Cutaneous Disease Research Articles

The physical and emotional impact of cutaneous dermatomyositis: a qualitative study.

Dermatomyositis (DM) is a rare autoimmune disease characterized by distinctive cutaneous manifestations, often accompanied by muscle inflammation and interstitial lung disease. DM has a significant impact on quality of life (QoL)in patients, due to the physical and emotional symptoms caused by their disease. Despite this known emotional impact, there is no published literature capturing how adults with DM feel about their disease, from their perspective. We seek to better understand how cutaneous DM impacts patients in their daily lives. Seventeen patients with cutaneous DM presenting to an autoimmune dermatology clinic were interviewed about how their cutaneous findings have impacted their life. Patients were asked three questions: what troubles you the most about your cutaneous/skin DM, how much bother does the skin DM cause, and what about your skin disease most impacts your daily life. Responses were scribed by a second researcher. Themes and subthemes from the interviews were generated. Of 17 patients, 17 (100%) were female, 7 (41%) had amyopathic DM, median age was 65years (IQR 48-68), and median Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) activity score was 12 (IQR 6-17.5) at the time of interview. Seven themes emerged. Most reported physical signs included: itchiness (n = 10, 59%) and physical pain/uncomfortableness (n = 6, 35%). Our study demonstrates that patients are burdened by the physical, emotional and social aspects of their disease, and struggle to manage it. This better understanding of how patients feel will help guide management and allow clinicians to address patient needs. Additionally, these insights may help in the development of QoL tools that address the concerns of patients with severe and chronic skin conditions, like DM.

Metformin Treatment of Hidradenitis Suppurativa: Effect on Metabolic Parameters, Inflammation, Cardiovascular Risk Biomarkers, and Immune Mediators.

Hidradenitis suppurativa (HS) is a common cutaneous and systemic inflammatory disease with a significant impact on mental health and quality of life. It is associated with obesity, insulin resistance, metabolic syndrome, cardiovascular (CV) disease, and increased all-cause mortality. Metformin is used frequently in HS treatment and is effective for some patients. The mechanism of action of metformin in HS is unknown. A case-control study of 40 patients with HS (20 on metformin and 20 controls) was conducted to assess differences in metabolic markers, inflammation (C-reactive protein [CRP], serum adipokines, and CV risk biomarkers), and serum immune mediators. Body mass index (BMI), insulin resistance (77%), and metabolic syndrome (44%) were high overall, but not significantly different between the groups. This highlights the need for co-morbidity screening and management. A significant reduction in fasting insulin and a trend towards a reduction in insulin resistance were identified in the metformin group compared with pre-treatment levels. CV risk biomarkers were significantly favourable in the metformin group (lymphocytes, monocyte-lymphocyte ratio, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio). CRP was lower in the metformin group but was not statistically significant. Adipokines were dysregulated overall but were not different between the two groups. Serum IFN-γ, IL-8, TNF-α, and CXCL1 trended lower in the metformin group but did not reach significance. These results suggest that metformin improves CV risk biomarkers and insulin resistance in patients with HS. When the results of this study are considered alongside other studies in HS and related conditions, it is likely that metformin also has beneficial effects on metabolic markers and systemic inflammation in HS (CRP, serum adipokines, and immune mediators), warranting further research.

Analysis of the mathematical model of cutaneous Leishmaniasis disease

Mathematical models are powerful tools to study various real-world problems from different perspectives. This branch has been given much more popularity over the last several decades. Various mathematical models corresponding to different diseases have been studied so far. Keeping these details in mind, the present manuscript is devoted to present a detailed mathematical analysis of the Cutaneous Leishmaniasis disease model. Some basic properties of the model are studied including positivity, the existence of equilibrium points, and reproductive number. The existence and uniqueness of the solution for the model under consideration are also investigated. Local and global stability analyses of equilibrium points are also studied. For the required results, we use the Lyapunov function method and the third additive compound matrix technique based on the Metzler procedure. Sensitivity analysis is also investigated by using some tools from the numerical-functional analysis. A numerical analysis of the proposed model is performed by using a nonstandard finite difference scheme. Moreover, for the justification of our results, we give some graphical presentation of the model for each class in the model. Also, we present some graphical presentations related to the sensitivity analysis along with the tables for its various indices.

