The Journal of dermatological treatment最新文献

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.

Purpose: The Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II) was developed to enhance the methodological rigor of clinical practice guidelines (CPGs), aiming to generate trustworthy recommendations for various clinical scenarios. Despite its importance, there exists a gap in the quality of CPGs pertaining to Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (SJS-TEN). The aim of the study was to evaluate SJS-TEN CPGs to shed light on areas for enhancing SJS-TEN guidelines' quality.

Materials and methods: A systematic review was conducted to identify SJS-TEN CPGs from January 2011 to December 2023 across bibliographic and guideline databases, as well as dermatology association websites. Four reviewers employed the AGREE II instrument to appraise the quality of eligible CPGs. Subsequently, AGREE II domain scores were calculated and their recommendations mapped.

Results and conclusions: Seven eligible SJS-TEN CPGs reviewed, originating from Europe, North America, Asia, and an authorship Group. The highest AGREE II domain scores were observed in scope and purpose (mean: 63%, standard deviation [SD]: 23.195%) and clarity of presentation (mean: 70%, SD: 14.5%). Conversely, the lowest score was noted in the applicability domain (mean: 28%, SD: 17.44%). Only two guidelines by the British Association of Dermatologists (28.6%) met the 'recommend' level. Recommendations from all CPGs were compared in tabular form.

Background: Data directly comparing targeted narrowband ultraviolet B (NB-UVB), 308-nm excimer laser, and 308-nm excimer lamp for vitiligo are limited.

Objectives: We compared the efficacy and safety of these three modalities in vitiligo.

Methods: In this retrospective study, we reviewed the medical records of vitiligo patients at the Photodermatology Clinic, Siriraj Hospital. Patients received either targeted NB-UVB (group A), a 308-nm excimer laser (group B), or a 308-nm excimer lamp (group C), administered two to three times per week for at least 3 months. Photographs taken before and after therapy were evaluated. The primary outcome was repigmentation, graded on a five-tier scale: poor (0-25%), fair (26-50%), good (51-75%), very good (76-90%), and excellent (91-100%). The secondary outcome was treatment-related adverse events.

Results: No statistically significant differences in efficacy were observed among the three groups, indicated by a very good to excellent response in 42.4% (group A), 17.6% (group B), and 29.4% (group C). Although group A showed higher response rates at 3 and 6 months, differences were not significant. Adverse effects were significantly more frequent in group C.

Conclusions: All three devices demonstrated comparable efficacy and promoted rapid repigmentation. However, the excimer lamp had the highest rate of adverse effects.

Objective: To investigate the efficacy and safety of 308-nm excimer laser therapy with or without fire needle therapy in patients with stable acral vitiligo.

Methods: A retrospective study was conducted to review patients with stable acral vitiligo treated between January 2020 and October 2024. In addition to topical halometasone cream, patients received either 308-nm excimer laser therapy alone (laser group) or a combination of 308-nm excimer laser and fire needle therapies (combination group) for three months. Vitiligo Area Scoring Index (VASI), physician global assessment (PGA), pain during treatment, and side effects were compared between the groups.

Results: A total of 62 patients (32 in the laser group and 30 in the combination group.) were included. The mean age was 34.2 ± 9.8 years, with 39 (62.9%) males. Baseline characteristics were comparable between the two groups. Patients in both groups experienced a reduction in VASI scores (0.06 ± 0.74 and 0.16 ± 0.14 in the laser and combination groups, respectively). Compared with the laser group, the combination group showed significant improvement in lesion appearance, but reported mild pain (p < 0.001). Both groups experienced mild skin reactions, which resolved quickly after treatment.

Conclusions: Combination therapy with 308-nm excimer laser and fire needle is a safe and effective approach for stable acral vitiligo.

Purpose: To evaluate the burden of chronic spontaneous urticaria (CSU) compared with atopic dermatitis (AD) and psoriasis (PSO).

