Search Results (98)

Introduction: Lichen sclerosus (LSc) is a chronic, progressive, inflammatory skin disease that primarily affects the anogenital region in both sexes and across all age groups. Aim: To investigate the relationship between quality of life (QoL) and disease severity, as measured by a newly developed Lichen Sclerosus Score (LSc score), with respect to anatomical site before and after 12 weeks of treatment. Methods: A total of 136 patients diagnosed with LSc (88 men, 48 women) were enrolled between March and September 2022. Patients were clinically evaluated using the LSc score and completed the Dermatology Life Quality Index (DLQI). Treatment was individualized based on clinical findings and history. At 12 weeks, both clinical assessment and DLQI were repeated. Results: LSc scores significantly decreased following treatment (p < 0.001), except in the female subgroup. In men, LSc scores were strongly correlated with DLQI scores both before (r = 0.709; p < 0.001) and after (r = 0.492; p < 0.001) treatment. Among women, a significant correlation was found only before treatment (r = 0.457; p < 0.001). Significant associations were identified between LSc score and DLQI items 1, 8, and 9 in men and the overall cohort. No statistically significant differences in LSc scores or DLQI were observed across anatomical sites after correction for multiple comparisons. Conclusions: Disease severity in genital LSc is closely associated with QoL impairment. This is, to our knowledge, the first study to examine the correlation between a clinical severity score and DLQI. While anatomical site did not significantly affect scores, certain sites may have a disproportionate impact, underscoring the complex ways in which LSc affects patients’ lives. Full article

Background: Psoriasis is a chronic inflammatory skin disease linked to systemic comorbidities, including metabolic, cardiovascular, and autoimmune disorders. Thyroid dysfunction, particularly hypothyroidism, has been observed in patients with moderate-to-severe psoriasis, suggesting possible shared inflammatory pathways. Objectives: This study aims to explore the relationship between psoriasis and thyroid dysfunction in adults with moderate-to-severe psoriasis undergoing biologic therapy to determine whether psoriasis predisposes individuals to thyroid disorders and to identify demographic or clinical factors influencing this association. Materials and Methods: A cross-sectional study included adult patients with moderate-to-severe psoriasis receiving biologic therapy, recruited from the Psoriasis Unit at the Dermatology Department of Hospital Universitario San Cecilio in Granada, Spain, from 2017 to 2023. Patients with mild psoriasis or those treated with conventional systemic therapies were excluded. The data collected included demographics and clinical characteristics, such as age, sex, BMI (body mass index), and psoriasis severity (psoriasis severity was evaluated using the Psoriasis Area Severity Index (PASI), body surface area (BSA) involvement, Investigator’s Global Assessment (IGA), pruritus severity using the Numerical Rating Scale (NRS), and impact on quality of life through the Dermatology Life Quality Index (DLQI)). Thyroid dysfunction, including hypothyroidism and subclinical hypothyroidism, was assessed based on records from the Endocrinology Department. Results: Thyroid dysfunction was found in 4.2% of patients, all classified as hypothyroidism, primarily subclinical. The affected patients were generally older, with a mean age of 57.4 years. No significant differences in psoriasis severity (PASI, BSA) or treatment response were observed between patients with and without thyroid dysfunction. Conclusion: Our findings suggest hypothyroidism is the main thyroid dysfunction in psoriatic patients, independent of psoriasis severity. The lack of impact on psoriasis severity suggests hypothyroidism may be an independent comorbidity, warranting further research into shared inflammatory mechanisms. Full article

Background/Objectives: Acne vulgaris (AV), a common dermatological condition in adolescence, has been widely recognized not only for its physical impact but also for its significant psychological and social consequences, particularly the internalization of stigma. This study specifically aimed to evaluate the state of internalized stigma in adolescents with AV and its relationship with quality of life and disease severity. Additionally, we sought to identify and assess the factors associated with internalized stigma. Methods: A total of 179 patients with AV were included in this cross-sectional observational study. We employed a convenience sampling strategy. The Internalized Stigma Scale (ISS) was used to assess patients’ stigma. The Acne Quality of Life Scale (AQLS) and the Dermatology Life Quality Index (DLQI) were used to assess patients’ quality of life. The Global Acne Grading System (GAGS) was used to assess disease severity. Results: Cronbach’s alpha coefficient for the ISS was determined to be 0.79. In our study, the mean total ISS scores for patients with AV were notably high. The ISS was significantly positively correlated with the AQLS score (r = 0.653, p < 0.001), DLQI score (r = 0.487, p < 0.001), and GAGS score (r = 0.257, p = 0.006). Linear regression analysis was performed to predict the ISS variable. Accordingly, the AQLS positively and significantly predicts (β = 0.521, p < 0.001). Conclusions: AVs often experience high levels of stigma. Internalized stigma is strongly associated with reduced quality of life and increased disease severity. Moreover, the AQLS significantly affects stigma. Full article

