JEADV clinical practice最新文献

Background

Laser tattoo removal traditionally employs q-switched and picosecond lasers, which require multiple sessions. Besides the selective photothermolysis that laser devices offer, the photoacoustic effect by acoustic pulse devices may provide further benefits.

Objectives

To assess the efficacy of combined use of a radial shock acoustic wave (SAW) device and a picosecond laser in quicker clearance of tattoos.

Methods

A split-lesion study was performed in 32 adult patients with Fitzpatrick skin type I–III. Overall, 26 tattoos were evaluated until the end of the study. One side of each tattoo received only the picosecond laser treatment, and the other side, a sequential combination of picosecond and SAW. The sessions were repeated at 4–6 weeks intervals for a total of four sittings. Outcome assessment was carried out by two blinded assessors using standardized photography. An assessment of physician improvement score, side-effects score and patient satisfaction score (Visual Analogue Scale of Pain [VAS] and 5-point Likert scale) was taken during and at the end of the study.

Results

The blinded assessment showed a statistically significant improvement on the SAW+picosecond laser treatment side (p = 0.14; OR: 5.44; 95% CI: 1.41–21.05). Scores in VAS for pain decreased through the sessions, with the combination side exhibiting a more pain-tolerant profile. Regarding the outcome of patient satisfaction, at Visit 4, the mean value for the SAW-treated side was 3.9 (more clear difference), whereas only 3/26 participants stated that the only laser-treated side was marginally better. No serious side effects were reported.

Conclusions

The addition of a radial shock acoustic wave device to the state-of-the-art picosecond laser treatment seems to offer a more effective and well-tolerated approach for tattoo removal.

Background

Conventional photodynamic treatment (cPDT) of thin basal cell carcinomas (BCCs) has uncomfortably high rates of incomplete clearance. Incomplete clearance/recurrence rates for superficial BCCs are as high as 40% and even higher for tumours treated on the head and neck. Our experience has been that flushing is more pronounced on the head and neck during cPDT photoactivation. We postulated that haemoglobin, although delivering oxygen, may be acting as a competing chromophore.

Objectives

To determine whether a 2-phased photoactivation protocol, in which blood is removed before the second phase intense pulsed light (IPL) activation, improves clearance rates.

Methods

Retrospective observational study of 206 treatment-naïve BCCs ≤ 1 mm thickness treated over a 7-year period with a 2-phased photoactivation protocol (‘biphasic PDT’). The first phase consists of conventional red-light activation (20−37 Jcm⁻²). Second phase photoactivation uses IPL (30−45 Jcm⁻²) delivered with sufficient mechanical pressure in the handpiece to blanch the skin.

Optical coherence tomography (OCT) has been used to aid in lesion diagnosis, to establish suitability of tumour for treatment and to improve verification of treatment outcomes.

Results

In the final group of 175 tumours, of which most were located on the head and neck and over 40% were nodular, there were only four incomplete treatments over a 2-year median follow-up period (up to 7 years). The few incomplete clearances were easily managed.

Conclusions

One or two biphasic photodynamic treatments are highly effective (98% clearance) in thin, treatment-naïve BCCs (≤ 1 mm in thickness) selected on clinical and OCT assessment.

Background

Genital pustular psoriasis is a rare and often underdiagnosed condition that can severely affect physical comfort, quality of life and psychological well-being. It can be particularly challenging to manage, often requiring systemic therapies due to its potential unresponsiveness to conventional topical treatment.

Objectives

To evaluate the effectiveness of apremilast in treating male patients with refractory genital psoriasis with pustular features, a rare subtype that can be mistaken for other conditions, including infections and Reiter's syndrome.

Methods

A retrospective case series of six male patients, aged 21−47 years, presenting with recurrent circinate balanitis or balanoposthitis and histological features suggestive of pustular psoriasis (intraepidermal neutrophilic aggregates without frank pustules). These patients had previously failed multiple treatments, including topical corticosteroids, calcineurin inhibitors, acitretin, ciclosporin and methotrexate. Apremilast was initiated with a 6-day titration protocol, and patients were followed for 1–3 months.

