Chronic Skin Condition Research Articles

Gender, race, and economic factors influencing screening practices in hidradenitis suppurativa: a cross-sectional analysis.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that significantly impacts patients' quality of life. Despite its substantial burden, HS remains underdiagnosed and undertreated, particularly among marginalized populations. This study aimed to elucidate the primary social determinants of health (SDOH) and structural determinants of health (StDOH) influencing rates and patterns of screening for patients diagnosed with HS. Using data from the All of Us Research Program database, participants with HS were identified using ICD-10 codes and stratified based on various sociodemographic factors, including race, gender, and income. The primary outcome variables were participation in viral screening and disease screening among HS patients. Statistical analyses were performed to assess the relationship between sociodemographic factors and screening practices. Income and gender had significant impacts on screening practices. Higher-income patients were more likely to receive necessary disease screening and less likely to receive unnecessary disease screening compared to lower-income patients. Non-male patients had significantly higher rates of unnecessary disease and viral screening than male patients. While differences in screening practices within each income level were significant, there were no significant differences across different income brackets or racial groups. These findings suggest that subjectivity associated with individual physicians' recommendations may contribute to disparities in screening outcomes, especially in lower-income and non-male HS patients. The study highlights the need for more clearly delineated screening guidelines and continued research on the role of SDOH in improving patient health outcomes.

Management of Plaque Psoriasis with Multimodal Treatment of Ayurveda - A Case Report

Psoriasis is the immune system problem that causes skin to revitalize at faster rate. It’s the chronic disease that has psychological and social impact on patient’s life. This condition had been narrated many decennium ago but proper aetiology and its cure remain under researched. In Ayurveda this multifaceted etiology disease needs multimodal treatment. The modern treatment provides only temporary relief with too many serious side effects. The treatment embraced here was in accordance with ayurvedic Samprapti. This case report details the successful management of plaque psoriasis in a 32-year-old female patient using a multimodal treatment approach, which incorporated Panchakarma, a traditional Ayurvedic detoxification therapy. The patient presented with erythematous plaques on forehead, neck region, lateral surface of legs and at arms along with itchy and burning skin. Auspitz sign and Koebner phenomenon was positive. Diagnosis made on the basis of Sign and Symptoms. After a thorough evaluation of the patient's constitution and the nature of the disease, a customized Panchakarma protocol was devised involving Virechana (Purgation) followed by Basti (medicated enema) along with Shamana Chikitsa (Internal Medication). The results revealed a remarkable improvement in the patient's psoriasis lesions, with a significant reduction in PASI scores, reduction in scaling, erythema, and in duration. The patient reported a substantial reduction in itching and discomfort. This case report emphasizes the potential of Panchakarma as an adjunctive therapy for plaque psoriasis, highlighting the holistic and personalized approach of Ayurveda in managing chronic skin conditions. Further research and larger-scale studies are warranted to confirm the effectiveness of Panchakarma in the treatment of psoriasis and to observe its long-term benefits and safety profile.

Primary sensory neuron-derived miR-let-7b underlies stress-elicited psoriasis

Psoriasis, a chronic autoimmune skin condition with significant global morbidity, badly impairs patients’ quality of life. Stress has been identified as a prominent trigger for psoriasis, and effectively management of stress can ameliorate its pathological manifestations. However, the precise mechanisms by which stress influences psoriasis remain elusive. In this study, we found that mice subjected to chronic social defeat stress (CSDS) exhibit severer imiquimod (IMQ)-induced psoriasis with increased epidermal scaling, epidermal hyperplasia, number of epidermal ridges, itch, and skin inflammation than control mice. Mechanistic study reveals that CSDS leads to an elevated release of miR-let-7b, an endogenous ligand of Toll-like receptor 7 (TLR7), from the peripheral terminal of dorsal root ganglia (DRG) neurons into the skin. This process can stimulate skin-resident macrophages to release cytokines (such as IL-6 and TNF-a) and chemokines (such as MCP-1), subsequently promoting the recruitment of additional macrophages into the skin. Notably, the specific blockade of miR-let-7b in DRG neurons effectively relieve stress-induced exacerbations of psoriasis. Furthermore, intradermal injection of synthetic miR-let-7b can induce a psoriasis-like phenotype in wildtype mice, a phenomenon that can be countered by the application of a TLR7 antagonist. Additionally, microfluidic chamber coculture assays demonstrated that miR-let-7b released by DRG neurons activates macrophages via TLR7 expressed on these immune cells. Totally, this study found that stress-induced upregulation and release of miR-let-7b from DRG neurons stimulates macrophages to secrete more inflammatory cytokines and chemokines, thereby exacerbating skin inflammation and the psoriatic phenotype. These findings provide a potential therapeutic strategy targeting the miR-let-7b/TLR7 pathway to alleviate stress-induced exacerbation of psoriasis.

