Annals of dermatology最新文献

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by eczematous lesions and pruritus. Facial and neck involvement in AD can be challenging to differentiate from other facial dermatoses, such as allergic contact dermatitis, seborrheic dermatitis, rosacea, and drug-induced facial dermatitis, complicating treatment strategies.

Objective: This study aimed to investigate the distribution of facial involvement patterns in patients with AD and to explore the differential diagnosis, focusing on head and neck lesions.

Methods: A retrospective study was conducted on 100 patients diagnosed with AD at a single medical center. Facial and neck lesions were categorized into 5 distinct patterns-periorificial, centrofacial, diffuse, patch, and mixed-based on anatomical distribution. The study also evaluated the impact of dupilumab treatment on these patterns.

Results: The most frequently affected anatomical regions were the frontal (68%), buccal (60%), and orbital (57%) areas. The most common facial involvement pattern was periorificial (28%), followed by diffuse (24%) and centrofacial (21%). The dupilumab-treated group showed a higher frequency of the diffuse pattern compared to other treatment groups. Additionally, periorbital hyperpigmentation, Dennie-Morgan folds, and cheilitis were common minor features.

Conclusion: The study identified distinct facial involvement patterns in AD, with centrofacial and periorificial patterns being the most prevalent. These findings underscore the importance of recognizing facial and neck involvement in AD for accurate diagnosis and personalized treatment. Further large-scale studies are needed to validate these results and explore the underlying mechanisms influencing facial involvement.

Background: Monopolar radiofrequency (MRF) is widely used for non-invasive facial rejuvenation.

Objective: In this study, we compared the clinical efficacy and patient-reported procedural pain of a novel MRF system with continuous water cooling (RF-CWC) versus conventional MRF with cryogen spray cooling (RF-CSC) in 22 Asian women.

Methods: In this prospective, randomized, split-face, single-blind trial, 22 participants received a single session of both RF-CWC and RF-CSC. Clinical outcomes-including changes in pore size, elasticity, skin density, fine lines, and lifting-were assessed over 8 weeks using quantitative measurements and investigator-assessed global improvement scores. Procedural pain was also recorded. To support the clinical findings, an ex vivo model was used to evaluate collagen and elastin fiber density, collagen I and III concentrations, and dermal temperature profiles.

Results: RF-CWC demonstrated clinical efficacy comparable to that of RF-CSC in terms of lifting, skin volume, and wrinkle reduction, while significantly reducing procedural pain. Ex vivo analysis confirmed enhanced collagen remodeling and efficient dermal heating with RF-CWC.

Conclusion: RF-CWC offers a clinically effective and better-tolerated alternative to traditional cryogen-cooled MRF for facial rejuvenation.

Trial registration: Clinical Research Information Service Identifier: KCT0010406.

Background: Skin hyperpigmentation is caused by excessive melanin and can result from various factors, including ultraviolet exposure. Pentasodium tetracarboxymethyl palmitoyl dipeptide-12 (PTPD-12), an autophagy-inducing peptide, has shown potential in regulating melanogenesis in melanocytes and keratinocytes.

Objective: To evaluate the clinical efficacy and safety of a topical cream containing PTPD-12 in treating facial hyperpigmented disorders.

Methods: A prospective, randomized, split-face, controlled clinical trial was conducted over 8 weeks in 21 participants with bilaterally symmetrical facial hyperpigmentation. Subjects applied a PTPD-12-containing cream to one side of the face and a control cream to the other, twice daily. Melanin index (MI), erythema index, The Investigator Global Assessment (IGA) and Patient Global Assessment (PGA), and histological analysis were performed.

Results: Treatment with PTPD-12 cream resulted in a significant reduction in MI from 216.93±45.57 at baseline to 194.69±38.70 at week 8 (mean change, -22.23±15.16; p<0.0001). The IGA score on the treated side (1.78±0.76) was significantly better than that of the control side (1.28±0.63; p=0.0011). Also, the PGA score was significantly higher on the treated side (2.05±0.80) compared to the control side (1.25±0.62; p=0.0020). Fontana-Masson staining revealed a visible decrease in epidermal melanin in areas treated with the PTPD-12 cream. No significant adverse effects were observed throughout the study.

Conclusion: PTPD-12 cream significantly reduced melanin levels in facial hyperpigmentation, supporting its potential as a novel, safe, and effective therapeutic option for pigmentary disorders.

