Dermatology and Therapy

Behçet’s disease (BD) is a systemic autoinflammatory vasculitis. It occurs predominantly in Turkey but very rarely in Europe. The clinical manifestations of BD involve the skin and mucosal membranes; cardiovascular, gastrointestinal and nervous systems; and the eyes and joints. A 26-year-old man was repeatedly hospitalized at the Department of Dermatology of the Medical University of Bialystok. He had a family history of family members' deaths from unknown cause and a long personal history of recurring headaches and nonspecific pain in the chest as well as a 2-year history of recurring painful erosions on the oral mucosa. Recently, before admission to hospital, another erosion had appeared on the scrotum, which rapidly evolved into a painful ulceration. The patient also presented a large erosion in the area of the right hip and acne lesions. He consulted doctors of different specialties and underwent laboratory and imaging tests. Considering the symptoms, BD was diagnosed. Azathioprine was introduced, along with topical treatment. Great improvement of the skin lesions was achieved. He was later admitted to the department a few times for follow-up visits and remains in good general condition. BD is an extremely rare disease in Europe, especially in Poland. The fact that BD is a rare disease outside Asia leads to lower awareness and the possibility of not considering it in the differential diagnosis. The great diversity of symptoms also causes difficulties in tracking this disease. The various manifestations of BD require a broad spectrum of additional tests and an interdisciplinary approach to the patient.

Yếu tố tăng trưởng fibroblast cơ bản (bFGF) đóng vai trò chính trong quá trình hồi phục vết thương. Trong hai thập kỷ qua, các nghiên cứu lâm sàng và cơ bản về bFGF đã được thực hiện tích cực tại Nhật Bản với các báo cáo về hiệu quả mạnh mẽ của nó trong việc thúc đẩy quá trình hồi phục của các vết loét mạn tính và vết thương bỏng bằng cách kích thích các tế bào chủ chốt trong da. Tuy nhiên, hiệu quả của nó vẫn chưa được công nhận trên phạm vi quốc tế. Do đó, nghiên cứu này xem xét kiến thức hiện tại về giá trị điều trị của bFGF trong quản lý vết thương và ngăn ngừa sẹo đã được tích lũy tại Nhật Bản trong hai thập kỷ qua. Chúng tôi xem xét tư liệu tiếng Nhật chứng tỏ tác dụng giảm sẹo của bFGF và đánh giá một cách đầy đủ cách mà những tác dụng này được thực hiện. Sử dụng các từ khóa tìm kiếm “bFGF HOẶC yếu tố tăng trưởng VÀ hồi phục vết thương tại Nhật Bản” và “bFGF VÀ ngăn ngừa sẹo tại Nhật Bản,” chúng tôi đã tiến hành tìm kiếm trong cơ sở dữ liệu PubMed cho các công bố về vai trò của bFGF trong quản lý vết thương và sẹo tại Nhật Bản. Tất cả các bài báo đủ điều kiện được công bố từ năm 1988 đến tháng 12 năm 2019 đã được lấy và xem xét. Kết quả tìm kiếm của chúng tôi cho thấy 208 bài viết; 82 bài liên quan đến ứng dụng của bFGF cho việc hồi phục vết thương da tại Nhật Bản. Trong số đó, 27 bài đáp ứng tất cả các tiêu chí bao gồm; 11 bài là nghiên cứu tại phòng thí nghiệm, 7 bài là báo cáo ca, 4 bài là nghiên cứu lâm sàng, và 5 bài là thử nghiệm ngẫu nhiên có kiểm soát. Cần có thêm nghiên cứu, với sự công nhận giá trị điều trị của bFGF trong quản lý vết thương và sẹo cùng với các ứng dụng lâm sàng của nó, nhằm cung cấp thêm lợi ích lâm sàng trong khi cải thiện quá trình hồi phục vết thương và giảm nguy cơ hình thành sẹo sau phẫu thuật.

Hidradenitis suppurativa (HS) is a chronic, immune-mediated skin condition characterized by inflammatory lesions that can cause pain, impaired physical activity, and reduced quality of life. This study evaluated the efficacy and safety of risankizumab, a humanized immunoglobulin G1 monoclonal antibody that specifically inhibits interleukin 23 by binding to its p19 subunit, for the treatment of HS. This phase II multicenter, randomized, placebo-controlled, double-blind study investigated the efficacy and safety of risankizumab in patients with moderate-to-severe HS. Patients were randomized 1:1:1 to receive subcutaneous risankizumab 180 mg; risankizumab 360 mg; or placebo at weeks 0, 1, 2, 4, and 12. Patients initially randomized to placebo received blinded risankizumab 360 mg at weeks 16, 17, and 18; patients initially randomized to risankizumab received blinded matching placebo at the same time points. From weeks 20–60, all patients received open-label risankizumab 360 mg every 8 weeks. The primary endpoint was the achievement of HS Clinical Response (HiSCR) at week 16. Safety was assessed by monitoring of treatment-emergent adverse events (TEAEs). A total of 243 patients were randomized (risankizumab 180 mg, n = 80; risankizumab 360 mg, n = 81; placebo, n = 82). HiSCR was achieved by 46.8% of patients with risankizumab 180 mg, 43.4% with risankizumab 360 mg, and 41.5% with placebo at week 16. The primary endpoint was not met, and the study was terminated early. Incidence of TEAEs, severe TEAEs, TEAEs considered possibly related to study drug, and TEAEs leading to discontinuation of study drug were generally low and comparable across treatment groups. Risankizumab does not appear to be an efficacious treatment for moderate-to-severe HS. Future studies to understand the complex molecular mechanisms underlying HS pathogenesis and develop improved therapies are warranted. ClinicalTrials.gov identifier: NCT03926169.