MiR‑155 promotes an inflammatory response in HaCaT cells via the IRF2BP2/KLF2/NF‑κB pathway in psoriasis.

Psoriasis is a chronic inflammatory skin condition with numerous causes, including genetic, immunological and infectious factors. The course of psoriasis is long and recurrence is common; pathogenesis is not completely understood. However, there is an association between advancement of psoriasis and aberrant microRNA (miR or miRNA)‑155 expression. Through bioinformatics, the present study aimed to analyze the differentially expressed genes and miRNAs in psoriasis and its biological mechanism and function psoriatic inflammation. First of all, differentially expressed genes (DEGs) and miRNAs (DEMs) in patients with psoriasis were identified using GEO2R interactive web application. A psoriasis inflammatory model was established using lipopolysaccharide (LPS)‑treated HaCaT keratinocytes, which were transfected with miR‑155 mimic or inhibitor. Cell Counting Kit‑8 was used for the assessment of cell viability and proliferation, and changes in the cell cycle were examined using flow cytometry. ELISA and reverse transcription‑quantitative PCR (RT‑qPCR) were used to detect the expression levels of the inflammatory factors IL‑1β and IL‑6. The dual‑luciferase reporter assay was used to verify the targeting association between miR‑155‑5p and IFN regulatory factor 2 binding protein 2 (IRF2BP2). To verify the targeting association of miR‑155 and the IRF2BP2/kruppel‑like factor 2 (KLF2)/NF‑κB signaling pathway, expression levels of IRF2BP2, KLF2 and p65 were identified by RT‑qPCR and western blotting. IRF2BP2 levels were also confirmed by immunofluorescence, in conjunction with bioinformatics database analysis. Overexpression of miR‑155 inhibited proliferation of HaCaT cells and increased the number of cells in S phase and decreasing number of cells in G1 and G2 phase. In the LPS‑induced inflammatory state, miR‑155 overexpression heightened the inflammatory response of HaCaT cells while inhibition of miR‑155 lessened it. Suppression of inflammatory cytokine expression by miR‑155‑5p inhibitor was reversed by knockdown of IRF2BP2. miR‑155 was shown to interact with IRF2BP2 to negatively regulate its expression, leading to decreased KLF2 expression and increased p65 expression and secretion of inflammatory factors, intensifying the inflammatory response of HaCaT cells. Therefore, miR‑155 may contribute to development of psoriasis by inducing tissue and cell damage by increasing the inflammatory response of HaCaT cells via the IRF2BP2/KLF2/NF‑κB pathway. In conclusion, the results of the present study offer novel perspectives on the role of miR‑155 in the onset and progression of psoriasis.

Efficacy of Treatments in Reducing Facial Erythema in Rosacea: A Systematic Review.

