to their pivotal RCTs.

Results: Despite some gaps between RCT and RWE outcomes, particularly in underrepresented subpopulations, IL-23p19 inhibitors show strong effectiveness and favorable safety across both settings in the short- and especially in the long term, accompanied by an improvement in health-related quality of life and reduction of the main symptoms.

Conclusion: Altogether, these factors make these medicines ideal treatment options. Future research should focus on improving patient-reported outcomes, specifically addressing psychological and quality-of-life aspects, to further optimize psoriasis management.

Purpose/aim: Remote clinical research has potential to increase study diversity, reduce costs for researchers and participants, and increase efficiency of studies. This study evaluates the reliability and feasibility of using SkinTracker, a mobile application, for remote AD severity assessment through mobile-app based photography and surveys.

Methods: This single-center observational study enrolled 28 participants (18 with AD and 10 healthy controls) in an eight-week hybrid clinical study. Participants completed bi-weekly tasks and submitted standardized skin photographs via the SkinTracker app, and clinic-based skin exams and digital single-lens reflex (SLR) photos were obtained at baseline and week 8. Eczema Area Severity Index and Investigator Global Assessment scores were assigned to the photographs by a grader. Intraclass correlation coefficients were used to evaluate agreement between app-based, in-person, and SLR assessments for the 18 participants with AD.

Results: App-based AD assessment scores had excellent agreement with in-person scores, indicating the reliability of SkinTracker to assess disease activity remotely. Furthermore, all participants had high compliance and satisfaction with app-based activities, indicating that using SkinTracker for remote clinical research is achievable and even preferred by participants.

Conclusion: Overall, these findings show that SkinTracker is both reliable and feasible for monitoring atopic dermatitis disease activity remotely.

Objective: Untreated vulvar lichen sclerosus (VLS) can lead to irreversible anatomical changes and increase malignancy risk. Some patients show poor response to standard treatments, resulting in refractory cases (RVLS).

Methods: To explore risk factors associated with RVLS and integrate treatment strategies for improved clinical management, we conducted a retrospective analysis, which included patients with VLS who visited our outpatient clinic between March 2017 and March 2025. Additionally, an evidence synthesis of the currently reported treatment regimens for RVLS was conducted.

Results: A total of 457 patients were included, of whom 36 were diagnosed with RVLS (7.9%). A multivariable logistic regression model identified comorbid autoimmune thyroid diseases (OR 2.45; 95%CI 1.09-5.34), perianal region involvement (OR 3.20; 95%CI 1.19-8.09), and presence of erosion/fissures (OR 3.13; 95%CI 1.44-7.29) as independent predictors for RVLS. Furthermore, the treatment approaches for 281 patients with RVLS across 20 studies included Janus kinase inhibitors (JAK), adalimumab, methotrexate, cyclosporine, photodynamic therapy (PDT), and laser therapy, with assessments of efficacy, side effects, and recurrence.

Conclusions: Our study identified three predictive factors for RVLS, which may help in treatment decisions and reduce ineffective therapy. And therapies such as JAK and PDT show promise as optimized options, although larger studies are needed.

Background: Interleukin (IL) inhibitors are increasingly used in the management of moderate-to-severe plaque psoriasis. However, their use in patients with a history of cancer is debated.

Objective: We conducted a multicenter retrospective study across nine Italian Dermatology Units to assess the real-world effectiveness and safety of IL inhibitors (IL-23, IL-17, IL-12/23) in 136 oncological patients with moderate-to-severe plaque psoriasis. In particular, we evaluated 116 patients who developed the neoplasm before starting the biologic with a mean time from diagnosis of neoplasia to the first biologic dose of 8.31 years. We also assessed 20 patients who received a diagnosis of neoplasm during treatment with IL inhibitors after a mean time of 2.41 years from the start of the biologic with a cumulative incidence of 3.06 per 1000 individuals.

Results: Three patients experienced neoplasm recurrence during treatment with IL inhibitors, which led to the discontinuation of these drugs. In our study, biologics have demonstrated safety and effectiveness as treatment options for patients with both a history of neoplasm and those with concurrent tumors. However, further investigation is needed, particularly through larger and longer multicenter studies.