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Dermatology Reports Mar 2022The close relationship between the intestine and the skin has been widely stated, seen from gastrointestinal (GI) disorders often accompanied by skin manifestations....
The close relationship between the intestine and the skin has been widely stated, seen from gastrointestinal (GI) disorders often accompanied by skin manifestations. Exactly how the gut microbiome is related to skin inflammation and influences the pathophysiology mechanism of skin disorders are still unclear. Many studies have shown a two-way relationship between gut and skin associated with GI health and skin homeostasis and allostasis. This systematic review aimed to explore the associations between the gut microbiome with inflammatory skin disorders, such as acne, psoriasis, atopic dermatitis, and urticaria, and to discover the advanced concept of this relationship. The literature search was limited to any articles published up to December 2020 using PubMed and EBSCOHost. The review followed the PRISMA guidelines for conducting a systematic review. Of the 319 articles screened based on title and abstract, 111 articles underwent full-text screening. Of these, 23 articles met our inclusion criteria, comprising 13 atopic dermatitis (AD), three psoriasis, four acne vulgaris, and four chronic urticaria articles. Acne vulgaris, atopic dermatitis, psoriasis, and chronic urticaria are inflammation skin disorders that were studied recently to ascertain the relationship of these disorders with dysbiosis of the GI microbiome. All acne vulgaris, psoriasis, and chronic urticaria studies stated the association of gut microbiome with skin manifestations. However, the results in atopic dermatitis are still conflicting. Most of the articles agree that plays an essential role as anti-inflammation bacteria, and Proteobacteria and Enterobacteria impact inflammation in inflammatory skin disorders.
PubMed: 35371420
DOI: 10.4081/dr.2022.9188 -
Annals of Palliative Medicine Feb 2022Acne is a chronic inflammatory disease that occurs in the sebaceous glands of the hair follicles. Depressed acne scars, also known as depressed scars, remain after... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Acne is a chronic inflammatory disease that occurs in the sebaceous glands of the hair follicles. Depressed acne scars, also known as depressed scars, remain after recovery. Clinical treatments of depressed scars include chemical peels, surgical treatments, radio frequency treatments, and laser treatments. Ultra-pulse carbon dioxide (CO2) fractional laser treatment has become the main method for treating depressed scars in recent years, but there are no systematic reports on the effectiveness and safety of this treatment.
METHODS
English databases, including PubMed, Embase, and Ovid-Medline, were searched to retrieve relevant articles. The search period ran from the establishment of the databases to April 2021. The search terms included CO2 lattice laser, depressed acne scars, depressed scars, and effectiveness.
RESULTS
A total of 6 articles comprising 467 patients with depressed acne scars were included in the meta-analysis. The results showed that patients treated with ultra-pulsed CO2 fractionated laser scored higher in skin smoothness compared to other methods [standard mean difference (SMD) =0.49, 95% confidence interval (CI): 0.13-0.84; P=0.008], and significantly higher total skin lesion scores (SMD =0.35, 95% CI: -0.00 to 0.70; P=0.05).
DISCUSSION
A total of 6 articles were included in this study on the clinical efficacy of the ultra-pulse CO2 fractional laser in the treatment of depressed acne scars. The study found that compared to other treatments, this laser had a better curative effect in terms of the effective rate and patient skin smoothness score.
Topics: Acne Vulgaris; Carbon Dioxide; Cicatrix; Humans; Lasers, Gas; Treatment Outcome
PubMed: 35249351
DOI: 10.21037/apm-22-70 -
Annals of Palliative Medicine Feb 2022First-line medications for acne vulgaris include retinoids and antibiotics. Dapsone is a topical drug approved by the U.S. Food and Drug Administration for the treatment... (Meta-Analysis)
Meta-Analysis
BACKGROUND
First-line medications for acne vulgaris include retinoids and antibiotics. Dapsone is a topical drug approved by the U.S. Food and Drug Administration for the treatment of acne. However, due to its side effects, the clinical application of dapsone has not been promoted, and the value of the medication is still unclear. The aim of this study is to determine the efficacy and safety of dapsone gel in patients with acne.