Background: Psoriasis is a persistent, inflammatory skin disease with autoimmune characteristics. Beyond the obvious signs of skin lesions, it has negative systemic repercussions that impair the patient’s quality of life. This study aimed to determine the effectiveness of N-acetylcysteine (NAC) alone or in combination with Vitamin E in the treatment of mild to moderate active psoriasis vulgaris. Methods: This study was an open-label, prospective, randomized, controlled interventional clinical trial conducted at Cairo Hospital for Dermatology and Venereology (Al-Haud Al-Marsoud). In total, 45 patients with mild to moderate symptoms were randomly assigned to three groups, with fifteen patients each, as follows: the control group received the standard psoriatic treatment of topical steroids and salicylic acid; the acetylcysteine group received standard psoriatic treatment in addition to NAC 600 mg per day 30 min prior to breakfast for 8 weeks; and the acetylcysteine and Vitamin E group received standard psoriatic treatment in addition to NAC 600 mg per day, in a similar way of dosing like the previous group, and Vitamin E 1000 mg per day. All participants performed a comprehensive assessment including hematological parameters, the Psoriasis Area and Severity Index (PASI), the Dermatology Life Quality Index (DLQI), malondialdehyde (MDA), and interleukin-36 gamma (IL-36γ). Results: The treatment strategy involving the use of NAC alone and in combination with Vitamin E showed significant improvement in the assessed parameters compared to the control group receiving conventional therapy. The acetylcysteine group showed improvements of 41% in PASI and 49.4% in DLQI, a decrease of 34.3% in MDA, and a decrease of 31% in IL-36γ. Similarly, the acetylcysteine and Vitamin E group showed improvements of 52% in PASI and 42% in DLQI, a decrease of 37% in MDA, and a decrease of 35% in IL-36γ. There were no significant differences found between the N-acetylcysteine and N-acetylcysteine and Vitamin E groups. Moreover, significant positive correlations were found between MDA, IL-36γ, and PASI at baseline and after the third follow-up. Conclusions: This study found promising therapeutic benefits in the addition of NAC to the conventional therapy in psoriatic patients with mild to moderate symptoms, as it significantly improved psoriasis disease outcomes and improved the patient’s quality of life. However, the addition of Vitamin E to the NAC regimen did not show additional benefits. Full article

Background and Objectives: Chronic wounds severely impair patients’ quality of life (QoL), impacting physical, emotional, and functional well-being. Understanding the multidimensional effects of treatment is key to implementing effective, patient-centered care strategies. This study aimed to assess changes in QoL among patients with chronic wounds using the Dermatology Life Quality Index (DLQI) and EuroQol-5D (EQ-5D), comparing outcomes across treatment modalities. Materials and Methods: A longitudinal observational study was conducted between 2019 and 2024 across three hospitals in the Valencian Community. A total of 278 patients with venous lower-limb ulcers of more than six weeks’ duration were included. Quality-of-life assessments were performed at baseline, one-month follow-up, and discharge. Treatments included alginate, foam, moist wound healing (MWH), compression therapy, and negative-pressure wound therapy (NPWT). Statistical analysis involved Friedman’s test and repeated-measures ANOVA. Results: Significant improvements were observed in overall QoL across most treatment modalities. EQ-5D scores progressively increased, while DLQI scores decreased. Pain, embarrassment, and limitations in daily life (e.g., shopping and social activities) showed marked reductions. MWH and foam demonstrated the most favorable impact on QoL, while NPWT showed more modest improvements, possibly due to patient complexity. Notably, the variable “sexuality” remained unchanged (mean = 0.00), possibly due to underreporting or communication barriers. Conclusions: Chronic wound treatments significantly improve patients’ quality of life, particularly in terms of pain and social functioning. The use of combined tools (DLQI and EQ-5D) allows for a more comprehensive understanding of these outcomes. These findings highlight the importance of tailoring wound care to individual needs and addressing psychosocial domains, including sexuality. Community nursing, nutritional support, and long-term follow-up should be incorporated into care plans to optimize results, especially in older adults. Full article

