Dermatologic Therapy

Brentuximab vedotin (BV) has been approved for CD30-positive cutaneous T-cell lymphoma (CTCL) after at least one previous systemic treatment in China. However, real clinical practice is still limited. We aim to retrospectively review our experience with BV in a cohort of Chinese patients with CTCL, focusing on its efficacy and safety. We included 17 CTCL patients treated with BV at Peking Union Medical College Hospital from January 2021 to June 2024, including 12 with mycosis fungoides (MF)/Sézary syndrome (SS) and five with primary cutaneous anaplastic large-cell lymphoma (pc-ALCL). Patients had previously received a median of three treatment regimens (including acitretin, interferon, methotrexate, histone deacetylase inhibitors, phototherapy, radiotherapy, and chemotherapy). Sixteen patients received BV treatment at an initial dose of 1.8 mg/kg intravenously every 3 weeks, either as monotherapy (7/17) or in combination with gemcitabine, chidamide, or multiagent chemotherapy. The median treatment cycle has six cycles. Two patients received BV as the last treatment before undergoing allogeneic stem cell transplantation (alloSCT). The overall response rate (ORR) was 71% (13/17), with 18% (3/17) achieving complete remission (CR). In the MF/SS group, the ORR was 58% (7/12), while in the pc-ALCL group, it was 100% (5/5). Adverse events (AEs) were observed in 12 patients, including peripheral neuropathy (PN) in three cases, fever in six cases, neutropenia in three cases, exfoliative dermatitis in two cases, and abnormal liver function in one case. Only one patient experienced ≥ Grade 3 AEs. Based on clinical experience in our center, BV, either as monotherapy or combined with chemotherapy, showed a good response in the treatment of advanced CTCL patients with good tolerability.

Rosacea, a common chronic, predominantly centro-facial dermatosis, has previously been classified into distinct subtypes with a range of morphological signs that overlap with other inflammatory skin disorders. Recently, there has been a move towards diagnosis of clinical phenotypes, largely driven by a better understanding of the pathophysiology of rosacea and clinical trial endpoints. Despite this, treatment remains a challenge. The Australasian Medical Dermatology Group held a Rosacea workshop in November 2022 to develop a practical narrative. Eighteen recommendations were agreed upon using a modified eDelphi process in the first round, including a rosacea treatment algorithm.

There are two main isoforms of glucocorticoid receptor (GR) α- and β-isoforms. GRβ isoform is the dominant inhibitor of the GRα receptor and plays a significant role in a poor response to systemic glucocorticoids (GCs) under numerous conditions. The A3669G (rs6198) polymorphism (SNP) in the untranslated region of human GR stabilizes the mRNA of the dominant-negative GRβ isoform. However, the mechanisms which generate mRNA encoding the GRβ isoform have been poorly defined, especially in pemphigus patients who do not respond to GCs. The main aim was to study gene SNP of GR in patients with pemphigus vulgaris (PV) and healthy controls. We investigated whether the A3669G SNP of the human GRβ gene is a susceptibility allele for PV and contributes to GC resistance development. The presence of the A3669G SNP was determined by high-resolution melting analysis and then confirmed by direct sequencing. GR A3669G SNP (AG genotype) occurred more frequently in PV patients (n = 72; 25%) compared with healthy controls (n = 92; 3.2%; p<0.001). Allele G was significantly more presented in PV patients (p<0.001). Out of 48 patients with AA genotype of A3669G SNP, only 6 had GC resistance, whereas 11 out of 18 with AG genotype developed GC resistance (p<0.0001). The frequency of a poor response to GC in the group of patients with AG genotype was 4.89 times higher compared to AG negative one (p<0.0001). Our study showed that the A3669G SNP was more present in PV patients. Moreover, GC resistance appeared more frequently in patients with the AG genotype (p<0.0001). Since those patients predominantly with severe pemphigus had GC resistance (p=0.001), we feel that A3669G SNP (AG genotype) contributes to its development. However, more studies are needed to determine whether A3669G SNP of the human GR gene associated with the disease severity and poor response to GCs in these patients.