Rosacea is a chronic inflammatory skin condition that affects over 5% of individuals worldwide. Its clinical presentation is characterized by an array of features, including erythema, papules and pustules, phymatous changes, telangiectasia, and ocular manifestations. Specifically, the multifaceted manifestation of erythema varies widely in intensity and distribution. Factors contributing to pathogenesis include neurovascular dysregulation, increased levels of pro-inflammatory mediators, and aberrant vasodilation. Erythema management plays an important role in reducing the psychosocial burden associated with rosacea and improving overall quality of life. Cochrane CENTRAL, Medline, and Embase databases were searched from inception to September 2023 and included 33 clinical trials reporting on a total of 7411 rosacea patients (74.1% female) and 21 different topical or systemic treatments. The mean age was 48.8 years (range, 18-83 years), and the mean time to outcome assessment was 8.1 weeks (standard deviation, 4.1 weeks). Treatment efficacy was assessed by outcome measures including percent improvement from baseline on 4- and 5-point scales, clinician erythema assessment (CEA) success (improvement ≥1 point), and CEA and patient self-assessment success (improvement ≥1 point). Pooled effect sizes for each treatment were calculated as a weighted average based on the number of patients in each study. The most effective topical treatments for reducing erythema include sodium sulphacetamide and sulphur, praziquantel, metronidazole, and B244 spray (Nitrosomonas eutropha). The most effective systemic treatment was paroxetine. Our findings highlight the varying efficacy of treatments in addressing the erythema in rosacea, recognizing the nuances of clinical presentations.

Impact of childhood psoriasis on children and parents during transition to adolescence: An interpretative phenomenological analysis

AbstractObjectivesPsoriasis is a chronic skin condition that can develop at any age. Childhood psoriasis can lead to stigmatization and reduced quality of life in children and parents. This study aimed to gather a detailed family‐level understanding of the experience of childhood psoriasis during the time of transition to adolescence.DesignA multi‐perspectival interpretative phenomenological analysis (IPA) was used.MethodsSixteen semi‐structured interviews with eight parent–child dyads were conducted and analysed in accordance with IPA principles.ResultsThree superordinate themes and three sub‐themes were identified: 1. ‘Transition and transaction’ including: 1.1 ‘Shifting responsibilities and self‐efficacy’; 2. ‘Stigma and social impact’; and 3. ‘The treatment journey’ including: 3.1 ‘Finding an effective treatment’, 3.2 ‘Coping with on‐going management’. Uncertainties surrounding treatment options were an initial focus of difficulty for families. In adolescence, the difficulty shifted to be more identity focussed as the responsibility for disease management and the increased awareness on body image posed added challenges. Both parents and children described visibility and stigma as the most distressing aspects of living with psoriasis and experienced negative emotions that resurfaced during adolescence.ConclusionsThis study suggests that childhood psoriasis can have a significant impact on children, particularly as they begin to transition to adolescence. Findings also highlight the burden of psoriasis for parents. As such, psychological interventions (such as adapted forms of mindfulness‐based Cognitive‐Behavioural‐Therapy) are needed to target and reduce stress. Such interventions are likely to require a systemic focus and support validation of the real impact and fear of stigmatization.

Epidemiology and Healthcare of Juvenile and Late-Onset Acne: Claims Data Analysis.

Acne is the most frequent chronic inflammatory skin condition in adolescence but occurs also in later age. Our study aimed to characterise the epidemiology, geographical distribution, comorbidity and healthcare of acne juvenilis (AJ) and acne tarda (AT). Statutory health insurance (SHI) data from 2016 to 2020 were analysed. Prevalence rates, including geographical distribution, comorbidities and drug use by specialists group, were measured. In 2020, the prevalence of acne among adults was 1.50% (AT > 25years) and among adolescents was 3.88% (AT ≤ 25years). The highest prevalence (13.02%) was observed at the age of 17 years. Sex differences were higher in AT (73.80% in women) than in AJ (64.55% in women). Compared with non-affected persons, individuals with acne - in particular with AT - showed significantly higher rates of skin-related comorbidities, including folliculitis (rate ratio (RR) 8.89), pyoderma (RR 7.27) and rosacea (RR 5.53), and non-skin-related comorbidities, such as ovarian dysfunction (RR 2.36), rhinitis allergica (RR 1.84) and Crohn's disease (RR 1.79). Preferred systemic therapeutics prescribed were anti-infectives in AT (46.86%) and retinoids in AJ (52.35%). In the majority of cases, dermatologists were involved in the treatment of acne (AT 65.77%; AJ 76.27%). The most commonly prescribed topical agents were adapalene with benzoyl peroxide (AT 87.72%; AJ 85.75%), while systemic isotretinoin (AT 81.20%; AJ 90.06%) was also a frequently used drug. General practitioners were more likely to prescribe anti-infectives, especially topical antibiotics such as chlortetracycline (AT 52.38%; AJ 44.44%) and systemic antibiotics, especially tetracycline (AT 58.33%; AJ 67.50%). Acne affects a relevant proportion of the German population not only in adolescence, and management of this inflammatory skin disease does not naturally follow medical guidelines or specialist recommendations. These findings emphasise the importance of specialised care and comprehensive therapeutic management that should also consider the exploration of comorbidities.