METHODS
Systematic searches were performed using the following databases on January 4, 2020: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Service System (SinoMed), China Science and Technology Journal Database (CQVIP), and Wanfang Data Knowledge Service Platform. A meta-analysis of randomized controlled trials was then conducted to analyze the efficacy and adverse events of dapsone gel treatment compared with excipient and other drug therapies. RevMan 5.3 software was used to calculate the odds ratio (OR), and the confidence interval (CI) was 95%.
RESULTS
Data of 11,424 participants across 7 trials which met the inclusion criteria were analyzed. Meta-analysis showed that dapsone gel alone or dapsone gel combined with isotretinoin was superior to excipient alone or oral isotretinoin alone in the treatment of acne (OR =1.51, 95% CI: 1.38-1.66, P<0.0001 random effects model, I2=0%). This indicates that dapsone gel is effective for the treatment of acne. We also found that dapsone gel is a more effective treatment for females (OR =1.80, 95% CI: 1.46-2.23). There was no significant difference in the incidence of adverse events between the dapsone group and the control group (OR =0.94, 95% CI: 0.82-1.14, P=0.24 random effects model; I2=29%). The common local adverse reactions in the dapsone group, such as dryness, heat, and eczema, were not statistically significant compared with those in the control group, and the side effects were transient.
DISCUSSION
Dapsone gel is effective in treating acne, and there is no significant difference in adverse events compared with other drugs.
Topics: Acne Vulgaris; Anti-Bacterial Agents; Dapsone; Eczema; Female; Humans; Treatment Outcome; United States
PubMed: 35249339
DOI: 10.21037/apm-21-3935 -
Frontiers in Medicine 2021Microneedling is a promising method for the treatment of acne scars, while the effect of microneedling combined with platelet-rich plasma (PRP) remains unknown. We...
BACKGROUND
Microneedling is a promising method for the treatment of acne scars, while the effect of microneedling combined with platelet-rich plasma (PRP) remains unknown. We performed a meta-analysis of controlled studies to compare the efficacy and safety of microneedling treatment with and without additional PRP in patients with acne scars.
METHODS
Randomized and non-randomized controlled studies were identified by search of Medline, Embase, and Cochrane's Library databases. Results were pooled with a random-effects model, incorporating the possible heterogeneity.
RESULTS
Four randomized and 10 split-face non-randomized controlled studies with 472 patients were included. Compared to microneedling therapy without PRP, combined treatment with microneedling and PRP was associated with increased odds of clinical improvement of >50% in Goodman's qualitative scale [GQS: odds ratio (OR): 2.97, 95% confidence interval (CI): 1.96-4.51, < 0.001; = 0%], and a significantly improved mean GQS score (mean difference: -0.32, 95% CI: -0.44 to -0.20, < 0.001; = 0%). Combined treatment was associated with a higher patient satisfying rate (OR: 4.15, 95% CI: 2.13 to 8.09, < 0.001; = 53%), while the incidence of severe adverse events such as severe erythema (OR: 1.59, 95% CI:.73 to 3.46, = 0.24; = 0%) and severe edema (OR: 1.14, 95% CI: 0.47 to 2.76, = 0.77; = 0%) were not significantly different.
CONCLUSIONS
Combined treatment with microneedling with PRP is more effective than microneedling without PRP for patients with acne scars.
PubMed: 35237616
DOI: 10.3389/fmed.2021.788754 -
The Cochrane Database of Systematic... Mar 2022Steroids have been used widely since the early 1970s for the treatment of adult-onset minimal change disease (MCD). Recently, newer agents have been used in adult MCD... (Review)
Review
BACKGROUND
Steroids have been used widely since the early 1970s for the treatment of adult-onset minimal change disease (MCD). Recently, newer agents have been used in adult MCD aiming to reduce the risk of adverse effects. The response rates to immunosuppressive agents in adult MCD are more variable than in children. The optimal agent, dose, and duration of treatment for the first episode of nephrotic syndrome, or for disease relapse(s) have not been determined. This is an update of a review first published in 2008.
