Chronic Skin Disease Research Articles

Total eosinophil count as a biomarker for therapeutic effects of upadacitinib in atopic dermatitis over 48 weeks.

Atopic dermatitis (AD) is a chronic skin disease characterized by type 2-skewed immune responses, and significantly influenced by cytokines dependent on Janus kinases (JAKs). Upadacitinib, a JAK1 inhibitor, is effective for moderate-to-severe AD. This study aims to identify biomarkers that reflect long-term therapeutic effects of upadacitinib 15 mg or 30 mg. A retrospective study from August 2021 to July 2023 included 213 AD patients treated with upadacitinib 15 mg and 70 AD patients with 30 mg. We analyzed eczema area and severity index (EASI), peak pruritus-numerical rating scale (PP-NRS), serum immunoglobulin E (IgE), thymus and activation-regulated chemokine (TARC), lactate dehydrogenase (LDH), and total eosinophil count (TEC) at weeks 0, 4, 12, 24, 36, and 48 of treatment. Both treatments with upadacitinib 15 mg and 30 mg significantly reduced EASI and PP-NRS scores over week 4 to 48 compared to baseline. Upadacitinib 15 mg or 30 mg treatment significantly decreased TEC compared to baseline through week 4 to 36 or week 4 to 48, respectively. The percent reduction of TEC correlated with those of EASI and PP-NRS through week 4 to 48 of treatment with upadacitinib 15 mg, or through week 12 to 48 with 30 mg, respectively. After adjusting for % reductions of other laboratory markers, the significance of correlations was preserved at weeks 36 and 48 of 15 mg treatment, while at weeks 4 and 36 of 30 mg treatment. The % reduction of TEC correlated with those of EASI and PP-NRS during upadacitinib treatment, indicating its potential as a biomarker reflecting treatment responses to upadacitinib in AD patients. However, the variability of significant correlation during treatment indicates that further inspection is needed for its usefulness in monitoring responses to upadacitinib treatment for AD.

Gram-negative anaerobes elicit a robust keratinocytes immune response with potential insights into HS pathogenesis.

Hidradenitis Suppurativa (HS) is a chronic autoinflammatory skin disease with activated keratinocytes, tunnel formation and a complex immune infiltrate in tissue. The HS microbiome is polymicrobial with an abundance of commensal gram-positive facultative (GPs) Staphylococcus species and gram-negative anaerobic (GNA) bacteria like Prevotella, Fusobacterium and Porphyromonas with increasing predominance of GNAs with disease severity. We sought to define the keratinocyte response to bacteria commonly isolated from HS lesions to probe pathogenic relationships between HS and the microbiome. Type strains of Prevotella nigrescens, Prevotella melaninogenica, Prevotella intermedia, Prevotella asaccharolytica, Fusobacterium nucleatum, as well as Staphylococcus aureus and the normal skin commensal Staphylococcus epidermidis were heat-killed and co-incubated with normal human keratinocytes. RNA was collected and analysed using RNAseq and RT-qPCR. The supernatant was collected from cell culture for protein quantification. Transcriptomic profiles between HS clinical samples and stimulated keratinocytes were compared. Co-staining of patient HS frozen sections was used to localize bacteria in lesions. A mouse intradermal injection model was used to investigate early immune recruitment. TLR4 and JAK inhibitors were used to investigate mechanistic avenues of bacterial response inhibition. GNAs, especially F. nucleatum, stimulated vastly higher CXCL8, IL17C, CCL20, IL6, TNF and IL36γ transcription in normal skin keratinocytes than the GPs S. epidermidis and S. aureus. Using RNAseq, we found that F. nucleatum (and Prevotella) strongly induced the IL-17 pathway in keratinocytes and overlapped with transcriptome profiles of HS patient clinical samples. Bacteria were juxtaposed to activated keratinocytes invivo, and F. nucleatum strongly recruited murine neutrophil and macrophage migration. Both the TLR4 and pan-JAK inhibitors reduced cytokine production. Detailed transcriptomic profiling of healthy skin keratinocytes exposed to GNAs prevalent in HS revealed a potent, extensive inflammatory response vastly stronger than GPs. GNAs stimulated HS-relevant genes, including many genes in the IL-17 response pathway, and were significantly associated with HS tissue transcriptomes. The close association of activated keratinocytes with bacteria in HS lesions and innate infiltration in murine skin cemented GNA pathogenic potential. These novel mechanistic insights could drive future targeted therapies.

