The Journal of dermatological treatment最新文献

Background: The comparative effects of phototherapy and topical therapy in patients with vitiligo remain unclear. A network meta-analysis (NMA) was conducted to assess which combination therapy was more beneficial for patients with vitiligo.

Methods: This study analyzed phototherapy, including narrowband ultraviolet B (NB-UVB) and 308-nm excimer laser/light (EL) combined with topical therapies. Randomized controlled trials were sourced from PubMed, Embase, and Cochrane Library. Data analysis was based on a random-effects model, and surface under the cumulative ranking (SUCRA) curves employed to assess the efficacy of the interventions.

Results: This NMA included 27 trials, with a total of 2417 lesions (patches). According to the results of the SUCRA, for achieving ≥50% repigmentation, the top three combination therapies were phototherapy combined with antioxidants (SUCRA 87.7), corticosteroids (SUCRA 69.6), and calcineurin inhibitors (SUCRA 52.5), while for ≥75% repigmentation, the leading therapies were phototherapy combined with antioxidants (SUCRA 89.0), calcineurin inhibitors (SUCRA 70.3), and fractional CO₂ laser (SUCRA 63.6).

Conclusions: This meta-analysis suggests that combining phototherapy with topical antioxidants, corticosteroids, or calcineurin inhibitors may offer superior outcomes for vitiligo patients. This study provides a reference for clinicians to develop personalized treatment plans for patients with vitiligo.

Cannabis use has increased significantly in the last decade. This article presents a case where a patient needed more local anesthetic (LA) than usual to induce effective anesthesia during hair transplant surgery. The reason cannabis users often need more LA is poorly understood. One possibility is that cannabis withdrawal effect makes patients more sensitive to pain and stress. Additionally, vasodilatory property of cannabis may speed up LA clearance from the application site. The interactions of two major cannabinoids, cannabidiol (CBD) and tetrahydrocannabinol (THC), with cannabinoid receptor type 1 (CB1), cannabinoid receptor type 2 (CB2), and transient receptor potential vanilloid 1 (TRPV1) receptors are also complex. Furthermore, CBD and THC function as cytochrome P450 enzyme inhibitors potentially impacting systemic metabolism. When planning to administer LA during hair restoration surgery in cannabis users, clinicians should obtain a detailed history of prior consumption (type of cannabis, frequency, dosage). Preoperative planning should consider the anticipated duration of surgery and calculate the maximum safe LA dose to avoid the risk of toxicity. Also, patients should be carefully monitored for vital signs during surgery. If a patient requires frequent re-injection to remain pain free, the surgeon may need to re-assess the surgical plan to avoid toxicity.

Purpose: Alopecia areata (AA), an autoimmune disorder characterized by non-scarring hair loss, is detrimental to the psychological health and quality of life of people living with AA. Clinically meaningful hair regrowth is possible, but the relationship with downstream patient-reported outcomes (PROs) is complex.

Materials and methods: This post hoc analysis of ALLEGRO-2b/3 (NCT03732807) longitudinal data from Weeks 24-48 compared improvements in PROs between patients who achieved (responders) or did not achieve (non-responders) clinically meaningful scalp hair regrowth. Responders were defined by a Week 24 Severity of Alopecia Tool (SALT) score ≤20 (SALT20) or ≤10 (SALT10). Across 6 PROs assessing multiple AA-related health domains, response proportions and mean changes from baseline were estimated for Weeks 24-48.

Results: Among 650 included participants, 114 (17.5%) were SALT20 responders, of which 76 (11.7%) were also SALT10 responders. Generally, more responders than non-responders reported improvements in AA and related symptoms or limitations and satisfaction with hair regrowth. Responders additionally reported greater improvement from baseline than non-responders for measures of AA-related emotional symptoms, mental health, and work or activity limitations.

Conclusions: These results support a positive relationship between scalp hair regrowth and downstream PROs-including satisfaction and psychosocial burden-demonstrating an association between clinically meaningful hair regrowth and patient-reported treatment benefits.

Objectives: With the development of biotechnology, double-layer artificial dermis repair material has been increasingly employed to repair deep skin and soft tissue defects. This study aims to investigate the effectiveness of double-layer artificial dermis repair material combined with autologous skin patch in repairing deep skin and soft tissue defects.

Methods: This study conducted a retrospective analysis of 18 patients with deep skin and soft tissue defects who were treated with a combination of double-layer artificial dermal repair materials and autologous skin grafting at our hospital between January 2022 and January 2024.

Results: A total of 18 patients were treated, including 7 males and 11 females, with an average age of 41.7 ± 19.12 years. All patients exhibited good vascularization of the double-layer artificial dermal material postoperatively. In one patient, only a small part of the autologous skin patch survived after the first grafting, and the skin healed well after the second grafting. The remaining patients healed well after the operation. Two months after the operation, the results showed that no obvious hyperplastic contracture scar was found in the wound grafts of 18 patients, and the total Vancouver Scar Scale (VSS) score was not significantly different between 1 month and 2 months after the operation (p > 0.05).

Conclusion: Double-layer artificial dermis repair material combined with autologous skin patch provides a reliable, less invasive and simple treatment for deep skin and soft tissue defects.

Purpose: Sarcoidosis is a chronic, multisystem granulomatous disorder characterized histologically by non-caseating granulomas. Despite the availability of various therapeutic options, long-term disease control remains a significant clinical challenge.

