搜索结果：Journal of the European Academy of Dermatology and Venereology : JEADV

Dose reduction (DR) of biologics for psoriasis is already applied in clinical practice but without clear guidelines, while dermatologists addressed the need for guidance. An international consensus may contribute to optimal implementation of biologic DR in clinical psoriasis practices. This consensus study aims for international consensus on DR of biologics in adult patients with psoriasis among dermatologists worldwide. An international, modified eDelphi consensus study was performed among dermatologists worldwide. A total of 11 statements on biologic DR were generated by the international steering committee, based on a previous literature review. Invitations were distributed via international dermatological societies. Participants rated their level of agreement per statement on a 9-point Likert scale. A maximum of three consensus rounds and one (digital) consensus meeting were expected. Statements reached consensus if &#x2265;70% agreed and <15% disagreed; otherwise, statements were revised for a next consensus round. In total, 62 dermatologists from Europe, South America, Asia, North America, Africa and Australia completed the eDelphi. After one round, 9 out of 11 statements reached consensus. The remaining 2 statements were adapted and reached consensus in the second round. Participants agreed on criteria when to consider and initiate/(dis)continue DR and on a two-step DR algorithm for adalimumab, etanercept and ustekinumab. Participants agreed that this two-step DR strategy can also be considered for IL-17 and IL-23 inhibitors while awaiting more scientific evidence on DR of these newer biologics. Dermatologists worldwide reached consensus on when and how to initiate and (dis)continue DR of biologics, and on a two-step DR algorithm for adalimumab, etanercept and ustekinumab in adult patients with psoriasis. DR of IL-17 and IL-23 inhibitors was deemed feasible; however, underlying evidence is still limited. This first international consensus provides essential information for uptake and implementation of biologic DR for psoriasis on a global scale. Psoriasis is a chronic immune&#x2010;mediated disease causing erythematous, scaly, itchy patches interfering with a patient's quality of life. Psoriasis affects 2%&#x2013;3% of the world population. Biologics like TNF&#x3b1;, IL&#x2010;12/23, IL&#x2010;17 and IL&#x2010;23 inhibitors (i) are highly effective treatments improving quality of life. However, as these drugs are prescribed in a fixed, registered dose, patients with controlled disease might be overtreated. Dose reduction (DR) of biologics might reduce avoidable overtreatment, reduce costs and possibly avoid adverse events. DR is already applied in daily practice but without clear (inter)national guidelines, while dermatologists addressed the need for more guidance in previous studies. This study aims for international consensus on DR of biologics in adult patients with psoriasis among dermatologists worldwide. In this international, modified eDelphi consensus study, a total of 62 dermatologists rated their level of agreement on a total of 11 statements on criteria for biologic DR. Statements reached consensus if &#x2265;70% agreed and <15% disagreed; otherwise, statements were revised for a next voting round. It was expected that a maximum of three voting rounds and one (digital) consensus meeting was necessary to reach consensus on all statements. After two rounds, all statements reached consensus. Dermatologists agreed on criteria when to consider and initiate/(dis)continue DR, and on a two&#x2010;step DR algorithm for adalimumab, etanercept (TNF&#x3b1;i) and ustekinumab (IL&#x2010;12/23i). The two&#x2010;step DR strategy was also deemed feasible for IL&#x2010;17i and IL&#x2010;23i; however, underlying evidence remains limited. This international consensus contributes to a clearer and safer uptake of biologic DR in clinical practice globally.

