The Journal of dermatological treatment最新文献

Objectives: Localized scleroderma, also called morphea, is an inflammatory cutaneous disorder characterized by sclerosis of the skin and underlying tissues. Morphea is currently classified into 4 subtypes: limited, generalized, linear and mixed. Linear morphea in an en coup de saber pattern (LScs) manifests as band-like, atrophic lesions predominantly affecting the frontoparietal area, leading to facial contour defects and skin pigmentation. However, pharmacological treatments for LScs are limited in meeting the aesthetic expectations of patients. Recently, autologous platelet concentrates have shown great therapeutic potential for tissue regeneration and wound healing, while few studies have been conducted on their use in LScs patients.

Methods and results: We present the first report of two patients with inactive LScs that were improved by treatment with injectable platelet-rich fibrin (i-PRF), a second-generation autologous platelet concentrate. Satisfactory aesthetic outcomes were both achieved in two patients within 5 injection sessions, with only mild pain and transient erythema after injection.

Conclusions: Injectable platelet-rich fibrin can be a novel, valid therapeutic alternative for morphea management.

Background: The clinical definition of moderate psoriasis is debated, affecting treatment eligibility and patient outcomes.

Objective: A panel of Italian dermatologists aimed to propose practical criteria to define moderate psoriasis, based on a comprehensive literature review and clinical experience.

Methods: The panel reviewed publications between 2016 and 2024 focusing on key severity scores, including the Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), Dermatology Life Quality Index (DLQI), and Physician's Global Assessment (PGA), along with special area involvement and patient-reported outcomes.

Results: Despite variability among studies, and the lack of universally accepted thresholds, the panel defined moderate psoriasis as a BSA of 5%-10%, DLQI of 5-10, a PGA score of 3, and involvement of at least two special areas (e.g. scalp, face, genitals, nails, hands, or feet). Distressing itch and psychosocial impact were also recognized as critical elements influencing perceived disease burden. A composite PGA-based approach, integrating objective measures with patient-centered criteria, is proposed for identifying patients with moderate psoriasis who may benefit from systemic therapy.

Conclusion: This pragmatic approach may help bridge the gap between guidelines and real-world clinical practice, ensuring more accurate treatment allocation and reducing undertreatment of psoriasis.

Purpose: Discoid lupus erythematosus (DLE) is a chronic autoimmune skin disorder that primarily affects sun-exposed areas and may lead to permanent scarring and dyspigmentation if inadequately treated. Therapeutic options for DLE remain limited, and long-term use of topical corticosteroids or calcineurin inhibitors is often constrained by adverse effects, particularly on facial skin. This report aims to describe the clinical response of facial DLE to topical crisaborole treatment.

Materials and methods: We report the case of a 20-year-old woman with a 7-year history of a persistent erythematous plaque on the nose, previously misdiagnosed and refractory to multiple treatments, including systemic antimalarials and topical agents. Histopathological examination and direct immunofluorescence findings supported a diagnosis of DLE without systemic involvement. The patient was treated with topical crisaborole 2% ointment once daily in combination with hydroxychloroquine.

Results: Marked clinical improvement was observed after two months of treatment. Sustained remission was maintained during a seven-month follow-up period with continued crisaborole use and dose reduction of hydroxychloroquine, without recurrence or adverse effects.

Conclusions: Crisaborole, a topical phosphodiesterase-4 inhibitor approved for atopic dermatitis, may represent a well-tolerated nonsteroidal therapeutic option for facial DLE, particularly in patients who are unresponsive to or intolerant of conventional treatments. Further studies are needed to clarify its efficacy and long-term safety in DLE.

Background: Acne vulgaris is a common skin disorder that negatively affects adolescents' quality of life. Recent evidence suggests that combining isotretinoin with desloratadine may enhance treatment outcomes.

Objectives and methods: This study aimed to develop a practical algorithm for SSD management in Italy, by gathering insights from Italian dermatology experts on diagnosis, treatment and long-term management of SSD.

Results: According to literature review and clinical experience, accurate diagnosis of SSD requires medical history, clinical evaluation, disease severity assessment and trichoscopy. The differentiation of SSD from psoriasis, eczema, and tinea capitis is essential to guide appropriate treatment, which should counteract the main pathogenic mechanisms underlying the disease and be tailored to the severity of clinical manifestations. Topical antifungals are the first-line treatments due to their efficacy in reducing Malassezia colonization. The use of topical anti-inflammatory agents, including corticosteroids, is useful for moderate-to-severe cases, but should be limited due to potential adverse effects. Selenium disulfide may be a useful option for both acute symptom control and long-term maintenance because of its antifungal, sebostatic, keratolytic, and microbiome-restoring properties, associated with a high degree of patient satisfaction. Systemic antifungals may be considered in refractory cases.

Conclusion: This experts' view provides a structured approach to SSD management in Italy, integrating clinical experience and scientific evidence.

