The Journal of dermatology最新文献

Chronic pruritus is common and often difficult to treat. Although several studies have examined how cleansing agents used during bathing relate to pruritus, the effect of washcloth use during bathing, including whether discontinuation is associated with lower itch, remains unclear. We conducted a single-center retrospective observational study of 79 washcloth users with diverse skin diseases to evaluate pruritus before and after washcloth withdrawal without treatment escalation. Pruritus severity was measured using a 0 to 10 Numerical Rating Scale (NRS), and scores were compared within patients. At baseline, the mean NRS score among users was 4.79, with cotton and synthetic-fiber washcloths showing comparable scores. Among those who discontinued washcloth use without treatment escalation, mean NRS scores decreased from 4.89 to 1.90 (p < 0.0001), while those who continued showed no significant change in pruritus scores (from 3.86 to 3.60; p > 0.9999). Our data suggest that discontinuing washcloth use may be associated with lower pruritus scores and could represent a practical, low-cost, and none-invasive measure for pruritus management warranting prospective evaluation.

Two-year effectiveness of tyrosine kinase 2 inhibitor deucravacitinib is unknown for psoriasis in real-world, especially in patients with different histories of systemic therapy. To evaluate the 104-week effectiveness of deucravacitinib in patients with psoriasis, stratified by prior use of apremilast or biologics. We studied 131 patients with moderate-to-severe psoriasis who received deucravacitinib 6 mg/day. Psoriasis area and severity index (PASI) and dermatology life quality index (DLQI) were analyzed in subgroups stratified by prior apremilast or biologic therapy. Deucravacitinib decreased PASI and DLQI through 104 weeks regardless of prior apremilast or biologic therapy. Week 104 achieving PASI 100 and absolute PASI ≤ 1 were higher in apremilast-naïve patients (15.4% and 53.8%) than in apremilast-experienced patients (0% and 25%, respectively). Week 104 achieving PASI 75, PASI 90, PASI 100, and absolute PASI ≤ 1 were higher in biologic-naïve patients (84.6%, 57.7%, 15.4%, and 53.8%) than in biologic-experienced patients (25%, 25%, 0%, and 25%, respectively). Deucravacitinib reduced PASI and DLQI through 104 weeks in patients with psoriasis regardless of prior apremilast or biologic therapy, with lower sustainability of PASI 100 or absolute PASI ≤ 1 achievements in patients with prior apremilast or biologic treatment.

Background: Dermatomyositis (DM) can present initially with respiratory symptoms and may be misdiagnosed as infection or other pulmonary disorders, leading to delayed recognition and worse outcomes. We aimed to characterize this respiratory-onset phenotype and to evaluate whether elbow Gottron's sign is associated with respiratory-onset and clinically meaningful adverse outcomes.

Methods: We conducted a single-center retrospective cohort study of 190 DM patients. Respiratory-onset was defined as respiratory symptoms documented as the first presenting complaint (cough, sputum production, wheezing, chest tightness, dyspnea, and/or auscultatory Velcro crackles); imaging findings were not used to define onset phenotype. Outcomes included respiratory failure (primary), progressive ILD, and death. Multivariable logistic regression and ROC analyses were performed.

Results: The initial symptoms of DM patients with respiratory system manifestations are mostly cough, sputum, wheezing, chest tightness, fever, and Velcro rales. Laboratory tests show that erythrocyte sedimentation rate, lactate dehydrogenase, anti-MDA5 antibody, anti-RO-52 antibody, carcinoembryonic antigen, and ferritin are all higher in this group compared to those with initial symptoms from other systems. ROC curve analysis demonstrated that elbow Gottron's sign alone provided modest but significant predictive value for respiratory failure (AUC = 0.668). Notably, a combined model incorporating both respiratory symptoms and elbow Gottron's sign showed significantly improved discriminative performance (AUC = 0.765). These findings support the role of elbow Gottron's sign as a clinically relevant marker for identifying dermatomyositis with respiratory onset and for stratifying the risk of respiratory failure in this patient subgroup.

Conclusions: Respiratory-onset identifies a clinically meaningful high-risk DM phenotype with substantially increased respiratory failure. Elbow Gottron's sign is a readily observable cutaneous clue that may facilitate earlier recognition and risk stratification.