Phosphatidylserine Topically Attenuates Imiquimod-induced Psoriasis Through Inflammation Inhibition in Mice.

Psoriasis is a chronic skin condition that is associated with persistent inflammation and skin lesions. Topical therapy has been a promising approach to the alleviation of psoriasis through the application of anti-inflammatory agents. Phosphatidylserine (PS) administration has shown anti-inflammatory effects in the trials. Consequently, the objective of this study was to evaluate the effects of topical PS on the potential improvement of an imiquimod (IMQ)-induced psoriasis model. Additionally, cyclosporine A was utilized as a comparative anti-psoriatic agent in our study. The psoriasis model was established by topically applying IMQ to the dorsal skin of mice once daily for five consecutive days. The efficacy of topical PS was assessed using the Psoriasis Area and Severity Index (PASI) score to evaluate skin lesions. Subsequently, the skin samples were analyzed using Baker's scoring system, Masson's trichrome staining, immunohistochemistry, and real-time PCR analysis. IMQ-induced plaque-type psoriasis resulted in a significant increase (P<0.05) in dermal thickness, hyperkeratosis, PASI score, and inflammatory cytokines at the lesion site. The topical PS and cyclosporine A significantly (P<0.05) reduced PASI score and dermal thickness, while also alleviating erythema and scaling when compared to untreated mice. Furthermore, biomolecular assessments revealed that PS significantly (P<0.05) inhibited the gene expression of IL-17, IL-23, and TNF-α cytokines in the IMQ-induced lesions. Topical PS may pointedly alleviate psoriasis through the inhibition of inflammation. The beneficial effects of the PS recommend further investigation in both experimental and clinical studies in the control of skin psoriasis.

Causal relationship and mediation effects of immune cells and plasma metabolites in atopic dermatitis: A Mendelian randomization study.

Atopic dermatitis (AD) is a chronic inflammatory skin condition with complex etiology involving genetic, environmental, and immunological factors. This study employs Mendelian randomization to explore the causal relationships between immune cell phenotypes and AD, and the mediating effects of plasma metabolites. Using data from European cohorts, we identified 7 immune cell phenotypes significantly associated with AD. Mediation analysis revealed that the alpha-ketobutyrate to 4-methyl-2-oxopentanoate ratio negatively regulates CCR2 on monocytes, while the glycerol to carnitine ratio positively regulates HLA-DR on CD14- CD16- cells. These findings underscore the critical role of metabolic pathways in modulating immune responses and suggest potential dietary and therapeutic interventions for AD management. Further research should consider more diverse populations to validate these findings.

CGF therapy: bridging androgenetic alopecia observations to psoriasis treatment via IL-17 pathway.

