The Journal of dermatology最新文献

Chronic itch represents a social burden due to its high prevalence, negative impact on quality of life, and limited treatment options. Spatial (simultaneously applied stimuli at multiple skin sites) and temporal (repeated stimuli over time) summation are key mechanisms in itch processing but have not been investigated in detail in humans. This study assessed experimentally induced histaminergic and non-histaminergic itch provocations in healthy volunteers. In the spatial summation experiment, histamine or cowhage was applied in randomized order to one area, two areas on the same arm, or two areas on different arms. Itch and pain intensities were recorded for 9 min, followed by assessment of alloknesis and hyperknesis. In the temporal summation experiment, each pruritogen was applied either once or repeatedly at intervals of 90 or 180 s apart to the forearm. Itch and pain intensities were recorded for 15 min, after which superficial blood perfusion (SBP), alloknesis, and hyperknesis were assessed. Itch intensity and calculated area under the curve (AUC) were significantly facilitated by special summation after both ipsilateral and contralateral applications of both pruritogens. Temporal summation significantly increased AUC after reapplication of either of the pruritogens after 180 s. Reapplication after 90 s significantly increased cowhage-induced SBP, while reapplication after 180 s increased histamine-induced SBP. In conclusion, spatial summation augmented itch intensity and AUC, whereas temporal summation increased AUC and enhanced SBP. Both effects were observed for histaminergic and non-histaminergic itch, highlighting differences in fundamental mechanisms.

Atopic dermatitis (AD) is a chronic, itchy skin disease that often begins in infancy and may persist into adulthood. The high co-occurrence of allergic comorbidities (ACMs; asthma, food allergy, and allergic rhinitis) makes it a growing public health concern. However, real-world data on treatment patterns and the economic burden of AD in children remain sparse. This retrospective observational study aimed to assess the clinical profiles of pediatric patients with AD using data from the JMDC Claims database. Children aged 0-6 years diagnosed with AD between January 2018 and September 2023 were included. A total of 244 316 children with AD (mean age: 3.1 years; 51.3% male) were included. Of these, 17.7% had AD-only, and 82.3% had AD with ACM. Allergic rhinitis was the most prevalent ACM. Topical corticosteroids were the most prescribed treatment, with 94.0% of patients with ACMs and 85.5% of those with AD-only receiving them. Potent corticosteroids were more frequently used in the AD with ACM group. Systemic steroids (31.5% vs. 4.8%) and antihistamines (95.5% vs. 56.1%) were used more often in the AD with ACMs group than in the AD-only group. Patients in the AD with ACM versus AD-only group had more outpatient visits (11.1/year vs. 6.5/year) and comparable hospitalization frequency, but shorter hospital stays (2.4 vs. 7.7 days per year). Median annual healthcare costs were substantially higher in the AD with ACM group compared to the AD-only group (139 391 Yen vs. 98 646 Yen), with costs increasing as the number of ACMs increased. Notably, 84.7% of patients with three ACMs incurred annual healthcare costs exceeding 100 000 Yen. These findings highlighted the increased clinical and economic burden associated with the increasing number of ACMs in children with AD, emphasizing the need for more intensive treatment and healthcare resources.

Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape for malignant melanoma (MM). However, given variable response rates and potential toxicities, identifying robust biomarkers is crucial. We investigated whether the modified Glasgow Prognostic Score (mGPS) predicts treatment efficacy and toxicity in Asian patients with advanced MM receiving first-line ICIs. We retrospectively analyzed 132 patients with stage IV MM treated at Shizuoka Cancer Center between 2012 and 2024. Patients were stratified by mGPS, which integrates C-reactive protein and albumin levels. Outcomes included objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and the incidence of severe adverse events. The cohort was distributed as mGPS0 (70.5%), mGPS1 (12.9%), and mGPS2 (16.7%). Treatment efficacy declined notably with higher scores: ORR was 28.0% for mGPS0 and 23.5% for mGPS1, but dropped to 4.5% for mGPS2. Survival analysis revealed a clear prognostic stratification; median PFS was 6.2, 2.5, and 1.5 months, and median OS was 23.5, 14.6, and 1.9 months for mGPS0, mGPS1, and mGPS2, respectively. The mGPS2 group demonstrated significantly worse survival outcomes compared to the mGPS0 group. Conversely, the incidence of grade ≥ 3 adverse events did not differ significantly among the categories. The mGPS is a simple, accessible biomarker reflecting systemic inflammation and nutritional status. It effectively predicts ICI treatment outcomes in patients with advanced MM, particularly identifying those with mGPS2 as having a significantly poor prognosis.

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.

Psoriasis is frequently associated with comorbidities such as metabolic syndrome and acute coronary syndrome (ACS). Coronary artery calcification (CAC), an independent predictor of coronary events, has been reported to be more prevalent in psoriasis patients than in healthy controls. However, its clinical significance and relationship with ACS risk in psoriasis remain incompletely understood. We conducted a single-center retrospective cross-sectional study involving 89 Japanese patients with psoriasis who underwent chest computed tomography (CT) to assess the presence of CAC. In selected patients with CAC, coronary CT angiography (CCTA) was performed, and the fractional flow reserve derived from CT (FFR_CT) was calculated. Thirty-one patients with CAC were more likely to have psoriasis vulgaris, were older, had lower estimated glomerular filtration rates (eGFR), and exhibited higher hemoglobin A1c (HbA1c) levels compared with those without CAC. Among the 22 patients who underwent CCTA, coronary artery calcium scores (CACS) were positively correlated with Psoriasis Area and Severity Index (PASI) scores, serum C-reactive protein (CRP), and HbA1c levels. FFR_CT was measured in 10 patients with ≥ 40% coronary stenosis; six had FFR_CT value ≤ 0.80, indicating a high risk of ACS. Multivariable logistic regression analysis using a stepwise selection method identified age as the only significant predictor of ACS risk. In conclusion, elderly psoriasis patients with concomitant diabetes mellitus (DM) may have an elevated risk of ACS and could benefit from cardiology referral for cardiovascular risk assessment.