Background: Tumor necrosis factor-alpha (TNF-α), IL-12/23, IL-17A, and IL-17F are key proinflammatory cytokines involved in the pathogenesis of psoriasis. Biologic therapies targeting these interleukins have demonstrated clinical efficacy. However, the exact relationship between their serum levels and clinical response remains unclear. The aims of this study are to assess changes in cytokine levels (TNF-α, IL-12/23, IL-17A, IL-17F) after 12 weeks of biologic treatment in psoriasis to test if there is any correlation between their serum level and PASI (Psoriasis Area Severity Index) and DLQI (Dermatology Life Quality Index) scores before or after treatment and to check the influence of clinical and lifestyle factors on these levels. Methods: In this prospective study, 36 patients with moderate-to-severe plaque psoriasis receiving anti-TNF-α, anti-IL-17, or anti-IL-23 therapy were assessed at baseline and after 12 weeks. The serum levels of these cytokines were measured using the ELISA technique. Clinical response was evaluated using PASI and DLQI scores. Spearman correlation analysis was used to assess the relationship between interleukins’ serum levels and these scores. Results: A significant decrease in TNF-α levels and DLQI and PASI scores was observed after 12 weeks across all treatments. A moderate positive correlation (r = 0.391, p = 0.018) was found between serum TNF-α levels and PASI scores at week 12. Conclusions: The serum levels of TNF-α are significantly correlated with PASI scores following 12 weeks of biologic therapy, supporting their potential role as a biomarker for monitoring treatment efficacy in psoriasis. Full article

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that severely impairs quality of life. Treatment typically involves a patient-oriented combination of medical therapies, surgery, and lifestyle modifications. However, data on the impact of surgical treatments on quality of life remain limited. This prospective monocentric study aimed to evaluate the effect of wide surgical excision in patients with moderate to severe HS (Hurley stage II/III) who were naïve to systemic biologic treatments. Between March 2017 and November 2022, 82 patients (51% female; 80% Hurley II, 20% Hurley III) underwent major surgical excision. Assessments were performed before surgery and at three and six months postoperatively. The primary endpoint was the change in Dermatologic Life Quality Index (DLQI); secondary endpoints included changes in pain (NRS-11) and disease severity scores. DLQI improved from 11.7 at baseline to 8.3 at three months and 4.7 at six months (p < 0.001). Pain scores and the modified Hidradenitis Suppurativa Score (mHSS) also significantly decreased (p < 0.001). In conclusion, major surgery significantly improved quality of life and pain in HS patients, confirming its essential role in a multimodal treatment approach. Patient-reported outcome measures are crucial for assessing treatment efficacy in HS. Full article

Background/Objectives: Tralokinumab, a fully human monoclonal antibody targeting IL-13, has shown efficacy and safety in clinical trials and real-life studies for atopic dermatitis (AD). However, data on its effectiveness across AD phenotypes are limited. Methods: A multicentric study evaluated tralokinumab’s efficacy over 52 weeks in 416 severe AD patients. EASI (Eczema Area and Severity Index), P-NRS (Pruritus Numerical Rating Scale), DLQI (Dermatology Life Quality Index), and ADCT (Atopic Dermatitis Control Tool) were recorded up to 52 weeks of treatment. Results: The EASI, P-NRS, DLQI, and ADCT trends across phenotypes showed significant improvement in all phenotype subgroups. By week 16, classical and generalized lichenoid phenotypes showed the highest EASI improvements compared to the generalized inflammatory (75.0 vs. 45.5 [p < 0.001] and 79.3 vs. 45.5 [p < 0.001]), with most achieving EASI-75 (p < 0.001, χ² = 25.96). By week 24, generalized lichenoid reached 100% EASI improvement, significantly outperforming other phenotypes. The highest EASI-75 rates were seen in classical, generalized lichenoid, and portrait/head and neck phenotypes (p = 0.016, χ² = 13.85). No significant differences were observed at weeks 32, 40, or 52. Conclusions: Our results suggest that tralokinumab’s durability and tolerability are consistent across the various phenotypes. The classical and generalized lichenoid were the fastest phenotypes to improve. However, given the uneven distribution of phenotypes and the gradual reduction in patient numbers over time, larger prospective studies are essential to confirm the observed trends. Full article

