Dermatologic Therapy

There is an increasing demand for low-level light therapy devices for the treatment of dermatologic conditions, such as acne, hair loss, undesirable body hair, and skin aging. This study evaluated the safety and effectiveness of a novel hand-held low-level light therapy device with a 680 nm red laser diode and a 450 nm blue light-emitting diode for the treatment of mild-to-moderate acne. A prospective clinical study was conducted on 57 patients with mild-to-moderate acne and Fitzpatrick skin types II–IV. Treatments were self-administered by the patients at home daily for 4 weeks. Conventional treatment was restricted during the study period. The number of inflammatory and noninflammatory lesion counts, Investigator’s Global Assessment grade, patients’ self-assessment, and adverse events were measured every two weeks, and follow-ups were performed until four weeks after the final treatment. Moreover, we evaluated the bactericidal effect of low-level light therapy on Cutibacterium acnes, a causative agent of acne vulgaris, in vitro. The mean number of inflammatory acne lesions decreased statistically at weeks 4 () and 8 (). The proportion of Investigator’s Global Assessment grade 3, indicating moderate acne severity, decreased significantly at the final visit. No severe adverse reactions were reported. Furthermore, there was a significant reduction in the viability of Cutibacterium acnes following low-level light therapy exposure in vitro. The results of this study demonstrate that this novel, hand-held, and low-level light therapy device are safe and effective for the treatment of inflammatory acne, with good adherence.

Background. Standard protocol to detect melanoma relies on visual assessment in which the sensitivity and specificity are low for early melanomas. Pigmented lesion assay (PLA) offers objective metrics to aid in determining suspicious lesions; however, the literature on the diagnostic accuracy is controversial. Methods. To assess the performance of PLA, we retrospectively assessed the diagnostic accuracy using two different cohorts, total (n = 426) and biopsied (n = 96), modifying the definition of true negative for each. Sensitivity, specificity, negative predictive value, positive predictive value, prevalence, and Cohen’s kappa were calculated. Results. 370 PLA (−) lesions and 56 in the PLA (+). Of the 40 PLA (−) lesions that were biopsied, 5 (12.5%) were diagnosed as melanoma and 16 (40.0%) were atypical melanocytic nevus. Of the 56 PLA (+) lesions, 14 (25.0%) were melanoma, of which 10 (71.4%) were double positive, 3 (21.4%) were PRAME only, and 1 (7.1%) was LINC only. For the total cohort (n = 426), sensitivity of 73.7%, specificity of 89.7%, NPV of 98.6%, PPV of 25.0%, prevalence of 4.5%, accuracy of 89.0%, and kappa agreement of 0.329 were calculated. The biopsied cohort revealed the same sensitivity and PPV; however, specificity was 45.5%, accuracy was 51.0%, NPV was 87.5%), and kappa agreement was 0.110. Conclusion. There differences in our study seen between cohorts highlight the importance to recognize that neither findings are perfect. The real value likely falls in between, but further studies are needed.

Interleukin 17 (IL-17) inhibitors such as secukinumab, ixekizumab, and IL17 receptor (IL17RA) inhibitor brodalumab have proved to be highly effective and safe in psoriasis treatment. Still, a substantial proportion of patients show a primary or secondary inefficacy. When this happens, the clinician can change the therapeutical axis (swap) or perform an intraclass switch among IL-17 inhibitors. The latter option could allow us to address some comorbidity better, spare the other axis in case of the future inefficacy, and avoid interacting with other molecules with a different safety profile. To date, no sufficient data are available on the efficacy of a second IL-17 inhibitor therapy. Our study included 29 patients with moderate to severe psoriasis undergoing an intraclass switch among IL-17 inhibitors. The mean PASI dropped from 11.1 ± 6.1 to 5.2 ± 6.6 at week 16, with response maintained at week 28 and week 52 (3.4 ± 4.2 and 3.0 ± 4.3, respectively) with no occurrence of serious adverse events. Our data support the evidence that intraclass switch among IL-17 inhibitors is a safe and effective therapeutic option in these patients. This trial is registered with SS_DERMO_20.