Background and Aim: Atopic dermatitis (AD) impacts the quality of life of patients and their families. This survey-based study aimed to understand the perspectives of physicians in Egypt and Lebanon regarding available educational initiatives and support programs for patients with AD, which was complemented by the social analytics study, offering a more comprehensive understanding of the perceptions of AD among social media users. Methods: The survey included 200 physicians, comprising primary care physicians, family medicine physicians, pediatricians, and dermatologists from Egypt and Lebanon. The social analytics study leveraged artificial intelligence to analyze 100 million websites across the region, identifying mentions of AD-related terminologies. Results: The physician survey uncovered gaps in AD awareness and education in Egypt and Lebanon, with limited educational initiatives and digital applications available for patients. The perceptions of physicians varied regarding the use of telemedicine in dermatological disease management. According to the social analytics study, online discussions about AD predominantly originated from Egypt, featuring educational content on causes, diagnosis, management, and AD patient journey. Discussions included news about training programs, AD-related healthcare initiatives, and drug approvals. Some authors, beauty clinics, and manufacturers actively promoted their services and products. Patients actively engaged in online discussions on self-care and natural remedies, sharing their experiences of living with AD. Notably, there were substantial volumes of incorrect and inaccurate information being shared and promoted by some authors. Conclusion: Education about AD is crucial for patients and healthcare professionals. While social media offers opportunities for increased patient engagement, the prevalence of misinformation poses a significant challenge. Addressing issues related to education and discerning misinformation is essential for achieving optimal outcomes in the management of AD within the region.

Background: Chronic pruritus of unknown origin (CPUO) is a highly debilitating disease that lacks effective treatment. There have been case reports of effective use of Janus Kinase (JAK) inhibitors in CPUO, including a case treated with baricitinib, a selective JAK 1/2 inhibitor. Objectives: To evaluate if itch in a cohort of CPUO patients was effectively reduced after treatment with baricitinib. Patients and Methods: This is a retrospective case series examining all patients with CPUO who were treated with baricitinib from February 2022 to August 2023 at the National Skin Center, Singapore. Itch scores on a 0–10 numerical rating scale (NRS) at 0.5-point intervals were recorded and analyzed over time. Results: Sixteen patients (56% women, mean age of 62.2 ± 19.7 years old) with CPUO were included in the analysis. Their mean [range] duration of chronic itch was 15.4 [1–50] years, and the mean follow-up period of baricitinib treatment was 10.2 ± 6.7 months. The median [IQR] NRS itch score before and after baricitinib treatment were 8.5 [6.5–10.0] and 3.5 [1.25–5.0], respectively, with a mean reduction in the itch score of 4.9 ± 2.7 (p<0.0001). All except one patient reported significant improvement in itch severity. There were no reports of symptomatic side effects, except for a drop in hemoglobin in a patient with thalassemia and a dry throat in another patient. There were five cases of mild elevation in creatine kinase levels, three of which normalized over time, and two cases of mild elevation in creatinine levels. Conclusion: This study suggests that baricitinib can effectively reduce pruritus in patients with CPUO and supports the conduct of randomized placebo-controlled trials to better elucidate the efficacy of JAK inhibitors in management of CPUO.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects the quality of life (QoL) of afflicted patients. This current study was designed to assess the QoL of first-degree relatives of HS patients and the various associated parameters. Methods: We conducted this cross-sectional study at the Outpatient Dermatology Clinics of Shahid Faghihi Hospital and Imam Reza Clinic, affiliated with Shiraz University of Medical Sciences, Shiraz, Iran, from 2021 to 2022. Thirty-nine first-degree relatives of thirty-nine patients with HS were selected to enter this cross-sectional study, through the census sampling method. The Family Dermatology Life Quality Index (FDLQI) was used to determine the scores. Results: A total of 39 patients (24 men and 15 women) with HS were included in the present study. The mean total score of the FDLQI questionnaire was 9.10 ± 6.77, which indicates a moderate impact on the QoL of the first-degree relatives of HS patients. In HS patients with underlying diseases, FDLQI scores were greater. Other first-degree relatives had a higher average overall FDLQI score than the patient’s spouse. Comorbid first-degree relatives showed considerably higher FDLQI scores than those without. FDLQI scores increased with first-kin age. Conclusion: The FDLQI score of first-degree relatives of HS patients is considerably affected by any other underlying condition. Additionally, FDLQI scores were substantially associated with the first-degree relative’s relationship with the patient (spouse vs. other relation) and the patient’s and relative’s underlying diseases.