Nagashima-type palmoplantar keratoderma (NPPK) is a hereditary non-epidermolytic keratoderma predominantly reported in East Asian populations. It is mainly caused by biallelic loss-of-function variants in SERPINB7, but the functional impact of certain variants remains unclear. In this study, we performed Sanger sequencing on three unrelated Chinese patients with clinically diagnosed NPPK and identified biallelic pathogenic SERPINB7 variants in all cases. Among these, a novel in-frame indel variant (c.806_814delinsT, p.Ser269_Glu273delinsLeu) and three known founder variants (c.796C>T, c.522dupT, and c.455G>T) were detected. Transcript analysis revealed that the c.455G>T variant, despite being located at the exon-intron 6 junction, functions as a missense variant (p.Gly152Val) without affecting mRNA splicing. Functional studies, including protein structural modeling and legumain protease activity assays, revealed that both variants impaired the inhibitory function of SERPINB7, leading to increased legumain activity. These findings expand the mutational spectrum of SERPINB7 and provide new insights into the pathogenicity of the c.806_814delinsT and c.455G>T variants in the Chinese population.

Prurigo nodularis (PN) is a chronic, intensely pruritic dermatosis driven by neuroimmune dysregulation for which targeted therapies are emerging. The objective of our study is to evaluate the efficacy and safety of Janus kinase inhibitors (JAK-Is) for the treatment of PN. We conducted a systematic search in sources including PubMed/Medline, Scopus, Web of Science, and Embase; the search was completed on September 9, 2025. Inclusion criteria were the use of any JAK-I in a patient with confirmed PN, and exclusion criteria were reviews, duplicate reports, and studies with incomplete outcome data. Risk of bias was assessed using the NHLBI quality assessment tools for observational studies and the Murad et al. checklist for case reports and case series. Ten clinical studies (n = 180 patients) and 21 case reports/series (n = 31 patients) were included (total n = 211). Agents evaluated included upadacitinib, tofacitinib, abrocitinib, and baricitinib. Applying standardized response criteria, 139/180 patients (77.2%) in clinical studies achieved meaningful clinical improvement. Rapid itch relief was frequently observed (days to weeks). Quality of life improved substantially (mean reduction from 20.4 to 3.9). Reported adverse events were generally mild (infections, laboratory abnormalities, dyslipidemia, acneiform eruption); serious events were rare. Limitations include small sample sizes, predominance of uncontrolled and observational designs, heterogeneity of outcomes, and limited long-term safety data. Current evidence suggests JAK-Is are highly effective and generally well tolerated for PN, warranting larger randomized controlled trials with extended follow-up.

Ritlecitinib is an oral JAK3/TEC family kinase inhibitor approved for individuals aged ≥ 12 years with severe alopecia areata. Here we report interim efficacy and safety results with ritlecitinib up to Month 24 in the Asian subpopulation from the ALLEGRO phase 2b/3 and ALLEGRO-LT studies. Data are reported for participants with Severity of Alopecia Tool score ≥ 50 who received ritlecitinib 50 mg with (200/50-mg group) or without (50-mg group) an initial 4-week 200-mg daily loading dose in ALLEGRO-2b/3, and continued ritlecitinib 50 mg in ALLEGRO-LT. In long-term studies, it is common for summaries at later time points to reflect participants who remained in the study, tolerated the drug, and had a positive treatment response. To account for this, efficacy summaries were presented both as observed and by using the last observation carried forward method. At Month 12, 51.7% and 44.7% (last observation carried forward) of Asian participants in the 50-mg (n = 58) and 200/50-mg groups (n = 47), respectively, achieved Severity of Alopecia Tool score ≤ 20 (≤ 20% scalp hair loss); the respective proportions were 50.0% and 47.8% at Month 24. Of participants who achieved Severity of Alopecia Tool score ≤ 20 at Month 12 in the 50-mg and 200/50-mg groups, 68.2% and 86.7% sustained this response through Month 24, respectively. At Month 12, 74.0% and 57.9% of participants in the 50-mg and 200/50-mg groups, respectively, had an eyebrow hair regrowth response; at Month 24, the proportions were 72.0% and 48.7%. At Month 12, 65.1% and 54.1% of participants in the 50-mg and 200/50-mg groups, respectively, had an eyelash hair regrowth response; the proportions were 65.1% and 52.8% at Month 24. The proportion of participants with a Patients' Global Impression of Change response of "moderately" or "greatly" improved since baseline increased through Month 24 in both groups. Ritlecitinib had an acceptable safety profile, consistent with that in the overall population. Overall, ritlecitinib 50 mg (±200-mg loading dose) demonstrated clinically meaningful and sustained efficacy through Month 24 in the Asian subpopulation, consistent with results in the overall population. Trial Registration: ClinicalTrials.gov: NCT04006457.