The Journal of dermatological treatment最新文献

Objective: Untreated vulvar lichen sclerosus (VLS) can lead to irreversible anatomical changes and increase malignancy risk. Some patients show poor response to standard treatments, resulting in refractory cases (RVLS).

Methods: To explore risk factors associated with RVLS and integrate treatment strategies for improved clinical management, we conducted a retrospective analysis, which included patients with VLS who visited our outpatient clinic between March 2017 and March 2025. Additionally, an evidence synthesis of the currently reported treatment regimens for RVLS was conducted.

Results: A total of 457 patients were included, of whom 36 were diagnosed with RVLS (7.9%). A multivariable logistic regression model identified comorbid autoimmune thyroid diseases (OR 2.45; 95%CI 1.09-5.34), perianal region involvement (OR 3.20; 95%CI 1.19-8.09), and presence of erosion/fissures (OR 3.13; 95%CI 1.44-7.29) as independent predictors for RVLS. Furthermore, the treatment approaches for 281 patients with RVLS across 20 studies included Janus kinase inhibitors (JAK), adalimumab, methotrexate, cyclosporine, photodynamic therapy (PDT), and laser therapy, with assessments of efficacy, side effects, and recurrence.

Conclusions: Our study identified three predictive factors for RVLS, which may help in treatment decisions and reduce ineffective therapy. And therapies such as JAK and PDT show promise as optimized options, although larger studies are needed.

Background: Interleukin (IL) inhibitors are increasingly used in the management of moderate-to-severe plaque psoriasis. However, their use in patients with a history of cancer is debated.

Objective: We conducted a multicenter retrospective study across nine Italian Dermatology Units to assess the real-world effectiveness and safety of IL inhibitors (IL-23, IL-17, IL-12/23) in 136 oncological patients with moderate-to-severe plaque psoriasis. In particular, we evaluated 116 patients who developed the neoplasm before starting the biologic with a mean time from diagnosis of neoplasia to the first biologic dose of 8.31 years. We also assessed 20 patients who received a diagnosis of neoplasm during treatment with IL inhibitors after a mean time of 2.41 years from the start of the biologic with a cumulative incidence of 3.06 per 1000 individuals.

Results: Three patients experienced neoplasm recurrence during treatment with IL inhibitors, which led to the discontinuation of these drugs. In our study, biologics have demonstrated safety and effectiveness as treatment options for patients with both a history of neoplasm and those with concurrent tumors. However, further investigation is needed, particularly through larger and longer multicenter studies.

Background: Tapinarof cream 1% once daily (QD) demonstrated significant efficacy in patients down to age 2 years with atopic dermatitis (AD) in the ADORING 1 and 2 phase 3 trials. We report local tolerability outcomes.Methods: Patients received Tapinarof or vehicle cream QD for 8 weeks. Tolerability was evaluated using patient/parent/caregiver and investigator 5-point Local Tolerability Scales (LTS). Investigators assessed tolerability for sensitive skin areas, including face/neck.Results: 813 patients were randomized (∼80% pediatric). Mean pretreatment baseline overall LTS scores were similar across groups and trials: 1.0-1.9 (patient-assessed) indicating slight burning/stinging and itching; and 0.3-0.6 (investigator-assessed) indicating no-to-minimal irritation. Tapinarof was well tolerated with improvement from pretreatment baseline and no-to-minimal burning/stinging and itching from first application through Week 8 (patient-reported): mean Week 8 LTS scores were 0.2-0.4 (burning/stinging) and 0.6-0.8 (itching). Investigators reported improvement from pretreatment baseline with no-to-minimal irritation (dryness/erythema/peeling) from first Tapinarof application through Week 8 (mean LTS scores: 0.2 and 0.1 in ADORING 1 and 2, respectively). Across sensitive skin, investigators reported no-to-minimal irritation from first application through Week 8 (mean scores [Tapinarof versus vehicle]: 0-0.3 versus 0-1.0).Conclusion: Tapinarof was well tolerated locally from first application through Week 8, including on sensitive skin areas.

Clinicaltrials.gov numbers NCT05014568, NCT05032859.

Objective: This study aims to analyze the different therapeutic responses between topical antimicrobial-corticosteroid combination and topical corticosteroids alone on improving the skin microbiome and skin barrier of patients with atopic dermatitis (AD).

Methods: Forty patients with mild-to-moderate AD were randomly assigned to receive two kinds of treatment. Skin swabs were collected from the lesional sites and nearby nonlesional sites at baseline, after topical medication treatment and 2 weeks post-treatment, and were analyzed by DNA sequencing of the fungal internal transcribed spacer (ITS)1-5 rDNA gene and the V3V4 region of the bacterial 16S rRNA gene.