Objective: To investigate the distribution characteristics of specific immunoglobulin E (IgE) to dust mite components in patients with atopic dermatitis (AD), aiming to provide a reference basis for the development of microarray protein chips for allergen component discrimination diagnosis and personalized desensitization therapy. Methods: A total of 55 patients who visited Huishan District People’s Hospital of Wuxi City, Xishan People’s Hospital of Wuxi City, and People’s Hospital of Wuxi City from January 2023 to December 2023 were selected. The results of serum total IgE (total IgE) and specific IgE detection were analyzed. Results: Among the 55 patients, 54 (98.2%) were positive (cutoff value > 0.35 Ua/mL, the normal value for serum total IgE is under 150–400 IU/mL) for serum total IgE antibodies, 52 (94.6%) were positive for Dermatophagoides pteronyssinus (Dp)–specific IgE antibodies, and 50 (90.9%) were positive for Dermatophagoides farinae (Df)–specific IgE antibodies. The protein chip results were consistent with the existing Phadia detection results. Conclusion: The development of chips based on CRD (component-resolved diagnosis) cannot only rely on IgE binding rate to assist in precise treatment of patients but also choose personalized desensitization therapy, providing more practical recommendations for preventing cross-allergy, avoiding allergic environments, or ingesting sensitizing foods for susceptible individuals.

Dermatophyte infections of the skin and nails are frequent, but current antimycotics have several drawbacks. In search of new treatments, we looked into the vast array of herbal active agents. Derived from plants, they are sustainable, agreeable for patients, and may have less side effects than traditional antimycotics. In this study, we assessed 43 herbal agents for their effectiveness against Trichophyton rubrum (T. rubrum), Trichophyton benhamiae (T. benhamiae), Trichophyton tonsurans (T. tonsurans), and Microsporum canis (M. canis), four major human dermatophyte pathogens. The antifungal effect was tested by incorporating the agents into agar plates and measuring the dermatophyte growth after 7 days. Against T. rubrum, 16 out of 43 herbal agents showed total inhibition of dermatophyte growth. 14 out of 43 herbal agents inhibited the growth of T. benhamiae completely. 18 out of 43 herbal agents were effective against T. tonsurans. Against M. canis, 15 out of 43 herbal agents showed total growth inhibition. Twelve herbal agents inhibited the growth of all tested dermatophytes completely. This study demonstrates the high antimycotic potential of herbal therapeutics and identified promising candidates for the topical treatment of dermatomycoses. Substances are highly agreeable and should be tolerated well. Some might even provide new options for the systemic treatment of fungal diseases.

Studies find climate therapy (CT) at the Dead Sea of psoriasis efficient for induction therapy, but few studies address disease relapse, long-term maintenance using CT, confounders, and the patient perspective. CT combines sunlight, balneotherapy, stress reduction, and education. This study aimed to examine Dead Sea CT and relapse of psoriasis over a 2 years period, patients’ satisfaction, and treatment outcome and preference relative to other therapies. A structured questionnaire was offered to patients, who during the recent 2 years had undergone a 4 week course of CT at the Dead Sea. Patients included applied for a new CT session due to relapse of their psoriasis. Questionnaire items covered their recall of relapse, disease severity, potential triggers of relapse and patient’s preference relative to other treatment options. The study enrolled 40 patients, with an average age of 55.5 years. CT was highly effective and resulted in marked reduction in the affected skin area, from 16% to less than 1% of the body surface. The median time from CT to first visible new lesion was 4.8 months, to first bothersome relapse 6.1 months and to full blown relapse 8.0 months. Patient satisfaction with conventional therapeutic modalities, especially oral methotrexate, was reserved, and CT was generally preferred. Relapse after CT was an inclusion criterion, and patients with long-lasting healing were not assessed. CT for 4 week treatment course of moderate to severe psoriasis at the Dead Sea which was studied in patients with relapsing disease was highly efficient for induction for clearing of the skin, matching new biologicals. In the studied group, return to prestate level took median 8 months on average. Patients’ satisfaction with CT scored high, and maintenance through repeated Dead Sea treatments often is best treatment of this segment having intolerance or poor effect of other treatments, or fear of medicines as a personal attitude.

Background. Keloids are benign fibroproliferative tumors that are unique to humans. However, the exact mechanism of keloid formation remains unclear. The inflammatory cytokines released by immune cells can activate fibroblasts, connective tissue cell proliferation, and angiogenesis. Hypoxia is common in the process of fibrosis in many diseases. This study aimed to investigate the relationship between immune response, hypoxia, and keloid formation. Methods. Gene methylation and expression data were downloaded from the GEO database. Thereafter, differentially methylated genes associated with immunity and hypoxia were identified. Machine learning was performed to identify potential diagnostic/immunity/hypoxia-related differentially methylated/expressed genes, followed by analysis of functional enrichment, transcription factors, protein-protein interactions, and expression validation by reverse transcription quantitative polymerase chain reaction and immunohistochemistry. Results. In total, 16 immunity/hypoxia-related hypermethylated low-expression genes and 18 immunity/hypoxia-related hypomethylated high-expression genes were identified in keloids. Based on machine learning, nine differentially methylated and expressed genes were selected as potential diagnostic markers for keloids, including two hypoxia-related genes (CDKN1A and PGAM2) and seven immunity-related genes (DCD, PTGDS, WFIKKN1, SEMA5A, IL1R1, ITGAL, and SOS1). Some significantly enriched signaling pathways were identified, including the FoxO, PI3K-Akt, focal adhesion, and ErbB signaling pathways. SOS1 is involved in disease regulation with 65 transcription factors and has a higher interaction score with other molecules. Conclusions. Two hypoxia-related genes (CDKN1A and PGAM2) and seven immunity-related genes (DCD, PTGDS, WFIKKN1, SEMA5A, IL1R1, ITGAL, and SOS1) could be considered potential diagnostic markers for keloids, and may be helpful in understanding the importance of oxygen balance and immune regulation in keloids.