OBJECTIVES
We aimed to 1) evaluate the benefits and harms of different agents, including both immunosuppressive and non-immunosuppressive agents, in adults with MCD causing the nephrotic syndrome; and 2) evaluate the efficacy of interventions on 'time-to-remission' of nephrotic syndrome, in adults with MCD causing the nephrotic syndrome.
SEARCH METHODS
We searched the Cochrane Kidney and Transplant Register of Studies up to 21 July 2021 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov.
SELECTION CRITERIA
Randomised controlled trials (RCTs) and quasi-RCTs of any intervention for MCD with nephrotic syndrome in adults over 18 years were included. Studies comparing different types, routes, frequencies, and duration of immunosuppressive agents and non-immunosuppressive agents were assessed.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random-effects model and results were expressed as a risk ratio (RR) for dichotomous outcomes, or mean difference (MD) for continuous data with 95% confidence intervals (CI). Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
MAIN RESULTS
Fifteen RCTs (769 randomised participants) were identified; four studies evaluated different prednisolone regimens, eight studies evaluated the calcineurin inhibitors (CNIs) (tacrolimus or cyclosporin), two studies evaluated enteric-coated mycophenolate sodium (EC-MPS) and one study evaluated levamisole. In all but two studies of non-corticosteroid agents, reduced-dose prednisolone was given with the treatment agent and the comparator was high-dose prednisolone. In the risk of bias assessment, 11 and seven studies were at low risk of bias for sequence generation and allocation concealment, respectively. No studies were at low risk of performance bias and eight studies were at low risk of detection bias. Thirteen, 10 and six studies were at low risk of attrition bias, reporting bias and other bias, respectively. Compared with no specific treatment, it is uncertain whether prednisolone increases the number with complete remission (1 study, 28 participants: RR 1.44, 95% CI 0.95 to 2.19), complete or partial remission (1 study, 28 participants: RR 1.38, 95% CI 0.98 to 1.95), subsequent relapse (1 study, 28 participants: RR 0.75, 95% CI 0.48 to 1.17), or reduces the adverse effects because the certainty of the evidence is very low. Compared with oral prednisolone alone, it is uncertain whether intravenous methylprednisolone and prednisolone increase the number with complete remission (2 studies, 35 participants: RR 1.76, 95% CI 0.17 to 18.32; I² = 90%), relapse (two studies, 19 participants. RR 1.18, 95% CI 0.65 to 2.15; I² = 0%) or adverse events because the certainty of the evidence is very low. Compared with prednisolone alone, CNIs with reduced-dose prednisolone or without prednisolone probably make little or no difference to the number achieving complete remission (8 studies; 492 participants: RR 0.99, 95% CI 0.93 to 1.05; I² = 0%), complete or partial remission (4 studies, 269 participants: RR 1.01, 95% CI 0.96 to 1.05; I² = 0%), or relapse (7 studies; 422 participants: RR 0.73, 95% CI 0.51 to 1.03; I² = 0%) (moderate certainty evidence), may reduce the risk of obesity or Cushing's Syndrome (5 studies; 388 participants: RR 0.11, 95% CI 0.02 to 0.59; I² = 45%) and the risk of acne (4 studies; 270 participants: RR 0.15, 95% CI 0.03 to 0.67; I² = 0%) (low certainty evidence); and had uncertain effects on diabetes or hyperglycaemia, hypertension, and acute kidney injury (AKI) (low certainty evidence). Compared with prednisolone alone, EC-MPS with reduced-dose prednisolone probably make little or no difference to the number undergoing complete remission at 4 weeks (1 study, 114 participants: RR 1.12, 95% CI 0.84 to 1.50), and at 24 weeks probably make little or no difference to the number undergoing complete remission (2 studies, 134 participants: RR 1.12, 95% CI 0.84 to 1.38; I² = 0%) (moderate certainty evidence), complete or partial remission (2 studies 134 participants: RR 0.92, 95% CI 0.75 to 1.12; I² = 0%), relapse (2 studies, 83 participants: RR 0.50, 95% CI 0.07 to 3.74; I² = 56%) (low certainty evidence); or to the adverse events of new-onset glucose intolerance, death, or AKI (low certainty evidence). One study (24 participants) compared levamisole and prednisolone with prednisolone in patients with relapsing disease. The authors identified no differences in mean relapse rate or adverse effects but no standard deviations were provided.