Background: Atopic dermatitis (AD) is a common chronic inflammatory skin disease whose diagnosis relies on clinical presentation and history due to the absence of definitive diagnostic tests or biomarkers. The Korean Atopic Dermatitis Association (KADA) recently updated its diagnostic criteria to enhance accuracy and applicability.

Objective: This study validates the updated KADA criteria by assessing their diagnostic performance in a clinical setting and comparing them with the previous KADA and Japanese Dermatological Association (JDA) criteria.

Methods: A multicenter, cross-sectional study was conducted with 231 AD patients and 81 non-AD controls. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), Youden's index, and error rates for the criteria and individual clinical features included were analyzed.

Results: The updated KADA criteria demonstrated the highest sensitivity (63.20%) compared to the previous KADA (61.04%) and JDA criteria (47.62%), enabling better identification of a broader range of AD phenotypes. While its specificity (82.72%) was slightly lower than that of the previous KADA (88.89%) and JDA criteria (95.06%), the updated criteria maintained a strong PPV of 91.01% and a comparable NPV of 44.10%. The Youden's index for the updated criteria was 0.459, indicating a balanced trade-off between sensitivity and specificity, and the error rate was the lowest (31.41%), underscoring its enhanced overall diagnostic accuracy.

Conclusion: The updated KADA criteria provide a practical and intuitive diagnostic tool, effectively addressing the limitations of previous criteria and improving the efficient and comprehensive diagnosis of AD, especially in those with diverse presentations.

Background: Baricitinib is an oral Janus kinase 1 and 2 inhibitor that has shown significant efficacy in phase 3 trials for alopecia areata (AA). However, real-world data on its use for AA remain limited.

Objective: This study evaluated the efficacy and safety of baricitinib in Korean patients with AA.

Methods: In this retrospective multicenter study, 117 patients with AA received oral baricitinib 4 mg daily for at least 36 weeks. Patient demographics, Severity of Alopecia Tool (SALT) scores, and adverse events were assessed.

Results: SALT scores significantly decreased from baseline at all time points (p<0.001). By week 36, 55.4% of patients with a baseline SALT score >50 and 48.9% with a baseline score >95 achieved a SALT score of 20 or less. Notably, in Group A (baseline SALT score between 50 and 100) by week 36, the percentages for SALT 75, SALT 90, and SALT 100 were 52.0%, 44.0%, and 22.7%, respectively, while in Group B (baseline SALT score ≤50), the percentages were 81.0%, 66.7%, and 54.8%, respectively. Group B showed a significantly greater mean percentage improvement in SALT scores compared to Group A (p<0.001, Welch's t-test). Repeated measures analysis of variance further revealed that both group and time had significant effects on treatment response (p<0.001). Adverse reactions were mostly mild to moderate in severity and resolved with appropriate management.

Conclusion: Baricitinib was well tolerated and resulted in clinical improvement among patients with AA in a real-world clinical setting. Baricitinib is a potential treatment option for patients with treatment-resistant AA.

Background: The skin microbiome plays a critical role in regulating epidermal differentiation and immune responses. Understanding of how individual microbial species influence the expression of barrier proteins and lipid synthesis pathways is essential for elucidating their contributions to skin barrier function.

Objective: This study aimed to investigate the distinct effects of Staphylococcus aureus (S. aureus), Staphylococcus hominis (S. hominis), and Cutibacterium acnes (C. acnes) on the skin barrier protein expression and lipid synthesis, thereby clarifying their roles in maintaining skin barrier integrity and homeostasis.

Methods: Keratinocyte 2-dimensional monolayer cultures and self-assembled 3-dimensional skin models were treated with S. aureus, S. hominis, or C. acnes. Alterations in skin barrier proteins and lipid synthesis were assessed using quantitative real-time polymerase chain reaction, immunofluorescence staining, and Oil Red O staining.

Results: S. aureus significantly downregulated the messenger ribonucleic acid expression of skin barrier proteins and lipid synthesis enzymes, resulting in reduced lipid accumulation. In contrast, S. hominis upregulated barrier protein expression and enhanced lipid accumulation. Similarly, C. acnes increased the expression of both skin barrier proteins and lipid synthesis enzymes, leading to a marked increase in lipid accumulation.

Conclusion: Collectively, these findings suggest that S. aureus compromises the skin barrier function by downregulating the expression of barrier-associated proteins and lipid synthesis enzymes, whereas S. hominis and C. acnes enhance barrier integrity by upregulating these components. These differential microbial effects elucidate potential mechanisms by which the skin microbiome contributes to barrier homeostasis.

