The Journal of dermatological treatment最新文献

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.

Purpose/aim: Remote clinical research has potential to increase study diversity, reduce costs for researchers and participants, and increase efficiency of studies. This study evaluates the reliability and feasibility of using SkinTracker, a mobile application, for remote AD severity assessment through mobile-app based photography and surveys.

Methods: This single-center observational study enrolled 28 participants (18 with AD and 10 healthy controls) in an eight-week hybrid clinical study. Participants completed bi-weekly tasks and submitted standardized skin photographs via the SkinTracker app, and clinic-based skin exams and digital single-lens reflex (SLR) photos were obtained at baseline and week 8. Eczema Area Severity Index and Investigator Global Assessment scores were assigned to the photographs by a grader. Intraclass correlation coefficients were used to evaluate agreement between app-based, in-person, and SLR assessments for the 18 participants with AD.

Results: App-based AD assessment scores had excellent agreement with in-person scores, indicating the reliability of SkinTracker to assess disease activity remotely. Furthermore, all participants had high compliance and satisfaction with app-based activities, indicating that using SkinTracker for remote clinical research is achievable and even preferred by participants.

Conclusion: Overall, these findings show that SkinTracker is both reliable and feasible for monitoring atopic dermatitis disease activity remotely.

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.