AIM: This systematic review and meta-analysis aimed to compare the long-term efficacy and safety of physical therapies (laser and photodynamic therapy) versus conventional topical glucocorticoids for the treatment of vul...AIM: This systematic review and meta-analysis aimed to compare the long-term efficacy and safety of physical therapies (laser and photodynamic therapy) versus conventional topical glucocorticoids for the treatment of vulvar lichen sclerosus (VLS). MATERIALS AND METHODS: A total of ten randomized controlled trials (RCTs) published between 2010 and 2025 were included and analyzed to evaluate clinical symptom improvement, safety profiles, and long-term recurrence rates. RESULTS: Analysis indicates that physical therapies are generally superior to topical glucocorticoids in improving clinical symptoms, with photodynamic therapy (PDT) demonstrating the most significant relief. In terms of safety, adverse events associated with physical therapies were predominantly mild and transient local reactions (e.g., burning or redness), whereas topical glucocorticoid use carried risks of secondary infections, such as candidiasis. Furthermore, physical therapies, particularly PDT, showed better long-term recurrence control compared to glucocorticoids, which had high recurrence rates after discontinuation. CONCLUSION: Laser therapy and PDT are effective and safer alternative treatments for VLS. These modalities offer distinct advantages in sustained symptom relief and recurrence reduction, especially for patients with refractory disease or concerns regarding long-term steroid use.
Psoriasis affecting special anatomical sites (scalp, face, intertriginous areas, and genitals) poses unique treatment challenges and often shows inadequate responses. This study evaluates the real-world efficacy and safe...Psoriasis affecting special anatomical sites (scalp, face, intertriginous areas, and genitals) poses unique treatment challenges and often shows inadequate responses. This study evaluates the real-world efficacy and safety of IL-17 inhibitors in treating psoriasis affecting special sites, and identifies clinical determinants for achieving PASI75 and PASI90 responses. A retrospective cohort of 1,469 patients receiving IL-17 therapy was analyzed.Generalized linear models, univariate and multivariate logistic regression analyses were used to identify clinical factors influencing the PASI75 and PASI90 response. At week 12, significant improvements were observed in various measures of disease severity and quality of life (BSA, IGA, PASI, DLQI), with all comparisons yielding < 0.0001. Treatment response rates were 74.0% for PASI50, 58.6% for PASI75, and 41.5% for PASI90, while adverse events were rare (0.75%). Prediction models for PASI75 and PASI90 responses exhibited moderate discriminative ability. Independent predictors for both PASI75 and PASI90 included clinical BMI, DLQI, BSA, and IGA (all < 0.05), while job status was an independent predictor for PASI90 only ( < 0.05). Overall, IL-17 inhibitors show substantial efficacy and a favorable safety profile for psoriasis in special sites, with treatment response variability influenced primarily by baseline clinical characteristics such as BMI and disease severity indices.
OBJECTIVES: Facial hair development is a crucial aspect of gender affirmation for transgender men. Despite testosterone therapy, incomplete facial hair growth remains a common concern. This randomized, double-blind, plac...OBJECTIVES: Facial hair development is a crucial aspect of gender affirmation for transgender men. Despite testosterone therapy, incomplete facial hair growth remains a common concern. This randomized, double-blind, placebo-controlled trial evaluated topical 3% minoxidil for facial hair enhancement in 69 transgender men on stable gender-affirming hormone therapy (GAHT). METHODS: This randomized, double-blind, placebo-controlled trial enrolled 69 transgender men on stable GAHT, registered on the Thai Clinical Trials Registry (TCTR20220205004). Participants were randomized 1:1 to receive topical 3% minoxidil or vehicle placebo twice daily for 12 weeks. Primary outcomes were changes in hair density and diameter assessed videodermoscopy. Secondary outcomes included modified Ferriman-Gallwey Score (mFGS), Dermatology Life Quality Index (DLQI), and patient satisfaction. RESULTS: The minoxidil group ( = 34) demonstrated significant improvements versus placebo ( = 35) in beard density (11.16 vs. 0.08 hairs/cm, = 0.01), beard diameter (5.37 vs. -0.33 μm, = 0.01), mustache density (18.45 vs. 1.74 hairs/cm, = 0.003), and mustache diameter (4.83 vs. 1.31 μm, = 0.008). Physician and patient-assessed mFGS showed significant improvements with minoxidil ( < 0.05). Quality of life improved markedly (median DLQI: 5 to 1.5 vs. 4 to 3, < 0.05), with higher patient satisfaction scores (8.16 vs. 5.36, < 0.001). Adverse events were minimal and comparable between groups. CONCLUSIONS: Topical 3% minoxidil represents an effective, safe, and well-tolerated adjunctive treatment for facial hair enhancement in transgender men receiving GAHT.