Objectives: Compared with placebo, this phase I study evaluated the safety, tolerability, and pharmacokinetics of CG2001, a novel isopropyl alcohol-free minoxidil-finasteride combination topical foam, in Chinese males with androgenetic alopecia (AGA).

Methods: In this randomized, double-blind, placebo-controlled trial, 44 subjects received single and multiple doses across five cohorts with varying finasteride concentrations (0.025%-0.1%) and frequencies. Safety, tolerability, and pharmacokinetics were evaluated. The concentrations of minoxidil-finasteride were both measured.

Results: The result shows that CG2001 was safe and well-tolerated, with no serious adverse events. Systemic minoxidil exposure was consistent across most dosages, while finasteride exposure increased dose- and frequency-dependently, though it remained markedly lower than that reported with oral administration. Steady state was achieved for both drugs after 7 days.

Conculsions: The favorable safety profile and reduced systemic finasteride exposure position CG2001 as a promising alternative, supporting further clinical development in a phase IIa trial, and provide a pharmacokinetic foundation for subsequent efficacy trials in patients with AGA.

Objectives: Off-label prescribing is a common and often necessary practice in dermatology, as approved treatment options frequently fail to meet the diverse needs of patients. This is particularly relevant in the management of two prevalent inflammatory dermatoses - atopic dermatitis and psoriasis. Despite the widespread use of off-label therapies, their application often lacks formal guidance, highlighting the need for updated clinical recommendations and consideration of expanded drug indications.

Methods: This retrospective study analyzed medical records of 5072 patients with atopic dermatitis and/or psoriasis who were treated in Northern Poland between 2014 and 2024.

Results: It was found that 62.5% of patients with atopic dermatitis and 25.7% of patients with psoriasis received some form of off-label treatment. The frequency of off-label therapy demonstrated an inverse correlation with patient age. On average, individuals managed with a combination of on-label and off-label therapies achieved greater reductions in EASI, PASI, and DLQI scores compared to those treated exclusively according to SmPC guidelines, with the statistically significant difference for PASI reductions.

Conclusions: Off-label treatment is widely used in the management of both atopic dermatitis and psoriasis. Real-world evidence plays a crucial role in guiding clinical practice and should be leveraged to support the more evidence-based implementation of off-label therapies.

Objective: To compare the effectiveness and safety of pharmacological, physical, and complementary interventions for recurrent aphthous stomatitis (RAS) across clinically relevant outcomes.

Methods: This umbrella review was conducted according to PRISMA and Cochrane guidance and registered in PROSPERO (CRD42024594292). PubMed, Scopus, and the Cochrane Library were searched through August 2025. Eligible studies were systematic reviews, meta-analyses, or network meta-analyses evaluating treatments for RAS. Methodological quality was assessed using AMSTAR 2, and overlap of primary studies was quantified using the corrected covered area.

Results: A total of 41 reviews were included. Topical corticosteroids and low-level laser therapy consistently reduced pain and shortened healing time, although evidence for recurrence prevention was limited. Hyaluronic acid and herbal agents demonstrated favorable short-term efficacy with good safety profiles. Systemic agents such as colchicine and thalidomide showed benefit in severe or refractory RAS, but were constrained by the adverse effects and low-certainty evidence.

Conclusion: Evidence supports topical corticosteroids, hyaluronic acid, and laser therapy for short-term symptom control in RAS, while systemic agents should be reserved for selected refractory cases.

Backgrounds: Prurigo nodularis (PN) is a chronic pruritic inflammatory disease associated with immune and neural dysregulation. Although nemolizumab has demonstrated efficacy in clinical trials, real-world post-marketing data remain limited.

Objective: To evaluate the real-world efficacy, safety, and drug survival of nemolizumab in patients with PN.

Materials and methods: We retrospectively analyzed 38 patients with PN treated with nemolizumab at a single center. Peak Pruritus Numerical Rating Scale (PP-NRS) and Prurigo Nodularis Investigator's Global Assessment (PN-IGA) were assessed up to Week 24. Treatment-emergent adverse events (TEAEs) and drug survival were evaluated.

Results: Mean PP-NRS rapidly improved from 8.1 at baseline to 1.8 at Week 8 and remained stable through Week 24 (p < 0.001). PN-IGA scores gradually improved from 3.1 to 1.4 by Week 24 (p < 0.01). At Week 24, ≥4-point PP-NRS improvement and PP-NRS 0/1 were achieved in 90.9% and 59.1% of patients, respectively, while PN-IGA 0/1 was achieved in 50.0%. Early PP-NRS improvement correlated with long-term outcomes. TEAEs occurred in 39.5%, mainly cutaneous reactions, and drug survival was significantly lower in patients with TEAEs.

Conclusion: Nemolizumab provided rapid and sustained itch relief with gradual lesion improvement in real-world PN. Early pruritus response may predict long-term efficacy, while adverse events affect treatment persistence.