The objective of this retrospective study was to verify with the use of high-frequency ultrasonography whether Platelet-Rich Fibrin (PRF) can increase skin density and become an effective method of skin revitalization as well as to determine an optimal procedure protocol for the use of Platelet-Rich Fibrin to revitalize skin of the periorbital region. Ten patients (women, age 32–45) were assigned for the observation. They reported thinning and wrinkles of the skin in the periorbital area. For each individual two vials (18 mL) of peripheral blood were collected and placed in preprogrammed centrifuge (, 3 minutes). After centrifugation injectable-PRF (i-PRF, 2 mL) was collected and injected intradermally in the periorbital area, using the mesotherapy technique with 4 mm 30 G needles. The patients underwent four procedures in one month intervals. A high-frequency ultrasound device was used to measure skin density. Skin density analyses were performed before PRF administration, a month after the second and a month after the third procedure in the crow’s feet area. The results demonstrated an increase in skin density in all patients after just one procedure: on average it was 1.66 times higher compared to the baseline after the second and 5.08 times higher after the third treatment which was visualized using the DUB SkinScanner imaging. The enrolled patients’ satisfaction with their facial skin appearance was measured with the visual analogue scale (VAS). Digital photographs were taken before the first treatment and a month after the last treatment. The VAS assessment results were as follows: the average score before the treatment was 4 and the average score after the treatment was 8.5, indicating a significant increase in patient satisfaction. i‐PRF seems to be a promising treatment modality for skin rejuvenation in the periorbital area and might be a solution for those seeking natural methods. Although the results of this observation are very promising, there is need for larger controlled research to definitely confirm Platelet-Rich Fibrin efficacy in the skin revitalization processes.

The appropriate use of therapeutic moisturizers could reduce the need for more aggressive treatment in the management of atopic dermatitis (AD). We conducted a randomized, side-by-side, single-blinded, comparative study in 41 mild to moderate AD patients to compare a moisturizer and topical tacrolimus for restoring skin barrier function and managing AD. A moisturizer was applied twice daily for 4 weeks to one side of the flexural areas (moisturizer group). Topical tacrolimus was applied on the other side of the tested area (tacrolimus group). Biophysical skin parameters were measured at baseline, week 2, and week 4. Clinical qualitative assessments were also conducted. Analysis of the trend from baseline to week 4 revealed that the hydration level was significantly increased in both groups (, respectively). No biophysical parameters were significantly different between the two groups. Differences in the modified Eczema Area and Severity Index scores between the baseline and week 4 were significantly higher in the tacrolimus group than those in the moisturizer group (). In the Investigator’s Global Assessment, a significantly larger proportion of patients in the tacrolimus group showed clinical improvement than that in the moisturizer group at week 4 (). Although topical tacrolimus was superior to the moisturizer in preventing the clinical exacerbation of AD, the moisturizer was not inferior to topical tacrolimus in restoring skin barrier function. Therefore, moisturizer is considered to play an essential role in maintenance therapy for AD. Physicians need to emphasize the benefits of moisturizers when educating their patients.

Dupilumab is the first biologic agent approved for treatment of moderate to severe atopic dermatitis (AD). Phase 3 clinical trials have shown the efficacy and safety in AD children. However, real-world evidence is still scarce. Thirty-nine pediatric patients with uncontrolled AD who regularly received dupilumab were included in a single-center retrospective study. Eight patients (20.5%) were aged 2 to <6 years, fifteen (38.5%) were 6 to <12 years, and sixteen were 12 to <18 years. Changes in clinical AD scores (EASI, SCORAD, P-NRS, CDLQI, and POEM) at baseline, week 4 (W4), W10, and W16, as well as safety data were collected. At W16, the average EASI values dropped from 29.0 ± 16.2 to 5.1 ± 4.7, and 22 patients (73.3%) achieved 75% improvement in EASI. 16 patients (53.3%) achieved 75% improvement in SCORAD. Significant reduction was also observed in the changes of P-NRS, CDLQI, and POEM values. Notably, the change of clinical scores was similar among three age subgroups. At W16, the mean percent decreases in EASI for 2 to <6 years, 6 to <12 years, and 12 to <18 years, and subgroups were 67.3%, 78.5%, and 83.9%, respectively. A total of three cases of adverse effects were recorded, with conjunctivitis seen in two >6-year-old patients and the injection site reaction in one <6-year-old child. Dupilumab exhibited favorable efficacy and safety profile, including the 2 to <6 years old subgroup.