Background: Para-phenylenediamine (PPD) is a major hair dye allergen and often heralds broader contact allergy risk, yet the links among PPD sensitization, polysensitization (PS) and host genetics remain understudied.

Objective: To quantify the association between PPD sensitization and PS in Korean patch test patients and to explore whether single nucleotide polymorphisms (SNPs) in selected immunoregulatory genes modulate this relationship.

Methods: We retrospectively analysed 647 Korean patients patch tested with the Korean Standard Series. PS was defined as reactivity to ≥3 unrelated allergens; simultaneous positives to nickel, cobalt or chromate were counted as one event. Independent predictors of PPD sensitization were determined by multivariable logistic regression, and allergen networks were visualised with heatmaps. Seventeen patients were genotyped for SNPs in tumor necrosis factor-alpha, CXCL11, interleukin (IL)-10, IL-16 and STAT6.

Results: PPD sensitization was confirmed in 38 patients (5.9%) and remained independently associated with PS (adjusted odds ratio [OR], 2.72; 95% confidence interval, 1.11-6.67). Additional chemical predictors were mercury ammonium chloride (OR, 3.68; p=0.018) and fragrance mix I (OR, 3.18; p=0.013). Heatmaps revealed dense preservative and rubber allergen clusters in PPD positive and particularly PS positive subsets. Exploratory genotyping showed numerical differences in CXCL11 variant frequency in PPD+/PS+ patients (85.7%) compared to expected population frequencies (about 50% in East Asians), though the small sample size (n=17) precluded statistical significance testing.

Conclusion: PPD sensitization identifies patients at increased risk for PS and reactivity to mercury compounds and fragrance-related substances. Preliminary genetic observations require validation in larger studies to determine potential immunogenetic contributions.

The skin microbiome, a dynamic ecosystem of microorganisms, is essential for maintaining skin health by protecting against pathogens, modulating immunity, and enhancing barrier function. External factors such as pollutants, harsh skincare products, and aging disrupt microbial balance, leading to compromised skin health and accelerated aging. Aging-related changes, including reduced microbial diversity, loss of beneficial metabolites, and increased oxidative stress, contribute to inflammaging. Microbiome-supportive skincare, incorporating probiotics, prebiotics, and postbiotics, offers promising solutions to restore microbial balance, strengthen the skin barrier, and delay aging. These formulations work by reducing inflammation, enhancing antioxidant defenses, and regulating skin pH. However, challenges in microbiome research and product development persist, including individual variability in microbial composition, formulation complexities, and a limited understanding of microbe-skin interactions. Future innovations such as personalized microbiome skincare, genetically engineered probiotics, and advanced diagnostic tools could enable more targeted and effective interventions. Long-term clinical trials and detailed mechanistic studies are crucial to validate the efficacy of microbiome-focused skincare and optimize formulations for diverse populations. By addressing these challenges and advancing research, microbiome-supportive skincare has the potential to revolutionize approaches to skin health, preserving resilience and combating aging through tailored microbial interventions.

Background: Botulinum toxin type A (BTA) is widely used in dermatologic procedures. While its anti-fibrotic effects on fibroblasts are well established, its role in keratinocyte-driven inflammation and pruritus during wound healing remains underexplored.

Objective: To evaluate the effects of BTA on keratinocyte proliferation, migration, and transforming growth factor-beta (TGF-β)-induced expression of inflammatory and pruritus-associated mediator.

Methods: Human epidermal keratinocytes were stimulated with TGF-β to mimic wound conditions, followed by BTA co-treatment. Cell proliferation and migration were assessed using water soluble tetrazolium salt-8 and scratch assays. Western blotting evaluated Smad2/3 and extracellular signal-regulated kinase (ERK)1/2 phosphorylation. Reverse transcription-quantitative polymerase chain reaction was used to quantify inflammatory cytokines and itch-related mediators.

Results: BTA significantly enhanced keratinocyte proliferation without affecting migration. It inhibited TGF-β-induced phosphorylation of Smad2/3 and ERK1/2. BTA also downregulated pro-inflammatory cytokines (interleukin [IL]-1β, IL-6, tumor necrosis factor-α, monocyte chemotactic protein 1, prostaglandin E synthase) and pruritus-related mediators (IL-31, IL-33, cathepsin S, calcitonin gene-related peptide, substance P, and thymic stromal lymphopoietin).

Conclusion: BTA promotes keratinocyte proliferation and reduces TGF-β-induced inflammatory and pruritus-associated mediators. These findings suggest that BTA may facilitate wound healing by promoting keratinocyte proliferation while simultaneously modulating inflammation and pruritic responses.