Acne is a chronic inflammatory disease. Key to a patient’s success on fixed-dose adapalene–benzoyl peroxide (BPO) gel is ensuring adherence. Use of a pump system to deliver a pre-measured amount of gel with each pressure enables application of a more consistent dose vs. the tube, which should improve adherence. In the present study, we evaluate patient preference for two different containers for dispensing adapalene–BPO gel. In this 15-day, open-label study, 300 subjects were asked to treat their acne using fixed-dose adapalene 0.1%–BPO 2.5% gel dispensed in either a tube or a pump once-daily for up to 7 days. At week 1, subjects switched to the alternative packaging design for the same timeframe. At the end of the treatment period, subjects were asked to complete a subject preference survey. Among subjects completing the survey (n = 291), 79.0% (n = 230) preferred the pump for dispensing adapalene–BPO gel and 21.0% (n = 61) preferred the tube (p < 0.001). The top three characteristics of the pump were that it was easy to use (89.0%; n = 259/291), clean (73.2%; n = 213/291) and convenient (69.4%; n = 202/291). When asked to rate their experience with using the pump, 91.8% (n = 267/291; p < 0.001) of subjects reported being satisfied on a self-assessment scale. The majority of subjects stated they would tell their doctor about their preference for the pump next time adapalene–BPO gel was prescribed (76.6%; n = 223/291; p < 0.001) and would prefer the pump if both containers cost the same amount (80.1%; n = 233/291; p < 0.001). Patients prefer using a pump instead of a tube to dispense adapalene–BPO gel. This delivery mechanism helps to ensure consistent application and thus may improve patient adherence to the prescribed acne treatment regimen.

Inflammatory skin diseases are a significant burden on affected patients. Inflammation is caused by various stress factors to the epidermis resulting in, e.g., dryness, redness, and pruritus. Emollients are used in basic therapy to restore the natural skin barrier and relieve symptoms. A systematic review was performed to evaluate the efficacy and safety of ectoine-containing topical formulations in inflammatory skin diseases characterized by an impaired skin barrier. A systematic review was carried out in PubMed, the Cochrane Library, and Microsoft Academic up to October 2021. Inclusion criteria were ectoine-containing topical formulations (creams, emollients) used for (adjuvant) therapy of inflammatory skin diseases. Clinical studies of any design published in any language were included. A total of 230 references were screened for eligibility, of which six were selected for inclusion in the review (five studies on atopic dermatitis and one study on prevention and management of retinoid dermatitis). The application of topical formulations containing 5.5–7.0% ectoine positively influenced skin dryness and, consequently, pruritus and dermatitis-specific scores in patients with atopic dermatitis. Especially in infants and children, who belong to the most frequently affected group, the formulations were well-tolerated when applied for up to 4 weeks. In studies where ectoine was used as an adjuvant therapy, application was associated with a decreased need for pharmacological therapy and also improved the effectiveness of, e.g., topical corticosteroids. In patients undergoing isotretinoin therapy, ectoine was as effective as dexpanthenol in reducing retinoid dermatitis or improving symptoms. Ectoine is an effective natural substance with an excellent tolerability and safety profile, representing a beneficial alternative as basic therapy or to increase the efficacy of the pharmacological treatment regimen for patients with inflammatory skin diseases, including infants and children.

Keratoacanthomas are cutaneous neoplasms known for their rapid growth and spontaneous regression over a long time period. Their treatment can be difficult because of the potentially large field size and number of lesions. Intralesional methotrexate constitutes an effective, nonsurgical treatment of keratoacanthomas, as proven by our experience. We treated 11 elderly patients affected by keratoacanthoma with intralesional methotrexate. The injections were performed weekly, followed by 10 mg of folic acid to be taken 24 h later. All our patients underwent complete resolution of the lesions after 4–8 injections, without side effects. Intralesional methotrexate seems to be an effective and safe nonoperative treatment modality for keratoacanthoma, especially when it arises in anatomic areas difficult to treat with surgery, in elderly debilitated patients, and in those refusing surgery.