The Journal of dermatological treatment最新文献

Background: Facial photoaging involves structural and functional deterioration across multiple skin layers. Single-modality treatments rarely address pigmentary, vascular, and dermal matrix changes concurrently. Intense pulsed light (IPL) is widely used for the treatment of dyschromia and vascular lesions. Mesotherapy incorporating non-crosslinked sodium hyaluronate (NCSH), tranexamic acid (TXA), and vitamin C (VC) has been introduced to improve skin hydration and related dermal parameters. The present study assessed the efficacy and safety of combining these modalities for facial rejuvenation.

Methods: Eighty-four patients underwent three sessions of IPL with mesotherapy. Standardized VISIA imaging was conducted before each treatment (T0, T1, T2) and at 1-2 months (T3) and 3-6 months (T4) post-treatment. Efficacy was assessed using the Modified Fitzpatrick Wrinkle Scale (MFWS) and Global Aesthetic Improvement Scale (GAIS); adverse events and satisfaction were recorded.

Results: All six VISIA parameters and MFWS scores improved significantly (p $<$0.001), peaking at T3 with mild non-significant rebound at T4. GAIS and satisfaction assessments confirmed consistent aesthetic improvement. No severe adverse events occurred; transient burning, papular reactions, and erythema were most common. The overall satisfaction rate was 82.15%.

Conclusions: IPL combined with NCSH/TXA/VC mesotherapy provided safe, effective, and well-tolerated improvement in facial photoaging, representing a promising multimodal rejuvenation approach.

Purpose: Emerging evidence suggests rosacea as a recognizable adverse event during dupilumab therapy. This study aimed to investigate the potential association between dupilumab and rosacea using pharmacovigilance data and to characterize the clinical features of dupilumab-associated rosacea (DAR) through a review of reported cases.

Materials and methods: We utilized the FDA Adverse Event Reporting System (FAERS) database (2017-2024) to identify disproportionality signals using four methods: Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Information Component (IC), and Empirical Bayesian Geometric Mean (EBGM). To contextualize these findings, we performed a focused narrative review of 8 publications comprising 10 DAR cases with extractable individual data.

Results: A significant disproportionality signal was identified across all four methods (ROR 3.873; PRR 3.872; IC 1.865 with IC025 1.653; EBGM 3.642), with reports predominantly in adults and females. In the case review, a consistent phenotype emerged: papulopustules on persistent centrofacial erythema with frequent burning; facial predominance with occasional extension to neck, scalp, or upper trunk; frequent Demodex detection by scraping, KOH, or in vivo imaging; and occasional granulomatous histology. Onset ranged from approximately 2 weeks to 21 months, including one post-discontinuation case. Most patients improved with rosacea-directed therapy (topical ivermectin or metronidazole; anti-inflammatory-dose doxycycline). However, dechallenge or rechallenge patterns and the need for dose-interval extension, temporary interruption, or switching biologic (e.g., lebrikizumab, upadacitinib) in a subset support a drug-related pattern at the reporting level.

Conclusions: DAR represents a distinct clinical entity from dupilumab-associated head and neck dermatitis, which is eczematous and typically responds to antifungals or calcineurin inhibitors. While disproportionality signals indicate association rather than incidence or causality and are subject to reporting bias, clinicians should be aware of this potential adverse event to ensure appropriate management.

Background: Dose-stratified real-world data for JAK1 inhibitors in AD are limited.

Objective: To compare effectiveness and safety of standard vs high doses of abrocitinib and upadacitinib in routine care.

Methods: Multicenter, retrospective cohort study. The primary endpoint was Week-12 achievement of Eczema Area and Severity Index (EASI)-75. Secondary outcomes included patient-reported improvements at Minimal Clinically Important Difference (MCID) thresholds, Minimal Disease Activity (MDA) at Week 36, time-to-EASI-75, and treatment-emergent adverse events(TEAE).

Results: A total of 124 patients were analyzed (abrocitinib 100 mg, n = 28; abrocitinib 200 mg, n = 32; upadacitinib 15 mg, n = 30; upadacitinib 30 mg, n = 34). At Week 12, EASI-75 was achieved in 20/32 (62.5%) versus 10/28 (35.7%) for abrocitinib (OR 2.94, 95% CI 1.06-8.15; p = 0.036) and in 22/34 (64.7%) versus 14/30 (46.7%) for upadacitinib (OR 2.92, 95% CI 1.16-7.38; p = 0.021), favoring the higher-dose regimens. Itch improvement was more frequent with higher doses. By Week 36, full minimal disease activity was observed in 30.2% of patients receiving abrocitinib 200 mg and 26.7% receiving upadacitinib 30 mg, compared with 18.4% and 20.0% in the lower-dose groups. Kaplan-Meier analysis showed faster responses with high doses (median 12 vs 36 weeks; log-rank p < 0.01). Safety was comparable across groups.

Conclusion: High-dose JAK1 regimens achieve faster, numerically greater disease control without short-term safety tradeoffs, supporting escalation in suboptimal responders.

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.