AUTHORS' CONCLUSIONS
This updated review has identified evidence for the efficacy and adverse effects of CNIs and EC-MPS with or without reduced-dose prednisolone compared with prednisolone alone for the induction of remission in adults with MCD and nephrotic syndrome with some reductions in steroid-associated adverse events. RCT data on the efficacy and adverse effects of rituximab in adults with MCD are awaited. Further, adequately powered RCTs are required to determine the relative efficacies of CNIs and EC-MPS and to evaluate these medications in patients with relapsing or steroid-resistant disease.
Topics: Acute Kidney Injury; Adult; Calcineurin Inhibitors; Child; Female; Humans; Immunosuppressive Agents; Levamisole; Male; Methylprednisolone; Mycophenolic Acid; Nephrosis, Lipoid; Nephrotic Syndrome; Recurrence; Steroids
PubMed: 35230699
DOI: 10.1002/14651858.CD001537.pub5 -
Pharmaceutics Jan 2022(1) Background: Colchicine is a natural alkaloid with anti-inflammatory properties used to treat various disorders, including some skin diseases. This paper aims to... (Review)
Review
(1) Background: Colchicine is a natural alkaloid with anti-inflammatory properties used to treat various disorders, including some skin diseases. This paper aims to incorporate all the available studies proposing colchicine as a treatment alternative in the management of cutaneous conditions. (2) Methods: In this systematic review, the available articles present in various databases (PubMed, Scopus-Embase, and Web of Science), proposing colchicine as a treatment for cutaneous pathological conditions, have been selected. Exclusion criteria included a non-English language and non-human studies. (3) Results: Ninety-six studies were included. Most of them were case reports and case series studies describing colchicine as single therapy, or in combination with other drugs. Hidradenitis suppurativa, pyoderma gangrenosum, erythema nodosum, erythema induratum, storage diseases, perforating dermatosis, bullous diseases, psoriasis, vasculitis, acne, urticaria, stomatitis, actinic keratosis, and pustular dermatosis were the main diseases discussed in literature. Although the therapeutic outcomes were variable, most of the studies reported, on average, good clinical results (4) Conclusions: Colchicine could be, as a single therapy or in combination with other drugs, a possible treatment to manage several skin diseases.
PubMed: 35214027
DOI: 10.3390/pharmaceutics14020294 -
JAAD International Mar 2022Over 1 million isotretinoin prescriptions are authorized in the United States per year. An insight into the frequency, dose dependency, timing, and reversibility of hair... (Review)
Review
Over 1 million isotretinoin prescriptions are authorized in the United States per year. An insight into the frequency, dose dependency, timing, and reversibility of hair loss associated with isotretinoin treatment for acne vulgaris could help guide dosing regimens and patient counseling. The objective of this systematic review was to assess the frequency of hair loss in patients with acne vulgaris on <0.5 mg/kg/d daily doses of isotretinoin versus the frequency of hair loss in patients with acne vulgaris on ≥0.5 mg/kg/d daily doses of isotretinoin. An Embase and MEDLINE search was conducted on July 15, 2020, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review focused on acne vulgaris patients. The treatment of acne vulgaris is the most common use of isotretinoin, and the population is typically younger and with fewer comorbidities. Twenty-two studies reported hair loss with oral isotretinoin treatment. A frequency analysis suggested that patients with acne vulgaris on <0.5 mg/kg/d of isotretinoin experienced hair loss at a frequency of 3.2% (n = 18/565) compared with those on ≥0.5 mg/kg/d, who experienced hair loss at a frequency of 5.7% (n = 192/3375). Inferential statistics were not possible. Physicians should consider counseling patients about the risk of telogen effluvium prior to drug initiation, as is commonly done for other side effects. The potential trend of increased hair loss frequency at a higher daily dosing warrants further investigation using higher-quality research.