Study of mast cell density, distribution and morphology in skin lesions of leprosy

Background: Mast cells are found at all levels of dermis, grouped around blood vessels, nerves and appendages. An increase in the mast cell number has been reported in various cutaneous diseases. Mast cells respond to diverse range of stimuli like neuronal impulses, allergens, antigens, hormones, cytokines from T cells and keratinocytes and thus play a role in manifestation of dermatological disorders. The objective was to study mast cell density in various subsets of Hansen’s disease and analyse whether the distribution and density vary amongst the subsets. Methods: A total of 60 skin biopsies diagnosed as leprosy were included in this study. 10 control slides were also studied for mast cell density and distribution. Histopathological diagnosis was made on the biopsy and mast cell density and distribution was assessed on toluidine blue stained sections and compared with those of controls. Results: All the subsets of Hansen’s disease studied showed an increase in the number of mast cells. The highest mean mast cell count was noted in lepromatous leprosy (66/mm2), followed by erythema nodosum leprosum (42.6/mm2) and borderline lepromatous leprosy (40.8/mm2). The mean mast cell count showed progressive increase over the immunological spectrum of tuberculoid leprosy to lepromatous leprosy. The mast cells showed spindle and ovoid morphology in all the lesions (active) while round morphology was seen in controls. Conclusion: Tissue mast cell number, distribution and morphology vary depending on the degree of activation in different leprosy lesions. This may have a bearing on the diagnosis and management. Keywords: mast cells; lepromatous leprosy; tuberculoid leprosy; borderline tuberculoid; indeterminate leprosy

Evaluation of the LFA-REAL clinician-reported outcome (ClinRO) and patient-reported outcome (PRO): prespecified analysis of the phase III ustekinumab trial in patients with SLE

ObjectiveThe Lupus Foundation of America Rapid Evaluation of Activity in Lupus (LFA-REAL) system is a novel and simple SLE disease activity instrument, consisting of a tandem clinician-reported (ClinRO) and patient-reported...

Epidemiological study of Cutaneous Leishmaniasis disease in Maysan Governorate

Epidemiological study of Cutaneous Leishmaniasis disease in Maysan Governorate

Disseminated Protothecosis Due to Prototheca zopfii and Literature Review.

Prototheca species are achlorophyllic algae that are a rare cause of infection in humans. It most commonly causes localized cutaneous disease and rarely disseminated infection. Immunocompromised patients have the highest risk of disseminated protothecosis, with a higher mortality rate than localized cutaneous infections. At the species level, infections caused by Prototheca zopfii are reported less frequently than those caused by Prototheca wickerhamii. The diagnosis can be made using histopathology, culture, and molecular testing. There is no definitive evidence for an effective treatment, which currently consists of antifungals (primarily amphotericin B). With only a handful of cases of disseminated protothecosis reported worldwide that are caused by P. zopfii, we herein present an additional case of a postbone marrow transplant patient in the Midwest of the United States.

Skin involvement in systemic lupus erythematosus: a review article

Cutaneous disease is one of the most frequent manifestations of systemic lupus erythematosus (SLE), being classified as LE-specific and LE-nonspecific. LE-specific skin lesions are divided into acute cutaneous lupus erythematosus (ACLE), subacute cutaneous lupus erythematosus (SCLE) and chronic cutaneous lupus erythematosus (CCLE). The association with systemic involvement varies between each clinical subtype, with non-specific lesions being more frequent associated with active SLE than cutaneous specific lesions. The treatment consists of topical agents (glucocorticoids, topical calcineurin inhibitors) as well as systemic therapies (glucocorticoids, hydroxychloroquine, quinacrine, methotrexate, retinoids, dapsone, mycophenolate mofetil or even biologics). In the presence of strictly cutaneous involvement, periodic patient follow-up and monitoring for the progression to systemic disease remains an important mission for the dermatologist and the rheumatologist.

