Annals of dermatology最新文献

Background: Cutaneous angiosarcoma, a rare malignant tumor, is associated with high mortality and poor prognosis.

Objective: This study aimed to analyze the clinicopathologic features of cutaneous angiosarcoma and identify the prognostic factors influencing survival.

Methods: Medical records of patients diagnosed with cutaneous angiosarcoma between January 1995 and March 2023 were retrospectively reviewed. Demographic data, clinicopathologic features, and treatment modalities were analyzed to evaluate the correlation with overall survival (OS) and progression-free survival (PFS). A total of 70 patients were included in the study.

Results: Their mean age at diagnosis was 71 years (range, 41-91 years). Of them, 57 (81.4%) were males. Five-year OS and PFS rates were 29.0% and 10.7%, respectively. In univariate analysis, a mass in the frontal area of the scalp showed significant associations with poorer PFS (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.07-3.55; p=0.029) and poorer OS (HR, 2.42; 95% CI, 1.22-4.80; p=0.011). Mass size exceeding 3 cm had a notable impact on PFS (HR, 3.41; 95% CI, 1.32-8.82; p=0.011) and remained a significant independent adverse prognosticator in multivariate analysis (HR, 4.55; 95% CI, 1.22-16.99; p=0.024).

Conclusion: Cutaneous angiosarcoma is characterized by an unfavorable prognosis, with a larger mass size identified as an independent prognostic factor.

Background: Despite advances in systemic targeted therapies, topical agents remain the primary treatment for localized psoriasis. However, their therapeutic effects are often delayed and unsatisfactory. The dissolving microneedle (DMN) patch, a novel transdermal drug delivery system, enhances the absorption of topical agents through micro-channels.

Objective: To evaluate the efficacy of DMN patches in enhancing drug delivery and improving clinical outcomes in psoriatic plaques.

Methods: A prospective, randomized, split-body study was conducted to verify the efficacy of additional use of DMN patches after topical agent application in psoriasis treatment. Patients with mild psoriasis were enrolled and 6 paired lesions per patient were randomized into 3 groups: ointment-only, ointment-with-no needle patch, and ointment-with-DMN patch. Lesions were treated with a topical agent (betamethasone and calcipotriol) once daily for 2 weeks. Modified psoriasis area and severity index (mPASI) scores were measured weekly. In vitro and ex vivo experiments were performed to confirm micro-channel formation, microneedle dissolution, and drug penetration enhancement.

Results: A total of 132 paired lesions from 22 patients were analyzed. The ointment-with-DMN patch group showed significantly improved mPASI scores (80.4%±20.5%; 5.42→1.06) compared to the ointment-with-no needle patch (64.6%±33.0%; 4.94→1.68) (p<0.05) and ointment-only groups (55.5%±31.4%; 5.00→2.15) (p<0.001). In vitro studies demonstrated 2.1-fold enhanced drug delivery with DMN patches, while ex vivo histological analysis confirmed micro-channel formation. No adverse events, including infection or psoriasis exacerbation, were observed.

Conclusion: The DMN patch is an effective adjunctive tool that enhances transdermal drug delivery and improves therapeutic outcomes in psoriatic plaques, particularly those refractory to topical agents.

Trial registration: ClinicalTrials.gov Identifier: NCT02955576.

Background: Autoimmune mechanisms have important roles in the pathogenesis of alopecia areata (AA).

Objective: This study aimed to evaluate the exact biological and clinical importance of immunogenes in AA patients using bioinformatic methods.

Methods: Five AA scalp gene expression profiles were obtained from the Gene Expression Omnibus database. Differentially-expressed genes (DEGs) between AA and control groups were identified. An immune-related gene diagnostic signature (IRGDS) was established by protein-protein interaction network analysis, least absolute shrinkage and selection operator and logistic regression analysis.

Results: A total of 102 immune-related DEGs were identified. We developed an IRGDS composed of CD8A, CSF1R and CXCL10 for AA molecular pathological assessment and diagnosis (area under the receiver operating characteristic curve [AUC]=0.962). We also validated the diagnostic value of the IRGDS in an external cohort (AUC=0.955). Patients with high IRGDS scores presented with a higher abundance of immune cell infiltration and expression of genes associated with immune recruitment and immune activation, suggesting adverse biological alterations.

Conclusion: In our study, an IRGDS model with accurately diagnostic capacity for AA was established, and biological alterations were deciphered in AA. The IRGDS may be used as an auxiliary diagnostic marker for AA.

Background: In 2006, the Korean Atopic Dermatitis Association (KADA) working group released the diagnostic criteria for Korean atopic dermatitis (AD). Recently, more simplified, and practical AD diagnostic criteria have been proposed.

Objective: Based on updated criteria and experience, we studied to develop and share a consensus on diagnostic criteria for AD in Koreans.