Introduction: Allergic contact dermatitis (ACD) is a form of late hypersensitivity reaction of skin contact with allergens. As an inflammatory skin disease, ACD has a negative impact on the quality of life and there is a need to elucidate the etiopathogenetic factors of the disease, whereby using the psychoneuroimmunological (PNI) approach can be helpful. Psychological stress (PS), as a component of PNI, leads to aggravation of the contact hypersensitivity reaction. In response to the perception of PS, cortisol secretion is enhanced by activation of the hypothalamic–pituitary–adrenal (HPA) axis. Furthermore, the pro-inflammatory cytokines interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) play a role in activating the HPA axis as well as initiating and maintaining inflammatory responses. Recent studies show that IL-6, IL-1, and TNF-α values are increased in the serum of patients with contact dermatitis, as well as in keratinocyte cell culture. Methods: The study examined the association of PNI factors (serum IL-6 and TNF-α, stress intensity with a Perceived Stress Scale (PSS) questionnaire, quality of life of dermatology patients with a Dermatology Life Quality Index (DLQI)) with the disease severity evaluated using the Hand Eczema Extent Score (HEES) and the duration of disease in hand ACD patients. Results: Patients with hand ACD had higher PSS (p = 0.001) than healthy people, with no difference in IL-6 and TNF-α. Higher DLQI was associated with higher HEES and PSS (p = 0.002 and p < 0.001) and these were the only predictors of DLQI. The duration of the disease was not related to the investigated factors. Conclusion: This study is the first so far, to our knowledge, in which a detailed analysis of PNI factors in patients with hand ACD was conducted. The results show that patients with ACD have higher PS intensity, which can chronically indicate changes in the balance of the HPA axis and indirectly affect the quality of life and disease severity of this disease. The results of the research provide more knowledge about hand ACD and contribute to and emphasize the importance of a multidisciplinary approach to treatment, thus improving the quality of life of these patients. Full article

Background/Objectives: Atopic dermatitis (AD) and alopecia areata (AA) frequently coexist due to shared immune-mediated mechanisms. Treatments targeting AD, including Janus kinase (JAK) inhibitors and dupilumab, may impact AA outcomes in unpredictable ways. This study aims to evaluate the effects of advanced therapies on patients with concurrent AD and AA to inform treatment strategies. Methods: A retrospective cohort study was conducted on six patients diagnosed with both AD and AA. Treatments included systemic corticosteroids, dupilumab, and JAK inhibitors (baricitinib and upadacitinib). Outcomes were assessed at six months using the Severity of Alopecia Tool (SALT), Dermatology Life Quality Index (DLQI), and Scoring Atopic Dermatitis (SCORAD) scores. Results: Patients receiving JAK inhibitors showed significant improvements in AD and AA outcomes, with mean reductions of 95.65% in SALT scores, 91.03% in DLQI scores, and 89.57% in SCORAD scores. Dupilumab was associated with the onset or worsening of AA in two patients. Systemic corticosteroids provided short-term benefits but are unsuitable for long-term management due to safety concerns. Conclusions: JAK inhibitors are effective for managing concurrent AD and AA, offering substantial improvements in disease control and quality of life. However, dupilumab requires cautious use in patients with these comorbid conditions. Personalized treatment strategies, informed by patient-specific factors, are essential for optimizing outcomes and minimizing risks. Further research is needed to identify predictive markers and refine therapeutic approaches for this challenging population. Full article