Results: According to our research analysis, both topical steroids alone and combination treatment of steroids and antimicrobials effectively improved the severity of AD and repaired skin barrier. AD lesions were characterized by a decreased sebum level, lower abundance of Cutibacterium and a higher abundance of Staphylococcus. A combined topical treatment with an antimicrobial and steroid showed better responses in increasing skin sebum level and restoring the skin bacterial microbiome, whereas topical steroid alone did not improve skin dysbiosis.

Conclusion: A combined therapy with antimicrobial and steroid helps to recover the skin microbiome. Further studies are necessary to explore the therapeutic effects of treatments aiming at balancing the microbiome.

Purpose: Understanding the treatment goals and preferences of young atopic dermatitis (AD) patients and their caregivers is crucial for enhancing patient-centered care. This study aims to identify these goals and preferences and explore heterogeneity among subgroups.

Materials and methods: A web-based survey was conducted among children (6-11 years), adolescents (12-17 years), and young adults (18-30 years) with AD and caregivers of AD patients. Survey questions included multiple-choice, four-point Likert scale, and open-ended questions. Goals and preferences were stratified by age, gender, disease severity, current treatment, visible lesions, and atopic comorbidity.

Results: A total of 286 respondents were included. Prioritized treatment goals were 'no itch', 'preventing new lesions', and 'no lesions'. Prioritized treatment characteristics were 'high effectiveness' and 'long-term safety'. Young patients (6-30 years) considered convenience of treatment more important than caregivers, while caregivers considered short- and long-term safety more important than young patients. Pediatric patients (6-17 years) considered psychosocial goals more important than young adults. Goals and preferences also differed by disease severity, gender, current treatment, and atopic comorbidity.

Conclusions: Young AD patients and caregivers strive to reduce itch and lesions with effective and safe treatment. Goals and preferences differ within individuals at different stages of life, highlighting the importance of addressing individual needs to improve patient-centered care.

Objectives: To evaluate the efficacy and safety of apremilast, a phosphodiesterase-4 (PDE-4) inhibitor, in treating pityriasis lichenoides et varioliformis acuta (PLEVA) and explore its potential mechanisms.

Methods: We present a 16-year-old male with refractory PLEVA who failed conventional therapies (systemic corticosteroids, acitretin). Treatment with oral apremilast (30 mg twice daily) was initiated.

Results: Significant improvement was observed within 1 week, with near-complete clearance by 8 weeks. No relapse or adverse events occurred during 12-month follow-up.

Conclusions: Apremilast may be a safe and effective option for refractory PLEVA.

Objectives: Atopic dermatitis (AD) is a chronic inflammatory skin condition with increasing prevalence in infancy. Standard treatments rely heavily on topical corticosteroids, but concerns about long-term side effects and limited efficacy in some cases highlight the need for alternative therapeutic strategies.

Methods: We present a 13-month-old male with moderate AD refractory to moisturizers and hydrocortisone ointments. Sympathetic Nerve Entrapment Point Injection (SNEPI) was administered bilaterally at the T7 paraspinal level using 1 mL of normal saline once weekly for three sessions. Clinical outcomes were monitored during treatment and over a six-year follow-up period.

Results: Pruritus resolved and sleep normalized after the first treatment. By the third session, complete remission of skin lesions was achieved without corticosteroid use, with no recurrence observed during four weeks of follow-up. During a six-year follow-up, the child maintained stable skin with only occasional mild pruritus, suggesting sustained therapeutic benefit.

Conclusions: This case demonstrates the potential of SNEPI as a safe, effective, and steroid-free neuromodulatory treatment for pediatric AD, supporting the role of autonomic modulation in inflammatory skin disorders. Further clinical studies are warranted to evaluate the broader applicability of SNEPI in pediatric dermatology.

Objective: This study explores the effects of a skin management model based on a precision quantitative ointment dispenser on skin symptoms and quality of life in elderly psoriasis patients.

Methods: Elderly psoriasis patients adopted a skin management model based on a precision quantitative ointment dispenser. The Psoriasis Area and Severity Index (PASI) was measured prior to the intervention and at 2, 4, and 6 weeks post-intervention. The Chinese version of the Strategies Used by Patients to Promote Health (C-SUPPH), Symptom Checklist-90 (SCL-90), and Dermatology Life Quality Index (DLQI) were assessed at baseline and after 6 weeks. Patient satisfaction was measured following the 6-week intervention.

Results: Both groups demonstrated reductions in PASI scores at 2, 4, and 6 weeks, with the observation group scoring lower (p < 0.05). After 6 weeks, all dimensions of the C-SUPPH showed improvements in both groups, with the observation group exhibiting greater enhancements; SCL-90 scores for anxiety and phobic anxiety reduced in the observation group; DLQI scores decreased in both groups, but the observation group reported superior outcomes; the observation group recorded a higher satisfaction rate (p < 0.05).

Conclusion: The precision quantitative ointment dispenser-based skin management model improves skin symptoms and quality of life in elderly psoriasis patients.