Materials and methods: For the diagnostic criteria, a questionnaire was constructed by searching the English-language literature in MEDLINE and the Cochrane Database of Systematic Reviews. A modified Delphi method composed of 3 rounds of email questionnaires was adopted for the consensus process. Fifty-four KADA council members participated in the 3 rounds of votes and expert consensus recommendations were established.

Results: Diagnostic criteria for AD include pruritus, eczema with age-specific pattern, and chronic or relapsing history. Diagnostic aids for AD encompass xerosis, immunoglobulin E reactivity, hand-foot eczema, periorbital changes, periauricular changes, perioral changes, nipple eczema, perifollicular accentuation, and personal or family history of atopy.

Conclusion: This study streamlined and updated the diagnostic criteria for AD in Korea, making them more practicable for use in real-world clinical field.

Background: Oxidative stress causes fatal damage to follicular keratinocytes (FKCs) and is a common pathophysiology of many hair disorders.

Objective: This study investigated the protective effects of Red ginseng extract (RGE) and its main ginsenosides against oxidative hair damage using an in vitro organ model of human hair follicles.

Methods: We examined whether RGE and its constituent ginsenosides could prevent oxidative damage induced by H₂O₂ in FKCs by suppressing apoptosis and promoting hair growth.

Results: RGE and its main ginsenoside, G-Rb1, significantly inhibited reactive oxygen species production and apoptosis in FKCs. Furthermore, they effectively alleviated the inhibition of hair growth induced by oxidative damage and inhibited the transition of hair from the anagen to the telogen stage. The hair cycle and apoptosis were associated with the modulation of p53 and Bax/Bcl2 signaling.

Conclusion: RGE and G-Rb1 can effectively mitigate the oxidative damage caused by FKCs, thereby affecting hair growth and hair cycles.

Background: There is a growing demand for extending dosing intervals of dupilumab injections in patients with atopic dermatitis (AD) due to treatment burden and side effects. However, studies on successful dose reduction in real-world settings are lacking.

Objective: To assess the efficacy of a patient-centered dupilumab tapering regimen and to propose guidelines for target patients, appropriate intervals, and timing for tapering.

Methods: This single-center retrospective study included moderate to severe adult AD patients who underwent at least 16 weeks of dupilumab treatment. Interval prolongation was considered in controlled patients assessed by Eczema Area and Severity Index (EASI) score and serum inflammatory markers after at least 40 weeks of treatment with a standard regimen. Logistic regression model with generalized estimating equations was used to compare repetitive measurements over time between the two groups.

Results: A total of 52 patients were included with 11 patients extending intervals to 3-4 weeks without flare-ups. The mean duration of dupilumab treatment before tapering was 53.27 weeks. The tapering group exhibited significantly lower body mass index. All patients of the tapering group showed EASI scores under 4 and immunoglobulin E (IgE) levels under 1,000 IU/mL at week 40. EASI scores and IgE levels remained consistently low after dose reduction, with a mean follow-up time of 14.36 months.

Conclusion: Patients with extended dosing intervals demonstrated sustained effectiveness. Dose tapering might be a valuable option for non-obese patients with positive clinical response characterized by an EASI score under 4 and IgE levels under 1,000 at week 40.

Background: Although nail psoriasis is a common manifestation among patients with psoriasis, large-scale research exploring the association between nail psoriasis lesions and their intra-nail locations has not been conducted. This study is necessary to elucidate the shared pathophysiology among various phenotypes of nail psoriasis.

Objective: We aimed to understand the association between nail psoriasis lesions and analyze their intra-nail locations.

Methods: We obtained a total of 5,602 cropped fingernail images from 636 patients with psoriasis. We employed the Computer Vision Annotation Tool to annotate the intra-nail locations of nail psoriasis lesions. We computed χ² statistic to examine the relationship between nail psoriasis lesions and conducted an analysis of their intra-nail locations.

Results: Based on the number of lesions, nail pitting was the most common, followed by leukonychia, with the red spots in the lunula being the rarest. We elucidated the associations between different nail psoriasis lesions, pinpointing a significant association between onycholysis and oil spots (χ² statistic=1,623.88), followed by onycholysis-subungual hyperkeratosis (1,607.50), and subungual hyperkeratosis-oil spots (985.76). A spatial relationship was observed between onycholysis and oil spots, with the intra-nail location of onycholysis being more distal compared to the nearest oil spots. A distribution pattern of nail psoriasis was also demonstrated, where nail matrix lesions were primarily located at the center of the nail, and nail bed lesions were predominantly located near the lateral nail folds.

Conclusion: This study represents a pioneering analysis of the intra-nail location of nail psoriasis lesions, revealing substantial associations and spatial relationships between different lesions.