UNLABELLED: Facial erythema and telangiectasia in rosacea are commonly treated with vascular lasers. Combination with ivermectin 1% cream, may enhance outcomes when combined with laser therapy. This study assesses wheth...UNLABELLED: Facial erythema and telangiectasia in rosacea are commonly treated with vascular lasers. Combination with ivermectin 1% cream, may enhance outcomes when combined with laser therapy. This study assesses whether topical ivermectin improves the efficacy of Potassium Titanyl Phosphate (KTP) 532 nm laser for facial erythema in rosacea. This is a randomized, evaluator-blinded, split-face study. 24 patients with rosacea received four KTP laser sessions; one facial side was additionally treated daily with ivermectin 1% cream. The primary outcome was the change in Normalized Erythema Index (NEI). Secondary measures included Skin Redness Index (SRI), Clinical Erythema Assessment, Physician Global Assessment, telangiectasia score, inflammatory lesion counts, patient satisfaction, and safety. At week 16, the combination side showed a significantly greater NEI reduction than laser alone (ΔNEI%: 16.6 vs 5.3; = 0.04). No significant differences were observed in SRI, and all other scores. However, papule reduction across visits was significantly greater with ivermectin ( = 0.02). Both treatments were well tolerated, with no serious adverse events. KTP laser effectively reduces erythema and inflammatory lesions; adjunctive ivermectin may further enhance papulopustular lesions. The combination is well tolerated, suggesting a potential adjunctive role for topical ivermectin in laser-based rosacea therapy. CLINICAL TRIAL REGISTER: clinicalTrials.gov (NCT06033352).
OBJECTIVES: Localized scleroderma, also called morphea, is an inflammatory cutaneous disorder characterized by sclerosis of the skin and underlying tissues. Morphea is currently classified into 4 subtypes: limited, gener...OBJECTIVES: Localized scleroderma, also called morphea, is an inflammatory cutaneous disorder characterized by sclerosis of the skin and underlying tissues. Morphea is currently classified into 4 subtypes: limited, generalized, linear and mixed. Linear morphea in an en coup de saber pattern (LScs) manifests as band-like, atrophic lesions predominantly affecting the frontoparietal area, leading to facial contour defects and skin pigmentation. However, pharmacological treatments for LScs are limited in meeting the aesthetic expectations of patients. Recently, autologous platelet concentrates have shown great therapeutic potential for tissue regeneration and wound healing, while few studies have been conducted on their use in LScs patients. METHODS AND RESULTS: We present the first report of two patients with inactive LScs that were improved by treatment with injectable platelet-rich fibrin (i-PRF), a second-generation autologous platelet concentrate. Satisfactory aesthetic outcomes were both achieved in two patients within 5 injection sessions, with only mild pain and transient erythema after injection. CONCLUSIONS: Injectable platelet-rich fibrin can be a novel, valid therapeutic alternative for morphea management.