Concentrated Growth Factor (CGF), rich in CD34 + stem cells, is widely used in treatments for androgenetic alopecia and skin rejuvenation due to its immune-modulating properties. Psoriasis, a chronic inflammatory skin condition, presents significant treatment challenges, particularly for patients who cannot use biologics due to conditions such as cancer and lesions resistant to treatments. The potential of CGF in treating psoriasis is promising, given its broad immunoregulatory effects which confirmed in our previous androgenetic alopecia work. We evaluated the impact of CGF on IL-17 levels in two contexts: patients treated for androgenetic alopecia and a psoriasis mouse model. Twelve patients received three monthly injections of CGF, with serum IL-17 levels measured before and after treatment. In the psoriasis mouse model, groups were treated with CGF, and outcomes were assessed using the Psoriasis Area and Severity Index (PASI), skin barrier scores, histological analysis, and RNA sequencing. Additionally, in vitro experiments applied CD34 + cells from CGF to keratinocytes to measure levels of TNF-α, IFN-γ, IL-23, and IL-17. In patients with androgenetic alopecia, three monthly CGF injections resulted in significantly reduced serum IL-17 levels. In the psoriatic mouse model, CGF-treated groups exhibited lower PASI scores and improved skin barrier scores compared to controls. Histological analysis revealed enhanced skin characteristics, while RNA sequencing demonstrated downregulated IL-17 and upregulated CD34 expression, as well as improved expression of barrier-related genes. In vitro, the application of CD34 + cells from CGF to keratinocytes led to a significant reduction in TNF-α, IFN-γ, IL-23, and IL-17 levels, indicating strong anti-inflammatory effects. A clinical case of a psoriasis patient unresponsive to IL-23 therapy (Guselkumab) showed significant improvement following CGF treatment. These findings indicate that CGF could serve as an effective and versatile treatment for psoriasis, especially for patients who have already undergone biologic therapies but continue to experience resistant lesions.

Attenuation of 1-chloro-2,4-dinitrobenzene-induced inflammation in atopic dermatitis-like skin lesions in rats by a pyrrole containing FELL-NH 2 bioconjugate: Cannabinoid receptor type 1 involvement

Atopic dermatitis (AD) is a chronic inflammatory skin condition of significant health and social importance, which justifies the search for new means of treatment. Since the endogenous cannabinoid system appears to be involved in the pathogenesis of AD, the proposed article summarizes the clinical impact on skin inflammation in a rat model of 1-chloro-2,4-dinitrobenzene-induced atopic dermatitis-like condition after exogenous systemic administration of the cannabinoid receptor type 1 (CB1r) agonist anandamide, as well as after local treatment with a newly synthesized pyrrole moiety containing bioconjugate of FELL tetrapeptide with CB1r-dependent analgesic activity. The changes in skin lesions and ear thickness were estimated along with the CB1r expression immunohistochemically determined on skin punch biopsies. The results showed attenuation of skin lesions by anandamide and lack of positive effect after introduction of CB1r antagonist, accompanied by a change in CB1r expression, suggesting the involvement of the cannabinoid system in the defensive functions of the skin. The topically applied newly synthesized bioconjugate also favorably affected skin manifestations of inflammation, but without a change in CB1r expression, suggesting the involvement of other mechanisms in the reported effects.

Special considerations for hidradenitis suppurativa in skin of colour: A review of literature

AbstractHidradenitis suppurativa, a chronic inflammatory skin condition, disproportionately affects individuals with skin of colour (SOC), particularly African Americans. Despite the increased prevalence in SOC, racial minorities are underrepresented in HS clinical trials, limiting our understanding of treatment efficacy. The purpose of this narrative review is to discuss the current literature regarding the clinical presentation, comorbidities, and management of HS in SOC individuals. A PubMed search was conducted using the terms Hidradenitis suppurativa, comorbidities, skin of colour, African–American, Hispanic, and quality of life with relevant studies written in English and pertaining to the demographics and clinical trials were included. African American patients with HS tend to experience more severe disease manifestations, higher rates of comorbidities like inflammatory bowel disease and anaemia, increased healthcare utilisation, and a greater likelihood of surgical interventions. While the current literature provides extensive information about African Americans regarding comorbidities and disease prevalence, there is a lack of research on Hispanic and other ethnic groups. For future research, it is important to broaden our focus to include various ethnic groups. Addressing these disparities requires focused interventions, inclusive clinical research initiatives, and healthcare policies tailored to the specific needs of patients with skin of colour.

Assessing the inclusion of women of color in lichen sclerosus treatment studies: a scoping review.

