Dermatologic Therapy

At present, COVID-19 vaccination is an effective method to stop the spread of the epidemic and reduce disease severity and mortality. It has been reported that COVID-19 vaccine can activate several autoimmune diseases. However, whether it can affect development of vitiligo remains elusive. In this study, we aimed to evaluate the possible risk factors of vitiligo disease activity or recurrence after COVID-19 vaccination. We recruited 383 vitiligo patients, of whom 126 were not vaccinated and 257 had received the COVID-19 vaccine. Vitiligo disease activity (VIDA) score was used to analyze key risk factors of vitiligo in patients who underwent COVID-19 vaccination. Multivariate logistic regression models were used to explore the risk factors associated with VIDA. Compared with patients without history of undergoing vaccination, the VIDA score of vaccinated patients increased significantly (3(2, 4) vs. 3(2, 3) scores, ). Logistic regression analysis identified COVID-19 vaccination (odds ratio (OR): 3.040, 95% confidence interval (CI): 1.649–5.603) as an independent risk factor for VIDA. The data showed that COVID-19 vaccination aggravated the development of vitiligo, which is a key risk factor for recurrence.

Background. Given the chronic relapsing, remitting course of psoriasis, data about long-term effectiveness may be useful to assess the maintenance of clinical response over time. Objective. To evaluate 2-year drug survival of risankizumab and identify any predictive factor of discontinuation for ineffectiveness. Materials and Methods. A multicenter retrospective study was conducted in patients who initiated risankizumab between July 2019 and December 2020. PASI was measured at baseline and after 104 weeks. Any adverse event was registered during visits. Univariable and multivariable logistic regressions were used to assess baseline patients’ characteristics that predicted clinical response. The drug survival analysis was descriptively performed using the Kaplan–Meier survival curve. Results. 112 patients with moderate-to-severe plaque psoriasis were included. The overall median observation time was 35.3 months (26.7–37.3); the estimated survivor cumulative function at months 12 and 24 was 93.6% and 90.6%, respectively. No differences in BMI, disease duration, disease severity, or previous biological therapies were observed in patients who responded or did not respond to treatment. No significant adverse events were reported, but there was relapse of psoriatic arthritis and ulcerative colitis in a patient. Conclusions. We found that risankizumab was associated with long-term effectiveness, and a favorable safety profile in a population of psoriatic patients was observed, over a period of 2 years.

Background. Bacillus Calmette–Guerin polysaccharide nucleic acid (BCG-PSN), as an immune modulator, can effectively regulate the immune function of the body, control the release of histamine inflammatory substances, and achieve allergic effects against chronic spontaneous urticaria (CSU). This study aimed to evaluate the effectiveness of BCG-PSN on the levels of inflammatory factors and Th1/Th2 differentiation in CSU. Methods. A systemic literature search of BCG-PSN treatment of CSU was performed using the PubMed, Cochrane Library, Web of Science, CBM, and other databases. A quantitative meta-analysis was conducted according to the guidelines of the Cochrane Handbook. Review manager software 5.4 was used for meta-analysis. Results. Twenty-seven studies pertaining to 2840 patients were included. The duration of treatment was 4 to 12 weeks. BCG-PSN can increase CD3+T levels (MD = 6.06; 95% CI: 5.30 to 6.82;  < 0.00001; I² = 31%), CD4+T levels (MD = 5.41; 95% CI: 4.82 to 6.01;  < 0.00001; I² = 40%), and CD4+/CD8+(MD = 0.33; 95% CI: 0.28 to 0.38;  < 0.00001; I² = 15%); at the same time, BCG-PSN can downregulate CD8+T levels (MD = −3.28; 95% CI: −3.82 to −2.74;  < 0.00001; I² = 32%). Furthermore, BCG-PSN could downregulate IL-4 levels (MD = −4.06, 95% CI: −5.15 to −2.97,  < 0.00001; I² = 0%), TNF-α levels (MD = −2.34; 95% CI: −3.01 to −1.66;  < 0.00001; I² = 26%) and upregulate IL-10 levels (MD = 25.59, 95% CI: 23.50 to 27.69,  < 0.00001; I² = 0%) and INF-γ levels (MD = 4.62, 95% CI: 3.79 to 5.45,  < 0.00001; I² = 5%). Conclusions. BCG-PSN can regulate the levels of inflammatory factors and Th1/Th2 differentiation in CSU. However, the long-term effectiveness and more objective experimental indicators of BCG-PSN remain to be further studied. Trial Registration. This trial is registered with PROSPERO ID: CRD42022332475.

