The Journal of dermatology最新文献

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.

The treatment of pemphigus vulgaris (PV) often requires long-term systemic corticosteroids. Although new biologicals like rituximab are changing the landscape, traditional immunosuppressants still prevail in many underdeveloped areas. One such medication is methotrexate (MTX), which has been widely used in autoimmune and autoinflammatory diseases, but its role in treating pemphigus remains somewhat unclear and controversial. This study aimed to evaluate the effect and safety profile of using low-dose MTX in PV patients receiving glucocorticoids. PV patients who visited the Department of Dermatology, Peking University First Hospital from January 2010 to December 2021 were retrospectively screened. Based on different treatment regimens, patients were automatically divided into a corticosteroid monotherapy group and a corticosteroid combined with low-dose MTX group (MTX was administered at a dose of no more than15 mg per week, with a minimum duration of 8 weeks). All patients were followed up for 1 year. A total of 142 patients with PV were eligible for the study (100 in the corticosteroid monotherapy group and 42 in the corticosteroid combined with low-dose MTX group). The Kaplan-Meier curve indicated that the corticosteroid combined with low-dose MTX group achieved a 50% reduction in glucocorticoid use faster, with a P value of 0.0132, especially among patients who initially received more than 60 mg of steroids per day. The inclusion of MTX reduced the occurrence of hyperpilidemia. There was not sufficient evidence to determine if the addition of MTX was associated with more bacterial infection cases for certain. The inclusion of low-dose MTX in the corticosteroid treatment regimen for patients with PV, particularly those receiving high doses, can facilitate the reduction of glucocorticoid dosages and lower the incidence of hyperlipidemia, without increasing the risk of other adverse effects.

Drug-induced hypersensitivity syndrome (DIHS) is one of the severe drug eruptions accompanied by fever and multiple organ dysfunction, and it is induced by a relatively limited range of drugs, including anticonvulsants. A distinctive feature of this condition is its association with the reactivation of herpes viruses, particularly human herpesvirus 6. The pathogenesis involves two key factors: drug allergy and herpesvirus reactivation. DIHS is often challenging to diagnose in its early stages, and its clinical course varies widely, ranging from relatively mild to life-threatening cases. Additionally, unexpected complications, such as autoimmune diseases, may occur during the convalescent phase. As a result, diagnosing, treating, and predicting the prognosis of DIHS remain complex issues. In response to these challenges, the Ministry of Health, Labour and Welfare Study Group on Severe Erythema Multiforme has taken the lead in developing new guidelines for the management of DIHS. These guidelines aim to support clinical practice by providing up-to-date, evidence-based information on the diagnosis, treatment, and prognosis of DIHS.