Vulvar lichen sclerosus (VLS) is an underrecognized chronic inflammatory skin condition with significant clinical features and potential for malignant transformation. To date, there are no studies comparing the course of this disease in women of color to other racial groups. The objective of this study was to provide a scoping review examining racial demographic data in VLS treatment studies and specifically assessing for the inclusion of women of color. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a primary literature search was conducted using 4 databases: Ovid Medline(R), Scopus, Cochrane, and Web of Science from all years to December 2022. We included published studies with adult women diagnosed with VLS and containing a treatment arm using topical corticosteroids. Single case reports, literature reviews, systemic reviews, meta-analyses, and reports not available in English were excluded. Overall, 1340 nonduplicate studies were assessed for eligibility criteria. In total, 65 publications were included. Only 6 included racial demographic data. Black women made up at most 3.8% of the sample population and Latinx women made up at most 5.7%. Our review focused on a specific intervention (ie, the use of topical corticosteroids for the treatment of VLS), which may restrict the generalizability of our findings to other interventions. No risk of bias assessment was done due to the scoping nature of the review. Women of color are underrepresented in studies of topical corticosteroid use in adult women with VLS. Intentional diversity in recruitment will enable the collection of data that is both more accurate and reflective of a broader spectrum of perspectives and life experiences.

Impact of Atopic Dermatitis (Eczema) and Its Treatment on the Risk of Adverse Events Following Total Knee Arthroplasty.

Atopic dermatitis (AD), also known as eczema, is a highly prevalent, chronic inflammatory skin condition. The perioperative outcomes of patients with AD after total knee arthroplasty (TKA) have not been characterized. Adult patients who underwent TKA were identified in the PearlDiver administrative database. After matching based on patient characteristics, 90-day adverse events and 5-year revisions were compared by multivariable analyses and log-rank tests, respectively. Patients with atopic dermatitis were then stratified by medication status for repeated analysis between resultant subcohorts. Relative to age, sex, and comorbidity matched patients without AD, those with AD had increased odds of aggregated adverse events (OR = 1.36), pneumonia (OR = 2.07), urinary tract infection (UTI, OR = 1.77), and emergency department (ED) visits (OR = 1.70) (P < 0.0001 for each). Those on medication for moderate-to-severe disease had similar associations as the primary analysis. Those not on medications were similar, but not found to have elevated odds of pneumonia. 5-year revisions were not markedly different. TKA patients with AD were at increased odds of pneumonia, UTI, and ED visits, but these risks were not exacerbated by immunosuppressive medications. Surgeons who are managing patients with AD for TKA should be vigilant but reassured by overall similar 5-year survival to revision.

Effectiveness and Safety of a Dermocosmetic Cream as an Adjunct to Adapalene for Mild and Moderate Acne in Indonesia: Results of a Multicenter Randomized Controlled Study.

Acne is a chronic inflammatory skin condition affecting mainly teenagers and adults as well. Guidelines recommend retinoids as a first-line treatment for mild-to-moderate acne. However, dermocosmetics in adjunct could potentially improve efficacy and tolerability. This study was conducted to determine the effectiveness and safety of a dermocosmetic cream containing salicylic acid, lipohydroxy acid, niacinamide, Aqua posae filiformis, procerad and zinc salt in the treatment of mild-to-moderate acne vulgaris in adjunct to different regimens of adapalene compared to adapalene only. This randomized, controlled, parallel-group, evaluator-blind study was conducted over 8weeks on male and female acne subjects at five teaching hospitals in Indonesia. A total of 291 participants were enrolled and divided into three treatment groups: Group A adapalene 0.1% cream nightly - Group B dermocosmetic cream daily + adapalene 0.1% cream every two nights - Group C dermocosmetic cream daily + adapalene 0.1% cream nightly. Clinical evaluations of treatment included scoring on Global Evaluation of Acne (GEA) scale, lesion count (Indonesian Acne Expert Meeting scale), treatment tolerability and treatment satisfaction. Evaluations were performed on Day28 and Day56 of treatment. After 28 and 56days of treatment, all groups exhibited improvements across the various measures. Data analysis, utilizing Anova for repeated measurements, revealed a statistically significant difference between GroupsC and A for reduction of GEA scores (p = 0.038) in favor of GroupC. On Day56, percentages of subjects with GEA Scale improvements of at least 1grade in comparison with baseline were in GroupC (61.7%) followed by GroupA (47.9%) and GroupB (45.3%). Better treatment tolerance and satisfaction scores were noted in GroupsB and C. Combination of the dermocosmetic cream with adapalene showed higher efficacy, tolerability and satisfaction in comparison to adapalene alone.

