The Journal of dermatological treatment最新文献

Introduction: Vitiligo is a chronic autoimmune depigmenting disorder. Ruxolitinib 1.5% cream is currently the only therapy specifically approved for its treatment. In addition, clinical guidelines recommend off label standard therapies, including topical corticosteroids (TCS), topical calcineurin inhibitors (TCI), phototherapy (narrowband UVB or excimer devices), and selected off-label systemic regimens.

Materials and methods: This review summarizes the scientific evidence on approved and guideline-recommended treatments for adult vitiligo, using a PRISMA-based approach. Only English-language articles published between 2000 and 2025 were included. Interventions comprised approved therapies and standard treatments recommended by guidelines. Outcomes evaluated were changes in Facial and Total Vitiligo Area Scoring Index (F-VASI/T-VASI), quality of life, and safety. Risk of bias was assessed using the Risk of Bias 2 (RoB 2) tool for randomized controlled trials (RCTs) and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) for non-randomized studies.

Results: Ruxolitinib cream demonstrated superior F-VASI responses compared with vehicles in phase II-III RCTs. Evidence supports the efficacy of potent or very potent TCS, TCI, and NB-UVB or targeted 308-nm devices in localized disease.

Conclusion: Systemic regimens show benefits in selected clinical scenarios, although supporting evidence remains heterogeneous. Treatment selection should be individualized based on disease activity, extent, anatomical site, and patient preferences.

Purpose: To assess the efficacy and safety of 'fractional' long-pulsed Nd:YAG (FLP-Nd:YAG) for the treatment of severe diffused glans penis venous malformations (GPVM).

Methods: Thirteen patients (Age 1.2-29 years) with diffused GPVM were enrolled in this study from August 2013 to January 2025. Twelve patients except one young male with erectile dysfunction underwent FLP-Nd:YAG laser treatment (there were intervals between circular spots). Outcome was graded using a five-point scale, and complications were documented after each session.

Results: Ten patients reached a 'nearly cured' status, and two patients achieved an 'excellent' outcome. The mean number of sessions was 3.2 (range 2 ∼ 5). Symptoms were significantly alleviated following treatment. The minor complications were blister formation or thin crusting (n = 4), temporary hyperpigmentation (n = 5), superficial scars (n = 2), and mild hypesthesia (n = 1). Major complications included localized tissue depression (n = 1) and long-term fibrous nodules (n = 1). All patients were followed up for 4 to 11 months. Mild recurrence was observed in three cases.

Conclusion: FLP-Nd:YAG laser therapy achieved high lesion clearance rates with low incidence of major complications in severe diffused GPVMs. It offered rapid treatment with a noninvasive, bloodless procedure, making it especially suitable for pediatric patients.

Background: Lebrikizumab, a high-affinity monoclonal antibody targeting interleukin-13, effectively treats moderate-to-severe atopic dermatitis (AD).

Methods: Lebrikizumab-treated patients in ADvocate1&2 achieving per-protocol response-IGA (0,1) or EASI 75 at Week 16-were re-randomized 2:2:1 to lebrikizumab 250 mg every 2 weeks (Q2W), Q4W, or placebo (lebrikizumab withdrawal). Patients completing Week 52 could enroll in the extension study, ADjoin. Deep response was defined as IGA (0), EASI 100, or Pruritus Numerical Rating Scale score 0 or 1 (NRS [0,1]). This analysis reports as-observed data.

Results and conclusions: From Week 16-104, among IGA (0,1) responders at Week 16, increased proportions of patients achieved IGA (0) with lebrikizumab Q2W (33.8% [Nx = 77] to 52.3% [Nx = 44]) and Q4W (29.9% [Nx = 77] to 45.5% [Nx = 55]); among EASI 75 responders at Week 16, increased proportions of patients achieved EASI 100 with lebrikizumab Q2W (21.4% [Nx = 112] to 39.7% [Nx = 68]) and Q4W (20.0% [Nx = 115] to 41.3% [Nx = 80]); and among per-protocol responders, increased proportions of patients reported Pruritus NRS (0,1) with lebrikizumab Q2W (35.2% [Nx = 108] to 57.4% [Nx = 61]) and Q4W (34.2% [Nx = 114] to 55.4% [Nx = 65]). Continued lebrikizumab treatment for 2 years resulted in approximately half of per-protocol responders achieving complete skin clearance (IGA 0) and itch relief, raising the bar of treatment goals for AD patients.