BACKGROUND: The Fas/Fas Ligand (Fas/FasL) system mediates key physiological and pathological pathways. Therapies targeting this system are currently unavailable due to the complexity of the Fas/FasL pathway and the side...BACKGROUND: The Fas/Fas Ligand (Fas/FasL) system mediates key physiological and pathological pathways. Therapies targeting this system are currently unavailable due to the complexity of the Fas/FasL pathway and the side effects associated with reduced apoptosis of cancer cells and the lack of regulation of the immune system. PC111 is a human monoclonal antibody that uniquely targets the soluble (s) but not the membrane-bound (m) FasL, the latter being responsible for immunosurveillance and cancer; the selective mode of action of PC111 precludes its interference with the latter mechanisms. We showed previously that selective blocking soluble FasL (sFasL) could be an effective non-immunosuppressive treatment in mouse models of Pemphigus (PV) and Stevens-Johnson/toxic epidermal necrolysis (SJS/TEN). AIM: To identify additional diseases where sFasL is elevated and potentially involved in their pathogenesis. FINDINGS: sFasL is up regulated in drug reaction with eosinophilia and systemic symptoms. Systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and Sjogren syndrome also have elevated levels of sFasL that are involved in some of the mechanisms underlying the diseases. Finally, sFasL is elevated in the bronchoalveolar lavage (BAL) and plasma of Acute Respiratory Distress Syndrome, while blocking sFasL reverses apoptosis in lung epithelial cells, thus reducing mortality. CONCLUSION: By selectively blocking sFasL, one could potentially modify the course of several diseases.
Deucravacitinib, a selective tyrosine kinase 2 (TYK2) inhibitor, has demonstrated efficacy in randomized trials for plaque psoriasis, but real-world data in Asian populations remain limited. This 24-week prospective real...Deucravacitinib, a selective tyrosine kinase 2 (TYK2) inhibitor, has demonstrated efficacy in randomized trials for plaque psoriasis, but real-world data in Asian populations remain limited. This 24-week prospective real-world cohort study evaluated the effectiveness and safety of deucravacitinib in 101 Chinese adults with plaque psoriasis treated with 6 mg once daily. The prespecified primary endpoint was PASI75 at week 24. Secondary outcomes included PASI90, PASI100, PASI ≤1, and sPGA 0/1 at week 24. At baseline, 68.3% of patients had PASI <10. At week 24, 77.2% achieved PASI75, 58.4% achieved PASI90, and 22.8% achieved PASI100; 81.2% achieved PASI ≤1 and 83.2% achieved sPGA 0/1. A post hoc exploratory analysis suggested numerically higher response rates in patients with predominant small plaque morphology. Treatment was generally well tolerated, with no serious adverse events or discontinuations. Mild pruritic eruptions were infrequent and occurred mainly in individuals with atopic backgrounds. These findings support the real-world effectiveness and safety of deucravacitinib in Chinese patients with plaque psoriasis; morphological observations are exploratory and hypothesis-generating.
BACKGROUND: Androgenetic alopecia (AGA) is the most common form of hair loss, marked by progressive shedding and follicular miniaturization, with advanced stages leading to irreversible follicular loss. Follicular Unit E...BACKGROUND: Androgenetic alopecia (AGA) is the most common form of hair loss, marked by progressive shedding and follicular miniaturization, with advanced stages leading to irreversible follicular loss. Follicular Unit Extraction (FUE) provides favorable outcomes even in patients with reduced follicular density. Concentrated Growth Factors (CGF), a third-generation platelet concentrate rich in growth factors (GFs), may enhance follicular survival, promote growth, and improve density with good safety, yet evidence supporting its combined use with FUE remains limited. OBJECTIVE: This study aims to conduct a prospective clinical comparative trial to evaluate the synergistic effect of CGF when used in conjunction with FUE for the treatment of AGA. METHOD: This study randomized 26 male AGA patients (2022-2024) to receive FUE alone or with CGF injections. Efficacy was assessed hair density, terminal hair ratio, standardized images, and patient/investigator GAIS satisfaction. Safety was evaluated through adverse event monitoring. RESULTS: Baseline characteristics were comparable. At nine months, the experimental group showed significantly higher hair density and a greater increase in terminal hair proportion than the control group ( < 0.05). CONCLUSION: CGF-assisted FUE significantly improved hair density and terminal hair ratio compared with FUE alone, with favorable safety and high patient satisfaction.