Patient and Healthcare Provider Perspectives on the Pathway to Diagnosis of Seborrheic Dermatitis in the United States.

Seborrheic dermatitis (SD) is a common, chronic inflammatory skin condition associated with significant impact on quality of life, yet its etiology and pathophysiology are not well understood. With significant impact on patients' quality of life, understanding the diagnostic pathway from the perspectives of patient and healthcare providers (HCPs) is crucial. An online survey was developed and administered in conjunction with the Harris Poll to gain insight into patient and HCP perspectives about SD diagnosis and management from December 2021 to January 2022. Most patients were unaware of SD before their diagnosis (71%) and experienced difficulty finding information online (56%). Patients delayed seeking medical attention for SD by an average of 3.6years, with most patients feeling their symptoms did not require medical attention (63%), a perception that HCPs correctly anticipated. Additionally, most patients (58%) reported embarrassment discussing their SD symptoms with HCPs, a factor HCPs underestimated. HCPs also underestimated the percentage of patients self-reporting moderate-severity SD. Patients preferred dermatology HCPs for SD treatment (79%), and reported visiting an average of 2.3different HCPs, with 75% of patients seeing more than one provider. These insights highlight the complexities in the diagnostic and management pathways of SD and underscore the need for a more nuanced understanding and approach in addressing the condition. Infographic available for this article. INFOGRAPHIC.

Role of Phytochemicals in the Management of Atopic Dermatitis: A Comprehensive Review

Abstract: Atopic dermatitis is a chronic inflammatory skin condition that affects millions of people around the world. In the past decades, phytochemicals have gained attention for the treatment of atopic dermatitis due to their inflammatory, antioxidant, and immunomodulatory properties, which could be beneficial in alleviating the suffering associated with atopic dermatitis. Although various conventional treatments, such as immune modulators and biologicals, are available for the treatment of atopic dermatitis their effectiveness can be limited due to some adverse effects. The present review aimed to explore the various phytochemicals to be identified as a complementary and alternative treatment option for the management of atopic dermatitis. Phytochemicals offer the potential advantage of reducing both local and systemic side effects associated with long-term use of corticosteroids, as well as addressing the higher costs of biological drug therapies. A comprehensive literature review was conducted using databases such as PubMed, Scopus, and Web of Science to identify the pharmacologically proven phytochemicals for the management of atopic dermatitis by covering articles published from 2015 to 2023. Various phytochemicals, such as berberine, piperine, ferulic acid, baicalin, vasicine, neferine, kaempferol, α- Boswellic Acid, gallic acid, etc., werebe highlighted for their potential therapeutic effects in atopic dermatitis. In conclusion, phytochemicals present a promising, safe, complementary, and alternative treatment option for atopic dermatitis management.

Comparing EQ-5D-5L, PROPr, SF-6D and TTO utilities in patients with chronic skin diseases.

We aim to compare the measurement properties of three indirect (EQ-5D-5L, PROPr, SF-6D) and one direct (time trade-off, TTO) utility assessment methods in patients with chronic skin diseases. 120 patients with physician-diagnosed chronic skin diseases (psoriasis 39%, atopic dermatitis 27%, acne 19%) completed a cross-sectional survey. Respondents completed the EQ-5D-5L, PROMIS-29+2 and SF-36v1 questionnaires and a 10-year TTO task for own current health. Utilities were computed using the US value sets. Ceiling, convergent and known-group validity were compared across the utilities derived with these four methods. Known-groups were defined based on general, physical and mental health. The agreement between utilities was assessed using intraclass correlation coefficients (ICC). Mean utilities for the EQ-5D-5L, PROPr, SF-6D and TTO were 0.79, 0.47, 0.76 and 0.89. In corresponding order, the ceiling was 28%, 0%, 2% and 65%. The SF-6D showed excellent agreement with the EQ-5D-5L (ICC = 0.770). PROPr demonstrated poor agreement with the EQ-5D-5L (ICC = 0.381) and fair with SF-6D utilities (ICC = 0.445). TTO utilities showed poor agreement with indirectly assessed utilities (ICC = 0.058-0.242). The EQ-5D-5L better discriminated between known groups of general and physical health, while the SF-6D and PROPr outperformed the EQ-5D-5L for mental health problems. There is a great variability in utilities across the four methods in patients with chronic skin conditions. The EQ-5D-5L, despite its higher ceiling, appears to be the most efficient in discriminating between patient groups for physical health aspects. Our findings inform the choice of instrument for quality-adjusted life year calculations in cost-utility analyses.