Background: Facial aging is characterized by midface volume loss from structural and dermal atrophy.

Objectives: To evaluate the efficacy and safety of a hyaluronic acid-polynucleotide (HA-PN) hybrid filler for temporary restoration of anteromedial cheek volume.

Methods: In this single-center, open-label trial, 15 adults with moderate-to-severe anteromedial cheek volume loss (Mid-Face Volume Deficit Scale [MFVDS] score ≥ 3) received up to 1 mL HA-PN hybrid filler per side. Evaluations at baseline and weeks 4, 12, and 24 comprised blinded photographic MFVDS rating (primary endpoint: ≥1-grade improvement at week 4), GAIS (Global Aesthetic Improvement Scale) score, participant satisfaction, transepidermal water loss, skin hydration, elasticity, and adverse events.

Results: All participants completed the study without serious adverse events. MFVDS scores improved significantly at week 4 and remained improved through weeks 12 and 24. GAIS and satisfaction scores paralleled these gains. Transepidermal water loss decreased and hydration increased over time, and Cutometer parameters (R2 R5 R7) showed progressive improvements in elasticity, indicating enhanced skin quality along with midface volumization.

Conclusions: The HA-PN hybrid filler demonstrated improvements in midface volume restoration with concurrent improvements in skin barrier function, hydration, and elasticity, and was well tolerated over 24 weeks within the constraints of the study design.

Background: Moderate-to-severe atopic dermatitis (AD) often relapses after dupilumab discontinuation. This study compared proactive intermittent tacrolimus versus on-demand therapy for post-discontinuation maintenance.

Methods: This was a real-world, mixed retrospective-prospective observational study conducted at a single dermatology center. Patients who discontinued dupilumab were identified through retrospective chart review, and a subset was followed prospectively. Based on observed post-discontinuation topical management patterns, patients were classified into a proactive maintenance group or a reactive, as-needed treatment group. Patients were followed for 24 weeks, with extended follow-up to 52 weeks for exploratory analyses. The primary outcome was time to first flare.

Results: Median follow-up was 28 weeks. Proactive maintenance prolonged flare-free survival (HR 0.62, 95% CI 0.45-0.86, p = 0.004), reduced flare rate (IRR 0.68, 95% CI 0.52-0.88, p = 0.003), and lowered steroid use (mean difference -18.4 g, p < 0.001). PROs improved more (POEM β -2.1; DLQI β -1.8). Local reactions were comparable (8.3 vs. 7.9%); no serious adverse events occurred.

Conclusion: Proactive intermittent tacrolimus after dupilumab reduces flare risk and steroid burden, improving outcomes, and is a feasible maintenance strategy.

Background: This multicenter study aimed to evaluate treatment adherence and satisfaction among patients with acne vulgaris.

Methods: A total of 2,349 patients from 18 dermatology centers across Türkiye completed structured questionnaires.

Results: The participants were predominantly female (79.4%) with a mean age of 21.6 years. Overall, 48% reported consistent adherence to therapy, with significantly lower adherence among males (p < 0.001). The most frequent reasons for nonadherence were forgetfulness (28.7%), dislike of the treatment (26.4%), and reluctance to maintain long-term therapy (21.5%). Treatment adherence was positively associated with higher educational levels (p = 0.006) and greater acne severity (p < 0.001). Logistic regression revealed that systemic oral therapy (OR = 4.37, 95% CI: 3.147-6.086; p < 0.001) and oral isotretinoin (OR = 4.81, 95% CI: 3.379-6.869; p < 0.001) significantly increased adherence compared to topical therapy. Oral treatment was also independently associated with greater satisfaction (OR = 2.33, 95% CI: 1.767-3.095; p < 0.001). Moreover, mild acne severity (OR = 1.67, 95% CI: 1.216-2.297; p = 0.002) and older age (per year; OR = 1.05, 95% CI: 1.020-1.088; p = 0.001) predicted higher satisfaction.

