The Journal of dermatology最新文献

Despite the systemic inflammatory implications of hidradenitis suppurativa (HS), the relationship between systemic inflammatory markers and HS has not been definitively established in the existing literature. This review aimed to evaluate the relationship of peripheral blood inflammatory markers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), pan-immune-inflammation value (PIV) and systemic immune-inflammation index (SII) with the presence and severity of HS. A comprehensive search of the PubMed, Embase and Cochrane databases was conducted. Studies with data on these peripheral blood inflammatory markers in HS patients were included. A meta-analysis was performed using standardized mean differences to evaluate the association between these inflammatory markers and HS. Our study included 23 research articles that included 2623 cases and 22 015 controls. The results demonstrated that (1) CRP, ESR, NLR, and SII levels were significantly higher in HS patients than controls, and (2) CRP, ESR, PIV, and SII positively correlated with HS severity between Hurley stages I and II and II and III. NLR and PLR also correlated with severity between stages II and III. CRP, ESR, NLR and SII are significantly associated with the presence of HS, while CRP, ESR, SII, and PIV are important indicators of HS severity. NLR and PLR become particularly significant in groups with severe HS. Our results underscore the systemic inflammatory involvement in HS and suggest that these inflammatory markers could be valuable in clinical practice for screening and monitoring the progression of HS.

Autoantibodies, including anti-BP180 and anti-BP230 antibodies in bullous pemphigoid (BP) and mucous membrane pemphigoid (MMP), and anti-type VII collagen (COL7) antibodies in epidermolysis bullosa acquisita (EBA), are well characterized. Enzyme-linked immunosorbent assays (ELISAs) for the detection of these antibodies in the serum are valuable for diagnosis. Previous studies have indicated that anti-BP180 and anti-BP230 antibodies in blister fluid and saliva can be detected using ELISA. The aim of this study was to detect anti-BP180, anti-BP230, and anti-COL7 antibodies in several types of samples, including blister fluid, an erosive surface swab, and saliva, by ELISAs and to compare the titers of these antibodies between different types of samples. Thirty-three patients with BP/MMP, two patients with EBA, and 13 patients with non-pemphigoid diseases were included in this study. Samples were collected from each patient and analyzed using commercial ELISA kits. In the cases of BP/MMP, the mean ± standard deviation indices of BP180 ELISA were 411.9 ± 538.3, 253.5 ± 333.3, 2.360 ± 1.714, and 1.599 ± 1.262, and those of BP230 ELISA were 27.73 ± 37.65, 20.52 ± 30.04, 0.486 ± 0.7915, and 0.346 ± 0.4373, from sera, blister fluids, erosive surface swabs, and saliva, respectively. The indices of BP180 and BP230 ELISAs using serum were significantly correlated with those of BP180 and BP230 ELISAs using blister fluid (r = 0.9342 and r = 0.9882), an erosive surface swab (r = 0.7586 and r = 0.9332), and saliva (r = 0.5731 and r = 0.6147), respectively. This study revealed that autoantibodies were detectable in blister fluids, erosive surfaces, and saliva, and their correlation with serum titers in pemphigoid diseases was highest in blister fluid. In summary, blister fluid can be a minimally invasive sample alternative to serum for the detection of pemphigoid-related antibodies.

Atopic dermatitis, psoriasis, alopecia areata, and vitiligo have been associated with comorbid conditions, including infections, malignancies, and cardiovascular diseases. This study evaluated the prevalence and incidence rates of these comorbidities in patients from Japan. This retrospective cohort study used data collected from the JMDC claims database between June 2013 and December 2020. Patients with a diagnosis of atopic dermatitis, psoriasis, alopecia areata, or vitiligo were matched (1:1) by age, sex, and index month with individuals with no claims records for atopic dermatitis, psoriasis, alopecia areata, or vitiligo diagnosis. Data included 691 338, 51 988, 43 692, and 8912 patients in the atopic dermatitis, psoriasis, alopecia areata, and vitiligo cohorts, respectively, and matched controls. The most prevalent comorbidities in the atopic dermatitis cohort versus matched controls included allergic rhinitis (47% vs 37%), conjunctivitis (33% vs 23%), asthma (27% vs 20%), viral infection (22% vs 15%), and acne (11% vs 3%). Incidence rates per 100 000 person-years of comorbidities in the atopic dermatitis cohort versus matched controls were: venous thromboembolism, 51.4 (95% confidence interval [CI], 48.3-54.7) versus 31.7 (95% CI, 29.2-34.2); lymphoma, 13.8 (95% CI,12.2-15.6) versus 5.7 (95% CI, 4.7-6.8); cutaneous T-cell lymphoma, 1.6 (95% CI, 1.1-2.2) versus 0.1 (95% CI, 0.0-0.4); and herpes zoster, 740.9 (95% CI, 728.8-753.1) versus 397.6 (95% CI, 388.9-406.6). Similar trends were observed in the psoriasis versus nonpsoriasis cohorts, with 95% CIs mostly overlapping for alopecia areata and vitiligo cohorts versus controls. Overall, patients from Japan with dermatologic diseases have a higher prevalence and incidence of certain health conditions, particularly venous thromboembolism, lymphoma, and infections in patients with atopic dermatitis and psoriasis, compared with individuals without these dermatologic diseases.