Methods: This retrospective, cross-sectional study used real-world data from adult respondents from the 2019 US National Health and Wellness Survey (NHWS). Outcome measures included the 36-item Short-Form Survey version 2 (SF-36v2; mental and physical component summary [MCS and PCS] scores), Work Productivity and Activity Impairment (WPAI), and healthcare resource utilization (HCRU).

Results: Among 74,994 respondents (CSU N = 371; AD N = 549; PSO N = 2061), mean (standard deviation [SD]) age at data collection was 41.7 (14.0), 48.4 (16.3), and 51.4 (16.6) years for CSU, AD, and PSO, respectively. Mean (standard error [SE]) MCS and PCS scores were lower (worse) among respondents with physician-diagnosed CSU vs. AD and PSO, respectively: MCS: 41.3 (0.6) vs. 44.8 (0.5) vs. 45.3 (0.2); PCS: 42.1 (0.5) vs. 47.8 (0.4) vs. 47.7 (0.2); all p < 0.001. Respondents with CSU reported higher (p < 0.001) work and activity impairment and HCRU vs. respondents with AD or PSO.

Conclusion: After adjusting for confounders, respondents with CSU experienced higher humanistic and economic burden compared with respondents with AD or PSO, indicating a need for new treatments and improved clinical management.

Background: Ivarmacitinib (SHR0302), a selective Janus kinase-1 inhibitor, is a novel treatment for moderate-to-severe atopic dermatitis (AD).

Objectives: This post hoc analysis evaluated the impact of early itch relief with ivarmacitinib on quality of life (QoL), working productivity, and sleep quality in affected patients.

Methods: Data from ivarmacitinib treatment groups in a phase III trial (NCT04875169) were analyzed. Patients were classified as early itch responders (EIR; ≥4-point reduction in Worst Itch Numeric Rating Scale at week 4) or non-early itch responders (non-EIR). Outcomes included the Dermatology Life Quality Index (DLQI) total score, DLQI 0/1 response rate, DLQI work/study item, and the Patient-Oriented Eczema Measure (POEM) sleep item.

Results: Of 225 patients, 90 were EIR and 135 were non-EIR. The EIR group showed significantly greater improvements in DLQI total score, DLQI 0/1 response rate, and work productivity from week 4 through week 52 compared to the non-EIR group. Sleep disturbance due to itch was also significantly improved in the EIR group from week 4 to week 40, though the difference at week 52 was not statistically significant.

Conclusions: Early itch relief with ivarmacitinib showed significant improvements in QoL, sleep, and work productivity in patients with moderate-to-severe AD.

Background: Prior exposure to systemic treatments may affect treatment outcomes in moderate-to-severe atopic dermatitis (AD).

Objective: This study aimed to explore the efficacy and safety of Ivarmacitinib (SHR0302) in moderate-to-severe AD patients with or without previous systemic treatments.

Methods: This was a post-hoc analysis of a phase III clinical trial of Ivarmacitinib in moderate-to-severe AD (NCT04875169). Subgroup analysis by with (N = 132) or without (N = 204) previous systemic treatments (systemic corticosteroids, biologics, or other immunomodulators) was performed.

Results: In patients with previous systemic treatments, Ivarmacitinib 8 mg (n = 34) and 4 mg (n = 53) exhibited higher Investigator Global Assessment (IGA), Eczema Area and Severity Index (EASI)-75, EASI-90, and Worst Itch Numeric Rating Scale (WI-NRS) 4 response rates, and a greater reduction in Dermatology Life Quality Index (DLQI) score compared with placebo (n = 45) at most timepoints from W4 to W16. In patients without previous systemic treatments, these outcomes were notably increased in Ivarmacitinib 8 mg (n = 78) and 4 mg (n = 60) versus placebo (n = 66) throughout W4 to W16. The adverse events were generally comparable between Ivarmacitinib and placebo groups, regardless of previous systemic treatments.

