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Acta Dermato-venereologica Feb 2018Treatment of vitiligo is challenging and requires a multidisciplinary approach. Fractional carbon dioxide (CO2) laser as an add-on to conventional treatment has been... (Meta-Analysis)
Meta-Analysis Review
Treatment of vitiligo is challenging and requires a multidisciplinary approach. Fractional carbon dioxide (CO2) laser as an add-on to conventional treatment has been reported to be effective, but there is no consensus on its use. A systematic review was performed by searching major databases for relevant publications to February 2017. Six studies with 85 participants were included. For those with refractory vitiligo, the addition of fractional CO2 laser to routine treatment modalities was superior to conventional treatment alone in terms of > 50% re-pigmentation (risk ratio (RR) 4.90, 95% confidence interval (95% CI), 1.15-20.93; p = 0.03), physician improvement score (mean difference (MD) 0.81, 95% CI 0.33-1.29; p < 0.001), < 25% re-pigmentation (RR 0.64, 95% CI, 0.49-0.85; p=0.002) and patient satisfaction (MD 1.61, 95% CI 0.73-2.49; p< 0.001). Side-effects were minor. These results provide evidence supporting that fractional CO2 laser is a valuable treatment modality for patients with vitiligo, especially for those with refractory vitiligo.
Topics: Chi-Square Distribution; Combined Modality Therapy; Humans; Lasers, Gas; Low-Level Light Therapy; Odds Ratio; Risk Factors; Skin; Skin Pigmentation; Treatment Outcome; Vitiligo
PubMed: 29110015
DOI: 10.2340/00015555-2836 -
The British Journal of Dermatology Apr 2018Vitiligo is a chronic disorder causing skin depigmentation with global prevalence varying from 0·2% to 1·8%. U.K. guidelines recommend assessment of psychological... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Vitiligo is a chronic disorder causing skin depigmentation with global prevalence varying from 0·2% to 1·8%. U.K. guidelines recommend assessment of psychological state during clinical evaluation of vitiligo. However, the prevalence of psychological comorbidity in people with vitiligo has not been described.
OBJECTIVES
To establish the prevalence of psychological symptoms or disorders in people with vitiligo and describe the outcome measures used.
METHODS
We performed a comprehensive search of MEDLINE, Embase, CINAHL and PsycINFO to identify observational studies assessing the prevalence of psychological symptoms or disorders (December 2016). DerSimonian and Lard random-effects models were used to estimate the overall pooled prevalence.
RESULTS
We identified 29 studies with 2530 people with vitiligo. Most studies included a measure of either depression (n = 25) or anxiety (n = 13). The commonest tools were the Hospital Anxiety and Depression Scale and the Centre for Epidemiology Studies Depression Scale. Ten studies provided information on 13 other psychological outcomes. Pooled prevalence using depression-specific and anxiety-specific questionnaires was 0·29 [95% confidence interval (CI) 0·21-0·38] and 0·33 (95% CI 0·18-0·49), respectively. Prevalence was lower for clinically diagnosed depression (0·21, 95% CI 0·15-0·28) and anxiety (0·15, 95% CI 0·06-0·24). When nonspecific tools were used the prevalence remained similar for depression (0·27, 95% CI 0·08-0·46) but increased for anxiety (0·46, 95% CI 0·39-0·52). High heterogeneity was observed.
CONCLUSIONS
A range of psychological outcomes are common in people with vitiligo. The prevalence of anxiety was influenced by type of screening tool, suggesting the need for validation of psychological outcome screening tools in the field of dermatology.
Topics: Anxiety Disorders; Depressive Disorder; Female; Humans; Male; Observational Studies as Topic; Prevalence; Psychiatric Status Rating Scales; Research Design; Vitiligo
PubMed: 28991357
DOI: 10.1111/bjd.16049 -
International Journal of Psychological... 2020The main purpose of this study is to describe how negative emotions were investigated in the sphere of dermatological diseases, in order (1) to summarize literature...