Background: Acne is a pathology of the pilosebaceous unit. It is characterized by a highly complex etiopathology which includes inflammation, hyperkeratinization, increased sebum production, colonization of Cutibacterium acne, hyperandrogenemia, and hyperinsulinemia. This condition, together with hirsutism, androgenic alopecia, and acanthosis nigricans, are highly prevalent cutaneous manifestations of the polycystic ovary syndrome (PCOS). While conventional therapies represent effective treatment options, they are not free from side effects which may reduce compliance. In this context, considerable attention has been directed toward nutraceutical supplements, which include different molecules with great potential to reduce inflammation, hyperkeratinization, hyperseborrhea, and hyperinsulinemia. Myo-inositol has been shown to be effective in improving some of the signs and symptoms of patients with microcystic ovaries: reducing body mass index (BMI), testosterone free levels, dehydroepiandrosterone sulfate (DHEAS) levels, and improving ovarian function and insulin sensitivity. Methods: The authors conducted a retrospective study that included 200 patients suffering from PCOS. Over 6 months, they analyzed the effects of the supplementation of LEVIGON™ (Sanitpharma; Milan, Italy)—a specific nutraceutical formulation containing myo-inositol, microlipodispersed magnesium, and folic acid—on the clinical picture of acne and hirsutism. Results: The supplementation of LEVIGON™ showed a significant reduction of BMI, testosterone, testosterone free, and DHEAS levels, thus improving the clinical picture of acne and hirsutism. Moreover, the impact of acne on the quality of life, assessed using the Cardiff Acne Disability Index (CADI) and Dermatology Life Quality Index (DLQI) scale, improved significantly after 3 and 6 months. Women with hirsutism benefited also from a significant improvement of the Ferriman-Gallwey score after both 3 and 6 months (p < 0.0001; p < 0.0001 respectively compared to the baseline). Conclusions: Myo-inositol supplementation, associated with microlipodispersed magnesium in a bioaccessible form, proved to be extremely useful in reducing acne and hirsutism in patients suffering from microcystic ovaries. In addition, there were no side effects, thus confirming excellent compliance. Further long-term randomized clinical trials are needed to confirm this preliminary evidence. Full article

Background: Real-world data on the prevalence and burden of patients with chronic spontaneous urticaria (CSU) are limited in Japan. This study aimed to estimate CSU prevalence and assess its humanistic and economic burden. Methods: This analysis utilized data from Japanese adult respondents self-reporting physician-diagnosed CSU collected through the 2019 National Health and Wellness Survey. The weighted 12-month prevalence was estimated using 2018 international census projections. Outcomes included the SF-12v2 (physical and mental component summary [PCS and MCS] scores), health utility index (SF-6D and EQ-5D), Dermatology Life Quality Index (DLQI), Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Work Productivity and Activity Impairment scores at data collection, and healthcare resource utilization over the past 6 months. Results: Among 30,006 respondents, 334 reported having CSU, of whom 62.3% were female. The mean (SD) age at data collection and CSU diagnosis was 50.8 (15.3) and 39.2 (14.9) years, respectively. The weighted prevalence of CSU was 1.1%. The mean (SD) PCS and MCS scores were 50.3 (7.0) and 45.1 (10.0), respectively. The mean (SD) health utility measures (SF-6D and EQ-5D) were 0.71 (0.13) and 0.79 (0.18), respectively. The mean (SD) DLQI score was 3.8 (6.0). More than 40% of patients reported mild/moderate/severe anxiety and depression. The mean % (SD) scores for absenteeism, presenteeism, overall work impairment, and activity impairment were 7.6 (17.6), 27.2 (27.2), 30.3 (29.6), and 28.5 (27.8), respectively. Approximately 90.0% of patients visited healthcare providers, including emergency room visits (6.9%) and hospitalizations (9.9%). Conclusions: This study provides insights into the diagnosed prevalence and burden of CSU in Japan, highlighting its impact on patients’ lives. Full article

