The Journal of dermatology最新文献

Ritlecitinib is an oral Janus kinase 3/tyrosine kinase expressed in hepatocellular carcinoma (JAK3/TEC) family kinase inhibitor approved for the treatment of severe alopecia areata (AA). Benefit-risk profiles of two doses of ritlecitinib (50 mg vs 30 mg once daily) were evaluated by integrating patient preferences and clinical efficacy and safety estimates for ritlecitinib. A discrete-choice experiment (DCE) was utilized to elicit preferences for benefit and safety attributes of systemic AA treatments. Benefits included probabilities of ≥80% scalp hair coverage and achieving moderate to normal eyebrows and eyelashes. Potential risks included 3-year probabilities of serious infection, cancer, and blood clots. Preference estimates were used to calculate the maximum acceptable risk (MAR) that patients would accept for expected increases in benefit from choosing a higher ritlecitinib dose over a lower dose. Ritlecitinib benefits were calculated from the ALLEGRO-2b/3 clinical trial. MARs were calculated separately for each risk and jointly for all possible combinations. Adults (n = 201) with physician-confirmed ≥50% scalp hair loss from AA participated. To achieve expected increases in the probabilities of ≥80% scalp hair coverage or moderate to normal eyebrows and eyelashes when choosing 50 mg over 30 mg of ritlecitinib, patients would be willing to accept increases in each 3-year risk up to a mean of 3.88 absolute percentage points (95% confidence interval [CI], 2.86-4.90) for serious infection, 1.63 (95% CI, 1.08-2.18) for cancer, and 5.30 (95% CI, 3.60-7.00) for blood clots. These results, combined with the estimated differences in risks between the two doses, indicate that patients with AA value increases in the probabilities of scalp, eyebrow, and eyelash hair regrowth, with the average patient accepting increases in potential treatment-related risks for the 50-mg dose in exchange for higher efficacy than 30 mg. The DCE approach to measuring risk tolerance, combined with comparisons to expected benefit and risk differences, can be used to optimize AA treatment dose selection.

Reactive B-cell rich lymphoid proliferation (rB-LP), once called pseudolymphoma, is a benign lymphoproliferative disorder, which is histologically characterized by dense dermal infiltrate forming reactive germinal centers with tingible body macrophages. The disease frequently involves the face, scalp, and ear lobes. Treatment includes topical or intralesional steroids, surgical resection, ultraviolet therapy, laser treatment, and radiation therapy. Cases with multiple skin lesions, however, are difficult to treat with local therapies. Oral steroids are sometimes used, although the variety of side effects and recurrence during decreases in the dosage are the main problem. Here we report seven cases of rB-LP treated with dapsone, which has anti-inflammatory effect. Although the number of cases was limited, there was a trend that patients with multiple nodules on both sides of the face showed a good response. The limitations of this study include it being a case series from a single institute, and possible effects of topical steroids. We can, however, safely say that dapsone may be useful in some patients with rB-LP.

Trichogerminoma (TG) is a rare, benign, cutaneous adnexal tumor originating from the hair germ epithelium. It typically presents as an asymptomatic, slowly enlarging nodule predominantly on the head, face, or trunk. Despite its benign nature, precise diagnosis is crucial because of its potential to become malignant. There has been no previous report on the dermoscopic findings of TG. In this study, we reviewed the dermoscopic findings of two cases in detail and contrasted them with the pathological findings. In the first case, an 80-year-old male presented with a forehead nodule that was initially suspected to be basal cell carcinoma (BCC). Dermoscopic examination revealed arborizing vessels, milia-like cysts, and comedo-like openings. Histological examination supported a diagnosis of TG, showing basaloid cell nests with peripheral palisading and pathognomonic "cell balls." The second case involved a 50-year-old female with a nodular lesion on her scalp. Dermoscopy showed arborizing vessels, milia-like cysts, and blue-gray ovoid nests. Based on the presence of "cell balls" observed in histopathological examination, this case was also diagnosed as TG. This report is seminal in documenting the specific dermoscopic patterns associated with TG, notably the presence of arborizing vessels in conjunction with features indicative of adnexal differentiation, such as milia-like cysts and comedo-like openings. Although differentiating TG from other follicular tumors such as BCC and trichoblastoma based solely on dermoscopy is challenging, these features suggest follicular differentiation in TG. This report contributes uniquely to the existing data on TG, enhancing our understanding of this rare tumor and how to diagnose it.