The Journal of dermatological treatment最新文献

Introduction: Psoriasis (PsO) is a common chronic, inflammatory, immune-mediated disease. In 2023, a 4.4% prevalence of PsO was reported in Portugal. Currently, Tumor Necrosis Factor inhibitors (TNFi) are the recommended first-line (1 L) biologic agents in Portugal given their lower cost. However, TNFi may not be suitable for several patients. In these patients, interleukin inhibitors (ILi) should be considered as they provide more effective outcomes and a better safety profile.

Methods: Qualitative interviews with PsO experts were conducted to identify PsO biologic treatment needs, resulting in an online survey to explore clinical cases focused on subpopulations of PsO. A delphi study evaluated consensus on clinical criteria to initiate non-TNFi therapy in seven predefined subpopulations of patients.

Results: This study highlights the benefit of starting non-TNFi therapy in all PsO predefined subpopulations. Patients with infection risk, mild heart failure and associated comorbidities, autoimmune diseases and family history of demyelinating disease consensually benefit from starting non-TNFi therapy in 1 L. Several risks associated with latent tuberculosis, advanced age and oncological disease were also evaluated.

Conclusion: Given the existence of various risks associated with TNFi usage, this clinical perspective overview of Portuguese experts in PsO treatment emphasizes the need for a tailored therapeutic framework in the management of PsO.

The diagnoses of longitudinal melanonychia (LM) may be nail matrix nevus, etc. During excision, factors like small/pale lesions make it hard to define the boundary. Head - mounted magnifiers have limited magnification and intraoperative dermatoscopes are often unavailable. We used a DSLR camera to take and magnify pictures. First estimate the incision, then adjust. This method is recommended for doctors without intraoperative dermatoscopes.

Purpose: To investigate the potential genetic basis of Netherton syndrome (NS) through first- and second-generation DNA sequencing techniques. Additionally, we evaluated the therapeutic efficacy of Abrocitinib in NS patients.

Materials and methods: We conducted whole-exome sequencing analysis on a pedigree comprising one affected individual with NS. Subsequently, the identified patient was treated with Abrocitinib, and clinical improvements in cutaneous manifestations were systematically assessed.

Results: Genetic analysis revealed that the patient harbored compound heterozygous mutations in the SPINK5 gene, including a missense mutation in exon 26 (c.2475G > T, p.Trp825Cys). Following six months of Abrocitinib therapy, the patient exhibited marked improvement in skin rash and overall disease severity.

Conclusions: Our findings suggest that SPINK5 missense mutations may contribute to the pathogenesis of NS. Furthermore, Abrocitinib demonstrates promising therapeutic potential in the management of NS, warranting further investigation in larger clinical cohorts.

Background: Dupilumab, an interleukin 4 (IL-4) receptor α-antagonist approved for the treatment of atopic dermatitis, is considered effective in preventing disease recurrences. However, the incidence and characteristics od atopic dermatitis flares during treatment with dupilumab in a real-life setting have not been described in the literature.

Objective: This study aims to evaluate the prevalence of disease flares in patients in treatment with dupilumab and to describe the features of flares in our study population.

Methods: We conducted a retrospective observational study in which we collected demographic and clinical data on adult patients with a diagnosis of severe atopic dermatitis in treatment with dupilumab for a minimum of six months, who reached EASI75 within six months of treatment initiation.

Results: Ninety-nine patients were enrolled. Recurrences were recorded for 38.4% of patients and 7.1% developed a second recurrence. The EASI at recurrence was always lower than the EASI before treatment initiation. The localization of disease at head and neck before treatment was associated to the same localization of disease at the first recurrence (p = 0.011). The risk of recurrence was associated to the baseline EASI score (p = 0.005). The presence of dupilumab-related conjunctivitis was significantly associated to recurrences (p = 0.02).

Conclusions: Treatment with dupilumab does not exclude the risk of a relapse, which can be estimated around 50% within a timespan of three years. In the most cases, flares should not be regarded as treatment failures, and can be easily managed with additional treatment.

Background: Psoriatic disease (PsD) is a chronic immune-mediated condition with substantial humanistic burden. Despite guidelines emphasizing patient awareness for effective management, many individuals remain uninformed about its systemic nature and associated comorbidities.

Aim: This study assessed PsD patient awareness in the Gulf region using the 'Psoriasis and Beyond' survey.

Materials and methods: A cross-sectional online survey was conducted from March 2022 to June 2023, involving adult patients with moderate-to-severe psoriasis from the United Arab Emirates (UAE), Kuwait, Qatar, and Oman. Clinical characteristics and patient awareness data were collected.

Results: Among 346 patients (52 with psoriatic arthritis, PsA), 63% were aware of the term 'PsD,' with higher awareness among those with both psoriasis and PsA. However, only 61% recognized its systemic nature. Quality of life (QoL) was significantly affected in 28% of respondents, particularly those with both psoriasis and PsA. Stigma and discrimination were reported by 73% of patients. While 37% had some knowledge about PsD, many perceived their health as beyond their control.