The treatment of keloids, particularly in high-tension areas, is challenging due to their extension beyond the original wound boundaries and high recurrence rates, thereby rendering traditional treatments ineffective. In this study, we investigated the effectiveness of a novel single-stage treatment approach that combined acellular dermal matrix (ADM) with keloid-specific epidermal skin grafting. To further prevent recurrence after neo-skin formation, the treatment was followed by fractionated laser and radiation therapy (LCR). Seven patients with high-tension keloids, including one with keloids at two locations, were treated and followed-up for an average of 15.9 months. The patients showed significant improvements in wound healing and skin appearance, with a marked reduction in the Patient and Observer Scar Assessment Scale (POSAS) (scores from 91.1 ± 5.6 to 23.8 ± 6.1 (p<0.001)). This approach effectively minimizes tension, reduces the likelihood of keloid recurrence, and serves as a viable alternative to conventional methods that often involve challenges related to donor-site acquisition. No recurrence was observed during the follow-up period, indicating a promising innovation in the management of extensive keloids and offering improved healing and esthetic outcomes, particularly in high-tension areas.

Palmoplantar pustulosis (PPP) is often considered as pustular psoriasis of extremities. Benvitimod has been approved for mild to moderate psoriasis. We thus designed this study to evaluate the efficacy and safety of benvitimod for treating PPP. Of 47 PPP patients recruited from 4 hospitals, 40 finished 8 weeks visit and completed 4 weeks safety follow-up visit. The Palmoplantar Pustular Psoriasis Area and Severity Index (PPPASI) and Dermatology Life Quality Index (DLQI) scores fell continuously. At week 8, mean ± SD PPPASI and DLQI were 3.39 ± 3.86 (p<0.0001) and 2.49 ± 3.34 (p<0.0001), respectively. At week 8, 70% (28/40) achieved PPPASI-50 response, 35% (14/40) achieved PPPASI-75 response, and 17.5% (7/40) achieved PPPASI-90 response. Relapse occurred in 7.5% (3/40) of the patients. Of 47 patients enrolled, self-reported compliance was 12.77% (6/47). Common drug-related adverse events (5/47) included xerosis cutis. Only one patient’s disease progressed during treatment. Our study demonstrated the efficacy and safety of benvitimod.

Background: Neurofilament light chain (NfL) has been identified as a biomarker in neuroaxonal injury. Cutaneous nerve injury resulting from inflammation and/or forced scratching may also potentially affect serum NfL (sNfL) levels. Objectives: We aimed to explore the relationship between sNfL levels and the severity of skin inflammation and scratch lesions in patients with pruritus. Methods: In this cross-sectional pilot study, we measured the sNfL levels of 10 patients with pruritus of different aetiologies, and calculated age- and BMI-adjusted sNfL percentiles based on a normative database consisting of 4532 control individuals. Next, we investigated the relationship between the levels of sNfL and the severity of skin inflammation and scratching injuries in these patients using a newly-created Skin Inflammation and Scratch Lesions (SISL) score. Results: A positive correlation was observed between sNfL levels and the severity of skin inflammation and scratch lesions as measured by the SISL score (Spearman’s rho = 0.70, p=0.031). When correlated separately, both the “skin inflammation only” and “scratch lesions only” scores correlated positively with sNfL levels (Spearman’s rho = 0.68, p=0.031; Spearman’s rho = 0.66, p=0.041, respectively). Conclusions: sNfL may be a potential biomarker for cutaneous nerve injury associated with skin inflammation and/or scratching.