A Rare Case of Idiopathic Atrophoderma of Pasini and Pierini

Idiopathic atrophoderma of Pasini and Pierini (IAPP) is a rare pigmented atrophic cutaneous disease. Here, we report a case of a 27-year-old woman who presented with asymptomatic brown patches on her upper back for one year. There was no prior history of swelling or induration of the lesions. Physical examination showed atrophic patches with clear boundaries, consistent with snow footprints or cliff-drop-like changes on edge. Dermoscopy revealed numerous bare linear, branched blood vessels and perifollicular brownish areas, which differs from only one previously reported IAPP. Biopsy showed perivascular mononuclear cells infiltrating the dermis and reduced elastic fibers in the upper and middle dermis. Typical clinical findings of “footprints in the snow” appearance and dermoscopy could combine for a definite diagnosis aiding in differentiating from morphea presenting with whitish structureless and hairless areas. This case report might stimulate clinicians to diagnose such a rare disease in patients with similar lesions to avoid unnecessary treatment.

Spesolimab, an interleukin-36 receptor monoclonal antibody, for the treatment of generalized pustular psoriasis

ABSTRACT Introduction Generalized pustular psoriasis (GPP) is a rare cutaneous and systemic inflammatory disease which is characterized by flares of widespread painful pustulation of the skin, often associated with fever and elevated inflammatory markers. Although it has historically been regarded as a severe variant of plaque psoriasis, genetic and immunological developments over the past decade have revealed that it is a distinct auto-inflammatory entity, in which over-activity of the interleukin-36 signaling pathway is fundamental. Treatments targeting the IL-36 pathway are under investigation, and in 2022 spesolimab, a monoclonal antibody against the IL-36 receptor, was licensed for treating flares of GPP Areas covered In this review I discuss the epidemiology, clinical features, genetics, patho-mechanisms, and current treatment options for GPP. I describe the results of clinical trials that led to the licensing of spesolimab for flares of GPP. Expert opinion The marked efficacy of spesolimab in GPP opens a new era of highly effective, scientifically-rational, and evidence-based treatment for this orphan disease, and has implications for other diseases in which interleukin 36 signaling is involved.

Combined Cutaneous & Visceral Forms of Leishmaniasis; Case Report

This is a three years old child from Himreen rural areas the patient had fever, pallor, & hepatosplenomegaly and two ulcers on the face. The patient responded to Pentostam. While we used in Iraq to see leishmaniasis as either pure cutaneous or pure visceral forms of leishmaniasis, this is a case with combined cutaneous & visceral forms of leishmaniasis in a patient with normal immune system. Which may explained by the leishmaniae species that primarily cause cutaneous disease & rarely cause visceral disease or by primarily viscerotropic leishma'nia that primarily cause visceral disease which may also cause skin lesions or by mixed infections by two different species of leishmaniae, one of them is dermatotropic, & the other one is viscerotropic.

Ultrasonographic Patterns of Calcium Hydroxyapatite According to Dilution and Mix With Hyaluronic Acid.

To assess the ultrasonographic patterns of different calcium hydroxyapatite (CaHA) formulations, including the undiluted, diluted, and mixed with hyaluronic acid (HA) compounds. To review the ultrasonographic images of patients ≥18 years with confirmed injections of CaHA clinically and ultrasonographically, and without different concomitant types of fillers in the same region or other systemic or localized cutaneous diseases. Twenty-one patients met the criteria (90% female; 10% male; mean age: 52 years ± 12.8). Of these, 33.3% have been injected with an undiluted formulation, 33.3% with diluted, and 33.3% with a mixed formulation. All cases were studied with devices presenting frequencies that ranged from 18 to 24 MHz. Twelve cases (57%) were also studied with the 70 MHz. The ultrasonographic patterns of CaHA presented differences in the presence and intensity of PAS and the degree of inflammation according to the dilution and mix with HA. Diluted formulations show a milder intensity posterior acoustic shadowing (PAS) artifact than undiluted at 18-24 MHz. In mixed formulations, 57% showed mild PAS, and 43% demonstrated no PAS artifact at 18-24 MHz, besides fewer inflammatory changes in the periphery of the deposits. The ultrasonographic patterns of CaHA show differences in the presence and intensity of PAS and the degree of inflammation according to the dilution and mix with HA. Awareness of these ultrasonographic variations can support better discrimination of CaHA.

