The Journal of dermatological treatment最新文献

Background: Vitiligo is an autoimmune skin depigmentation disorder significantly impacting quality of life. This condition is difficult to treat, with high relapse rates. Additionally, vitiligo associates with other autoimmune conditions, complicating patient management. Improving patient outcomes relies on understanding vitiligo's clinical landscape and genetic risk factors.

Objectives: We aimed to understand vitiligo's patient distribution, current management practices, how comorbid autoimmune conditions influence treatment and how genetic risk factors vary in diverse populations.

Methods: We conducted a cross-sectional study of the All of Us research program, consisting of surveys, electronic health records and genomic data from 206,173 participants in the USA recruited between the summer of 2017 and 1 July 2022. We determined diagnostic and prescribing rates and elucidated differences in genetic risk within different populations.

Results: Oral corticosteroids are most frequently prescribed, followed by other immunosuppressive drugs and topical medications. Comorbid systemic lupus erythematosus impacted treatment choices. Single nucleotide polymorphisms associated with increased risk in patients of European decent were not always associated with increase risk in patients of other ancestry.

Conclusions: This work highlights the current treatment landscape for vitiligo in the USA. We demonstrated that comorbid conditions impact treatment choices and genetic risk factors vary between ethnic groups.

Objective: To characterize the systemic treatment patterns and current state of moderate-to-severe psoriasis patients in real-world settings in Greece.

Methods: CRYSTAL-Greece was a multicenter, cross-sectional and retrospective chart review study assessing Psoriasis Area and Index (PASI), Dermatology Life Quality Index (DLQI) and EuroQol-5-Dimensions 5-Levels (EQ-5D-5L). Eligible patients were consented adults (18-75 years old) on continuous treatment with any approved systemic therapy regimen for ≥24 weeks.

Results: 280 eligible patients were enrolled between 07APR2020 and 30NOV2020. Current treatment at the study visit was biologic monotherapy in 78.2% of patients, non-biologic monotherapy in 16.1%, and conventional systemic + biologic in 5.7%. Median absolute PASI score was 1.8; of patients, 36.8%/64.6%/83.9% had PASI ≤ 1/≤3/≤5. Rates of absolute PASI > 5 were 13.7% and 28.9% in the biologic and non-biologic monotherapy subgroups, respectively. Median DLQI score was 2.0, with 18.9% of patients having DLQI > 5 (16.0% and 26.7% in the biologic and non-biologic monotherapy subgroups, respectively). The correlation between DLQI and absolute PASI was low positive (Spearman rho = 0.432; p < 0.001). Most affected EQ-5D-5L dimensions were anxiety/depression (58.6%) and pain/discomfort (28.6%).

Conclusion: A considerable proportion of patients still do not achieve complete or almost complete skin clearance, while one fifth of the population experience at least moderate impairment of quality of life.

Purpose: Keloid tissue represents an abnormal proliferation of fibroblasts, typically resulting from skin injury. These lesions can lead to significant physiological dysfunction and aesthetic concerns, particularly when located on the face. Traditional treatments, such as intralesional injections, laser therapy, and surgical excision, have shown limited efficacy and are associated with high recurrence rates.

Materials and methods: In a recent case, a 19-year-old male with a keloid on the upper lip did not respond to local injections of triamcinolone acetonide (TAC) or carbon dioxide ablative fractional resurfacing laser therapy.

Results: A combined treatment approach involving trepanation and superficial radiotherapy successfully flattened the keloid tissue, with no recurrence observed during a 3-year follow-up period.

Conclusions: This case underscores the potential efficiency and safety of combined therapeutic interventions and contributes valuable evidence towards the development of novel treatment strategies for keloids.

Aim: To present three cases of filler-induced alopecia (FIA) and summarize the current knowledge of its clinical features, mechanisms and treatments.

Methods: In the first two cases, two females developed well-defined triangular patches of hair loss after hyaluronic acid (HA) injections, and received corticosteriod injections with topical 5% minoxidil. The third case described another female who experienced alopecia areata-like hair loss after autologous fat grafting, and received combined therapies including corticosteriod, 5% minoxidil and microneedling.

Results: All patients got gradual hair regrowth with treatments.

Conclusions: Early recognition and intervention are crucial to prevent permanent hair follicle damage. A thorough understanding of frontotemporal anatomy is essential for clinical practitioners to minimize risks during cosmetic procedures involving filler injections.

Background: Biologics are essential in treating psoriasis. In recent years, the pathogenesis exploration and development of new target drugs have provided a more complete evidence-based foundation for the biological treatment of psoriasis. This study aims to use bibliometrics to analyze the research status and development trends of biologics in psoriasis.

Methods: The bibliometric analysis of publications related to biologics in psoriasis from 2004 to 2023 was conducted using the Web of Science Core Collection (WoSCC) database as the search data source. To perform the bibliometric analysis and create visual knowledge graphs, CiteSpace, the Bibliometrix R package, and VOSviewers were utilized.

Results: The study included a total of 3800 articles. The United States had the highest number of publications. The leading authors and institutions were Steven R. Feldman and the University of Manchester, respectively, in the global partnership. The cluster plot divided all keywords into 11 categories. Currently, Secukinumab and Guselkumab are representative biological agents being studied due to their considerable efficacy and long-term safety.