Female pattern hair loss (FPHL) significantly affects women's well-being and quality of life (QoL), and low-dose oral minoxidil (LDOM) has increasingly gained attention as a convenient and effective treatment option. Alt...Female pattern hair loss (FPHL) significantly affects women's well-being and quality of life (QoL), and low-dose oral minoxidil (LDOM) has increasingly gained attention as a convenient and effective treatment option. Although hypertrichosis is reported more often with LDOM than with topical formulations, patient perceptions and tolerance of this side effect remain poorly understood. We conducted a telephone survey at a single institution among women with FPHL currently taking or previously treated with LDOM for at least one month to evaluate treatment effectiveness, QoL, and side effect burden using the Women's Androgenetic Alopecia Quality of Life Questionnaire (WAA-QOL). Among 102 participants, the median duration of LDOM use was 12 months. Hair loss severity improved from a median score of 7 to 4 on a 10-point scale. Unwanted hair growth occurred in 71.6% of patients, most commonly on the face, arms, and legs; however, 93.2% did not consider it a reason to discontinue treatment, and most cases were mild or moderate. WAA-QOL scores improved significantly from baseline (67 to 39, p<0.001), with no predictors of unwanted hair growth identified. Overall, patients experienced clinical and QoL improvements, supporting a favorable patient-centered profile for LDOM.
BACKGROUND: Pemphigus is a recurrent and potentially life-threatening autoimmune bullous disease. This study aimed to develop a nomogram to predict relapse risk in pemphigus patients after complete remission (CR). METHOD...BACKGROUND: Pemphigus is a recurrent and potentially life-threatening autoimmune bullous disease. This study aimed to develop a nomogram to predict relapse risk in pemphigus patients after complete remission (CR). METHODS: We retrospectively analyzed 110 pemphigus patients who achieved CR between 2021 and 2023 and were followed for at least 12 months. Independent predictors of relapse were identified using univariate and multivariate Cox regression analyses and incorporated into a nomogram. Model performance was evaluated using calibration curves, receiver operating characteristic (ROC) analysis, and decision curve analysis (DCA). RESULTS: During follow-up, 41.8% of patients experienced relapse. Multivariate analysis identified anemia, hypercholesterolemia, previous relapse history, elevated desmoglein (Dsg) antibody levels, and discontinuation of therapy after CR as independent risk factors. The nomogram demonstrated good discrimination with a concordance index of 0.726 (95% CI, 0.659-0.793). The AUCs for predicting relapse at 6, 12, and 18 months after achieving CR were 0.771, 0.853, and 0.811, respectively. DCA supported the clinical utility of the model, and survival analysis effectively stratified patients into high- and low-risk groups. CONCLUSION: This nomogram may serve as a practical tool for identifying pemphigus patients at high risk of relapse after CR.
BACKGROUND: Biologic therapies have transformed psoriasis management, and their incorporation into Brazil's public healthcare system (SUS) in 2019 expanded access nationwide. However, real-world utilization and perceptio...BACKGROUND: Biologic therapies have transformed psoriasis management, and their incorporation into Brazil's public healthcare system (SUS) in 2019 expanded access nationwide. However, real-world utilization and perceptions remain incompletely understood. OBJECTIVES: To evaluate perceptions, barriers, and prescription patterns regarding biologic therapy among Brazilian dermatologists and patients five years after universal incorporation, while quantifying the prevalence of undertreatment. METHODS: We conducted two independent cross-sectional online surveys throughout 2024 among dermatologists ( = 225) and patients with psoriasis or psoriatic arthritis ( = 1,001). Data on demographics, clinical characteristics, and perceived barriers were analyzed. RESULTS: Overall, 64.9% of dermatologists prescribed biologics, with higher prescribing rates among younger physicians ( = 0.022), those with fewer years of practice ( = 0.013), higher patient volumes ( < 0.001), and practice in tertiary centers ( = 0.001). Only 25.5% of patients were receiving biologics, strongly associated with psoriatic arthritis ( < 0.001), with no difference between public and private care. Key barriers included perceptions that conventional therapies are sufficient (59.5%), insufficient training (38.0%), and administrative burden (45.5%), while patients mainly reported safety (45.7%) and cost (30.9%) concerns. Undertreatment was prevalent, affecting over 50% of patients with moderate-to-severe disease. While 71.3% of non-users were willing to start biologics, only 28.0% had received a medical recommendation. CONCLUSIONS: Persistent educational and structural barriers continue to limit optimal biologic use despite formal availability, highlighting the need for targeted education, streamlined care pathways, and improved physician-patient communication to achieve equitable outcomes.