Results

All six patients showed complete remission within 1−3 months of starting apremilast, with no major side effects reported. Diagnostic work-up, including viral, bacterial, mycological swabs and syphilis serology, was negative for all patients, and no extragenital symptoms typically associated with Reiter's syndrome were observed.

Conclusions

Apremilast appears to be an effective and well-tolerated treatment for refractory genital psoriasis with pustular features, providing a promising therapeutic option for patients with this challenging condition. Further studies with larger cohorts and randomized trials are needed to confirm its long-term efficacy and safety.

Background

Delayed hypersensitivity reactions, such as allergic contact dermatitis (ACD), present distinct patterns across age groups. While age-related immune changes are well-documented, their impact on patch test outcomes and allergen sensitization in elderly individuals remains underexplored.

Objectives

This study assessed age-related differences in allergen sensitization and immune response in ACD by comparing patch test reactions between elderly individuals (≥ 65 years) and younger adults (18−40 years). In addition, findings were also compared with a similar study conducted between 1997 and 2001.

Methods

A retrospective cohort study analysed a total of 2377 patients who underwent patch testing at the University of Padua's Dermatology Clinic from 2006 to 2019. The study included 709 elderly and 1668 younger adults, evaluating standard allergen series for differences in sensitization based on age, sex and affected body sites.

Results

Elderly patients had a lower rate of positive patch test reactions (62.6%) compared to younger individuals (71.5%) and exhibited fewer cases of multiple contact allergies. Allergic reactions were more frequently localized to the face in the elderly, while younger adults showed more cases of hand dermatitis. The intensity of allergic reactions was generally milder in the elderly. Strong reactions were significantly more frequent among younger individuals, especially for nickel. Sensitization patterns differed, with younger adults more commonly reactive to nickel and cobalt, while balsam of Peru and neomycin were more prevalent in the elderly.

Conclusions

Although aging is associated with a decline in immune responsiveness, elderly individuals remain significantly sensitized to allergens such as balsam of Peru and neomycin. Compared to data from 1997 to 2001, both age groups show an increased prevalence of sensitization and multiple contact allergies, suggesting a temporal trend. These findings highlight the importance of considering age-related immune changes when diagnosing and managing ACD in older patients.

Background

Bullous pemphigoid (BP) is the most common autoimmune blistering skin disease, primarily affecting the elderly. The role of interleukin-13 (IL-13) in BP pathogenesis remains unclear, particularly regarding its potential as a therapeutic target.

Objectives

To evaluate differences in serum IL-13 levels between idiopathic and drug-induced BP patients and healthy controls, and to investigate correlations between IL-13 levels, disease severity, mucosal involvement, and prognosis.

Methods

This retrospective cohort study included 42 BP patients diagnosed between 2008 and 2023 at a dermatology referral center, along with 12 healthy controls and four pemphigus vulgaris patients. Serum IL-13 levels were measured using ELISA. The primary outcomes were IL-13 levels and their association with disease etiology, eosinophil counts, mucosal involvement, and the need for adjuvant therapy.

Results

Serum IL-13 levels were lower in BP patients (n = 42, mean 62.46 pg/mL ± 16.53) compared to healthy controls (n = 12, mean 87.83 pg/mL ±8.87, p < 0.0001) and pemphigus patients (n = 4, mean 87.6 pg/mL ± 5.16, p = 0.013). Idiopathic BP patients exhibited higher IL-13 levels than Dipeptidyl peptidase-4 (DPP4) -induced BP patients (67.01 pg/mL ± 14.3 vs. 57.36 pg/mL ± 21, p = 0.0104). No significant correlation was found between IL-13 levels and mucosal involvement (p = 0.338), eosinophil counts (Pearson correlation coefficient = 0.18, p = 0.253), the need for adjuvant therapy (p = 0.32), or prognosis (p = 0.45). Higher eosinophil levels correlated with the need for adjuvant therapy (p = 0.027).

Conclusions

Serum IL-13 levels are lower in BP patients compared to healthy controls, and in DPP4-induced BP compared to idiopathic BP, suggesting a complex role of IL-13 in BP pathogenesis. IL-13 levels did not correlate with disease severity or prognosis, indicating that IL-13 may not be a reliable marker for BP severity or outcome. Further research is needed to clarify IL-13's role in BP and to guide therapeutic strategies.