Advanced hidradenitis suppurativa (HS) is often irresponsive to conservative treatment and requires extensive surgery to improve the clinical symptoms and prevent recurrence. This study aimed to assess the effectiveness of single-stage split-thickness skin grafting in patients with Hurley Stage III HS. A retrospective review of all cases of Hurley Stage III HS received skin grafting was done. Data on patient demographics, lesion characters, surgical details, and follow-up information were collected. Fifty-two cases of Hurley Stage III HS located in the axillary, groin, perineum, buttock, and penis were treated with split-thickness skin grafting. There were 20 male and 3 female patients included with a mean age of 38.7 years (range: 24–77). The overall success rate was 96.2% at a mean follow-up time of 29.3 months (range: 2–86). Early complications and late complications were observed in 30.7% (n = 16) and 59.6% (n = 31) of the cases, respectively. Wound scarring was the most common complication reported in 32.7% (n = 17) of the cases. Only one case (1.9%) of recurrence was reported in the perianal region at the postoperative 4.4 months. The satisfaction survey showed that 78.3% (18 of 23) patients were satisfied or very satisfied with the surgical result. Despite the advances in HS surgery, the recurrence rates continue to be high. Single-stage split-thickness skin grafting is a feasible approach for treating Hurley Stage III HS with a high success rate, low HS recurrence rates, and high patient satisfaction during long-term follow-up.

Psoriasis is a prevalent chronic inflammatory skin disease impacting 1 to 3% of the general population in the Western World. Topical therapies are the most often used treatment in psoriasis, frequently as ancillary treatments to traditional systemic or biologic treatments in individuals with severe disease. Topical therapy with fixed-dose combination of a vitamin D analogue (calcipotriol (Cal)) and corticosteroid (betamethasone dipropionate (BD)) has been recommended as first-line topical treatment, and its efficacy and safety are supported by an increasing body of evidence. Ointment, gel, cream, and foam are the four distinct formulations of fixed-dose Cal/BD combination that have been authorized for the treatment of psoriasis. Several studies have compared these formulations in terms of efficacy, safety, and patients’ satisfaction. The objective of this study is to review all the comparative studies performed in patients with psoriasis of the Cal/BD foam formulation with respect to other topical treatments containing Cal and BD, either individually or in combination. The results of the studies published on this topic have shown that Cal/BD foam is more efficacious than both individual Cal/BD and Cal/BD ointment, gel, and cream. The safety profile, QoL, patient satisfaction, and cost-effectiveness were also higher for the Cal/BD foam formulation in different studies. Although more real-world clinical experience is required to validate the available data, Cal/BD foam may be the treatment of choice for both flare management and proactive maintenance treatment of psoriasis.

Background. Epstein–Barr virus (EBV) associated skin lesions have been mentioned in case report studies under multiple kinds of lymphoproliferative disorders/lymphoma diagnoses. However, due to the rarity and scattered reporting of cases, it is still unclear whether the related skin symptoms and their pathological findings can guide the clinical diagnosis and treatment of EBV-associated lymphoproliferative disease/lymphoma. Methods. In this review, we summarized the skin symptoms and clinicopathological features mentioned by previously reported cases of EBV-associated lymphoproliferative disorders/lymphoma to assist future clinical diagnosis. The inclusion criteria were based on the population, intervention, comparator, outcomes, and study designs. An electronic search was conducted by September 2023, and the following databases were used: PubMed, EMBASE, Cochrane Library, and Web of Science. Search keywords included “Epstein-Barr Virus Infections,” “Herpesvirus 4, Human,” “Lymphoma,” “Lymphoproliferative Disorders,” and “skin.” Results. The primary outcome was the clinical skin features and pathological findings of EBV-associated lymphoproliferative disease/lymphoma patients. Although it seems unrealistic to differentiate between patients with EBV-related lymphoproliferative disorders/lymphomas with different diagnoses on the basis of cutaneous symptoms and pathological findings alone, based on the evidence summarized in previous case reports, the clinical importance of EBV detection and identification in the differential diagnosis of lymphomas and lymphoproliferative disorders should be recognized. Conclusion. Given the homogeneity of risk factors associated with disease progression found in EBV-associated lymphoproliferative disease/lymphoma patients during the review, future studies can focus on summarizing skin symptoms and pathological outcomes based on possible risk factors for further deterioration in these patients.