Evaluation of the antifungal activity and mode of action of citral against Cladophialophora carrionii.

Introduction: Cladophialophora carrionii is one of the most frequent etiologic agents of human chromoblastomycosis, a chronic cutaneous disease. Such fungal infections are difficult to treat and underlines the need for new antifungal agents. Citral is a monoterpene with known pharmacological properties, including antimi-crobial activity. Aims: To investigate the antifungal activity of citral against strains of C. carrionii. Methodology: The minimum inhibitory concentration (MIC) and the minimum fungicidal concentration (MFC) were determined by broth microdilution techniques. Citral was tested to evaluate its effects on C. carrionii mycelia growth and germination of fungal conidia. Next, it was investigated the possible citral action on cell walls (sorbitol assay) and cell membranes (ergosterol binding assay). Results: The MIC50 and MFC50 of citral were respectively 128 μg/mL and 512 μg/mL. The study shows that citral displayed in vitro antifungal potential against strains of C. carrionii, where it was capable of inhibiting both its mycelial growth and germination of conidia for this fungus, whilst affecting the structure of fungal cell membranes. Citral’s mechanism of action involves binding to ergosterol. Further study is needed to completely describe its effects before clinical use as a therapeutic antifungal agent.

Rapid efficacy of anifrolumab across multiple subtypes of recalcitrant cutaneous lupus erythematosus parallels changes in discrete subsets of blood transcriptomic and cellular biomarkers.

Observations with rituximab suggest B-cell independent mechanisms of cutaneous lupus erythematosus (CLE) in systemic lupus erythematosus (SLE), especially discoid lupus erythematosus (DLE). Type-I interferon receptor blockade with anifrolumab shows efficacy in SLE, but efficacy for cutaneous disease of specific morphologies has not been studied. Interferon has pleotropic immune effects and it is unknown which of these are critical to therapeutic response. We evaluated clinical efficacy and quality-of-life impact of type-I interferon-blockade in: (i) rituximab-refractory CLE; (ii) DLE and other morphologies and (iii) transcriptomic and flow cytometric biomarkers. We conducted a prospective single-centre study of anifrolumab in refractory mucocutaneous SLE. CLE Disease Area and Severity Index (CLASI) activity score, health-related quality of life, 96-probe TaqMan® gene expression analysis capturing key SLE blood transcriptome signatures, and eight-colour flow cytometry were undertaken at baseline, 1, 3 and 6 months. Seven patients [DLE (n = 5), chilblain lupus erythematosus (n = 1), subacute CLE (n = 1)] were evaluated. The median number of prior therapies was six (range 3-15), including rituximab in six of seven patients. Median CLASI-A showed rapid and sustained improvement from 17 at baseline to 6 (P = 0.016) at 1 month and 0 (P < 0.001) by 3 months. The median percentage reduction in CLASI-A at 3 months was 60%. Significant improvements were observed in Dermatology Life Quality Index scores (P < 0.001), EuroQol 5D visual analogue scale (P = 0.002) and LupusQoL fatigue, image and planning domains (P ≤ 0.05). One patient discontinued treatment owing to severe herpes zoster. Clinical responses paralleled discrete suppression of interferon-stimulated genes (ISGs) from SLE blood transcriptome module M1.2 with more varied downregulation in other interferon modules. Myeloid and inflammation-annotated genes remained upregulated throughout treatment. Intermediate monocytes (CD14++CD16+) reduced to normal levels during therapy (P = 0.014), while other flow subsets showed no substantive changes. These data indicate rapid efficacy of anifrolumab in DLE and rituximab-resistant CLE. Response is associated with suppression of a subset of ISGs and decline in intermediate monocytes. Suppression of all ISGs or the wider SLE blood transcriptome is not required for response.

