The Journal of dermatological treatment最新文献

Background: Prurigo nodularis (PN) is a complex to manage heterogenous disease with limited available treatments. Patients with PN are usually older, with multiple comorbidities adding to the complexity of their care, frequently having failed to control symptoms with other treatments.

Objective: The objective of this analysis was to evaluate the efficacy of dupilumab across various patient subgroups based on their comorbidities, previous use of other medication or demographic characteristics.

Methods: In the PRIME and PRIME2 studies 311 adult patients with PN were randomized to either dupilumab (300 mg every 2 weeks [q2w]) or matching placebo for 24 weeks. Data from both studies were pooled, and the proportion of patients achieving improvement in itch (measured by Worst-Itch Numerical Rating Scale [WI-NRS] ≥ 4) and lesions (measured by Investigator's Global Assessment [IGA] PN-S [PN-Stage] 0 or 1) or the combination of both at 24 weeks was analyzed according to subgroups stratified by age, gender, body mass index (BMI), presence of comorbidities, and prior treatment use.

Results: Dupilumab treatment resulted in itch and lesion improvements at Week 24 compared with placebo in all subgroups studied, with statistical superiority demonstrated in most subgroups tested in this analysis.

Conclusion: Targeting type 2 inflammation with dupilumab was beneficial independent of age, gender, comorbidities and prior medication.

Aim of the study: Lebrikizumab monotherapy demonstrated efficacy for adults and adolescents with moderate-to-severe atopic dermatitis (AD). This study aims to evaluate the relationship between lebrikizumab serum levels and stable deep response after treatment cessation in Week 16-responder patients who maintained stable EASI 90 response post-induction up to Week 52.

Materials and methods: Analysis was pooled from two identically designed, randomized, double-blind, placebo-controlled, phase 3 trials, ADvocate1 (NCT04146363; conducted from September 24, 2019, to May 3, 2022) and ADvocate2 (NCT04178967; conducted from October 29, 2019, to April 28, 2022). The analysis subgroup includes those patients who were Week-16 responders, have been re-randomized to receive placebo (withdrawal arm), and maintained a stable EASI 90 response for at least 80% of visits up to 52 weeks, without rescue medication. Serum lebrikizumab was measured at Weeks 4, 16, 32, and 52.

Results: During withdrawal, 28% of responders (17/60) maintained a stable EASI 90 response with no or minimal fluctuations, including at Week 52, without rescue medication. Mean serum lebrikizumab decreased by 92% and over 99% from Week 16 to Weeks 32 and 52, respectively (Week 16 = 92.4 μg/mL; Week 32 = 7.3 μg/mL; Week 52 = 0.15 μg/mL).

Conclusion: Lebrikizumab demonstrated off-therapy maintenance of response in an AD patient subset for at least 38 weeks post-discontinuation.

Background: Androgenetic alopecia (AGA) is the most common form of hair loss, marked by progressive shedding and follicular miniaturization, with advanced stages leading to irreversible follicular loss. Follicular Unit Extraction (FUE) provides favorable outcomes even in patients with reduced follicular density. Concentrated Growth Factors (CGF), a third-generation platelet concentrate rich in growth factors (GFs), may enhance follicular survival, promote growth, and improve density with good safety, yet evidence supporting its combined use with FUE remains limited.

Objective: This study aims to conduct a prospective clinical comparative trial to evaluate the synergistic effect of CGF when used in conjunction with FUE for the treatment of AGA.

Method: This study randomized 26 male AGA patients (2022-2024) to receive FUE alone or with CGF injections. Efficacy was assessed via hair density, terminal hair ratio, standardized images, and patient/investigator GAIS satisfaction. Safety was evaluated through adverse event monitoring.

Results: Baseline characteristics were comparable. At nine months, the experimental group showed significantly higher hair density and a greater increase in terminal hair proportion than the control group (p < 0.05).

Conclusion: CGF-assisted FUE significantly improved hair density and terminal hair ratio compared with FUE alone, with favorable safety and high patient satisfaction.