Research progress of vitiligo repigmentation: from oxidative stress to autoimmunity.

Vitiligo belongs to a frequent chronic autoimmune skin disease with the features of pigmented plaques on the diseased skin along with potential damage of melanocytes. There are many factors underlying the pathogenesis of vitiligo, among which oxidative stress is extensively regarded to be the critical factor leading to the loss of melanocytes. The changed redox state resulting from oxidative stress, containing ROS overproduction along with the reduced activity of the skin's antioxidant system, makes melanocytes less resistant to exogenous or endogenous stimuli, and ultimately pushes normal defense mechanisms, resulting in the loss of melanocytes. Given the crucial potential of innate together with adaptive immunity in vitiligo, there is growing evidence of a relation between oxidative stress and autoimmunity. Our review offers estimable insights into the possible properties of oxidative stress and autoimmunity in pathogenesis of vitiligo, as well as the potential role of antioxidant-based supportive therapy in vitiligo repigmentation, providing a hopeful value for further research and development of effective treatments.

Stigmatization and Mental Health Impact of Chronic Pediatric Skin Disorders

Chronic skin disorders in children frequently are visible and can cause stigmatization. However, the extent of stigmatization from chronic skin disease and association with mental health needs further study. To examine the extent of stigma, dependence on disease visibility and severity, and association with mental health and quality of life (QOL) in chronic pediatric skin disease. A cross-sectional, single-visit study was conducted at 32 pediatric dermatology centers in the US and Canada from November 14, 2018, to November 17, 2021. Participants included patients aged 8 to 17 years with chronic skin disease and 1 parent. Using the Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) Stigma-Skin, the extent of stigma with child-, caregiver-, and physician-assessed disease visibility (primary outcome) and severity was compared, as well as reduced QOL (assessed by Skindex-Teen), depression, anxiety, and poor peer relationships (PROMIS child and proxy tools) (secondary outcomes). The study included 1671 children (57.9% female; mean [SD] age, 13.7 [2.7] years). A total of 56.4% participants had self-reported high disease visibility and 50.5% had moderate disease severity. Stigma scores significantly differed by level of physician-assessed and child/proxy-assessed disease visibility and severity. Among children with chronic skin disorders, predominantly acne, atopic dermatitis, alopecia areata, and vitiligo, only 27.0% had T scores less than 40 (minimal or no stigma) and 43.8% had at least moderate stigma (T score ≥45) compared with children with a range of chronic diseases. Stigma scores correlated strongly with reduced QOL (Spearman ρ = 0.73), depression (ρ = 0.61), anxiety (ρ = 0.54), and poor peer relationships (ρ = -0.49). Overall, 29.4% of parents were aware of bullying of their child, which was strongly associated with stigma (Cohen d = -0.79, with children who were not bullied experiencing lower levels of stigma). Girls reported more stigma than boys (Cohen d = 0.26). Children with hyperhidrosis and hidradenitis suppurativa were most likely to have increased depression and anxiety. The findings of this study suggest that physician assessment of disease severity and visibility is insufficient to evaluate the disease impact in the patient/caregiver. Identifying stigmatization, including bullying, and tracking improvement through medical and psychosocial interventions may be a key role for practitioners.

Examining the Interplay of Psychological Factors in Chronic Skin Disease: A Review on Depression, Anxiety, and Stress

The genesis of chronic skin illnesses is intricately intertwined with genetics, the environment, psychological and the immune system. However, recent studies have shown that mental health issues can exacerbate and control the severity of chronic skin disorders. Focusing on illnesses including psoriasis, atopic dermatitis, and urticaria, this article seeks to evaluate and discuss the current literature on the interplay of psychological aspects in chronic skin diseases. Here, we investigate the two-way connection between emotional discomfort (such as stress, worry, or depression) and the physiology of various skin conditions. Furthermore, we address possible mechanisms underlying the link between mental health and skin diseases, which will help the physicians to select the medicines and treatment approach.