Conclusion: The study identifies a significant knowledge gap among PsD patients in the Gulf region, highlighting the need for enhanced patient education and improved communication with healthcare providers.

Onychomycosis is a prevalent fungal infection of the nail unit that disproportionately affects individuals with diabetes, often presenting with increased severity and a higher risk of complications such as impaired mobility, secondary bacterial infection, and ulceration.

Objectives: This review examines the pathophysiological relationship between diabetes and onychomycosis, appraises the safety and efficacy profiles of current antifungal therapies, and outlines key considerations in selecting appropriate treatment regimens. It addresses pharmacokinetics, hepatic and renal considerations, and drug-drug interactions, while emphasizing the emerging role of topical therapies and the importance of a patient-centered approach.

Results: Early and accurate diagnosis utilizing mycological and molecular techniques such as fungal culture, histopathology, and polymerase chain reaction is essential to guide effective management in this high-risk population and mitigate adverse outcomes. Timely intervention is critical to reduce morbidity and prevent long-term complications. Topical and oral antifungals should be considered for mild to moderate and moderate to severe onychomycosis, respectively. The use of oral agents can be complicated by comorbidities and polypharmacy which heighten the risk of contraindications and drug-drug interactions. Therapeutic success in this population relies not only on appropriate drug selection but also on antifungal stewardship and patient adherence to prescribed regimens.

Conclusions: In view of the expanding aging population and increasing comorbidity burden, physicians should remain cognizant about diagnosing and treating onychomycosis in diabetic patients. An interdisciplinary approach to management is advisable.

Objectives: To evaluate the clinical characteristics and therapeutic outcomes of ulcerated infantile hemangioma (IH) and identify prognostic factors of ulcerated IH.

Methods: A single-center retrospective study recruiting patients with ulcerated IH between 2008 and 2023 was conducted. Clinical features and treatment response were analyzed to identify prognostic factors of ulcerated IH and differences in outcomes between early versus late pediatric dermatology referral.

Results: A total of 85 patients with ulcerated IH were included. Hemangiomas in the head and neck (H&N) and anogenital regions had an earlier presentation and occurrence of ulceration. Large hemangiomas or ulcers, combined/mixed IH, lip hemangiomas, and positive microbial growth were significant prognostic indicators for longer healing time, more complications and recurrence of ulceration. Cheek hemangiomas, focal IH and later onset ulceration were associated with less scarring and complications. Early referrals before ulceration had less ulcer recurrence (odds ratio [OR] = 0.139; 95% confidence interval [CI]: 0.028-0.693] and secondary complications (OR = 0.081 [95% CI: 0.019-0.348]). Prophylactic topical timolol maleate 0.5% was effective in reducing scar formation (OR = 0.06 [95% CI: 0.005-0.75]) and shortening follow-up duration (P = 0.044). Combination therapy with oral propranolol and pulsed dye laser was the mainstay of treatment (74%). Maintenance laser after ulcer resolution was associated with less ulcer recurrence (OR = 0.27 [95% CI: 0.075-0.96]).

Conclusion: Early referral of high-risk cases to a pediatric dermatology center before ulceration is crucial. Prophylactic topical timolol before ulceration and maintenance laser therapy after ulcer resolution can improve outcomes.

Purpose: Ruxolitinib cream was evaluated in patients with facial/neck atopic dermatitis (AD) in a decentralized, double-blind, randomized clinical trial (NCT05127421).

Materials and methods: Patients aged 12-70 years with AD (Investigator's Global Assessment [IGA] score 2/3, ≤20% affected body surface area [face/neck, ≥0.5%]) were randomized 2:1 to twice-daily 1.5% ruxolitinib cream or vehicle for 4 weeks; thereafter, all patients applied as-needed ruxolitinib cream for 4 additional weeks. The primary endpoint was ≥75% improvement in head/neck Eczema Area and Severity Index (EASI-75) at Week 4 assessed by blinded central reader using photographs.

Results: Among 77 randomized patients (median [range] age, 38.0 [17-66] y), 44.2% were Black. The mean (SD) baseline head/neck EASI was 1.2 (0.7). More patients who applied ruxolitinib cream vs vehicle achieved head/neck EASI-75 at Week 4 (37.0% vs 17.4%; p = 0.091). Improvements with ruxolitinib cream vs vehicle were observed for facial/neck IGA treatment success (IGA 0/1 with ≥2-point improvement from baseline) and Patient-Oriented Eczema Measure (overall and itch). Ruxolitinib cream was well tolerated, including on the face and neck. Application site reactions were infrequent (ruxolitinib cream, 1.9% [n = 1]; vehicle, 8.7% [n = 2]).

Conclusions: Ruxolitinib cream improved signs and symptoms of facial/neck AD vs vehicle and was well tolerated.