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.

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.

Purpose of the study: Head, neck (HN), and face involvement in atopic dermatitis (AD) poses a major psychological burden and can be challenging to effectively treat. New appearance of HN dermatitis has been reported with biologics used to treat AD. Lebrikizumab (LEBRI), a monoclonal targeting IL-13, is approved for AD treatment in the US, Europe and Asia. We evaluated HN dermatitis improvement using the HN Eczema Area and Severity Index (EASI) and a facial dermatitis questionnaire, along with safety evaluations focusing on HN and facial erythema.

Materials and methods: Efficacy analyses were performed on placebo (PBO) controlled modified intention-to-treat (mITT) populations from the 16-week induction periods of ADvocate1 and ADvocate2 (pooled) and ADhere studies. Treatment-emergent adverse events (TEAEs) of HN and facial erythema were summarized from eight Phase 2 and 3 clinical trials.

Results: LEBRI resulted in significantly greater improvements than PBO in EASI HN subscore as early as Week 2 (ADvocate 1&2), with 68.1% improvement at Week 16.

Conclusions: LEBRI improved EASI HN subscore and HN EASI clinical signs of erythema and facial dermatitis at Week 16. During the PBO-controlled period, an increased reporting of HN and facial erythema as TEAE was not observed in the LEBRI group and HN and facial TEAEs reporting did not increase with longer exposure.

Background: The number of monotherapies for hidradenitis suppurativa (HS) has expanded. However, the efficacy of active comparators has not been determined in head-to-head trials.

Aims: We conducted an NMA to determine the relative efficacy and safety of monotherapies for HS.

Methods: The literature was systematically reviewed to obtain data from trials that (1) were published in English, (2) investigated a systemically administered monotherapy with an immunomodulatory agent (3) randomized, and (4) quantified efficacy, at 16 weeks, insofar as the Hidradenitis Suppurativa Clinical Response 50 (HiSCR-50), Dermatology Life Quality Index (DLQI) and Numeric Rating Scale 30 (NRS30). For safety, we analyzed the occurrence of treatment-emergent adverse events (TEAEs). For sensitivity analyses, we conducted network meta-regressions adjusted for age and sex.

Results: We determined the efficacy of numerous regimens including those approved by the United States FDA; for instance, the FDA-approved 'bimekizumab 320 mg every 2 weeks' was more efficacious than 'IFX-1 800 mg every 2 weeks' (odd ratio = 1.99, 95% credible interval: 1.09,3.87, p < 0.05) in terms of HiSCR-50. Sensitivity analyses showed that the main analyses were robust. Overall, risk of bias across studies was low.

Conclusions: The current NMA provides comparative evidence on systematic immunomodulatory HS monotherapies from the most up-to-date trial evidence.

Aim: To evaluate the therapeutic efficacy and safety of the Janus kinase (JAK) inhibitor tofacitinib in the management of refractory perianal pyoderma gangrenosum (PG) under conditions of baseline immunosuppression and bone marrow suppression.

Methods: We present a 62-year-old male with a 4-month history of painful, progressive symmetrical perianal ulcerations diagnosed as PG, coexisting with condyloma acuminatum. The patient had a background of pure red cell aplasia and myasthenia gravis, and was undergoing chronic immunosuppressive therapy with prednisolone and tacrolimus. Previous interventions including topical agents, antibiotics, phototherapy, and surgical debridement were ineffective. Oral tofacitinib (5 mg/day) was introduced following multidisciplinary evaluation.

Results: Marked pain reduction was achieved by day two of tofacitinib therapy, with near-complete ulcer healing observed within two weeks. Hematologic parameters remained stable throughout the 4-month treatment course, which was well tolerated with no adverse effects. The patient remained relapse-free during a 1-year follow-up.

Conclusions: Tofacitinib may offer a rapid, effective, and well-tolerated treatment alternative in cases of refractory PG, even when layered onto preexisting immunosuppressive regimens. This case highlights the potential of JAK inhibitors as targeted therapy in complex PG presentations and supports their further clinical evaluation.

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.

Background: Vunakizumab (anti-interleukin-17A antibody) has shown favorable efficacy and safety in treating moderate-to-severe plaque psoriasis. The morbidity and severity of psoriasis vary in different regions of China.

Objective: This post-hoc exploratory analysis aims to investigate the efficacy and safety of vunakizumab in patients with moderate-to-severe plaque psoriasis across different regions of China.

Methods: This post-hoc exploratory analysis used data from a phase III trial (NCT04839016), with 461 patients receiving vunakizumab categorized into North (n = 118), Central (n = 252), and South (n = 91) China groups.

Results: Psoriasis area and severity index (PASI)75/90/100 and static physician's global assessment (sPGA) 0/1 response rates were similar among the three groups at week 12 (W12). Additionally, W12-W52 sustained PASI 75/90/100 and sPGA 0/1 response rates were also similar among groups. Similar improvements in patient-reported outcomes, including dermatology life quality index, itch-numerical rating scale, EuroQol-5D, and short form-36, were observed in the three groups. The incidence of adverse events was 80.5%, 90.1%, and 90.1% in the North, Central, and South China groups, respectively.

Conclusion: The efficacy and safety of vunakizumab are not affected by different regions of China in patients with moderate-to-severe plaque psoriasis.

Purpose: Human amniotic fluid stem cells (hAFSCs) have shown significant regenerative potential in treating hair loss, wound healing, and tissue repair. This study aims to evaluate the effects of human amniotic fluid (hAF) on hair follicle (HF) regeneration and immune system modulation.

Materials and Methods: The hAF used was pooled, acellular, and gamma-irradiated to standardize its contents and enhance its stability. Both irradiated (FAFI) and non-irradiated (FAF) hAF were assessed for their efficacy and safety in promoting hair growth and modulating immune responses in a rat model of hair loss. The study examined HF regeneration, transition to the anagen phase, and macrophage polarization from the pro-inflammatory M1 phenotype to the anti-inflammatory M2 phenotype.

Results: Both FAF and FAFI treatments significantly increased HF density, with FAFI exhibiting enhanced effects. Histological analysis demonstrated improved HF regeneration, increased M2 macrophages, and reduced collagen fiber deposition in treated areas. Gamma irradiation likely improved the efficacy of FAFI by stabilizing active components and inhibiting protease activity.

Conclusions: Irradiated hAF is a safe and effective therapeutic candidate for alopecia and HF growth disorders. These findings support further evaluation of hAF in clinical trials to validate its potential for hair regeneration therapies.

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.