Alopecia areata (AA) is a common chronic relapsing nonscarring alopecia. Severe forms of AA commonly manifest during childhood. Treatment of AA is challenging due to the variability of the disease course as well as unpredictable responses to treatment. There is no uniform approved treatment for cure or sustained remission in children till now. Tofacitinib emerged as a novel drug in the treatment of AA, but few studies have been conducted on its safety and efficacy in children. Limitation of this study includes retrospective nature, small sample size, and lack of prolonged follow-up. Aim. This retrospective study aimed to assess the efficacy and safety of oral tofacitinib in children with AA. Method. In this retrospective study, we included patients aged 18 years or younger with AA. The scalp blandness of included patients was greater than 20% and they were on oral tofacitinib for at least two months. The demographic data, clinical characteristics, tofacitinib efficacy, and adverse effects were recorded. The primary endpoint was the last recorded percent change in the Severity of Alopecia Tool (SALT) score during treatment. Results. We included 26 patients (12 males and 14 females) with AA with a mean age of 11.6 ± 4.42 (3–18) years. Eighteen of them were in the alopecia areata (AA) group, whereas eight patients had alopecia totalis (AT) or alopecia universalis (AU). The mean disease duration before starting treatment with tofacitinib was 3.9 ± 3.3 years. Most of the patients were on a tofacitinib daily dose of 5 mg (53.85%) and 10 mg (38.46%). Patients were on tofacitinib for 6.73 ± 3.79 months. The patients’ baseline SALT score was recorded as 68.58 ± 32.65 and the final SALT score was 17.65 ± 23.88. Thus, the patients achieved a 50.92% reduction in the SALT score. Interestingly, there were no statistically significant differences in clinical efficacy between subtypes of AA and AT/AU. Conclusion. Tofacitinib was significantly effective in treating AA and AT/AU in children, with mild tolerable adverse effects, although relapse during treatment and tapering was recorded. Future randomized clinical trials with longer follow-up periods are needed to evaluate the safety of oral tofacitinib in children.

SERENA is an ongoing European noninterventional longitudinal study evaluating retention, effectiveness, safety, and quality of life (QoL) in secukinumab-treated patients with active moderate-to-severe plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis. Herein, 3-year interim results among patients with psoriasis enrolled in Greece are presented. Consented adults receiving secukinumab according to the approved label for ≥16 weeks were included. Of 292 patients enrolled, 290 eligible patients (mean age 48.4 years, 71.7% male) were analyzed. At treatment initiation, 65.9% of patients were biologic-naïve and mean total Psoriasis Area Severity Index (PASI) score was 29.0. At enrolment, mean treatment duration was approximately 1.0 year. The treatment retention rate at 1/2/3 years after enrolment was 94.4/87.3/85.9%; main reasons for discontinuation were lack of effectiveness and adverse events (AEs) (43.6% and 28.2% of discontinuations, respectively). At enrolment, the mean PASI score was 4.0, 61.3% of patients had PASI ≤ 3, 71.7% had Physician’s Global Assessment (PGA) score 0/1, 59.5% had Dermatology Life Quality Index (DLQI) score 0/1, while the mean EuroQoL Visual Analogue Scale (EQ-VAS) score was 82.0. At 1/2/3 years postenrolment, the mean PASI score was 1.9/1.6/1.0, 86.6/89.4/90.0% had PASI ≤ 3, 89.5/94.8/97.5% had PGA 0/1, 71.1/75.9/81.8% had DLQI 0/1, and mean EQ-VAS score was 85.7/90.0/92.0. Of enrolled patients, 7.2% experienced secukinumab-related AEs, while special interest AEs (candida infections, malignancy, and major adverse cardiovascular events) were reported in ≤2 patients, each. These results demonstrate high secukinumab persistence in the Greek population up to three years after study enrolment, accompanied by sustained improvements in both clinical and QoL parameters and a favorable safety profile.

Background. Alopecia areata (AA) is a nonscarring alopecia that can affect any hairy area of the body. Excimer light at 308 nm with immunosuppressive effects is recommended as a promising management method for AA. Objectives. To assess the efficacy and safety of excimer light at 308 nm alone versus a combination of tacrolimus 0.1% and excimer light in the treatment of alopecia areata. Methods. Forty patients with AA of the scalp were divided into two groups, group A was treated with an excimer lamp twice per week for three months, and group B was treated with a combination of tacrolimus 0.1% and an excimer light. The efficacy of the treatment was evaluated by the SALT score and serum T-regulatory cells at the baseline, after 3 months from the baseline, and after 6 months from the beginning of treatment. Results. In group (A), the median SALT decreased from the baseline (13.15) to (6.15) 3 months after the baseline and further decreased after 6 months of follow-up to (3.3). While in group (B), the median SALT score was decreased from the baseline (11.15) to (0.5) after 6 months from the beginning of treatment. After 3 months, there was improvement in Treg function in both groups A and B (4.98 ± 1.02, 5.50 ± 0.84), respectively. There was a significantly higher improvement in group B (85.19 ± 8.55) than group A (70.05 ± 9.95). Dermoscopic findings reveal decreased signs of activity in group B more than group A. Conclusion. The combination of excimer light and tacrolimus is more effective than excimer light alone in treatment of AA.