Dupilumab and tralokinumab for atopic dermatitis (AD) target the type 2 axis through different mechanisms of action, which may lead to variation in effectiveness and safety. Head-to-head trials, however, are lacking. To compare the real-world effectiveness and safety of dupilumab and tralokinumab in AD. This prospective cohort study enrolled biologic-/Janus kinase inhibitor-na&#xef;ve AD patients (&#x2265;12&#x2009;years) from the BioDay registry who initiated dupilumab or tralokinumab between November 2021 and September 2024. Visits were scheduled at baseline, 4&#x2009;weeks and every 3&#x2009;months up to 52&#x2009;weeks. Effectiveness outcomes included Eczema Area and Severity Index (EASI), weekly mean pruritus Numeric Rating Scale (NRS), treat-to-target thresholds (EASI&#x2009;&#x2264;&#x2009;7; NRS-pruritus&#x2009;&#x2264;&#x2009;4, with patients discontinuing treatment considered non-responders) and drug survival. Adverse events (AEs) were assessed at each visit. Inverse probability of treatment weighting (IPTW) was used to balance treatment groups. In total, 750 patients were included (643 dupilumab; 107 tralokinumab). After IPTW, baseline characteristics were well balanced. During follow-up, dupilumab patients had lower EASI scores than tralokinumab patients, although differences were not consistently statistically significant (p&#x2009;=&#x2009;0.10). NRS-pruritus scores were significantly lower with dupilumab at all visits (p&#x2009;<&#x2009;0.0001), mean differences did not exceed the 2-point clinical relevance threshold. The probability of achieving EASI&#x2009;&#x2264;&#x2009;7 and NRS-pruritus&#x2009;&#x2264;&#x2009;4 was higher with dupilumab (both p&#x2009;<&#x2009;0.0001), with risk differences of 34.7% and 40.2% at 52&#x2009;weeks, respectively. After 52&#x2009;weeks, dupilumab drug survival was 92.6% vs. 70.6% for tralokinumab. Ocular surface disease incidence was similar (HR 1.0, 95% CI 0.6-1.6, p&#x2009;=&#x2009;0.94) between treatments, leading to discontinuation of dupilumab in n&#x2009;=&#x2009;23 (3.4/100 PY) and tralokinumab in n&#x2009;=&#x2009;5 (5.4/100 PY). In this real-world comparison, dupilumab provided superior effectiveness compared with tralokinumab. In responders continuing treatment, EASI and NRS-pruritus differences were small. More substantial differences were observed when treatment targets EASI&#x2009;&#x2264;&#x2009;7 and NRS-pruritus&#x2009;&#x2264;&#x2009;4, and discontinuation rates were taken into account. Comparing dupilumab and tralokinumab treatment for atopic dermatitis Atopic dermatitis, also known as eczema, is a common long&#x2010;term skin disease that can cause intense itching and redness of the skin. Recently, several new treatments became available for people with moderate&#x2010;to&#x2010;severe eczema. These therapies include dupilumab and tralokinumab, which are given by injection and work by targeting specific parts of the immune system. Although both treatments are effective and safe, choosing between them can be challenging, as very few studies have directly compared these therapies. In this study, we used data from the Dutch BioDay registry, which follows patients with eczema who are treated with these new medicines as part of their usual care. We compared the effectiveness and safety of dupilumab and tralokinumab via assessment of the improvement of skin lesions, using the Eczema Area and Severity Index (EASI), patient&#x2010;reported itch and evaluation of side effects. Patients were followed for 1 year. In total, 750 patients were included in the study: 643 were treated with dupilumab and 107 with tralokinumab. Most patients experienced improvement of their eczema, with lower mean EASI and itch scores over the study period for both treatments. Improvements were slightly greater with dupilumab than with tralokinumab, and more patients stopped tralokinumab treatment because their eczema symptoms did not improve enough. The overall occurrence of side effects did not differ between the two treatments. Irritation of the eyes was the most frequently reported side effect. This real&#x2010;life comparative study may help patients and clinicians weigh the benefits and risks of dupilumab and tralokinumab treatment and support informed treatment decision&#x2010;making.