OBJECTIVE: To compare on-label persistence among adults with psoriasis who switched from other advanced therapies to guselkumab versus subcutaneous tumor necrosis factor inhibitors (SC TNFi), subcutaneous interleukin-17...OBJECTIVE: To compare on-label persistence among adults with psoriasis who switched from other advanced therapies to guselkumab versus subcutaneous tumor necrosis factor inhibitors (SC TNFi), subcutaneous interleukin-17 inhibitors (SC IL-17i), or apremilast. MATERIALS AND METHODS: This retrospective cohort study used U.S. claims data from the IQVIA PharMetrics® Plus database (2016- 2023). Overlap propensity score weights were used to balance cohorts on baseline characteristics. On-label persistence was defined as the absence of drug discontinuation (event) and any dose change relative to the U.S. label (censoring). Survival analyses were used to assess on-label persistence from the start of the maintenance phase. RESULTS: At 12, 18, and 24 months after the start of the maintenance phase, respectively, on-label persistence was 190%, 180%, and 179% more likely on guselkumab versus SC TNFi; 78%, 87%, and 91% more likely on guselkumab versus SC IL-17i; and 187%, 199%, and 193% more likely on guselkumab versus apremilast (all < 0.001). CONCLUSIONS: Patients experiencing suboptimal outcomes with other psoriasis-indicated advanced therapies achieved higher on-label persistence after switching to guselkumab, raising the potential for improved disease control relative to other treatment options.
Costanzo A, Bardazzi F, Burlando M
… +11 more, Campanati A, Carrera C, Dapavo P, Galluzzo M, Gargiulo L, Gisondi P, Loconsole F, Malagoli P, Megna M, Micali G, Piaserico S
BACKGROUND: The clinical definition of moderate psoriasis is debated, affecting treatment eligibility and patient outcomes. OBJECTIVE: A panel of Italian dermatologists aimed to propose practical criteria to define moder...BACKGROUND: The clinical definition of moderate psoriasis is debated, affecting treatment eligibility and patient outcomes. OBJECTIVE: A panel of Italian dermatologists aimed to propose practical criteria to define moderate psoriasis, based on a comprehensive literature review and clinical experience. METHODS: The panel reviewed publications between 2016 and 2024 focusing on key severity scores, including the Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), Dermatology Life Quality Index (DLQI), and Physician's Global Assessment (PGA), along with special area involvement and patient-reported outcomes. RESULTS: Despite variability among studies, and the lack of universally accepted thresholds, the panel defined moderate psoriasis as a BSA of 5%-10%, DLQI of 5-10, a PGA score of 3, and involvement of at least two special areas (e.g. scalp, face, genitals, nails, hands, or feet). Distressing itch and psychosocial impact were also recognized as critical elements influencing perceived disease burden. A composite PGA-based approach, integrating objective measures with patient-centered criteria, is proposed for identifying patients with moderate psoriasis who may benefit from systemic therapy. CONCLUSION: This pragmatic approach may help bridge the gap between guidelines and real-world clinical practice, ensuring more accurate treatment allocation and reducing undertreatment of psoriasis.
