The Journal of dermatology最新文献

Atopic dermatitis (AD) involves chronic eczema resulting from barrier dysfunction. Fine bubble (FB) technology generates microbubbles (< 100 μm) and ultrafine bubbles (< 1 μm) for surfactant-sparing cleansing. We assessed the short-term safety of an FB shower in AD. In this double-blind, randomized, crossover study, adults with mild AD completed two 2-week periods separated by a 2-week washout in sequence. Bathing instructions and petrolatum moisturizer use were standardized and enforced. The Eczema Area and Severity Index (EASI) was scored using whole-body photographs by a blinded team. Transepidermal water loss (TEWL) and stratum corneum hydration were measured on Days 0, 14, and 28. Because baselines were unavailable for the second 2-week period, the primary analysis compared Day 0-14 changes between groups using baseline-adjusted analysis of covariance; Day 0-28 changes were also explored. The primary outcomes were EASI changes; TEWL and hydration were the secondary outcomes. Groups used a conventional shower (control) first and then FB shower second or vice versa (once each). Twenty-three participants were analyzed (mean age 40.9 ± 8 years; 83% male). Day 0-14 EASI changes did not differ between FB and control (0.62 ± 2.21 vs. 0.05 ± 0.68; F = 0.93, p = 0.35). EASI changes to Day 28 were nonsignificant (0.02 ± 1.65 vs. -0.03 ± 1.02; p = 0.90). TEWL changes for Days 0-14 (0.31 ± 4.75 vs. 1.09 ± 6.21 g/m²/h) and to Day 28 (5.49 ± 14.43 vs. -0.27 ± 5.28 g/m²/h) showed no between-group differences. Hydration changes were similar for Days 0-14 (5.53 ± 13.23 vs. 6.14 ± 7.96 AU) and to Day 28 (18.41 ± 10.33 vs. 21.09 ± 11.07 AU). No serious adverse events or discontinuations for worsening symptoms occurred. Under standardized, low-irritant conditions, the FB shower was well-tolerated by adults with mild AD and did not worsen severity or barrier indices over 4 weeks. However, the superiority of FB to a conventional shower was not demonstrated.

Accurate diagnosis is essential for timely intervention in atopic dermatitis (AD), yet delays in diagnosis remain common. To better understand current clinical practices regarding infantile AD, a questionnaire survey was conducted among Japanese pediatricians working at medical institutions with 19 or fewer beds. Respondents who provided informed consent completed an online questionnaire that included items on screening practices, physician background, understanding of diagnostic and treatment practices, and recognition of key clinical issues. In total, 238 valid responses were analyzed. Most respondents indicated that they were non-allergists (85.7% of responses), aged 50 years or older (68.9% of responses) and reported high clinical experience in treating infantile eczema. Only 44.1% of respondents correctly recognized that AD is a condition within the collective term of infantile eczema. Almost all (92.0%) respondents correctly agreed that early intervention was effective for infantile AD and most recognized that AD treatment is prolonged, that AD induces other allergic diseases, and that AD is unlikely to resolve spontaneously in most cases. Understanding of the primary nature of AD was poor with 62.6% of respondents either incorrectly stating that AD is caused by other allergic diseases or that they did not know. The mean (SD) minimum age of AD diagnosis was 7.4 (4.81) months (median, 6.0 months) and 23.9% of physicians diagnosed AD after 1 year of age. Only 16.4% of respondents correctly identified a case of infantile AD and only 19.3% of respondents correctly selected the most appropriate treatment for a known case of infantile AD. Reluctance to inform parents/caregivers of an AD diagnosis was high and mostly due to anticipation of parental shock. Certain pediatricians in Japan have misunderstandings about infantile AD. Further awareness of infantile AD is necessary to ensure early diagnosis and intervention as well as management aligned with guideline recommendations.

The tyrosine kinase 2 inhibitor deucravacitinib is effective for psoriasis. However, it is unclear whether early responses to deucravacitinib in real-world practice are maintained for 2 years and whether patients without early responses can achieve delayed responses. This study is aimed to evaluate the sustainability of week 16 responses to deucravacitinib treatment for psoriasis and to evaluate delayed responses in week 16 poor responders. This prospective study included 117 Japanese patients with moderate-to-severe psoriasis treated with deucravacitinib. Patients who achieved psoriasis area and severity index (PASI) 75, PASI 90, PASI 100, absolute PASI ≤ 2, absolute PASI ≤ 1, static physician's global assessment (sPGA) 0/1, or dermatology life quality index (DLQI) 0/1 at week 16 were evaluated for maintenance of each outcome. Patients who did not achieve these outcomes at week 16 were evaluated for delayed achievement of each outcome through week 104. In week 16 achievers, week 104 maintenance rates of PASI 75, PASI 90, PASI 100, absolute PASI ≤ 2, and absolute PASI ≤ 1 were 95.2%, 87.5%, 66.7%, 100%, and 91.7%, respectively, while those of sPGA 0/1 and DLQI 0/1 were 100% and 88.9%, respectively. In week 16 non-achievers, week 104 achievement rates for PASI 75, PASI 90, PASI 100, absolute PASI ≤ 2, and absolute PASI ≤ 1 were 25.0%, 15.4%, 7.7%, 50.0%, and 23.5%, respectively, and those for sPGA 0/1 and DLQI 0/1 were 60.0% and 50.0%, respectively. Improvements of rash and quality of life achieved at week 16 of deucravacitinib treatment were mostly sustained through week 104. Some patients without week 16 responses could achieve delayed responses at later time points.

Nemolizumab, an anti-interleukin-31 receptor A monoclonal antibody, has been approved in Japan for treating atopic dermatitis (AD)-associated pruritus. While it is effective for itch control, nemolizumab-associated cutaneous adverse events have been increasingly recognized, yet their clinical features remain poorly characterized. In this study, we aimed to investigate the incidence, clinical characteristics, and timing of cutaneous manifestations associated with nemolizumab treatment in patients with AD, and to explore potential associations with baseline disease severity and immunological parameters. We conducted a multicenter retrospective study involving 219 patients aged ≥ 13 years with AD who received nemolizumab at 13 institutions in Japan between August 2022 and February 2024. Cutaneous eruptions were classified into six categories based on clinical consensus. Patients who received fewer than three doses without developing skin reactions were excluded. Clinical and laboratory parameters were compared between patients with and without cutaneous manifestations. Cutaneous manifestations occurred in 88 patients (40.2%), most commonly within the first three doses. Erythema was the most frequent presentation (69.3%), and 62.5% of eruptions were non-pruritic. No significant associations were observed between the occurrence of skin reactions and baseline eczema area and severity index scores, eosinophil counts, serum immunoglobulin E, or thymus and activation-regulated chemokine levels. Two cases of bullous pemphigoid were identified. Despite topical corticosteroid treatment, nemolizumab therapy was discontinued in 42% of the patients affected. In conclusion, nemolizumab frequently induces early-onset, morphologically distinct cutaneous eruptions that appear to be independent of baseline disease severity or biomarkers.