The main purpose of this study is to describe how negative emotions were investigated in the sphere of dermatological diseases, in order (1) to summarize literature trends about skin disorders and emotions, (2) to highlight any imbalances between the most studied and neglected emotions, (3) and to offer directions for future research. A computerized literature search provided 41 relevant and potentially eligible studies. Results showed that the study of emotions in skin disease is limited to Sadness/depression and Fear/anxiety. The emotions of Anger and Disgust have been poorly explored in empirical studies, despite they could be theoretically considered a vulnerability factor for the development of skin disorders and the dermatological extreme consequences, as negative emotionality toward self and the pathological skin condition. The bibliometric qualitative analysis with VOSViewer software revealed that the majority of the studies have been focused on the relationships between vitiligo and Sadness/depression, dermatitis and Fear/anxiety, psoriasis, and Anger, suggesting the need of future research exploring Disgust and, in general, a wider emotional spectrum.
PubMed: 32952965
DOI: 10.21500/20112084.4078 -
Evidence-based Complementary and... 2022The aim of this systematic review was to identify randomized controlled trials that looked at the effects of in any form on different skin diseases. Up to March 2022,... (Review)
Review
The aim of this systematic review was to identify randomized controlled trials that looked at the effects of in any form on different skin diseases. Up to March 2022, the online databases of Scopus, Web of Science, PubMed, Embase, Google Scholar, and Cochrane trials were searched. This study included 14 records of people who had experienced different types of skin disease including atopic dermatitis, vulgaris, arsenical keratosis, psoriasis, vitiligo, acute cutaneous leishmaniasis, warts, eczema, and acne. The mean SD age of the patients was 28.86 (4.49); [range: 18.3-51.4], with females accounting for 69% (506 out of 732) of the total. The follow-up mean SD was 8.16 (1.3) (ranged: 4 days to 24 weeks). The odds ratio (OR) was found to be 4.59 in a meta-analysis (95% CI: 2.02, 10.39). Whereas the null hypothesis in this systematic review was that lotion had no impact, OR 4.59 indicated that lotion could be effective. The efficacy of essential oil and extract has been demonstrated in most clinical studies. However, more research is needed to completely evaluate and validate the efficacy or inadequacy of therapy with , although it appears that it can be used as an alternative treatment to help people cope with skin problems.
PubMed: 36518853
DOI: 10.1155/2022/7993579 -
Oncotarget Jan 2017Nivolumab and pembrolizumab are antibodies against the programmed-death-receptor- 1 (PD-1) which are associated with distinct immune related adverse effects (AEs). This... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Nivolumab and pembrolizumab are antibodies against the programmed-death-receptor- 1 (PD-1) which are associated with distinct immune related adverse effects (AEs). This meta-analysis of randomized clinical trials aims to summarize current knowledge regarding the toxicity profile of these agents.
METHODS
PubMed search was conducted in February of 2016. The randomized trials needed to have at least one of the study arms consisting of nivolumab or pembrolizumab monotherapy and a control arm containing no anti-PD-1 therapy. Data were analyzed using random effects meta-analysis for risk ratios. Heterogeneity across studies was analyzed using Q and I2 statistics.
RESULTS
Nine randomized trials and 5,353 patients were included in our meta-analysis. There was evidence of significant heterogeneity between studies. The pooled relative risk (RR) for treatment-related all grade AEs and grade 3/4 AEs was 0.88 (95% CI 0.81-0.95;P=0.002) and 0.39 (95% CI 0.29-0.53; P<0.001) respectively favoring anti-PD-1 therapy versus standard of care approach. The RR of treatment-related death was 0.45 (95% CI 0.19-1.09; P=0.076). Patients treated with PD-1 inhibitors had an increased risk of hyperthyroidism [RR of 3.44 (95% CI 1.98-5.99; P<0.001)] and hypothyroidism [RR of 6.79 (95% CI 3.10-14.84; P<0.001)]. All grade pruritus and vitiligo were also more common among these patients. The pooled absolute risks of pneumonitis and hypophysitis were 2.65% and 0.47% respectively.
CONCLUSION
Approved PD-1 inhibitors are well tolerated, associated with significant low risk of severe treatment-related AEs and increased risk of thyroid dysfunction, pruritus, and vitiligo.
Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Agents, Immunological; Drug Approval; Humans; Neoplasms; Nivolumab; Odds Ratio; Programmed Cell Death 1 Receptor; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 27852042
DOI: 10.18632/oncotarget.13315 -
Cureus May 2020Objective The objective of the article is to summarize the current evidence regarding the association between angiotensin-converting enzyme insertion/deletion (ACE I/D)...