PURPOSE: To assess the efficacy and safety of 'fractional' long-pulsed Nd:YAG (FLP-Nd:YAG) for the treatment of severe diffused glans penis venous malformations (GPVM). METHODS: Thirteen patients (Age 1.2-29 years) with...PURPOSE: To assess the efficacy and safety of 'fractional' long-pulsed Nd:YAG (FLP-Nd:YAG) for the treatment of severe diffused glans penis venous malformations (GPVM). METHODS: Thirteen patients (Age 1.2-29 years) with diffused GPVM were enrolled in this study from August 2013 to January 2025. Twelve patients except one young male with erectile dysfunction underwent FLP-Nd:YAG laser treatment (there were intervals between circular spots). Outcome was graded using a five-point scale, and complications were documented after each session. RESULTS: Ten patients reached a 'nearly cured' status, and two patients achieved an 'excellent' outcome. The mean number of sessions was 3.2 (range 2 ∼ 5). Symptoms were significantly alleviated following treatment. The minor complications were blister formation or thin crusting ( = 4), temporary hyperpigmentation ( = 5), superficial scars ( = 2), and mild hypesthesia ( = 1). Major complications included localized tissue depression ( = 1) and long-term fibrous nodules ( = 1). All patients were followed up for 4 to 11 months. Mild recurrence was observed in three cases. CONCLUSION: FLP-Nd:YAG laser therapy achieved high lesion clearance rates with low incidence of major complications in severe diffused GPVMs. It offered rapid treatment with a noninvasive, bloodless procedure, making it especially suitable for pediatric patients.
OBJECTIVES: Prurigo nodularis (PN) is a chronic skin condition characterized by itchy nodules. Understanding the comprehensive patient perspective is essential for guiding treatment strategies. This study evaluated PN di...OBJECTIVES: Prurigo nodularis (PN) is a chronic skin condition characterized by itchy nodules. Understanding the comprehensive patient perspective is essential for guiding treatment strategies. This study evaluated PN disease burden, and satisfaction with non-biologic therapies in France, Germany, Italy, and the UK. METHODS: A cross-sectional survey was conducted in adult patients with a self-reported diagnosis of PN. Disease burden was evaluated using worst itch numeric rating scale (WI-NRS; 0-10, higher indicates more severe), non-itch skin symptoms, EQ-5D-5L, Dermatology Life Quality Index, Patient-Reported Outcomes Measurement Information System Sleep Disturbance, Hospital Anxiety and Depression Scale, and Work Productivity and Activity Impairment. RESULTS: The survey included 165 patients with 67.3%, 30.3%, and 2.4% reporting a WI-NRS score of ≥7, 3-6, and 0-2, respectively. Less than half (45.5%) reported satisfaction with non-biologic treatments. Patients with WI-NRS ≥7 (vs. 3-6) experienced significantly more severe non-itch skin symptoms, and greater negative impacts on health-related quality of life and productivity. CONCLUSION: Disease burden was high and satisfaction with non-biologic treatments was low. Patient-reported number of nodules did not strongly correlate with burden, suggesting that mild disease can induce high burden. Therefore, all aspects of disease should be considered to improve clinical management of PN.
Greco ME, Feresin F, Caro AD
… +10 more, Sasso FP, Proietti I, Cantisani C, di Guardo A, Fiorito LA, Perrotta N, Pellacani G, Potenza C, Nisticò SP, Dattola A
INTRODUCTION: Vitiligo is a chronic autoimmune depigmenting disorder. Ruxolitinib 1.5% cream is currently the only therapy specifically approved for its treatment. In addition, clinical guidelines recommend off label sta...INTRODUCTION: Vitiligo is a chronic autoimmune depigmenting disorder. Ruxolitinib 1.5% cream is currently the only therapy specifically approved for its treatment. In addition, clinical guidelines recommend off label standard therapies, including topical corticosteroids (TCS), topical calcineurin inhibitors (TCI), phototherapy (narrowband UVB or excimer devices), and selected off-label systemic regimens. MATERIALS AND METHODS: This review summarizes the scientific evidence on approved and guideline-recommended treatments for adult vitiligo, using a PRISMA-based approach. Only English-language articles published between 2000 and 2025 were included. Interventions comprised approved therapies and standard treatments recommended by guidelines. Outcomes evaluated were changes in Facial and Total Vitiligo Area Scoring Index (F-VASI/T-VASI), quality of life, and safety. Risk of bias was assessed using the Risk of Bias 2 (RoB 2) tool for randomized controlled trials (RCTs) and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) for non-randomized studies. RESULTS: Ruxolitinib cream demonstrated superior F-VASI responses compared with vehicles in phase II-III RCTs. Evidence supports the efficacy of potent or very potent TCS, TCI, and NB-UVB or targeted 308-nm devices in localized disease. CONCLUSION: Systemic regimens show benefits in selected clinical scenarios, although supporting evidence remains heterogeneous. Treatment selection should be individualized based on disease activity, extent, anatomical site, and patient preferences.