PubMed: 35199047
DOI: 10.1016/j.jdin.2022.01.002 -
JAMA Dermatology Mar 2022While originally approved for the management of heart failure, hypertension, and edema, spironolactone is commonly used off label in the management of acne,... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
While originally approved for the management of heart failure, hypertension, and edema, spironolactone is commonly used off label in the management of acne, hidradenitis, androgenetic alopecia, and hirsutism. However, spironolactone carries an official warning from the US Food and Drug Administration regarding potential for tumorigenicity.
OBJECTIVE
To determine the pooled occurrence of cancers, in particular breast and prostate cancers, among those who were ever treated with spironolactone.
DATA SOURCES
PubMed, Cochrane Library, Embase, and Web of Science were searched from inception through June 11, 2021. The search was restricted to studies in the English language.
STUDY SELECTION
Included studies reported the occurrence of cancers in men and women 18 years and older who were exposed to spironolactone.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers (K.B. and H.H.) selected studies, extracted data, and appraised the risk of bias using the Newcastle-Ottawa Scale. Studies were synthesized using random effects meta-analysis.
MAIN OUTCOMES AND MEASURES
Cancer occurrence, with a focus on breast and prostate cancers.
RESULTS
Seven studies met eligibility criteria, with sample sizes ranging from 18 035 to 2.3 million and a total population of 4 528 332 individuals (mean age, 62.6-72.0 years; in the studies without stratification by sex, women accounted for 17.2%-54.4%). All studies were considered to be of low risk of bias. No statistically significant association was observed between spironolactone use and risk of breast cancer (risk ratio [RR], 1.04; 95% CI, 0.86-1.22; certainty of evidence very low). There was an association between spironolactone use and decreased risk of prostate cancer (RR, 0.79; 95% CI, 0.68-0.90; certainty of evidence very low). There was no statistically significant association between spironolactone use and risk of ovarian cancer (RR, 1.52; 95% CI, 0.84-2.20; certainty of evidence very low), bladder cancer (RR, 0.89; 95% CI, 0.71-1.07; certainty of evidence very low), kidney cancer (RR, 0.96; 95% CI, 0.85-1.07; certainty of evidence low), gastric cancer (RR, 1.02; 95% CI, 0.80-1.24; certainty of evidence low), or esophageal cancer (RR, 1.09; 95% CI, 0.91-1.27; certainty of evidence low).
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis, spironolactone use was not associated with a substantial increased risk of cancer and was associated with a decreased risk of prostate cancer. However, the certainty of the evidence was low and future studies are needed, including among diverse populations such as younger individuals and those with acne or hirsutism.
Topics: Acne Vulgaris; Aged; Breast Neoplasms; Female; Hirsutism; Humans; Male; Middle Aged; Prostatic Neoplasms; Spironolactone; United States
PubMed: 35138351
DOI: 10.1001/jamadermatol.2021.5866 -
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 -
Dermatology and Therapy Feb 2022Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent disease, usually presenting after puberty with inflammatory lesions that mainly affect the apocrine... (Review)
Review
INTRODUCTION
Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent disease, usually presenting after puberty with inflammatory lesions that mainly affect the apocrine gland-bearing areas of the body, most commonly the axillary, inguinal and anogenital regions. The treatment of HS is associated with certain challenges due to intrinsic resistance to various treatments and the presence of comorbidities and complications. The antibiotic dapsone is an established treatment for HS, but the current evidence base is limited. The aim of this review is to systematically review the literature on the efficacy of dapsone in the treatment of HS.
METHODS
The Cochrane, PubMed and CINAHL databases were searched for relevant articles to be included in the systematic review.
RESULTS
A total of seven studies, with a cumulative patient population of 135 patients, were included. Of these 135 patients, 62.2% demonstrated various degrees of improvement following treatment. However, as only three of the seven studies used dapsone monotherapy it is difficult to assess the effectiveness of dapsone because the benefits observed may be due to concurrently administered treatment.
CONCLUSION
Overall, the quality of evidence supporting the use of dapsone is weak. However, it is a well established treatment recommended in current, various national guidelines. There is a crucial need for well-designed randomized controlled trials to support its usage.
PubMed: 34997914
DOI: 10.1007/s13555-021-00674-x