Adult patients with alopecia areata report a significantly better medication adherence compared to those with atopic dermatitis: Results from a large cross-sectional cohort study

BackgroundAlopecia areata (AA) and atopic dermatitis (AD) are chronic skin diseases where the suboptimal MA may result in poor clinical outcomes. ObjectiveTo assess the impact of AA on MA among adults compared to AD. MethodsPatient reported MA of adults with AA were compared with AD. Patients were identified from the Danish Skin Cohort, a nationwide prospective cohort of dermatological patients in Denmark. We used the Medication Adherence Report Scale- 5 (MARS-5), a self-reporting questionnaire, to assess MA. Demographic and disease characteristics were collected. Logistic regression was conducted. ResultsPatients with AA reported higher MA than AD (Mean 21.81 vs 18.29). Logistic regression analyses showed AA diagnosis had a statistically significant positive effect on MA (OR=3.94, 95% CI 2.01-8.89). Men reported significantly higher MA (OR=1.49, 95% CI 1.14-1.94). Current disease severity did not impact MA. LimitationsData were self-reported by patients. Data regarding the specific treatment undergone by patients was not available. ConclusionPatients with AA have significantly higher MA compared to patients with AD. The stability of AA patients' symptoms may lead to higher MA due to a desire for disease control. Conversely, the sporadicity of AD symptoms could negatively affect adherence, causing fluctuations in medication use.

A comparative study on the detection of Mycobacterium leprae DNA in urine samples of leprosy patients using Rlep-PCR with other conventional samples.

Mycobacterium leprae causes leprosy that is highly stigmatized and chronic infectious skin disease. Only some diagnostic tools are being used for the identification M. leprae in clinical samples, such as bacillary detection, and histopathological tests. These methods are invasive and often have low sensitivity. Currently, the PCR technique has been used as an effective tool fordetecting M. leprae DNA across different clinical samples. The current study aims to detect M. leprae DNA in urine samples of untreated and treated leprosy patients using the Rlep gene (129 bp) and compared the detection among Ridley-Jopling Classification. Clinical samples (Blood, Urine, and Slit Skin Smears (SSS)) were collected from leprosy and Non-leprosy patients. DNA extraction was performed using standard laboratory protocol and Conventional PCR was carried out for all samples using Rlep gene target and the amplicons of urine samples were sequenced by Sanger sequencing to confirm the Rlep gene target. The M. leprae DNA was successfully detected in all clinical samples across all types of leprosy among all the study groups using RLEP-PCR. Rlep gene target was able to detect the presence of M. leprae DNA in 79.17% of urine, 58.33% of blood, and 50% of SSS samples of untreated Smear-Negative leprosy patients. The statistical significant difference (p = 0.004) was observed between BI Negative (Slit Skin Smear test) and RLEP PCR positivity in urine samples of untreated leprosy group. The PCR positivity using Rlep gene target (129 bp) was highest in all clinical samples among the study groups, across all types of leprosy. Untreated tuberculoid and PNL leprosy patients showed the highest PCR positivity in urine samples, indicating its potential as a non-invasive diagnostic tool for leprosy and even for contact screening.

Understanding Vitiligo: Causes, Diagnosis, Promising Advances in Treatment and Management and the Impact on Mental Health

Vitiligo is a chronic skin disorder characterized by the loss of pigmentation, resulting in white patches on the skin. The condition arises from the destruction of melanocytes, the cells responsible for producing melanin, the pigment that gives colour to the skin, hair, and eyes. Although the exact etiology of vitiligo remains elusive, it is believed to involve a complex interplay of genetic, autoimmune, and environmental factors.
 This overview provides the key aspects of vitiligo, including its epidemiology, pathogenesis, clinical manifestations, and current treatment approaches. The prevalence of vitiligo varies globally, affecting individuals of all ethnic backgrounds and age groups.
 The autoimmune hypothesis proposes that the immune system mistakenly targets and attacks melanocytes, leading to their destruction. Triggering factors, such as oxidative stress, viral infections, and neural factors, may contribute to the initiation and progression of vitiligo.
 Clinically, vitiligo can significantly impact the quality of life for affected individuals, both psychologically and socially. The distribution and extent of involvement vary, and the condition can affect any part of the body.
 Various treatment modalities are available for vitiligo, ranging from topical corticosteroids and calcineurin inhibitors to phototherapy and surgical interventions. While these approaches may help to re-pigment the skin to some extent, there is no definitive cure, and the outcomes can be unpredictable. Ongoing research is focused on understanding the molecular mechanisms underlying vitiligo and developing targeted therapies to address the root causes of the disease.
 Keywords: Vitiligo, Autoimmune, Melanocytes, Pigmentation, Corticosteroids, Quality of life.

