The Journal of dermatological treatment最新文献

Objective: This study aims to analyze the different therapeutic responses between topical antimicrobial-corticosteroid combination and topical corticosteroids alone on improving the skin microbiome and skin barrier of patients with atopic dermatitis (AD).

Methods: Forty patients with mild-to-moderate AD were randomly assigned to receive two kinds of treatment. Skin swabs were collected from the lesional sites and nearby nonlesional sites at baseline, after topical medication treatment and 2 weeks post-treatment, and were analyzed by DNA sequencing of the fungal internal transcribed spacer (ITS)1-5 rDNA gene and the V3V4 region of the bacterial 16S rRNA gene.

Results: According to our research analysis, both topical steroids alone and combination treatment of steroids and antimicrobials effectively improved the severity of AD and repaired skin barrier. AD lesions were characterized by a decreased sebum level, lower abundance of Cutibacterium and a higher abundance of Staphylococcus. A combined topical treatment with an antimicrobial and steroid showed better responses in increasing skin sebum level and restoring the skin bacterial microbiome, whereas topical steroid alone did not improve skin dysbiosis.

Conclusion: A combined therapy with antimicrobial and steroid helps to recover the skin microbiome. Further studies are necessary to explore the therapeutic effects of treatments aiming at balancing the microbiome.

Background: Emerging research suggests that Janus kinase-signal transducer and activator of transcription (JAK-STAT) inhibitors may be associated with a higher risk of serious infection for patients with rheumatoid arthritis. However, there is no consensus on whether JAK inhibitors increase the risk of serious infection in patients with Immune-mediated inflammatory skin diseases (IMISDs).

Objectives: To ascertain the correlation between JAK inhibitor use and the risk of serious infection in patients with IMISDs.

Methods: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and registered Clinical Trials were searched up to June 1, 2024, using specific search terms related to JAK inhibitors and IMISDs. Randomized clinical trials (RCTs) comparing JAK inhibitors with a control group in patients with IMISDs were included. Studies focusing on cohort studies, case reports, case series, review articles, pooled analysis studies, post hoc analyses and topical JAK inhibitors were excluded. Data were extracted independently by two authors, focusing on serious infections defined according to each study's criteria. Crude numbers for serious infections were pooled and underwent meta-analysis. We assessed the primary outcome regarding the occurrence of severe infections for each study.

Results: Thirty-two randomized clinical trials involving 11,917 patients were included. Serious infections were reported in 0.62% of patients receiving JAK inhibitors and 0.51% of controls. Meta-analysis found no significant increase in risk of serious infection (I²=0.00%, RR, 0.68; 95% CI, 0.43-1.07). Subgroup analyses revealed no significant heterogeneity based on condition (p = .56) or medication (p = .69).

Conclusions: This meta-analysis demonstrates that JAK inhibitors do not significantly increase the risk of serious infections in IMISD patients compared to control treatments. These findings support the safety of JAK inhibitors in this population. Future research should focus on real-world evidence to further assess their risk-benefit profile in dermatological practice.

Background: Hailey-Hailey disease (HHD), a genetic blistering disease, is caused by a mutation in a calcium transporter protein in the Golgi apparatus encoded by the ATP2C1 gene. Clinically, HHD is characterized by flaccid vesicles, blisters, erosions, fissures, and maceration mainly in intertriginous regions. Some patients remain refractory to conventional treatments. Previously, a series of reports have confirmed naltrexone as an effective option for those patients. However, in China, naltrexone is unavailable in some hospitals and unaffordable for some patients.

Objective: To confirm naloxone as a treatment option for HHD, and assess the efficacy rate and safety of naltrexone for patients with HHD.

Methods: Two patients with biopsy-proven HHD received naloxone (2 mg/d, via intravenous infusion). We followed up with the two patients, assessing the change of skin lesions and obtaining photographs. We searched the PubMed databases using the keywords 'Hailey-Hailey disease' or 'benign familial pemphigus', and 'naltrexone' or 'naloxone', and reviewed English publications of reports and analyzed the efficacy and safety of naltrexone.

Results: Two patients prescribed naloxone showed completely remission in two weeks without any adverse reactions. The total remission rate of naltrexone for HHD is approximately 80%, without severe adverse effects.

Conclusion: Naltrexone is effective and safe in the treatment of HHD. Naloxone, an analog of naltrexone, can also effectively and safely treat HHD, potentially offering a new therapeutic option for patients with refractory HHD.

Purpose: Marionette lines, also known as static labiomandibular folds, are common age-related perioral wrinkles that impact facial aesthetics, particularly in Asian populations. This article aims to examine the anatomical basis, etiology, and filler injection techniques used for treating marionette lines.

Materials and methods: The study reviews anatomical studies and clinical practices related to marionette lines. Anatomical observations focus on the position of the modiolus and its relationship to age-related changes. Treatment approaches are examined through a review of filler injection techniques, including supramuscular and submuscular fat layer targeting, as well as neurotoxin use for enhancing treatment outcomes.