Unlocking relief: formulation, characterization, and in vivo assessment of salicylic acid-loaded microemulgel for psoriasis management.

Psoriasis, a chronic skin condition, affects around 2-5% of the population. Topical corticosteroids treat the vast majority of cases (> 80%). Because of the physicochemical characteristics of the damaged stratum corneum, all treatments are ineffective. Nevertheless, systemic immunosuppression, the oral strategy, has substantial adverse effects that may be avoided using the topical procedure. The research sought to determine if a salicylic acid-loaded microemulsion-based gel (emulgel) could successfully infiltrate and maintain salicylic acid in skin tissue for psoriasis treatment. The pseudo-ternary phase was generated in different Smix ratios (1:1, 2:1, and 3:1; Labrasol:Transcutol® P). At a 3:1 ratio, the Smix had a substantial microemulsion area. Microemulsion was characterized for particle size, pH, etc. For topical application, the selected microemulsion was combined with Carbopol 940 gel, and ex vivo permeation and drug retention study were conducted. The effectiveness of the developed gel was checked using the IMQ-induced psoriatic plaque model. Salicylic acid microemulsion has an average globule size of 79.72nm, pH 5.93, and 100% transmittance. In an ex vivo diffusion study, emulgel revealed greater penetration and more drug retention than ordinary salicylic acid gel. The emulgel was non-irritating on the skin of rats. In vivo studies revealed significant antipsoriatic activity of microemulsion-loaded gel compared to the marketed product. Developed emulgel was considered a potential product for an effective and safe way to administer salicylic acid for the treatment of skin diseases such as psoriasis.

The Enhancement of Regulatory T Cell Maturation and Th1/Th2 Balance through FOXP3 Expression by Lactobacillus paracasei in an Ovalbumin-Induced Allergic Skin Animal Model.

Chronic allergic skin conditions, including atopic dermatitis (AD), are characterized by pruritus, erythema, xerosis, desquamation, and inflammation, significantly impacting quality of life. Long-term steroid use, while common in treatment, carries the risk of adverse effects. Previous studies have demonstrated the potential of Lactobacillus paracasei subsp. paracasei NTU 101 (NTU 101) in alleviating AD symptoms from a preventive perspective. This study, however, focuses on exploring NTU 101's therapeutic potential by investigating its effects on regulatory T cell (Treg) maturation and Th1/Th2 balance. The results revealed that NTU 101 administration effectively reduced serum IgE levels and inflammatory cell infiltration in the skin, leading to a significant improvement in both epidermal and dermal thickness in the AD model. Additionally, NTU 101 modulated the immune response by increasing the proportion of CD4+/IL-4+ (Th2) cells in the spleen and concurrently enhancing FOXP3 expression in CD4+/CD25+ cells, which is critical for Treg cell development. This immune modulation was further associated with a rebalancing of the Th1/Th2 ratio, achieved by increasing the proportion of CD4+/IFN-γ+ (Th1) cells. Moreover, NTU 101 influenced the proportion of CD4+IL-17+ (Th17) cells, thereby supporting neutrophil maturation and promoting allergen clearance, ultimately mitigating AD symptoms. These findings underscore the potential of NTU 101 not only in managing AD symptoms but also in modulating key immune pathways involved in the pathogenesis of the disease, offering a promising alternative or adjunct to conventional steroid therapies.