Experience and caring needs of patients with psoriasis: A qualitative meta-synthesis.

As a chronic skin disease, psoriasis often affects the physical, psychological and social status of the patient, which in turn impacts on their experience of illness and needs. However, there is no review of qualitative research that integrates and analyses the experiences and needs of these three influences from a holistic perspective. This review follows the ENTREQ guidelines. Six English databases (JBI, Cochrane Library, PubMed, PsyINFO, CINAHL and Embase) and three Chinese databases (CNKI, VIP and Wanfang) were searched from January 2012 to October 2022. Literature was included if it was relevant to the experience of illness and caring needs of patients with psoriasis. The JBI-QARI was used to rate the quality of included studies. Eleven studies were included in the meta-synthesis. Four analytical themes were identified for analysis: physical challenges, psychological discomfort, social phenomena and caring needs. The combined physical, psychological and social effects of psoriasis and the consequent caring needs should be emphasised. Health professionals, including doctors and nurses, should be aware of the multiple changes in patients and their coping strategies, provide information about psoriasis, monitor and follow-up regularly over time and obtain feedback to inform further treatment and care so as to develop high-quality therapeutic interventions to help and guide patients with their coping strategies. These findings describe the physical, psychological and social experiences of illness and caring needs of patients with psoriasis. Healthcare professionals should be more aware of patients' easily overlooked psychological and social distress, providing prompt attention and recognition of patients' experiences and needs, offering relevant assistance and support and enhancing daily, regular follow-up to help them improve their understanding of and ability to manage their illness. This is a meta-synthesis without direct patient involvement.

ВОЗМОЖНОСТИ ПРИМЕНЕНИЯ ПИМЕКРОЛИМУСА В ТЕРАПИИ АТОПИЧЕСКОГО ДЕРМАТИТА

Atopic dermatitis is a common chronic skin disease that is always accompanied by itching and has a significant impact on the patient's quality of life. The goal of therapy for atopic dermatitis, like any chronic dermatosis, is to achieve stable remission, which, given the nature of the disease, can be achieved with the help of a drug that has anti-inflammatory potential and a high safety profile. The therapeutic options for the use of pimecrolimus in patients with atopic dermatitis are observed in the Article.

Different therapeutic approaches in melasma: advances and limitations.

Melasma is a chronic hyperpigmentation skin disorder that is more common in the female gender. Although melasma is a multifactorial skin disorder, however, sun-exposure and genetic predisposition are considered as the main etiologic factors in melasma occurrence. Although numerous topical and systemic therapeutic agents and also non-pharmacologic procedural treatments have been considered in melasma management, however, the commonly available therapeutic options have several limitations including the lack of sufficient clinical effectiveness, risk of relapse, and high rate of unwanted adverse drug reactions. Recruitment of nanotechnology for topical drug delivery in melasma management can lead to enhanced skin penetration, targeted drug delivery to the site of action, longer deposition at the targeted area, and limit systemic absorption and therefore systemic availability and adverse drug reactions. In the current review, first of all, the etiology, pathophysiology, and severity classification of melasma have been considered. Then, various pharmacologic and procedural therapeutic options in melasma treatment have been discussed. Afterward, the usage of various types of nanoparticles for the purpose of topical drug delivery for melasma management was considered. In the end, numerous clinical studies and controlled clinical trials on the assessment of the effectiveness of these novel topical formulations in melasma management are summarized.