Results: The review finds that the anatomical positioning of the modiolus in Asian populations predisposes them to increased susceptibility to commissural ptosis and wrinkle formation. Filler injections, particularly using a cannula for deeper layers, are effective for addressing volumetric loss in the supramuscular and submuscular layers. Neurotoxin injections into the depressor anguli oris muscle can enhance results by reducing downward force on the oral commissure.

Conclusions: Marionette lines are complex, multifactorial wrinkles that benefit from a multimodal treatment approach, combining dermal fillers and neurotoxins. Awareness of anatomical variations and proper injection techniques is crucial for achieving optimal aesthetic outcomes and minimizing risks.

Purpose: Dupilumab is a widely recommended treatment for moderate-to-severe atopic dermatitis (AD), with known ocular side effects but less frequent cutaneous reactions.

Material and methods: This case report details a 52-year-old female patient with atopic dermatitis treated with dupilumab. After an initially successful treatment, the patient developed a rosacea-like dermatitis. At first, dupilumab was continued alongside doxycycline, metronidazole gel and ivermectin cream.

Results: Following a worsening of her skin condition, dupilumab was discontinued. Lebrikizumab was introduced, leading to significant regression of the lesions.

Conclusions: This case highlights a rare paradoxical skin reaction to dupilumab, potentially linked to the blockade of IL-4Rα, which may shift the immune response towards a Th1/Th17 phenotype. The findings suggest that alternative therapies, such as IL-13 inhibitors, should be considered when cutaneous side effects arise during dupilumab treatment.

Purpose: Alopecia areata (AA), an autoimmune disorder characterized by non-scarring hair loss, is detrimental to the psychological health and quality of life of people living with AA. Clinically meaningful hair regrowth is possible, but the relationship with downstream patient-reported outcomes (PROs) is complex.

Materials and methods: This post hoc analysis of ALLEGRO-2b/3 (NCT03732807) longitudinal data from Weeks 24-48 compared improvements in PROs between patients who achieved (responders) or did not achieve (non-responders) clinically meaningful scalp hair regrowth. Responders were defined by a Week 24 Severity of Alopecia Tool (SALT) score ≤20 (SALT20) or ≤10 (SALT10). Across 6 PROs assessing multiple AA-related health domains, response proportions and mean changes from baseline were estimated for Weeks 24-48.

Results: Among 650 included participants, 114 (17.5%) were SALT20 responders, of which 76 (11.7%) were also SALT10 responders. Generally, more responders than non-responders reported improvements in AA and related symptoms or limitations and satisfaction with hair regrowth. Responders additionally reported greater improvement from baseline than non-responders for measures of AA-related emotional symptoms, mental health, and work or activity limitations.

Conclusions: These results support a positive relationship between scalp hair regrowth and downstream PROs-including satisfaction and psychosocial burden-demonstrating an association between clinically meaningful hair regrowth and patient-reported treatment benefits.

Purpose: Basal cell carcinoma (BCC) is one of the most common skin cancers. Most BCCs can be treated with surgery excision. For advanced BCC unsuitable for curative surgery, the combination of radiotherapy and Hedgehog pathway inhibitors (HHI) are effective systemic treatment options. However, there is a scarcity of evidence-based guidelines for the management of patients with advanced or metastatic BCC, particularly those who develop resistance to HHI therapy.

Materials and methods: We report the case of a patient with advanced BCC of the head and neck, which originated from a nevus sebaceous.

Results: The patient initially responded well to sonidegib, an HHI, but resistance emerged within a month. We then modified the systemic therapy to include a combination of radiotherapy and the anti-PD-1 agent sintilimab.

Conclusions: This adjusted treatment regimen led to effective long-term clinical responses without significant adverse events.

Purpose: This study aims to explore the effectiveness of low-dose oral minoxidil (LDOM) in treating short anagen hair syndrome (SAS), a rare congenital condition characterized by a shortened anagen phase. While SAS often resolves spontaneously with puberty, treatment remains controversial. Recent studies have demonstrated the efficacy of low-dose oral minoxidil (LDOM) in treating various hair loss conditions, including SAS.

Materials and methods: This report presents a case of a 24-year-old female with SAS who experienced significant improvement following LDOM treatment. The patient, who had persistent hair growth issues since childhood, had tried several therapies, including topical 5% minoxidil with limited success. The patient was started on LDOM at 1.25 mg and increased to 2.5 mg after one month.

Results: After starting LDOM, the patient reported reduced hair shedding, increased hair length, and improved hair density, which was also confirmed by Canfield's HairMetrix measurements. Despite experiencing mild facial hypertrichosis, the patient opted to continue the treatment.

Conclusion: This case adds to the growing body of evidence supporting LDOM as a viable treatment for adult SAS. The findings may also offer insights into the genetic basis of SAS and its overlap with other hair loss conditions, suggesting possible shared therapeutic approaches.