Objective The objective of the article is to summarize the current evidence regarding the association between angiotensin-converting enzyme insertion/deletion (ACE I/D) gene polymorphism and vitiligo disease. Methods A computerized search was performed through four electronic databases (PubMed, Scopus, Cochrane Central Register of Controlled Trials [CENTRAL], and Web of Science) with the relevant keywords. Included studies comprised of papers examining the association of ACE gene polymorphisms with vitiligo. Data were pooled as an odds ratio (OR) in random- and fixed-effect models using the Mantel-Haenszel (M-H) method. Review Manager 5.3 software (clicktime.com, Inc., San Francisco, US) was utilized in the meta-analysis. Results Ten studies (n=2,740) matching the inclusion criteria were included in the systematic review and meta-analysis. Results showed no significant difference between individuals carrying deletion/deletion (D/D) genotype and individuals with deletion/insertion (D/I) + insertion/insertion (I/I) genotypes in terms of vitiligo risk (odds ratio [OR]=1.13, 95% confidence interval [CI]: 0.78 to 1.64, p=0.53). However, vitiligo risk was higher in the individuals carrying the I/D genotype when compared with individuals with D/D + I/I genotypes (OR=1.29, 95% CI: 1.10 to 1.52, p=0.001). Moreover, the increased risk was observed in individuals carrying D/D when compared with I/I (OR=1.67, 95% CI: 1.33 to 2.09, p<0.0001). D allele was associated with significant risk when compared with the I allele (OR=1.29, 95% CI: 1.15 to 1.45, p<0.0001). Conclusion The current evidence suggests that there is a significant association between ACE I/D gene polymorphism and vitiligo. These findings support the use of ACE polymorphism in the prediction of vitiligo as a biomarker.
PubMed: 32528781
DOI: 10.7759/cureus.8046 -
JAMA Dermatology Mar 2022Although there have been increased efforts in dermatologic research to improve representation of patient sex, race, and ethnicity, there are limited data evaluating...
IMPORTANCE
Although there have been increased efforts in dermatologic research to improve representation of patient sex, race, and ethnicity, there are limited data evaluating resulting changes.
OBJECTIVE
To characterize the diversity of participants in dermatologic clinical trials conducted in the US published from 2015 to 2020 pertaining to common dermatologic conditions affecting all patient demographic categories compared with findings from 2010-2015.
EVIDENCE REVIEW
A systematic literature review through the PubMed database was conducted for randomized clinical trials published between July 1, 2015, and July 1, 2020, using keywords alopecia areata, acne, atopic dermatitis, lichen planus, psoriasis, seborrheic dermatitis, and vitiligo. Data collected included distribution of participant demographic characteristics, funding source, and journal type. Reflecting US Census data, studies were defined as unrepresentative of race and ethnicity if they included less than 20% ethnically or racially diverse participants or unrepresentative of sex if they included less than 45% women. Python was used for statistical analysis by χ2 tests or Fisher exact tests.
FINDINGS
A total of 392 randomized clinical trials were included. In comparison with the period from 2010-2015, the reporting rate for race and ethnicity in US studies has increased from 59.8% to 71.9% (P = .05). However, the proportion of reporting articles including at least 20% non-White representation remains unchanged at 38.1% with 37 of 97 reporting randomized clinical trials in 2010-2015 and 53 of 139 reporting randomized clinical trials in 2015-2020 (P = .99). Psoriasis studies included the least diversity, with 12.1% of studies recording at least 20% non-White participants and 29.5% of studies recording at least 45% female participants.
CONCLUSIONS AND RELEVANCE
The findings of this systematic review suggest that reporting racial and ethnic data since 2010-2015 has become more transparent. However, inclusion of representative patient populations may still be considered inadequate, particularly in psoriasis studies. Diversity in clinical trials is important for representation of the affected patient populations, and additional efforts are warranted in support of this endeavor.
Topics: Dermatitis, Atopic; Dermatology; Ethnicity; Female; Humans; Male; Psoriasis; Research Design
PubMed: 35080592
DOI: 10.1001/jamadermatol.2021.5596 -
Stem Cell Research & Therapy Jun 2024The aim of this study is to systematically review randomized controlled clinical trials (RCTs) studying various types of regenerative medicine methods (such as...
AIMS AND OBJECTIVES
The aim of this study is to systematically review randomized controlled clinical trials (RCTs) studying various types of regenerative medicine methods (such as platelet-rich plasma, stromal vascular fraction, cell therapy, conditioned media, etc.) in treating specific dermatologic diseases. Rejuvenation, scarring, wound healing, and other secondary conditions of skin damage were not investigated in this study.