Materials and methods: We report the case of a 55-year-old female diagnosed with sarcoidosis. Skin and lymph node biopsies revealed non-caseating granulomatous inflammation, and chest CT indicated pulmonary involvement. Infectious causes of granulomatous disease, including Mycobacterium tuberculosis, non-tuberculous mycobacteria, and fungal infections, were excluded through com-prehensive testing. The patient initially received conventional systemic corticosteroid therapy but developed treatment-related complications. Due to the need for sustained disease control, an alternative regimen combining low-dose corticosteroids with the selective JAK1 inhibitor abrocitinib was initiated.

Results: The patient showed significant clinical improvement following the combination therapy, with no observed treatment-related adverse events.

Conclusions: This case suggests that low-dose corticosteroids combined with a JAK1 inhibitor such as abrocitinib may represent a treatment option for patients with sarcoidosis.

Purpose: Marionette lines, also known as static labiomandibular folds, are common age-related perioral wrinkles that impact facial aesthetics, particularly in Asian populations. This article aims to examine the anatomical basis, etiology, and filler injection techniques used for treating marionette lines.

Materials and methods: The study reviews anatomical studies and clinical practices related to marionette lines. Anatomical observations focus on the position of the modiolus and its relationship to age-related changes. Treatment approaches are examined through a review of filler injection techniques, including supramuscular and submuscular fat layer targeting, as well as neurotoxin use for enhancing treatment outcomes.

Results: The review finds that the anatomical positioning of the modiolus in Asian populations predisposes them to increased susceptibility to commissural ptosis and wrinkle formation. Filler injections, particularly using a cannula for deeper layers, are effective for addressing volumetric loss in the supramuscular and submuscular layers. Neurotoxin injections into the depressor anguli oris muscle can enhance results by reducing downward force on the oral commissure.

Conclusions: Marionette lines are complex, multifactorial wrinkles that benefit from a multimodal treatment approach, combining dermal fillers and neurotoxins. Awareness of anatomical variations and proper injection techniques is crucial for achieving optimal aesthetic outcomes and minimizing risks.

Background: Psoriasis is frequently associated with non-communicable disease (NCD) comorbidities, prompting interest in how these concurrent conditions may influence psoriasis treatment outcomes.

Objectives: To assess NCD prevalence and their influence on psoriasis treatment outcomes.

Methods: From 2022 to 2024, we recruited psoriasis patients in Shanghai Skin Disease Hospital. Data on demographic features, NCD comorbidities and treatment outcomes at week 4 and week 8 were systematically collected through questionnaire, physical examination, and clinical severity assessment (psoriasis area and severity index [PASI], body surface area [BSA], physician's global assessment [PGA]).

Results: Among 1116 patients, 48.4% had at least one NCD comorbidity. NCD-free patients exhibited higher PASI₅₀ response rates at both week 4 (46.5 vs. 39.1%) and week 8 (72.2 vs. 70.9%). Log binomial regression revealed that NCDs significantly reduced the likelihood of achieving PASI₅₀ at week 4 (relative risk [RR] = 0.84, 95% confidence interval [CI]: 0.73-0.96), with a similar but non-significant trend at week 8 (RR = 0.98, 95% CI: 0.92-1.06).

Conclusion: NCDs negatively impact early treatment outcomes in psoriasis patients. So we propose that dermatologists should integrate systematic NCD management into psoriasis treatment regimen.

Background: Hailey-Hailey disease (HHD), a genetic blistering disease, is caused by a mutation in a calcium transporter protein in the Golgi apparatus encoded by the ATP2C1 gene. Clinically, HHD is characterized by flaccid vesicles, blisters, erosions, fissures, and maceration mainly in intertriginous regions. Some patients remain refractory to conventional treatments. Previously, a series of reports have confirmed naltrexone as an effective option for those patients. However, in China, naltrexone is unavailable in some hospitals and unaffordable for some patients.

Objective: To confirm naloxone as a treatment option for HHD, and assess the efficacy rate and safety of naltrexone for patients with HHD.

Methods: Two patients with biopsy-proven HHD received naloxone (2 mg/d, via intravenous infusion). We followed up with the two patients, assessing the change of skin lesions and obtaining photographs. We searched the PubMed databases using the keywords 'Hailey-Hailey disease' or 'benign familial pemphigus', and 'naltrexone' or 'naloxone', and reviewed English publications of reports and analyzed the efficacy and safety of naltrexone.

Results: Two patients prescribed naloxone showed completely remission in two weeks without any adverse reactions. The total remission rate of naltrexone for HHD is approximately 80%, without severe adverse effects.

Conclusion: Naltrexone is effective and safe in the treatment of HHD. Naloxone, an analog of naltrexone, can also effectively and safely treat HHD, potentially offering a new therapeutic option for patients with refractory HHD.

Introduction: Sex-differences in biological treatment outcomes in adult patients with psoriasis are well known. Potential sex-differences in a real-world cohort of pediatric and young adult patients with psoriasis using biologics were investigated in this study.

Methods: Data on pediatric (<18 years) and young adult (≥18 to ≤30 years) patients were obtained from the prospective, daily practice, ChildCAPTURE and BioCAPTURE registries. Drug survival and adverse event rates were compared between sexes. Confounder-corrected linear mixed models were used to compare Psoriasis Area and Severity Index (PASI) and (Children's) Dermatology Life Quality Index ((C)DLQI) scores between sexes.

Results: We included 117 pediatric (65 females) and 243 young adult (124 females) patients on biologics (753.4 observation years). Young adult males had a significantly higher PASI at biologic initiation compared to females, with the same trend for pediatric patients. A higher adverse event rate was observed in females compared to males in both pediatric and young adult patients. Drug survival, PASI and (C)DLQI course during the first treatment year, were comparable between pediatric and young adult females and males.

Conclusion: Awareness on sex-differences (start PASI and adverse event rates) in pediatric and young adult patients with psoriasis is important for timely initiation and adjustment of appropriate treatment.