Conclusions: Targeted therapy has emerged as a significant trend in the current treatment of psoriasis. Early and active use of biologics can effectively control disease progression, prevent or delay the occurrence of comorbidities, and may even alter the natural course of psoriasis. However, further investigation is required to fully understand the specific mechanisms of psoriasis and the use of biological agents.

Background: Palmoplantar pustulosis (PPP) is a chronic inflammatory condition, that leads to significant functional impairment and reduced quality of life. Despite its low incidence, treatment options are diverse and often ineffective, necessitating a review of recent therapeutic advances.

Objective: This review aims to evaluate the efficacy and safety of recent therapeutic options for the treatment of PPP, focusing on phototherapy, systemic therapies, and biologics.

Materials and methods: A systematic literature search identified 13 studies evaluating phototherapy and systemic therapies, including biologics. Inclusion criteria focused on randomized controlled trials with participants diagnosed with PPP.

Results: Phototherapy showed success: excimer laser demonstrated high efficacy for severe disease [PPP Area and Severity Index (PPPASI)-75 of 95.0%], while psoralen plus ultraviolet A therapy with retinoids or fumaric acid esters worked well in milder disease (PPPASI-90 of 90.0 and 81.8%, respectively). Evidence supports the efficacy and safety of guselkumab, brodalumab, and apremilast over a range of disease severity (PPPASI-50 ranged from 57.4 to 78.3% at week 16). Agents including anakinra, secukinumab, spesolimab, and RIST4721 (primary outcomes not achieved) may not be first-line treatments. By targeting multiple inflammatory pathways in PPP, JAK inhibitors may be more effective than biologics in treating PPP; however, more research is needed to confirm their safety and appropriate use.

Conclusions: Multiple new treatments exist for PPP with promising results, however longer-term studies with standardized outcome reporting are needed to determine optimal treatment strategies and their comparative efficacy.

Background: Chronic pruritus is the most prevalent and severe symptom of atopic dermatitis (AD).

Objective: This network meta-analysis aims to assess the comparative efficacy of systemic targeted monotherapies in alleviating pruritus among adults and adolescents with moderate-to-severe AD.

Methods: Data were collected from phase 3/4 randomized controlled trials (RCTs) published until 24 August 2024, focusing on targeted therapies for moderate-to-severe AD. The outcome measure was the proportion of patients achieving a ≥ 4-point improvement from baseline on the Pruritus Numerical Rating Scale (NRS). This analysis included both primary endpoints (week 12 or week 16) and secondary endpoints (weeks 2, 4, and 8).

Results: Eleven reports comprising 16 studies with 8,462 participants were included. At all time points examined, targeted therapies demonstrated statistically significant efficacy over placebo, with upadacitinib 30 mg showing the highest response rate. The next most effective treatments at the primary endpoint were abrocitinib 200 mg, upadacitinib 15 mg, dupilumab 300 mg, and lebrikizumab 250 mg. Cumulative ranking probabilities at secondary endpoints varied based on time points.

Conclusion: Targeted therapies, particularly upadacitinib 30 mg, showed significant advantages in managing moderate-to-severe AD pruritus. Further direct comparative trials are needed for conclusive evidence.

Background: There is a lack of real-life safety data on treatment options for chronic urticaria in the presence of comedication and comorbidities.

Methods: We present a single-center UCARE pilot study of 212 outpatients with chronic urticaria. Patients were divided into three groups according to different CU therapies according to international guidelines.

Results: Of 212 patients, 108 (mean age 48.9 years, 71.3% female) had 59 comorbidities, including cardiovascular, autoimmune and malignant diseases. Patients were followed for a mean of 24.6 months (SD ± 21.3). Urticaria therapies were divided into three groups: A: 105 (97.2%) with omalizumab and 2nd generation antihistamines), B: 16 patients (14.8%): dual therapy with antihistamines and cyclosporine in 10 (9.3%), montelukast in five (4. 6%), dapsone in four (3.7%), hydroxychloroquine in one patient (0.9%), C: 12 (11.1%) patients received a third drug for 4.9 months (SD ± 3.2) and one quadruple therapy (2.1 months). 10 out of 12 (83.3%) patients received montelukast, two (16.7%) cyclosporine, two (16.7%) dapsone and one (8.3%) hydroxychloroquine as a third drug for chronic urticaria.

Conclusions: Combining treatment modalities for chronic urticaria and comorbidities are available and feasible with a good safety profile.

Background: Data on the characteristics and treatment outcomes of super-responders and non-super-responders in psoriasis under adalimumab treatment are limited.

Methods: A retrospective analysis from psoriatic patients treated with adalimumab was compared to characterize super-responders vs non-super-responders' groups, identify factors associated with super response, and assess treatment outcomes after switching.

Results: 15 out of 70 (21.4%) patients were categorized as super-responder. The proportion of patients achieving a PASI 100 response was significantly higher in super-responders than non-super-responders at weeks 12, 24, and 52. Female sex and Charlson Co-morbidity Index were significantly associated with super-responders. A high level of high-density lipoprotein was independently associated with PASI 90 response at weeks 24 and 52. Additionally, nearly 35%-43% of non-super-responders switching to interleukin-17A (IL-17A) inhibitors may achieve a PASI 100 response at week 12. In contrast, all super-responders switching to IL-17A inhibitors achieved a PASI 100 response at week 4.

Conclusions: Super-responders treated with adalimumab have a higher rate of being female and fewer comorbidities. And super-responders have better PASI responses than non-super-responders, whether the patients were treated with adalimumab or switched to IL-17A inhibitors.