Diversity and geographical distribution of Leishmania species and the emergence of Leishmania (Leishmania) infantum and L. (Viannia) panamensis in Central-Western Venezuela

Transmission of cutaneous leishmaniasis in Venezuela reveals diverse and changing epidemiological landscapes, as well as a spectrum of clinical phenotypes presumed to be linked to a variety of Leishmania species. Central-western Venezuela constitutes one of the highest endemic epicenters in the country, and updated molecular epidemiological information is still lacking. Therefore, in this study we aimed to characterize the landscape of circulating Leishmania species across central-western Venezuela through the last two decades, performed comparisons of haplotype and nucleotide diversity, and built a geospatial map of parasite species distribution. A total of 120 clinical samples were collected from patients across the cutaneous disease spectrum, retrieving parasitic DNA, and further characterizing by PCR and sequencing of the HSP70 gene fragment. This data was later collated with further genetic, geospatial and epidemiological analyses. A peculiar pattern of species occurrence including Leishmania (Leishmania) amazonensis (77.63% N=59), Leishmania (Leishmania) infantum (14.47% N=11), Leishmania (Viannia) panamensis (5.26% N=4) and Leishmania (Viannia) braziliensis (2.63% N=2) was revealed, also highlighting a very low genetic diversity amongst all analyzed sequences. Geographical distribution showed that most cases are widely distributed across the greater urban-sub urban area of the Irribaren municipality. L.(L.) amazonensis appears to be widely dispersed throughout Lara state. Statistical analyses failed to reveal significance for any comparisons, leading to conclude a lack of association between the infective Leishmania species and clinical phenotypes. To the best of our knowledge, this is an unprecedented study which addresses comprehensively the geographical distribution of Leishmania species in central-western Venezuela throughout the last two decades, and the first to incriminate L. (L.) infantum as an etiologic agent of cutaneous leishmaniasis in this region. Our findings support that Leishmania endemism in central-western Venezuela is caused mainly by L.(L.) amazonensis. Future studies are needed to unveil additional details on the ecological intricacies and transmission aspects of leishmaniasis (i.e. sampling phlebotomines and mammals) and to adopt adequate public health prevention and control strategies and mitigate disease impact in this endemic region.

Cutaneous angiomatosis‐like presentation in koi carp (Cyprinus carpio koi): Clinical–pathological investigations

The skin represents an indicator of an animal's health status. Causes of cutaneous diseases in fish most often trace back to biological agents. However, fish skin diseases can also arise from a complex interaction of infectious and non-infectious causes, making it more difficult to identify a specific aetiology. In the period between April and September of the years 2019-2022, four koi carp (Cyprinus carpio koi) from two European countries presented with multifocal, irregularly round, few mm to 1cm, variably raised cutaneous reddened areas. The fish displayed good general condition. Cutaneous samples, investigated by microbiological and molecular methods and microscopy, did not indicate a primary pathogenic agent. Gross and histological findings of the cutaneous biopsies were consistent with a multifocal/reactive process centred on dermal vessels. The histological features were reminiscent of angiomatosis, a benign proliferative condition affecting the dermal vessels of mammals, including human patients. The clinical-pathological presentation and the dermatologic condition that affected the koi carp are discussed and compared with the veterinary and human literature.