The recent availability of immune checkpoint inhibitors (ICIs) has revolutionized the treatment of advanced malignant melanoma (MM). However, many patients with MM do not benefit from ICI treatment. As immunotherapy is associated with significant toxicity and high treatment costs despite its excellent efficacy, it is pertinent to select patients who are likely to respond to ICIs. In this single-center, retrospective study we investigated whether the controlling nutritional status (CONUT) score is a useful prognostic marker in Japanese patients with advanced-stage cancer. We analyzed 123 patients with stage IV MM treated with ICIs as first-line systemic treatment at our hospital between February 2012 and July 2024. Receiver operating characteristic curve analysis was used to calculate the CONUT cut-off value and CONUT into two groups of ≥3 and ≤2. Progression-free survival (PFS) and overall survival (OS) were determined using the Kaplan-Meier method, and differences in survival were assessed using the log-rank test. The Cox proportional hazard regression model was used to evaluate independent prognostic factors. Objective response rate (ORR), PFS, and OS were significantly low in the CONUT ≥3 group, characterized by low nutritional status and high inflammation. Multivariate analysis identified the CONUT score as an independent prognostic factor for both PFS and OS. The CONUT score was not significantly associated with the development of serious immune-related adverse events. The simplicity of the CONUT score may aid in identifying patients with MM who are suitable candidates for ICI treatment.

The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is widely used to distinguish between necrotizing fasciitis and cellulitis. However, LRINEC scores are not as sensitive or specific as initially reported, possibly due to differences in patient backgrounds in different countries. Here, we examined the validity of LRINEC scores in Japanese patients. We also investigated the possibility of developing a new scoring system. Patients with necrotizing fasciitis (n = 56) and cellulitis (n = 209) were retrospectively evaluated. The data were split into training (n = 199) and validation (n = 66) datasets. A logistic regression analysis was used to calculate the C-statistics of the LRINEC scores. A new equation was formulated using logistic regression analysis with an appropriate variable selection (Laboratory Risk Indicator for Necrotizing Fasciitis for Japanese Patients [J-LRINEC] score). The J-LRINEC score had a C-statistic of 0.9683, sensitivity of 91.4%, and specificity of 84.8%. The LRINEC score had a C-statistic of 0.914 and specificity of 96%; however, its usefulness was limited by its sensitivity of 68.9%. Our results suggest that the LRINEC score is valid for Japanese patients; however, the J-LRINEC score showed higher sensitivity and specificity, suggesting that it may be a useful tool for differentiating cellulitis from necrotizing fasciitis among Japanese patients.

Real-world evidence on the long-term effectiveness of deucravacitinib, a selective tyrosine kinase 2 inhibitor for psoriasis, remains limited, particularly in patients with different histories of systemic treatments. We evaluated the 52-week effectiveness of deucravacitinib in patients with psoriasis, stratified by a history of apremilast or biologic usage. This prospective, single-center study included 110 patients with moderate-to-severe psoriasis who received daily deucravacitinib (6 mg). Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores during the treatment were analyzed in subgroups stratified by a history of apremilast or biologic usage. Deucravacitinib decreased PASI and DLQI scores for 52 weeks in psoriasis patients, both with and without prior apremilast or biologic usage. The percent reductions from baseline PASI or DLQI at week 52 were similar in apremilast-experienced patients (92% or 77.9%) and apremilast-naive patients (88.3% or 81.6%), respectively. The achievement rates of PASI 100 or absolute PASI ≤1 at week 52 in apremilast-experienced patients (30.8% or 61.5%) were slightly higher than those in apremilast-naive patients (20.5% or 46.2%). The percent reductions from baseline PASI or DLQI at week 52 in biologic-naive patients (91.6 or 82.8%) were slightly higher than those in biologic-experienced patients (57.6% or 63.6%), respectively. The achievement rates of PASI 75, 100 or absolute PASI ≤1 at week 52 in biologic-naive patients (84.4%, 24.4%, or 53.3%) were slightly higher than those in biologic-experienced patients (57.1%, 14.3%, or 28.6%), respectively. Deucravacitinib generated sustained 52-week effectiveness in diverse patient subgroups, supporting its role as a universal treatment for psoriasis.

Pachydermoperiostosis (PDP) is a genetic disease characterized by digital clubbing, periostosis, and pachydermia. PDP with these three features, along with cutis verticis gyrata (CVG), is categorized as the "complete form," whereas cases without CVG are categorized as the "incomplete form." The condition is linked to elevated levels of systemic prostaglandin E2 (PGE2). About half of PDP patients experience arthralgia. The standard treatment for PDP is selective cyclooxygenase (COX)-2 inhibitors, but long-term usage can cause gastrointestinal side effects. Additionally, mutations in the SLCO2A1 can lead to chronic enteropathy associated with the SLCO2A1 gene (CEAS), making the use of selective COX-2 inhibitors particularly risky for PDP patients with CEAS. This has prompted the search for alternative treatments. In this study, five PDP patients-three with the complete form and two with the incomplete form-were treated with acetaminophen. The PGE-major urinary metabolite (PGE-MUM) was monitored as a biomarker of disease activity, reflecting systemic PGE2 levels. Before treatment, PGE-MUM levels were significantly elevated in patients with complete form and mildly elevated in those with incomplete form. Following acetaminophen, PGE-MUM levels decreased in patients with complete form, and all patients reported improvement in arthralgia without developing gastrointestinal symptoms. In conclusion, acetaminophen shows promise as an alternative treatment for PDP, effectively reducing PGE-MUM levels in certain patients and alleviating arthralgia while avoiding the gastrointestinal side effects associated with long-term COX-2 inhibitor usage.