Background. Occult psoriatic arthritis (PsA) refers to a subset of psoriasis patients showing lesions on imaging but do not exhibit arthritis symptoms. Objective. This study was aimed to discover a simple biomarker that could be easily incorporated in clinical practice to identify occult PsA patients, defined as psoriasis patients with lesions on imaging but without arthritis symptoms, among silent psoriasis (PsO) patients, defined as psoriasis patients without any arthritis symptoms. Methods. A total of 149 silent PsO patients, including 83 PsO alone patients, defined as psoriasis patients without any arthritis symptoms and evidence of lesions on imaging, and 66 occult PsA patients, were enrolled in this cross-sectional study, and they all underwent blood tests to determine hematological inflammation biomarkers. Results. Occult PsA patients had a higher derived neutrophil-to-lymphocyte ratio (dNLR) (1.6 (1.3–2.2) vs. 1.3 (0.9–1.8),  < 0.001), body mass index (BMI) (25.2 (23.7–28.1) vs. 24.0 (21.9–26.0),  = 0.002), diabetes mellitus (DM) rate (30.3% vs. 7.2%,  < 0.001), and nail involvement rate (65.2% vs. 41.0%,  = 0.003) than patients with PsO alone. A prediction nomogram was established, and the area under the curve (AUC) was 0.843. The sensitivity and specificity of the model for identifying occult PsA patients were 77.3% and 81.9%, respectively. Conclusion. Our findings suggest that dNLR is a valuable diagnostic biomarker for occult PsA, and our prediction nomogram could provide clinicians with a useful tool for differentiating occult PsA patients from PsO alone patients.

Background. Psoralen plus ultraviolet A (PUVA) is the preferred phototherapeutic modality for early-stage folliculotropic mycosis fungoides (FMF), and for early-stage non-FMF refractory to narrow-band ultraviolet B (NBUVB). However, PUVA has a problematic safety profile. Literature on the treatment with the combination of UVA and NBUVB for MF is sparse. Objective. To evaluate the effectiveness of UVA combined with NBUVB for early-stage MF, specifically for FMF and NBUVB-refractory non-FMF, in adult and pediatric patients. Methods. A retrospective analysis was conducted for patients treated with UVA combined with NBUVB at our center, during 1/2008–8/2022. Results. The cohort included 51 patients: 35 adults and 16 pediatric patients. The overall response rate (ORR) of 39 patients with early-FMF (25 adults and 14 children) was 95%, and the complete response (CR) was 62%. No significant differences in ORR/CR rates were noted between adult and pediatric patients. Of 12 patients with non-FMF (10 adults and 2 children), the ORR was 83% and the CR was 50%. In 17 patients (8 FMF and 9 non-FMF), prior NBUVB therapy resulted in partial response/stable disease; yet, UVA + NBUVB led to CR in 9 patients (4 FMF and 5 non-FMF). Side effects were minimal. Conclusion. Combined UVA and NBUVB is a good alternative to PUVA for adult or pediatric patients with early-stage MF , with FMF or non-FMF refractory to NBUVB.

Objectives. To determine the efficacy of platelet-rich plasma in treating alopecia areata. Methods. A systematic search was carried out in PubMed, Embase, and the Cochrane Library databases to identify any article evaluating the efficacy of platelet-rich plasma for the treatment of alopecia areata and comparing platelet-rich plasma with other treatment modalities. Results. Nine studies were included based on our inclusion criteria with a total of 616 patients. Various evaluations of alopecia areata treatment efficacy with platelet-rich plasma, including the comparison between platelet-rich plasma and triamcinolone acetonide, minoxidil, placebo, and other methods, such as fractional carbon dioxide laser and microneedling, were conducted in the included studies. The main results revealed that platelet-rich plasma and triamcinolone acetonide are both effective in the treatment of alopecia areata. However, the treatment response was in favor of platelet-rich plasma. Also, minoxidil showed positive effects on the treatment of alopecia areata alongside platelet-rich plasma. Platelet-rich plasma also has significantly better effects on alopecia areata compared to placebo. Most of the side effects of treatment of alopecia areata with platelet-rich plasma were minor, including burning sensation, pain during injection, erythema, edema, ecchymosis, crust formation, and headache. Conclusion. Based on the evidence reviewed, it is suggested that platelet-rich plasma is a safe and effective treatment option for alopecia areata. Furthermore, platelet-rich plasma has the advantage of being a steroid-sparing therapy, reducing the reliance on corticosteroids. The use of platelet-rich plasma is associated with fewer complications compared to other treatment modalities.