BACKGROUND: Moderate-to-severe atopic dermatitis (AD) often relapses after dupilumab discontinuation. This study compared proactive intermittent tacrolimus on-demand therapy for post-discontinuation maintenance. METHODS...BACKGROUND: Moderate-to-severe atopic dermatitis (AD) often relapses after dupilumab discontinuation. This study compared proactive intermittent tacrolimus on-demand therapy for post-discontinuation maintenance. METHODS: This was a real-world, mixed retrospective-prospective observational study conducted at a single dermatology center. Patients who discontinued dupilumab were identified through retrospective chart review, and a subset was followed prospectively. Based on observed post-discontinuation topical management patterns, patients were classified into a proactive maintenance group or a reactive, as-needed treatment group. Patients were followed for 24 weeks, with extended follow-up to 52 weeks for exploratory analyses. The primary outcome was time to first flare. RESULTS: Median follow-up was 28 weeks. Proactive maintenance prolonged flare-free survival (HR 0.62, 95% CI 0.45-0.86, = 0.004), reduced flare rate (IRR 0.68, 95% CI 0.52-0.88, = 0.003), and lowered steroid use (mean difference -18.4 g, < 0.001). PROs improved more (POEM β -2.1; DLQI β -1.8). Local reactions were comparable (8.3 7.9%); no serious adverse events occurred. CONCLUSION: Proactive intermittent tacrolimus after dupilumab reduces flare risk and steroid burden, improving outcomes, and is a feasible maintenance strategy.
Ferhatosmanoğlu A, Arıca İE, Polat M
… +18 more, Yıldırım M, Kalkan G, Başara Şahin R, Tosun M, Meral EN, Afacan Yıldırım E, Akpınar Kara Y, Aksoy Saraç G, Bal Avcı E, Canat HD, İlhan Erdil D, İnan Yüksel E, Kartal SP, Kaya Özden H, Külcü Çakmak S, Tümtürk M, Yıldırım YA, Karadağ AS
BACKGROUND: This multicenter study aimed to evaluate treatment adherence and satisfaction among patients with acne vulgaris. METHODS: A total of 2,349 patients from 18 dermatology centers across Türkiye completed structu...BACKGROUND: This multicenter study aimed to evaluate treatment adherence and satisfaction among patients with acne vulgaris. METHODS: A total of 2,349 patients from 18 dermatology centers across Türkiye completed structured questionnaires. RESULTS: The participants were predominantly female (79.4%) with a mean age of 21.6 years. Overall, 48% reported consistent adherence to therapy, with significantly lower adherence among males ( < 0.001). The most frequent reasons for nonadherence were forgetfulness (28.7%), dislike of the treatment (26.4%), and reluctance to maintain long-term therapy (21.5%). Treatment adherence was positively associated with higher educational levels ( = 0.006) and greater acne severity ( < 0.001). Logistic regression revealed that systemic oral therapy (OR = 4.37, 95% CI: 3.147-6.086; < 0.001) and oral isotretinoin (OR = 4.81, 95% CI: 3.379-6.869; < 0.001) significantly increased adherence compared to topical therapy. Oral treatment was also independently associated with greater satisfaction (OR = 2.33, 95% CI: 1.767-3.095; < 0.001). Moreover, mild acne severity (OR = 1.67, 95% CI: 1.216-2.297; = 0.002) and older age (per year; OR = 1.05, 95% CI: 1.020-1.088; = 0.001) predicted higher satisfaction. CONCLUSION: Systemic therapies-particularly oral isotretinoin-were associated with improved adherence and satisfaction.