METHOD
Major databases, including PubMed, Scopus, and Web of Science, were meticulously searched for RCTs up to January 2024, focusing on regenerative medicine interventions for specific dermatologic disorders (such as androgenetic alopecia, vitiligo, alopecia areata, etc.). Key data extracted encompassed participant characteristics and sample sizes, types of regenerative therapy, treatment efficacy, and adverse events.
RESULTS
In this systematic review, 64 studies involving a total of 2888 patients were examined. Women constituted 44.8% of the study population, while men made up 55.2% of the participants, with an average age of 27.64 years. The most frequently studied skin diseases were androgenetic alopecia (AGA) (45.3%) and vitiligo (31.2%). The most common regenerative methods investigated for these diseases were PRP and the transplantation of autologous epidermal melanocyte/keratinocyte cells, respectively. Studies reported up to 68.4% improvement in AGA and up to 71% improvement in vitiligo. Other diseases included in the review were alopecia areata, melasma, lichen sclerosus et atrophicus (LSA), inflammatory acne vulgaris, chronic telogen effluvium, erosive oral lichen planus, and dystrophic epidermolysis bullosa. Regenerative medicine was found to be an effective treatment option in all of these studies, along with other methods. The regenerative medicine techniques investigated in this study comprised the transplantation of autologous epidermal melanocyte/keratinocyte cells, isolated melanocyte transplantation, cell transplantation from hair follicle origins, melanocyte-keratinocyte suspension in PRP, conditioned media injection, a combination of PRP and basic fibroblast growth factor, intravenous injection of mesenchymal stem cells, concentrated growth factor, stromal vascular fraction (SVF), a combination of PRP and SVF, and preserving hair grafts in PRP.
CONCLUSION
Regenerative medicine holds promise as a treatment for specific dermatologic disorders. To validate our findings, it is recommended to conduct numerous clinical trials focusing on various skin conditions. In our study, we did not explore secondary skin lesions like scars or ulcers. Therefore, assessing the effectiveness of this treatment method for addressing these conditions would necessitate a separate study.
Topics: Adult; Female; Humans; Male; Platelet-Rich Plasma; Randomized Controlled Trials as Topic; Regenerative Medicine; Skin Diseases
PubMed: 38886861
DOI: 10.1186/s13287-024-03800-6 -
International Wound Journal Jun 2021Presently, there is an explosion in various uses of platelet-rich plasma (PRP). Several trials comparing combination therapy with PRP vs monotherapy for vitiligo have... (Meta-Analysis)
Meta-Analysis
Presently, there is an explosion in various uses of platelet-rich plasma (PRP). Several trials comparing combination therapy with PRP vs monotherapy for vitiligo have been published. However, evidence-based information is not enough for making well-informed decisions. This study aimed to evaluate several combination therapy strategies for vitiligo. EMBASE, PubMed, Web of Science, Cochrane Library and Google Scholar databases were searched to identify randomised controlled trials comparing combination therapy with PRP vs monotherapy for vitiligo. Eleven studies with 670 cases were included. Compared with monotherapy, clinical improvement of repigmentation was significantly higher in 308-nm excimer laser combined with PRP (odds rate for response rate of 50%-100% repigmentation, 4.47; 95% CI, 2.47-8.10; P < .00001) and in fractional carbon dioxide laser combined with PRP (mean difference for mean improvement grades of repigmentation, 1.61; 95% CI, 0.24-2.99; P = .02), respectively. Compared to monotherapy, there is no higher clinical improvement in strategies of PRP combined with narrowband-ultraviolet B or non-cultured epidermal cell suspension. Trivial adverse events were reported. This meta-analysis summarises current evidence that PRP combined with 308-nm excimer laser or fractional carbon dioxide laser is effective and safe for vitiligo. This systematic review and meta-analysis aims to evaluate the effectiveness and safety of several combination therapy strategies with PRP in the treatment of vitiligo. The response rate of repigmentation and mean improvement grades of repigmentation were mainly used for qualitative assessment. PRP combined with 308-nm excimer laser or fractional carbon dioxide laser is effective and safe for vitiligo due to its healing and regenerative properties.
