The Journal of dermatology最新文献

We report a rare case of dermatomyositis with positive anti-small ubiquitin-like modifier-1 activating enzyme antibody complicated by Rosai-Dorfman disease. A 41-year-old Japanese man presented with fever and general malaise, followed by developed progressive dysphagia. Physical examination revealed extensive erythema, along with characteristic heliotropic rash and erythematous keratotic plaques on the extremities. Laboratory examinations showed elevated muscle enzyme levels, and anti-small ubiquitin-like modifier-1 activating enzyme antibodies were detected by immunoprecipitation-Western blotting, whereas other myositis-specific autoantibodies were negative. Chest and abdominal computed tomography showed no findings suggestive of interstitial lung disease or internal malignancy, but revealed multiple painless lymphadenopathies in the inguinal regions. Lymph node biopsy revealed the diagnosis of Rosai-Dorfman disease. To the best of our knowledge, the present case is the first reported case of dermatomyositis associated with Rosai-Dorfman disease, which may suggest a shared immunopathological mechanism between the two diseases.

Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, has been reported to be effective and tolerable for moderate-to-severe palmoplantar pustulosis (PPP) in clinical trials, but real-world data are limited. To evaluate the 28-week real-world effectiveness of apremilast in patients with PPP. We conducted a single-center, retrospective study of 15 adult patients (≥ 18 years) with moderate-to-severe PPP (baseline physician's global assessment score ≥ 3) who required systemic treatment because topical therapy alone was insufficient or unsuitable. Patients received apremilast 30 mg twice daily. Palmoplantar Pustulosis Area and Severity Index (PPPASI) and Dermatology Life Quality Index (DLQI) were assessed at weeks 0, 4, 16, and 28 of treatment. Mean PPPASI and DLQI scores decreased continuously through Week 28. At Week 28, mean percent reductions of PPPASI and DLQI from baseline were 76.9% and 63.4%, respectively. Week 28 rates achieving PPPASI 50, PPPASI 75, PPPASI 90, and DLQI 0/1 were 90.0%, 60.0%, 30.0%, and 42.9%, respectively. Treatment-emergent adverse events were diarrhea in six patients, leading to discontinuation of apremilast in one patient. No serious adverse events occurred. These findings suggest that apremilast treatment is effective and tolerable for PPP patients requiring systemic treatment in routine practice. Further studies with larger cohorts and longer observation are required to confirm the sustainability of its clinical benefits.

Palmoplantar pustulosis (PPP) is a chronic relapsing inflammatory skin disorder predominantly affecting the palms and soles. Despite the continued use of oral systemic agents, real-world data on their durability and treatment patterns in PPP remain limited. To investigate the treatment patterns, drug survival, and clinical factors associated with treatment persistence in patients with PPP receiving oral systemic therapies. We conducted a retrospective cohort study of patients diagnosed with PPP at a tertiary care referral center in Korea between January 2010 and August 2023. Patients were categorized according to the initial oral agent prescribed-cyclosporine, acitretin, or methotrexate. Treatment trajectories were assessed using predefined criteria, and 12-month drug survival was evaluated. Clinical predictors of treatment non-persistence were identified using Cox proportional hazards regression analysis. Among 374 patients, 192 received oral systemic therapy (cyclosporine, n = 110; acitretin, n = 72; methotrexate, n = 8). Cyclosporine was the most commonly prescribed first-line agent. Median drug survival was the longest for cyclosporine, followed by methotrexate and acitretin (p = 0.15). Nail involvement was associated with greater persistence (HR = 0.617; 95% CI: 0.444-0.857; p = 0.004), whereas baseline hypertension increased discontinuation risk (HR = 1.492; 95% CI: 1.015-2.195; p = 0.042). Discontinuation patterns differed by agent: cyclosporine was often stopped early due to adverse events but remained durable in patients who tolerated it; acitretin was associated with early and persistent adverse events, with well-controlled disease emerging as a later reason for cessation; and methotrexate showed sustained use beyond 6 months, with most discontinuations attributed to well-controlled disease. This study highlights the heterogeneous treatment trajectories and variable drug survival among oral agents for PPP. Nail involvement and hypertension may be key clinical predictors of persistence. These findings support individualized treatment approaches to improve long-term management of PPP.

Anti-interleukin-13 antibodies, lebrikizumab, and tralokinumab are effective for atopic dermatitis (AD); however, real-world data on 1-year effectiveness for head and neck (H&N) lesions are limited. To evaluate the effectiveness of 48-week lebrikizumab or tralokinumab treatment on H&N lesions in patients with moderate-to-severe AD. We conducted a two-center retrospective study of Japanese AD patients treated with lebrikizumab (n = 160) or tralokinumab (n = 171). H&N eczema area and severity index (EASI) was assessed through 48 weeks in total patients or subgroups of baseline H&N EASI < 3 or ≥ 3. Lebrikizumab and tralokinumab rapidly reduced H&N EASI by Week 4, which was maintained through Week 48. At Week 48, achievement rates of H&N EASI 75, 90, or 100 were 77.3%, 37.3%, or 17.3% with lebrikizumab, and 75.0%, 44.8%, or 29.2% with tralokinumab, respectively. In lebrikizumab treatment, patients with baseline H&N EASI ≥ 3 showed numerically higher achievement rates of H&N EASI 90 at Week 16 and 48 compared to those with baseline H&N EASI < 3, whereas the results were the trend differed in tralokinumab treatment. This subgroup observation was limited to small baseline H&N EASI ≥ 3 subgroups and may not be generalizable. Taken together, treatment with lebrikizumab and tralokinumab rapidly reduced H&N EASI by Week 4, and these improvements were maintained through Week 48.

This study aimed to evaluate the clinical efficacy of combination therapy with clindamycin and benzoyl peroxide in treating acne vulgaris. We assessed the antimicrobial susceptibility of Cutibacterium acnes isolates obtained from these patients. In addition, the potential risk of C. acnes developing resistance to clindamycin and benzoyl peroxide following exposure was investigated in vitro. We analyzed 182 C. acnes isolates from patients with acne to evaluate the clindamycin susceptibility and resistance determinants and to examine the association between topical clindamycin use and resistance. We also tested the resistance frequency of C. acnes to clindamycin monotherapy and clindamycin/benzoyl peroxide combination therapy in vitro. The clindamycin resistance rates in the clindamycin/benzoyl peroxide and clindamycin monotherapy groups were 22.9% and 46.7%, respectively. The combination group showed a significantly lower clindamycin resistance rate (p < 0.05). Under clindamycin monotherapy, resistant strains emerged at a frequency of 8.1 × 10^-8 to 8.7 × 10^-8, whereas no resistant strains were detected under clindamycin/benzoyl peroxide combination conditions. The combination of clindamycin and benzoyl peroxide effectively suppressed the emergence of clindamycin-resistant C. acnes.