Stress keratin 17 and estrogen support viral persistence and modulate the immune environment during cervicovaginal murine papillomavirus infection

A murine papillomavirus, MmuPV1, infects both cutaneous and mucosal epithelia of laboratory mice and can be used to model high-risk human papillomavirus (HPV) infection and HPV-associated disease. We have shown that estrogen exacerbates papillomavirus-induced cervical disease in HPV-transgenic mice. We have also previously identified stress keratin 17 (K17) as a host factor that supports MmuPV1-induced cutaneous disease. Here, we sought to test the role of estrogen and K17 in MmuPV1 infection and associated disease in the female reproductive tract. We experimentally infected wild-type and K17 knockout (K17KO) mice with MmuPV1 in the female reproductive tract in the presence or absence of exogenous estrogen for 6 mon. We observed that a significantly higher percentage of K17KO mice cleared the virus as opposed to wild-type mice. In estrogen-treated wild-type mice, the MmuPV1 viral copy number was significantly higher compared to untreated mice by as early as 2 wk postinfection, suggesting that estrogen may help facilitate MmuPV1 infection and/or establishment. Consistent with this, viral clearance was not observed in either wild-type or K17KO mice when treated with estrogen. Furthermore, neoplastic disease progression and cervical carcinogenesis were supported by the presence of K17 and exacerbated by estrogen treatment. Subsequent analyses indicated that estrogen treatment induces a systemic immunosuppressive state in MmuPV1-infected animals and that both estrogen and K17 modulate the local intratumoral immune microenvironment within MmuPV1-induced neoplastic lesions. Collectively, these findings suggest that estrogen and K17 act at multiple stages of papillomavirus-induced disease at least in part via immunomodulatory mechanisms.

Efficacy and safety of deucravacitinib, an oral, selective, allosteric TYK2 inhibitor, in patients with active systemic lupus erythematosus: Results from a phase 2, randomized, double-blind, placebo-controlled study

Introduction: Tyrosine kinase 2 (TYK2) mediates signaling of Type I interferons and IL-23, key cytokines involved in systemic lupus erythematosus (SLE) pathogenesis. Deucravacitinib, an oral, selective, allosteric TYK2 inhibitor, is approved in multiple countries for the treatment of adults with plaque psoriasis. This analysis assessed the efficacy and safety of deucravacitinib in patients with active SLE.&#x0D; Methods: This 48-week, double-blind, phase 2 trial (NCT03252587) randomized patients 1:1:1:1 to deucravacitinib (3 mg BID, 6 mg BID, 12 mg QD) or placebo. Oral corticosteroid tapering was required from weeks 8-20; further tapering was optional from weeks 32-40. The primary endpoint was the proportion of patients achieving SLE Responder Index-4 (SRI[4]) at week 32. Key secondary endpoints at week 48 included percentage of patients achieving SRI(4) and decrease of ≥50% from baseline Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI-50), in patients with baseline CLASI ≥10. Change from baseline in CLASI Activity Score (CLASI-A) over time was also assessed.&#x0D; Results: Of 363 randomized patients, 275 (76%) completed 48 weeks of treatment. Baseline demographic and disease characteristics were balanced across treatment groups, with baseline mean CLASI-A scores ranging from 8.0 to 8.6. The primary endpoint at week 32 was met, with significantly greater proportions of patients in deucravacitinib 3 mg BID and 6 mg BID groups vs placebo achieving SRI(4) responses (placebo: 34.4%; deucravacitinib 3 mg BID: 58.2%, P=0.0006; 6 mg BID: 49.5%, P=0.021; 12 mg QD: 44.9%, P=0.078). Patients treated with deucravacitinib demonstrated improvement across all secondary endpoints compared with placebo. In patients with CLASI ≥10 at baseline, greater mean changes from baseline in CLASI-A were observed in deucravacitinib vs placebo over 48 weeks of treatment (placebo: 16.7%; deucravacitinib 3 mg BID: 69.6%, P=0.0006; 6 mg BID: 56.0%, P=0.0058; 12 mg QD: 62.1%, P=0.0009). Rates of adverse events (AEs), serious AEs, and AEs of interest were similar between deucravacitinib and placebo groups. Most common AEs with deucravacitinib were upper respiratory tract infection, nasopharyngitis, headache, and urinary tract infection. No deaths, major adverse cardiac events, thrombotic events, systemic opportunistic infections, or active tuberculosis occurred.&#x0D; Conclusion: Deucravacitinib demonstrated sustained, meaningful clinical efficacy in SRI(4), improvement in mucocutaneous activity as measured by CLASI-A responses, and was well tolerated in patients with active SLE up to 48 weeks.