Conclusion: Ivarmacitinib demonstrates good efficacy and a favorable safety profile in moderate-to-severe AD patients, irrespective of previous systemic treatments.

Objective: This retrospective cohort study evaluated the clinical effectiveness of platelet-rich fibrin (PRF) versus conventional therapy in chronic wound management.

Methods: Electronic health records from a single institution (2010-2020) were analyzed. Included patients were adults (≥18 years) diagnosed with a chronic wound and treated with either PRF or conventional therapy.

Results: Wound healing was faster in the PRF group (36.2 ± 9.3 days vs. 60.4 ± 11.4 days, p < .001). Multivariate Cox regression identified PRF as an independent factor for accelerated healing (HR = 0.61, 95% CI: 0.52-0.72, p = .001). Wound closure (89.8% vs. 70.6%, p < .001) and complete re-epithelialization (90.3% vs. 69.6%, p < .001) were higher in the PRF group. Wound recurrence (10.1% vs. 25.1%, p = .029) and scar formation (12.4% vs. 28.7%, p = .008) were lower in the PRF group. The incidence of adverse events was similar between groups (8.7% vs. 10.4%, p = .582).

Conclusion: PRF therapy accelerates chronic wound healing, improves healing quality by reducing recurrence and scarring, and demonstrates a safety profile comparable to conventional care.

Objectives: Dupilumab has demonstrated strong efficacy and safety in clinical trials for atopic dermatitis (AD), but real-world data from the Greater Gulf region remain limited. This study aimed to evaluate the real-world effectiveness and safety of dupilumab in adolescents and adults with moderate-to-severe AD in Saudi Arabia and the United Arab Emirates.

Methods: A retrospective observational study was conducted in adolescents and adults (≥12 years) with moderate-to-severe AD, who had received dupilumab for one to three years. Clinical outcomes were assessed using SCORing Atopic Dermatitis (SCORAD) and the Dermatology Life Quality Index (DLQI), while safety was evaluated through reported adverse events (AEs).

Results: Ninety-five patients were eligible, with a mean age of 29.3 years, and 52.6% were males. The mean baseline SCORAD score was 49.9, which decreased markedly to 21.5 after one month, 12.7 after three months, and 14.1 at six months. At six months, data were available for 71 patients, of whom 76% achieved SCORAD-50 and 52.1% achieved SCORAD-75. Reported AEs were generally mild, the most frequent being dry eyes (14.7%), dry eyes with pruritus (8.4%), and facial erythema (6.3%). No serious AEs or treatment discontinuations were recorded.

Conclusion: Dupilumab demonstrated sustained clinical improvements and favorable safety. These findings reinforce the results of previous real-world studies and Randomized Controlled Trials.

Purpose: Human amniotic fluid stem cells (hAFSCs) have shown significant regenerative potential in treating hair loss, wound healing, and tissue repair. This study aims to evaluate the effects of human amniotic fluid (hAF) on hair follicle (HF) regeneration and immune system modulation.

Materials and Methods: The hAF used was pooled, acellular, and gamma-irradiated to standardize its contents and enhance its stability. Both irradiated (FAFI) and non-irradiated (FAF) hAF were assessed for their efficacy and safety in promoting hair growth and modulating immune responses in a rat model of hair loss. The study examined HF regeneration, transition to the anagen phase, and macrophage polarization from the pro-inflammatory M1 phenotype to the anti-inflammatory M2 phenotype.

Results: Both FAF and FAFI treatments significantly increased HF density, with FAFI exhibiting enhanced effects. Histological analysis demonstrated improved HF regeneration, increased M2 macrophages, and reduced collagen fiber deposition in treated areas. Gamma irradiation likely improved the efficacy of FAFI by stabilizing active components and inhibiting protease activity.

Conclusions: Irradiated hAF is a safe and effective therapeutic candidate for alopecia and HF growth disorders. These findings support further evaluation of hAF in clinical trials to validate its potential for hair regeneration therapies.