Background: Biologic therapies have transformed psoriasis management, and their incorporation into Brazil's public healthcare system (SUS) in 2019 expanded access nationwide. However, real-world utilization and perceptions remain incompletely understood.

Objectives: To evaluate perceptions, barriers, and prescription patterns regarding biologic therapy among Brazilian dermatologists and patients five years after universal incorporation, while quantifying the prevalence of undertreatment.

Methods: We conducted two independent cross-sectional online surveys throughout 2024 among dermatologists (n = 225) and patients with psoriasis or psoriatic arthritis (n = 1,001). Data on demographics, clinical characteristics, and perceived barriers were analyzed.

Results: Overall, 64.9% of dermatologists prescribed biologics, with higher prescribing rates among younger physicians (p = 0.022), those with fewer years of practice (p = 0.013), higher patient volumes (p < 0.001), and practice in tertiary centers (p = 0.001). Only 25.5% of patients were receiving biologics, strongly associated with psoriatic arthritis (p < 0.001), with no difference between public and private care. Key barriers included perceptions that conventional therapies are sufficient (59.5%), insufficient training (38.0%), and administrative burden (45.5%), while patients mainly reported safety (45.7%) and cost (30.9%) concerns. Undertreatment was prevalent, affecting over 50% of patients with moderate-to-severe disease. While 71.3% of non-users were willing to start biologics, only 28.0% had received a medical recommendation.

Conclusions: Persistent educational and structural barriers continue to limit optimal biologic use despite formal availability, highlighting the need for targeted education, streamlined care pathways, and improved physician-patient communication to achieve equitable outcomes.

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.

Objectives: Prurigo nodularis (PN) is a chronic skin condition characterized by itchy nodules. Understanding the comprehensive patient perspective is essential for guiding treatment strategies. This study evaluated PN disease burden, and satisfaction with non-biologic therapies in France, Germany, Italy, and the UK.

Methods: A cross-sectional survey was conducted in adult patients with a self-reported diagnosis of PN. Disease burden was evaluated using worst itch numeric rating scale (WI-NRS; 0-10, higher indicates more severe), non-itch skin symptoms, EQ-5D-5L, Dermatology Life Quality Index, Patient-Reported Outcomes Measurement Information System Sleep Disturbance, Hospital Anxiety and Depression Scale, and Work Productivity and Activity Impairment.

Results: The survey included 165 patients with 67.3%, 30.3%, and 2.4% reporting a WI-NRS score of ≥7, 3-6, and 0-2, respectively. Less than half (45.5%) reported satisfaction with non-biologic treatments. Patients with WI-NRS ≥7 (vs. 3-6) experienced significantly more severe non-itch skin symptoms, and greater negative impacts on health-related quality of life and productivity.

Conclusion: Disease burden was high and satisfaction with non-biologic treatments was low. Patient-reported number of nodules did not strongly correlate with burden, suggesting that mild disease can induce high burden. Therefore, all aspects of disease should be considered to improve clinical management of PN.

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.

Aim: To describe the clinical response to the JAK inhibition, upadacitinib, in a patient with cutaneous infectious granulomatosis.

Methods: We reported a 36-year-old female with chronic, treatment-resistant facial and leg plaques. Histopathology supported a diagnosis of infectious granuloma, but no exact pathogen was detected after antifungal therapy. Immunohistochemical analysis indicated elevated levels of cytokines. This patient was treated with upadacitinib 15 mg daily.

Results: The symptoms had worsened despite prior antifungal therapy. This patient experienced rapid improvement and sustained remission following treatment with upadacitinib for pathogen-negative, immune-mediated granulomatosis. No recurrences were observed at the 8-month follow-up.

Conclusion: This case-report highlights a potential role for JAK inhibition, upadacitinib, in managing refractory cutaneous granulomatosis with an excessive immune response despite no identifiable pathogen and pathogen clearance.