Inducible nitric oxide synthase-expressing myeloid-derived suppressor cells regulated by interleukin 35 contribute to the pathogenesis of psoriasis.

Although psoriasis is classified as a T cell-mediated inflammatory disease, the contribution of myeloid cells to the pathogenesis of psoriasis is not fully understood. In the present study, we demonstrated that the expression of the anti-inflammatory cytokine interleukin-35 (IL-35) was significantly increased in patients with psoriasis with a marked increase in the number of myeloid-derived suppressor cells (MDSCs). Similar results were obtained in an imiquimod-induced psoriasis mouse model. IL-35 reduced the total number of MDSCs and their subtypes in the spleens and psoriatic skin lesions, ameliorating psoriasis. IL-35 also reduced the expression of inducible nitric oxide synthase in MDSCs, although it had no significant effect on interleukin-10 expression. Adoptive transfer of MDSCs from imiquimod-challenged mice aggravated the disease and weakened the effect of IL-35 in the recipient mice. In addition, mice transferred with MDSCs isolated from inducible nitric oxide synthase knockout mice had milder disease than those with wild-type MDSCs. Furthermore, wild-type MDSCs reversed the effects of IL-35, while MDSCs isolated from inducible nitric oxide synthase knockout mice did not affect IL-35 treatment. In summary, IL-35 may play a critical role in the regulation of iNOS-expressing MDSCs in the pathogenesis of psoriasis, highlighting IL-35 as a novel therapeutic strategy for patients with chronic psoriasis or other cutaneous inflammatory diseases.

A Study of the Efficacy of Doxycycline plus Trifarotene in the Treatment of Moderate to Severe Acne Vulgaris

Introduction: Acne is a common cutaneous disease affecting the pilosebaceous apparatus, in which there is hyperkeratinization, excessive sebum production, follicular colonization with Propionibacteriun acnes &amp; inflammation. It manifests as comedones, papules, pustules, nodules &amp; cysts on the face, neck, and trunk. Epidemiologic studies indicate acne affects approximately 9.4% of the global population, ranking it as the eighth most prevalent disease worldwide. It is a common skin condition of the face and trunk that negatively impacts the quality of life. Objectives: We evaluated the efficacy of oral doxycycline in combination with topical trifarotene in the treatment of moderate to severe acne vulgaris. Methods: This was an interventional study for 12-week duration to see the treatment outcome in moderate &amp; severe acne patients. This study was carried out at the Dept. of Dermatology &amp; Venereology, Enam medical college Hospital, Savar, Dhaka, Bangladesh from January 2022 to September 2022. We evaluated a new therapeutic regimen: Doxycycline 100 mg (Oral) once daily during dinner with food and enough water,21 days / month, for three consecutive months along with topical Trifarotene 0.005%w/w once daily at night after proper cleansing for the same duration. Acne severity was graded using Investigator Global Acne Assessment Scale (IGAS). Results: A total of 96 patients with moderate to severe acne were treated &amp; among them 85 completed this study. Out of these 85, 15 are males &amp; 70 are females. There was a marked improvement in IGAS with marked reduction in the number of inflammatory and non-inflammatory lesions between the beginning of the study and through follow up visits. Clinical response to Doxycycline Plus Trifarotene was excellent in 15%, good in 68%, moderate in 14% and mild in 3% and satisfaction to treatment was 22% very satisfied, 60% satisfied and 17% somewhat satisfied. Side effects were low and only 2.1% of cases had mild irritation. ........