Conclusion: Systemic therapies-particularly oral isotretinoin-were associated with improved adherence and satisfaction.

Objective: To compare on-label persistence among adults with psoriasis who switched from other advanced therapies to guselkumab versus subcutaneous tumor necrosis factor inhibitors (SC TNFi), subcutaneous interleukin-17 inhibitors (SC IL-17i), or apremilast.

Materials and methods: This retrospective cohort study used U.S. claims data from the IQVIA PharMetrics® Plus database (2016- 2023). Overlap propensity score weights were used to balance cohorts on baseline characteristics. On-label persistence was defined as the absence of drug discontinuation (event) and any dose change relative to the U.S. label (censoring). Survival analyses were used to assess on-label persistence from the start of the maintenance phase.

Results: At 12, 18, and 24 months after the start of the maintenance phase, respectively, on-label persistence was 190%, 180%, and 179% more likely on guselkumab versus SC TNFi; 78%, 87%, and 91% more likely on guselkumab versus SC IL-17i; and 187%, 199%, and 193% more likely on guselkumab versus apremilast (all p < 0.001).

Conclusions: Patients experiencing suboptimal outcomes with other psoriasis-indicated advanced therapies achieved higher on-label persistence after switching to guselkumab, raising the potential for improved disease control relative to other treatment options.

Aim: Deucravacitinib, a selective tyrosine kinase 2 (TYK2) inhibitor, has demonstrated efficacy in randomized trials for plaque psoriasis, but real-world data in Asian populations remain limited. This 24-week prospective real-world cohort study evaluated the effectiveness and safety of deucravacitinib in 101 Chinese adults with plaque psoriasis treated with 6 mg once daily.

Materials and methods: The prespecified primary endpoint was PASI75 at week 24. Secondary outcomes included PASI90, PASI100, PASI ≤1, and sPGA 0/1 at week 24.

Results: At baseline, 68.3% of patients had PASI <10. At week 24, 77.2% achieved PASI75, 58.4% achieved PASI90, and 22.8% achieved PASI100; 81.2% achieved PASI ≤1 and 83.2% achieved sPGA 0/1. A post hoc exploratory analysis suggested numerically higher response rates in patients with predominant small plaque morphology. Treatment was generally well tolerated, with no serious adverse events or discontinuations. Mild pruritic eruptions were infrequent and occurred mainly in individuals with atopic backgrounds.

Conclusions: These findings support the real-world effectiveness and safety of deucravacitinib in Chinese patients with plaque psoriasis; morphological observations are exploratory and hypothesis-generating.

Aim: This systematic review and meta-analysis aimed to compare the long-term efficacy and safety of physical therapies (laser and photodynamic therapy) versus conventional topical glucocorticoids for the treatment of vulvar lichen sclerosus (VLS).

Materials and methods: A total of ten randomized controlled trials (RCTs) published between 2010 and 2025 were included and analyzed to evaluate clinical symptom improvement, safety profiles, and long-term recurrence rates.

Results: Analysis indicates that physical therapies are generally superior to topical glucocorticoids in improving clinical symptoms, with photodynamic therapy (PDT) demonstrating the most significant relief. In terms of safety, adverse events associated with physical therapies were predominantly mild and transient local reactions (e.g., burning or redness), whereas topical glucocorticoid use carried risks of secondary infections, such as candidiasis. Furthermore, physical therapies, particularly PDT, showed better long-term recurrence control compared to glucocorticoids, which had high recurrence rates after discontinuation.

Conclusion: Laser therapy and PDT are effective and safer alternative treatments for VLS. These modalities offer distinct advantages in sustained symptom relief and recurrence reduction, especially for patients with refractory disease or concerns regarding long-term steroid use.