Role of Sheeta Upanaha in the Management of Vipadika – A Case Study

Skin is the mirror which reflects the harmony of Internal functions of body. Psoriasis is a non-infective inflammatory, Proliferative, Chronic skin disease in which there are scaly papules and plaques that can involve any part of body. Palmoplantar psoriasis refers to psoriasis that develops on palms and soles. Vipadika is included in Kshudra kusta having sign and symptoms similar to Palmoplantar psoriasis. In this case study, A 65-year-old male patient a known case of Palmoplantar psoriasis approached with symptoms of Scales and fissures over both palms and soles with Pain, Severe itching and burning sensation for the past 1year. After clinical examination and history of the patient he was advised, Deepana & Pachana, Shamana Snehapana and Seetha Upanaha as module of treatment. Even though treatment principles such as Deepana, Pachana, Shamana Snehapana might have helped in the overall result, but it was Seetha Upanaha Chikitsa observed to be quite significant in this case, as patient started feeling better after starting of Seetha upanaha. After implementation of treatment plan patient has become completely symptom free and there was no recurrence even after six months.

Management of Shushka Vicharchika through Shamana Aushadhis: a case report

Abstract Introduction: Among the Kshudra Kustha, Vicharchika exhibits symptoms such as Kandu (itching), Shrava (discharge), and Shyava Varna (blackish discoloration). Vicharchika is one among the Kshudra Kustha, which continues for a long period and has a propensity for aggravation. Most often, Vicharchika patients who do not respond well to contemporary medical care seek treatment from Ayurveda, hoping for a complete recovery from their illness. Materials and Methods: An 85-year-old male patient with signs and symptoms corresponding to Vicharchika was treated with Shamana Aushadhis (palliative therapy). Result: A remarkable improvement in the condition was observed in a span of 21 days. Discussion: Chronic skin diseases can be managed with Ayurvedic medications and the current article represents detailed management of it.

Curcumin-Based Ionic Liquid Hydrogel for Topical Transdermal Delivery of Curcumin To Improve Its Therapeutic Effect on the Psoriasis Mouse Model.

Psoriasis is a systemic, recurrent, chronic autoimmune skin disease. However, psoriasis drugs have poor skin permeability and high toxicity, resulting in low bioavailability and affecting their clinical application. In this study, we propose a curcumin-based ionic liquid hydrogel loaded with ilomastat (Cur-Car-IL@Ilo hydrogel), which can effectively maintain the sustained release of drugs and improve the skin permeability of drugs. We used a model of imiquimod-induced psoriasis and demonstrated that local application of Cur-Car-IL@Ilo hydrogel can improve skin lesions in mice with significantly reduced expression levels of inflammatory factors, matrix metalloproteinase 8, and collagen-I. The expressions of iron death-related proteins SLC7A11 and ASL4 were significantly decreased after treatment with Cur-Car-IL@Ilo hydrogel. Flora analysis showed that the content of anaerotruncus, proteus, and UCG-009 bacteria in the gut of psoriatic mice increased. The levels of paludicola, parabacteroides, prevotellaceae_UCG-001, escherichia-shigella, and aerococcus decreased, and the levels of some of the above bacteria tended to be normal after treatment. Therefore, the curcumin-based ionic liquid hydrogel can be used as a multifunctional, nonirritating, noninvasive, and highly effective percutaneous treatment of psoriasis.

Efficacy and safety of a combined pharmacological and surgical approach in patients affected by hidradenitis suppurativa: data from a retrospective real-world clinical study.

Hidradenitis suppurativa (HS) is a debilitating chronic skin disease; its therapeutic approach often requires combined medical and surgical treatment. The aim of this study was to assess the efficacy and safety of the surgical approach combined with different pharmacological treatments, evaluating the proportion of patients achieving the hidradenitis suppurativa clinical response (HiSCR), along with the incidence of postoperative complications, and local recurrence. A retrospective study of HS patients (Hurley I-III) presenting at least one skin lesion requiring surgery was performed. Demographic and clinical data were collected (kind and anatomical location of lesion excised, type of surgical procedure). Further data included: Hurley stage and IHS4 at baseline and week 16, HiSCR at week 16 after surgery, ongoing therapy at the time of surgery (topical, systemic antibiotic, biologics), postoperative complications and local recurrence at week 16. Forty-two patients with female predominance (66.7%, 28/42), with a mean age of 30.3 (SD±10.5) years, were enrolled. At week 16, 53% of patients achieved HiSCR, with baseline Hurley III inversely related to HiSCR achievement (P<0.05). No increased incidence of postoperative complications was detected. Three cases of local recurrence were reported at week 16. The results support the efficacy and safety of the combined therapy in the management of HS; no increased risk of complications emerged among patients concomitantly treated with biologics, compared to those on conventional systemic therapy or exclusively treated with surgery.