The most common cause of periorbital dermatitis is allergic contact dermatitis. This study aimed to determine the patch test results and demographic characteristics in patients diagnosed with periorbital dermatitis by evaluating their patch test results between 2012 and 2022. The thin-layer rapid-use epicutaneous test (T.R.U.E. test) results of patients diagnosed with periorbital dermatitis over the specified period were retrospectively evaluated. Of the 102 patients included in the study, 58 (56.9%) had a positive reaction to at least one allergen. The most common allergens to which the patients had positive reactions were nickel sulfate (31.0%), gold sodium thiosulfate (19.0%), fragrance mix (13.8%), balsam of Peru (10.3%), colophony (10.3%), cobalt dichloride (8.6%), formaldehyde resin (6.9%), thimerosal (5.2%), quaternium-15 (5.2%), carba mix (5.2%), and potassium dichromate (5.2%). This study provides comprehensive data on the demographic characteristics and patch test results of patients with periorbital dermatitis.

Objective. This single-center, prospective, open-label randomized study aimed to produce a repeatable procedure for isolating platelet-rich plasma (PRP), maximizing platelet recovery and concentration parameters from the collected material, and to assess the effectiveness of autologous platelet-rich plasma (concentrated platelet rich plasma C-PRP and platelet rich plasma low centrifugation concept PRP LCC) and platelet-rich fibrin (injectable platelet rich fibrin I-PRF and fluid platelet rich fibrin F-PRF) injections on skin density and thickness in facial aesthetic treatments. Methods. Twenty participants aged 30–60 underwent a series of three treatments (intervals: 4–6 weeks). The study encompassed the following two stages: a laboratory and a clinical one. In the first stage, the aim was to optimize centrifugation parameters (time and speed) of whole blood to produce the highest quality product for use in aesthetic treatments. Double centrifugation of blood produced the following four types of plasma fractions with different parameters: platelet-rich plasma (C-PRP and PRP LCC) and platelet-rich fibrin (I-PRF and F-PRF) each with two different platelet concentrations (202% in the first centrifugation and 148% in the second centrifugation). The total PLT recovery in the procedure was 76%, with an average of 32% in the first centrifugation and that of 44% in the second one. In the clinical stage, treatments involved C-PRP, PRP LCC, I-PRF, and F-PRF injections in the forehead, lower eyelid, and cheek areas. In ultrasound skin examination with randomly assigned measurements for each patient, a series of acoustic density values directly proportional to tissue density was obtained. Thickness of the skin was also determined (µm) by summation of the epidermis and dermis thickness. Measurements were made in the lateral forehead, lower eyelids, and cheek regions. Results. Statistical analysis elucidates the effectiveness of blood-derivatives therapy in the introduced regiment. The increase in skin density was statistically significant after the following treatment: three sessions in 4–6 week intervals, each consisting of 1 mL of C-PRP injections in the forehead area, 1 mL of I-PRF injections in the lower eyelid area, and 3.5 mL of PRP LCC and 3.5 mL of F-PRF injections in the cheek area. Furthermore, significant improvements in skin density were recorded in the cheek and forehead areas (F(3, 24) = 4.5170 with p=0.011971 for cheeks and F(3, 24) = 9.2327 with p=0.000305 for forehead). Lower eyelid skin density and thickness also increased significantly (F(3, 24) = 3.2653, p=0.038881). No significant changes were noted in skin thickness in the forehead and cheek areas (F(3, 6) = 1.438771, p=0.321616 for cheeks; F(3, 6) = 2.383248, p=0.168172 for forehead). Patient satisfaction was high, as evidenced by a GAIS average score of 2.75. Conclusion. The study confirms the efficacy of C-PRP, PRP LCC and I-PRF, and F-PRF injections in increasing skin density and, to a lesser extent, skin thickness in specific facial areas. As a result of this research, ready-to-use kits (PLASMOO) for obtaining PRP and PRF were developed and put into production. These findings underscore the potential of autologous plasma and fibrin formulations in aesthetic medicine, which offer substantial improvements in skin quality and patient satisfaction. This trial is registered with ISRCTN10538865.

