The Journal of dermatological treatment最新文献

Purpose: Twenty-nail dystrophy (TND) is a chronic nail disorder affecting all or some nails and posing a significant therapeutic challenge for dermatologists. Janus kinase (JAK) inhibitors have recently emerged as a promising treatment modality for refractory nail diseases.

Results: We report a case of a patient with idiopathic TND for 12 years duration, and successfully treated with oral tofacitinib, which offered a potential new therapeutic choice for this challenging entity. Some successful cases of treating inflammatory nail diseases with Janus kinase (JAK) inhibitors were reviewed.

Conclusion: Janus kinase (JAK) inhibitors may be a promising therapeutic option for patients with twenty-nail dystrophy.

Background: Psoriasis is a chronic inflammatory disease affecting about 2% of the global population, with moderate-to-severe forms requiring systemic treatment for successful disease management. By targeting the interleukin (IL)-23p19 subunit of IL-23, the master cytokine of psoriasis pathogenesis, guselkumab, tildrakizumab, and risankizumab offer improved risk-benefit profiles.

Objective: While randomized clinical trials (RCTs) provide controlled data, real-world evidence (RWE) offers insights into the performance of these therapies in diverse patient populations, including those with comorbidities or difficult-to-treat areas affected. With RWE on these inhibitors constantly emerging, a comprehensive overview and expert interpretation are essential for providing key insights into psoriasis management in clinical practice.

Methods: This review, therefore, examined RWE on the effectiveness and safety of IL-23p19 inhibitors compared to their pivotal RCTs.

Results: Despite some gaps between RCT and RWE outcomes, particularly in underrepresented subpopulations, IL-23p19 inhibitors show strong effectiveness and favorable safety across both settings in the short- and especially in the long term, accompanied by an improvement in health-related quality of life and reduction of the main symptoms.

Conclusion: Altogether, these factors make these medicines ideal treatment options. Future research should focus on improving patient-reported outcomes, specifically addressing psychological and quality-of-life aspects, to further optimize psoriasis management.

Purpose: One of the most well-known medications for treating delusional infestation (DI) is pimozide. Many patients may be reluctant to initiate treatment unless a medication has anti-pathogenic properties, as they feel otherwise it does not address their concerns regarding infestation. In this article, we explore the evidence that pimozide has a range of antipathogenic effects and how this fact can aid in patient care.

Materials and methods: A scoping literature review was performed using The National Library of Medicine (PubMed). The search terms used were pimozide AND anti-microbial OR anti-bacterial OR anti-infective. All relevant articles were reviewed up to September 2024.

Results: Our findings show that pimozide has antibacterial and antiparasitic effects through several unique mechanisms. Additionally, several older first-generation antipsychotics also have demonstrated anti-pathogenic properties. While the studies identified are entirely in vitro, the potential antipathogenic effects of pimozide may be pivotal to patients with DI as they make the critical decision to accept or reject treatment.

Conclusion: With adequate disclaimers that pimozide's therapeutic efficacy may not have to do with its anti-pathogen profile, the evidence that pimozide has anti-pathogenic properties may enable dermatology providers to strengthen their therapeutic approach and alliance with patients with DI and make life-changing therapy more acceptable to the patient.

Background: Emerging research suggests that Janus kinase-signal transducer and activator of transcription (JAK-STAT) inhibitors may be associated with a higher risk of serious infection for patients with rheumatoid arthritis. However, there is no consensus on whether JAK inhibitors increase the risk of serious infection in patients with Immune-mediated inflammatory skin diseases (IMISDs).

Objectives: To ascertain the correlation between JAK inhibitor use and the risk of serious infection in patients with IMISDs.

Methods: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and registered Clinical Trials were searched up to June 1, 2024, using specific search terms related to JAK inhibitors and IMISDs. Randomized clinical trials (RCTs) comparing JAK inhibitors with a control group in patients with IMISDs were included. Studies focusing on cohort studies, case reports, case series, review articles, pooled analysis studies, post hoc analyses and topical JAK inhibitors were excluded. Data were extracted independently by two authors, focusing on serious infections defined according to each study's criteria. Crude numbers for serious infections were pooled and underwent meta-analysis. We assessed the primary outcome regarding the occurrence of severe infections for each study.

Results: Thirty-two randomized clinical trials involving 11,917 patients were included. Serious infections were reported in 0.62% of patients receiving JAK inhibitors and 0.51% of controls. Meta-analysis found no significant increase in risk of serious infection (I²=0.00%, RR, 0.68; 95% CI, 0.43-1.07). Subgroup analyses revealed no significant heterogeneity based on condition (p = .56) or medication (p = .69).

Conclusions: This meta-analysis demonstrates that JAK inhibitors do not significantly increase the risk of serious infections in IMISD patients compared to control treatments. These findings support the safety of JAK inhibitors in this population. Future research should focus on real-world evidence to further assess their risk-benefit profile in dermatological practice.

Aim: Janus kinase (JAK) inhibitors have emerged as targeted therapies for atopic dermatitis (AD), and increasing evidence suggests their potential benefit in vitiligo. While both diseases are considered immunologically distinct, recent insights point to overlapping cytokine pathways that may be modulated by JAK1-selective inhibitors.

Materials and methods: We present a case of a 37-year-old male with moderate-to-severe AD and stable vitiligo who developed worsening of vitiligo following treatment with upadacitinib. Although AD symptoms resolved, vitiligo lesions progressed despite phototherapy.

Results: After switching from upadacitinib to abrocitinib, the patient experienced marked repigmentation of vitiligo lesions within three months, along with continued control of AD symptoms.

Conclusions: This case highlights the differential effects of upadacitinib and abrocitinib, possibly due to their distinct JAK2 inhibition profiles. The findings underscore the importance of considering kinase selectivity when using JAK inhibitors in patients with overlapping immune-mediated skin disorders.

Purpose: This study describes the use of upadacitinib, a JAK1 inhibitor, in combination with oral minoxidil for treatment of alopecia universalis (AU) with comorbid Crohn's disease (CD) and atopic dermatitis (AD). AU is the most extensive form of alopecia areata (AA), a chronic autoimmune condition that often requires systemic therapy for hair regrowth. While JAK inhibitors (JAKis) have demonstrated efficacy in each condition, data on upadacitinib's use in patients with coexisting disease are limited.

Materials and methods: We report the case of a 20-year-old male with CD who developed AU one year after initiating adalimumab. Following inadequate CD control and progression of hair loss, he was diagnosed with coexisting AU and AD. An IBD-directed regimen of upadacitinib (45 mg/day induction, 30 mg/day maintenance) was initiated with oral minoxidil, increased from 2.5 to 10 mg/day.

Results: By 7 weeks, he experienced resolution of gastrointestinal symptoms and early hair regrowth; by 11 weeks, he achieved complete regrowth of scalp, eyebrow, eyelash, and beard hair. Colonoscopy confirmed histologic remission.

Conclusions: This case highlights the potential of JAK is to address potentially overlapping immune-mediated disorders and suggests that upadacitinib, in combination with oral minoxidil, may promote rapid AU remission. These findings may inform future treatment approaches for complex autoimmune presentations.