Dietary Galacto-oligosaccharides Ameliorate Atopic Dermatitis-like Skin Inflammation and Behavioral Deficits by Modulating Gut Microbiota-Brain-Skin Axis.

Atopic dermatitis (AD), a chronic, highly pruritic, and inflammatory skin disorder, often coexists with psychiatric comorbidities including anxiety and depression, posing considerable challenges for treatment. The current research aims at evaluating the efficacy and potential therapeutic mechanism of galacto-oligosaccharides (GOS) on AD-like skin lesions and comorbid anxiety/depressive disorders. Macroscopical and histopathological examination showed that GOS could markedly relieve skin inflammation by decreasing the production of IgE, IL-4, IL-13, IFN-γ, and TNF-α and regulating the PPAR-γ/NF-κB signaling in DNFB-induced AD mice. Moreover, GOS significantly improved the anxiety- and depressive-like symptoms as mirrored by the behavior tests including FST, TST, OFT, and EZM through normalizing the neurotransmitter levels of 5-HT, DA, NE, and CORT in the brain. Mechanistically, by virtue of the high-throughput 16S rRNA gene sequencing and GC-MS techniques, GOS restructured the gut microbiota and specifically induced the proliferation of Lactobacillus and Alloprevotella, leading to an increase in the total content of fecal SCFAs, in particular acetate and butyrate. Pearson correlation analysis found a marked correlation among the altered gut microbiota/SCFAs, AD-associated skin manifestations, and comorbid behavioral phenotypes. Collectively, this work highlights that GOS is a promising strategy against both AD and associated depressive symptoms by modulating the gut microbiota-brain-skin axis.

Real world insights for psoriasis: the association of severity of skin lesions with work productivity, medical consumption costs and quality of life

Background Psoriasis is a prevalent, chronic skin disease with a potential impact on work productivity, medical consumption costs, and quality of life. The influence of the extent of skin lesions on these outcomes is not well known. Objective We determined associations of self-reported skin lesions with self-reported work productivity, medical consumption costs, and health-related quality of life in respondents with psoriasis. Methods In this cross-sectional study, we included respondents with self-reported psoriasis in the Netherlands in an online questionnaire. We assessed the self-reported percentage body surface area (BSA) of psoriasis lesions. We used validated instruments to assess work productivity (WPAI-PsO), medical consumption costs (iMCQ), and health-related quality of life (EQ-5D-5L and the DLQI). We used ordinal logistic regression to associate BSA categories >1% versus 0-1% with outcomes adjusted for multiple confounders. Results We included 501 respondents with a mean age of 43 ± 12 years; 64% were men. Median BSA was 2% (interquartile range 1–5%). A higher BSA was associated with higher overall work impairment due to psoriasis (common odds ratio [cOR] 2.44, 95% confidence interval [CI] 1.40–4.29; n = 205), higher medical consumption costs (cOR 2.06, 95% CI 1.45–2.94) and lower health-related quality of life. Associations were strongest with a BSA cutoff of 0% or 1% compared to 2% or higher categories. Discussion In our study, having few to no lesions in psoriasis was associated with lower overall work impairment due to psoriasis, lower medical consumption costs, and higher health-related quality of life.

Targeted therapy for immune mediated skin diseases. What should a dermatologist know?