Background: Chronic spontaneous urticaria (CSU) and moderate-to-severe atopic dermatitis (AD) are significant challenges in pediatric populations, negatively impacting quality of life (QoL). Biologic therapies, including omalizumab and dupilumab, showed considerable promise for patients unresponsive to conventional treatments. This study evaluated the real-life efficacy and safety of these biologics in pediatric CSU and AD patients. Methods: A retrospective, monocentric study was conducted enrolling pediatric patients (aged 6–18 years) followed at the “G. Martino” Hospital, University of Messina. This study included patients with CSU unresponsive to antihistamines and those with moderate-to-severe AD refractory to topical therapies. Disease severity and treatment efficacy were evaluated using the Urticaria Activity Score 7 (UAS7) for CSU, the Eczema Area and Severity Index (EASI) for AD, and QoL metrics, including the Dermatology Life Quality Index (DLQI) and numerical rating scales, for pruritus (p-NRS) and sleep (s-NRS), at baseline, 16 weeks, and 52 weeks. Safety was assessed through the monitoring of reported adverse events (AEs). Results: Omalizumab significantly reduced UAS7 scores by 71.9% at 16 weeks and 75.3% at 52 weeks (p < 0.001), with concurrent improvements in c-DLQI. Dupilumab reduced the EASI score by 75.3%, p-NRS by 40%, and s-NRS by 52.9% over 52 weeks, with c-DLQI improving by 72.6%. No severe AEs were observed; mild reactions included injection-site erythema and respiratory symptoms. Conclusions: Omalizumab and dupilumab demonstrated significant efficacy in reducing disease severity and improving QoL in pediatric patients with CSU and AD. Moreover, their safety profile underscores their potential as essential treatments for these conditions. Full article

Psoriasis is a multifactorial inflammatory disease. Methylglyoxal (MG) is a highly reactive dicarbonyl compound responsible for dicarbonyl stress in some inflammatory conditions, and it may play a role in the etiopathogenesis of psoriasis. Methods: A total of 50 patients with psoriasis and 35 healthy individuals participated in this study. The following indices were assessed in patients: Body Surface Area (BSA), Psoriasis Area and Severity Index (PASI), and Dermatology Life Quality Index (DLQI). MG concentration was evaluated in blood samples. The following inflammatory response indices were calculated: Systemic Inflammation Response Index (SIRI), Systemic Immuno-inflammation Index (SII), and Aggregate Index of Systemic Inflammation (AISI). Results: An analysis of the obtained data showed a statistically significant decrease in the mean serum MG concentration in patients with psoriasis when compared to the healthy individuals (1.19 ± 0.4 μg/mL vs. 1.75 ± 0.6 μg/mL; p = 0.000002). In the patients, MG concentration correlated negatively with psoriasis disease severity indicators (BSA and PASI), C-reactive protein (CRP) concentration, and inflammatory response indicators (SII and AISI). Conclusions: The decreased concentration of MG may be attributed to an increased accumulation of its derivatives (advanced glycation end-products) in the inflamed skin and/or scavenging by polyamines. Full article

Background/objectives: Psoriasis is a chronic inflammatory autoimmune disease with important systemic and psychosocial impacts. The association with metabolic syndrome (MS) impairs disease severity and negatively influences patient-reported outcomes, particularly their quality of life as measured by the Dermatology Life Quality Index (DLQI). This study aims to investigate the relationship between systemic inflammation, DLQI scores and disease severity, focusing on the persistent impact of MS on patient outcomes after one year of treatment. Methods: This retrospective cross-sectional study included 150 psoriasis patients, with 74 also meeting the diagnostic criteria for MS. Clinical and inflammatory markers such as systemic immune–inflammatory index (SII), cytokines (IL-17A, IL-23), leptin, BMI and triglycerides were analyzed alongside PASI and DLQI scores. Results: Patients with MS had significantly higher PASI and DLQI scores compared to those without MS, reflecting worse disease severity and quality of life (p < 0.01). Elevated SII levels were strongly associated with higher DLQI scores (p < 0.01). Despite considerable reductions in PASI scores over one year of treatment, DLQI scores indicated a persistent negative impact of MS on quality of life. Notably, markers of systemic inflammation, such as SII, leptin and cytokines, correlated positively with both PASI and DLQI scores, highlighting the role of systemic inflammation in disease burden. Conclusions: This study underlines the significant role of systemic inflammation and metabolic comorbidities in amplifying the burden of psoriasis. The persistent impact of MS on quality of life despite clinical improvement underscores the need for comprehensive treatment approaches targeting systemic inflammation, metabolic health and psychosocial factors to improve long-term outcomes. Full article