Background: The urge to scratch is, by definition, an integral part of the perception of itch. Consequently, scratch lesions can reflect the patient’s perception of itch, and underlying disease. However, only little is known about scratch patterns among different itchy conditions. Methods: In this cross-sectional study, we analyzed and compared the prevalence, type, site, and distribution of scratch lesions in patients across 11 diagnostic groups of itchy conditions. Statistical analysis was performed using chi-squared test or Mann–Whitney U tests when appropriate. Results: A total of 124 patients with acute or chronic pruritus were enrolled, 82 (66.1%) of whom presented scratch lesions. Among these, erosions/excoriations were the most prevalent (56.1%), followed by erythematous striated lesions (36.6%) and crusts (35.4%). Scratch lesions were present in descending prevalence on the arms (78.2%), trunk (75.6%), legs (74.4%), and head (19.2%). Distinct scratch lesions were identified in some diagnoses, enabling us to develop a diagnostic algorithm. Conclusions: In the present study, we characterized scratch patterns in various itchy skin conditions and developed a diagnostic algorithm accordingly. However, larger studies are necessary to support our findings.

Melasma is a common chronic acquired pigmentation disorder that is recognized as a type of photoaging disorder. Although the exact etiology and pathogenesis of melasma remain elusive, it is widely believed that it is triggered by multiple factors and involves multiple cells. Because of its impact on appearance and self-confidence, melasma can affect the mental health and quality of life of patients. Various types of therapies have been used to treat melasma; however, the treatment of melasma remains challenging because of its eradication difficulty and almost constant relapses. Energy-based and combination therapies have recently become a new trend with surprising therapeutic outcomes. This work provides an overview of the clinical characteristics, etiology, pathogenesis, histopathologic features, and management of melasma.

Facial threading, a popular nonsurgical cosmetic procedure, involves inserting threads into the skin to lift, tighten, and rejuvenate facial tissues. Threads made of materials like polydioxanone or poly-L-lactic acid cater to different treatment needs but have sparked controversy regarding their effectiveness. Originally inspired by theories in acupuncture, this technique aimed to induce tissue contraction and firmness. Modern advancements expanded its focus beyond skin layers, targeting deeper connective tissues to enhance firmness and stimulate fibroblast activation and proliferation. Recent trends emphasize combined therapies, including fillers, botulinum toxins, and energy-based devices, to create overall facial harmony rather than merely lifting or tightening specific areas. Mono threads have evolved from basic designs to volume threads, offering skin tightening, acting as fillers, and modifying facial shapes. They stimulate collagen regeneration, tissue metabolism, and fat tissue liquefaction, reducing volume and enhancing skin quality. The primary effects of these threads are supportive, akin to reinforcing concrete blocks, while barbed threads offer lifting effects by anchoring tissues upwards, inhibiting muscle movements that cause wrinkles. Histologically, threads induce tissue reactions, leading to fibrosis, but debates persist about the lasting lifting effects after complete thread absorption. Ongoing innovations focus on thread designs to optimize cosmetic outcomes, requiring evaluation for desired aesthetic goals. Despite widespread use, ongoing research aims to clarify mechanisms and improve thread designs for better cosmetic results.

There have been several reports of dupilumab use and the development of CTCL; however, the risk of CTCL development has not been adequately evaluated at the population level. The objective of this study is to determine whether dupilumab administration for AD is associated with an increased risk of developing CTCL and to identify at-risk populations within this group. This retrospective cohort study used TriNetX, a deidentified medical record database including over 107 million patients, to identify eligible patients. Treatment and control groups were evaluated for the development of CTCL. Patients of any age with a documented diagnosis of AD were included. The treatment cohort included individuals treated with dupilumab, while the control cohort included AD patients treated with alternative therapies. Selected biologics were excluded from both groups. Subgroup analyses were performed to evaluate three age groups and to identify whether the risk of CTCL development was higher within a given time frame after starting dupilumab. We identified a total of 1,181,533 patients with AD. Of these, 19,612 patients were prescribed dupilumab. Both treatment and control groups included 19,612 patients matched for age, race, and sex. The mean age was 32.3 years (P=0.96), and females accounted for approximately 52% (P=0.93) in both groups. Patients treated with dupilumab for AD had an increased relative risk (RR) of developing CTCL compared to those never treated with dupilumab (RR = 4.59, 95% confidence interval 2.459–8.567, P<0.0001). Subgroup analysis revealed that about half of the CTCL cases after dupilumab therapy (54.5%, 30/55) occurred in patients over the age of 60 years. In contrast, all CTCL cases (100%, 12/12) within the untreated cohort were observed in individuals over the age of 60. Of the patients diagnosed with CTCL following dupilumab use, the majority (62%, 34/55) were diagnosed within the first year. Overall, we find that the use of dupilumab for treating AD is associated with an increased relative risk of developing CTCL. This risk is highest in the first year of therapy and in adult patients. These findings suggest exercising caution in treating select groups of patients with dupilumab.