BackgroundMolecularly targeted therapies, such as monoclonal antibodies (mAbs) and Janus Kinase inhibitors (JAKis), have emerged as essential tools in the treatment of dermatological diseases. These therapies modulate the immune system through specific signaling pathways, providing effective alternatives to traditional systemic immunosuppressive agents. This review aims to provide an updated summary of targeted immune therapies for inflammatory skin diseases, considering their pathophysiology, efficacy, dosage, and safety profiles. MethodsThe review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search was conducted on PubMed over the past 10 years, focusing on randomized clinical trials, case reports, and case series related to targeted immune therapies in dermatology. Eligibility criteria were applied, and data were extracted from each study, including citation data, study design, and results. ResultsWe identified 1360 non-duplicate articles with the initial search strategy. Title and abstract review excluded 1150, while a full-text review excluded an additional 50 articles. The review included 143 studies published between 2012 and 2022, highlighting 39 drugs currently under investigation or in use for managing inflammatory skin diseases. Study limitationsThe heterogeneity of summarized information limits this review. Some recommendations originated from data from clinical trials, while others relied on retrospective analyses and small case series. Recommendations will likely be updated as new results emerge. ConclusionTargeted therapies have revolutionized the treatment of chronic skin diseases, offering new options for patients unresponsive to standard treatments. Paradoxical reactions are rarely observed. Further studies are needed to fully understand the mechanisms and nature of these therapies. Overall, targeted immune therapies in dermatology represent a promising development, significantly improving the quality of life for patients with chronic inflammatory skin diseases.

Dietary Antioxidants May Support Cosmetic Treatment in Patients with Rosacea.

Rosacea is a chronic skin disease that significantly reduces the quality of life (QoL) of patients. The aim of this study was to assess whether dietary antioxidants can support the effect of cosmetic treatment in improving the QoL of patients with rosacea. Basic data about participants (N = 160) were collected using a self-reported survey. QoL was assessed using the standardized Dermatology Life Quality Index (DLQI) questionnaire. An interventional cosmetic treatment was performed using cavitation peeling and sonophoresis with a commercial capillary repair serum. The study was registered as a clinical trial (NCT06271135). To assess antioxidant diet quality, for the first time, a new dietary antioxidant quality index (DAQI) was developed, which consisted of 12 items: dietary total antioxidant capacity, dietary polyphenols, phytosterols, lignans, vitamin C, vitamin E, β-carotene, zinc, iron, copper, manganese and selenium. It was found that the highest tertiles of DAQI diminished the odds about 40-45% of the moderate, large and extremely large effect of rosacea on QoL and about 8-11% of the occurrence of rosacea symptoms compared with the lowest tertile. This study showed that rosacea has a negative impact on QoL, but a comprehensive approach to treatment, including antioxidant cosmetic treatment and dietary antioxidants, can improve the QoL of patients with rosacea.

O244: Patients’ priorities in Vulval lichen sclerosus – results of a patient and public involvement for a study investigating autologous lipotransfer and platelet-rich plasma in Vulval lichen sclerosus

Abstract Background Vulval lichen sclerosus (VLS) is a high-burden, under-researched chronic skin disease. It is characterised by itching, pain, sexual dysfunction and poor quality of life. Up to 70% of patients develop fibrosis and vulval architectural changes. The only evidence-based treatment includes topical steroids. New potential surgical treatments include autologous fat transfer (AFG) and platelet-rich plasma (PRP) injections but high-level evidence supporting these treatments is sparse. Aims To identify patients’ research priorities and evaluate the acceptability of AFG and PRP as treatments for VLS and design a trial co-produced by patients. Methods One-to-one interviews, focus groups and online questionnaires were used to investigate patients’ research priorities, acceptability of treatments, preferred outcome assessment tools, views on a sham procedure and trial design. Results A focus group (n=18) and an online patient survey (n=809) identified the top research priorities: changes to vulval anatomy, emotional impact on intimate relationships, inability to have penetrative intercourse and pain during intercourse. Patients reported poor quality of life and said that addressing these would be life-changing. Ninety-nine percent of patients agreed that this trial should be performed and 73% were willing to take part if a sham procedure was used. A patient advisory group (n=5) has been created to co-produce the trial. Conclusion VLS is a complex disease with no core outcome set. Patient co-production is a keystone to a successful trial design and ensures that research is aligned with patients’ priorities. This research defines the key priorities of research into current surgical interventions for VLS.