Topics: Combined Modality Therapy; Humans; Lasers, Excimer; Platelet-Rich Plasma; Treatment Outcome; Vitiligo
PubMed: 33245822
DOI: 10.1111/iwj.13524 -
Frontiers in Immunology 2024The objective of this study is to evaluate the risk of secondary autoimmune diseases in multiple sclerosis (MS) patients treated with alemtuzumab (ALZ) through a... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND PURPOSE
The objective of this study is to evaluate the risk of secondary autoimmune diseases in multiple sclerosis (MS) patients treated with alemtuzumab (ALZ) through a meta-analysis.
METHODS
PubMed, Web of Science, OVID, EMBASE, and Cochrane central register of controlled trials were searched. Information and data were screened and extracted by 2 researchers. The obtained data were analyzed using the R software meta package. Quality assessment was conducted using the Newcastle-Ottawa Scale (NOS). The causes of heterogeneity were analyzed using subgroup analysis and sensitivity analysis. Publication bias was evaluated using funnel plots and Egger's test.
RESULTS
The search retrieved a total of 3530 papers from the databases. After screening, a total of 37 studies were included in the meta-analysis. The analysis results indicate that the pooled incidence rate of overall secondary autoimmune events (SAEs) in the included studies was 0.2824 [0.2348, 0.3300] (I²=94%, p<0.01). The overall incidence of autoimmune thyroid events (ATE) was 0.2257 [0.1810, 0.2703] (I²=94%, p<0.01). Among them, the rate of serious autoimmune thyroid events (SATE) was 0.0541 [0.0396, 0.0687] (I²=0%, p=0.44). The incidence rates of different thyroid events were as follows: Graves' disease (GD), 0.2266 [0.1632, 0.2900] (I²=83%, p<0.01); Hashimoto thyroiditis (HT), 0.0844 [0.0000, 0.2262] (I²=81%, p=0.02); Hashimoto thyroiditis with hypothyroidism (HTwH), 0.0499 [0.0058, 0.0940] (I²=37%, p=0.21); fluctuating thyroid dysfunction (FTD), 0.0219 [0.0015, 0.0424] (I²=0%, p=0.40); transient thyroiditis (TT), 0.0178 [0.0062, 0.0295] (I²=0%, p=0.94). The overall incidence of hematological events was 0.0431 [0.0274, 0.0621] (I²=70%, p<0.01). The incidence rates from high to low were as follows: lymphopenia, 0.0367 [0.0000, 0.0776] (I²=81%, p=0.02); Idiopathic thrombocytopenic purpura (ITP), 0.0258 [0.0199, 0.0323] (I²=25%, p=0.15); Hemolytic anemia (HA), 0.0177 [0.0081, 0.0391] (I²=29%, p=0.23); pancytopenia, 0.0136 [0.0000, 0.0314] (I²=0%, p=0.67); Neutropenia, 0.0081 [0.0000, 0.0183] (I²=0%, p=0.42). After excluding thyroid and hematological diseases, the combined incidence of other related SAEs was 0.0061 [0.0014, 0.0109] (I²=50%, p=0.02). The incidence of each disease ranked from highest to lowest as: skin psoriasis (SP), 0.0430 [0.0000, 0.0929] (I²=0%, p=0.57); alopecia areata (AA), 0.0159 [0.0024, 0.0372] (I²=19%, p=0.29); vitiligo, 0.0134 [0.0044, 0.0223] (I²=0%, p=0.81); inflammatory atrichia (IA), 0.0103 [0.0000, 0.0232] (I²=0%, p=0.43); chronic urticaria (CU), 0.0107 [0.0000, 0.0233] (I²=0%, p=0.60); and nephropathy, 0.0051 [0.0000, 0.0263] (I²=62%, p=0.02).
CONCLUSION
The occurrence of secondary autoimmune diseases in patients with MS treated with ALZ is noteworthy, particularly in the form of thyroid events and hematological events. Clinicians should monitor the overall condition of patients promptly for early management and avoid delayed diagnosis and treatment.
SYSTEMATIC REVIEW REGISTRATION
inplasy.com/inplasy-2024-4-0048/, identifier INPLASY202440048.
Topics: Humans; Alemtuzumab; Multiple Sclerosis; Autoimmune Diseases; Incidence; Hashimoto Disease
PubMed: 38690271
DOI: 10.3389/fimmu.2024.1343971