Sunlight is an important environmental determinant of human physiology, though its effects on health have been studied predominantly in the context of skin disease. While ultraviolet (UV) radiation is a well-established risk factor for skin cancer, evidence suggests that it may also have beneficial systemic effects. This narrative review synthesizes evidence from the past decade on the associations between sunlight and UV radiation exposure and mortality-related outcomes, with a focus on internal malignancies, cardiovascular disease and infectious diseases. A comprehensive search of PubMed and Embase was conducted for English-language articles published between January 2015 and June 2025. Of 148 articles identified, two duplicates were removed. After title and abstract screening, 64 full-text articles were assessed for eligibility; a total of 28 studies met the inclusion criteria and were included in the final review. Among the included studies, four examined cardiovascular outcomes, 12 evaluated infectious diseases, six focused on malignancies and six assessed all-cause mortality. Overall, most studies reported inverse associations between UV exposure and adverse health outcomes, suggesting potential protective effects. For example, a large cohort study found that individuals with 2000&#x2009;kJ/m2 higher annual solar radiation exposure had a 12% lower risk of all-cause mortality. The comparator group had an average of 26&#x2009;days of life lost over the 15.7-year follow-up period. This review identifies a pattern of potential beneficial associations between UV radiation exposure and systemic health outcomes, although confounding by various parameters including the healthy user effect and socioeconomic differences. When the benefits are considered alongside the well-established deleterious cutaneous effects of UV exposure, these findings underscore the need for balanced public health messaging that acknowledges the risks and potential benefits of sunlight exposure.

The aetiology of many inflammatory cutaneous diseases is T cell-driven and involves dysregulation of the immune response. The complex nature of the immune system's involvement in these diseases has made the development of effective, safe, and durable treatments challenging, resulting in a continued demand for the development of novel therapeutics. OX40 and its ligand OX40L have been previously identified as a crucial axis in T cell differentiation and function, and are promising targets for the treatment of T cell-driven disease. Development of OX40/OX40L agonists and inhibitors has potential uses in atopic dermatitis, alopecia areata, psoriasis, and more. While trials of these drugs have mainly been conducted in atopic dermatitis, they show promise in treating other dermatological conditions. Studies of amlitelimab and rocatinlimab have shown some efficacy but have demonstrated increased durability of response. Current concerns with the class are the potential for broad immune suppression with antagonists and the potential for worsening disease with agonists. Additional studies will enable us to determine their benefit-risk ratio in the real-world setting.

Biologic therapies have revolutionized psoriasis management, yet inter-individual response varies significantly and reliable predictors of complete skin clearance remain unclear. This study aimed to identify prognostic predictors of biologic efficacy in patients with psoriasis through a systematic review and meta-analysis. We systematically searched four databases (from their inception to January 28, 2026). Studies were screened and data extracted per predefined criteria; quality was assessed using the Newcastle-Ottawa Scale (NOS), and analyses were performed in Stata 15.0. Thirty studies (n&#x2009;=&#x2009;13,902) were included. Negative predictors of clearance included older age (odds ratio [OR] 0.99, 95% CI 0.98-0.99, p&#x2009;<&#x2009;0.001), higher body mass index (OR 0.94, 95% CI 0.92-0.97, p&#x2009;<&#x2009;0.001), comorbidities (OR 0.75, 95% CI 0.63-0.9, p&#x2009;=&#x2009;0.002), and involvement of special areas (OR 0.71, 95% CI 0.56-0.89, p&#x2009;=&#x2009;0.003). Conversely, a positive family history (OR 1.42, 95% CI 1.18-1.71, p&#x2009;<&#x2009;0.001) emerged as a significant predictor associated with better outcomes. No significant associations were observed for other analysed variables. Older age, higher comorbidity burden, obesity, and special-site involvement are associated with poorer biologic response in psoriasis, whereas family history is associated with better outcomes. These readily available baseline factors facilitate phenotype-based risk stratification and may guide treatment selection in clinical practice.

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To establish consensus-driven practical recommendations for the clinical management of Seborrheic Dermatitis (SD), covering both acute treatment and long-term maintenance strategies. We conducted a modified Delphi consensus involving 33 dermatology experts under the auspices of the EADV. The process utilized an efficient, two-round, blinded voting structure to iteratively refine an initial list of 84 evidence-based statements, facilitating a structured convergence of expert opinion. The iterative Delphi process proved effective in building consensus. After the second round of voting on a refined list of 68 statements, a final consensus was achieved for 44 statements, with near-consensus for another 6. This demonstrates the method's efficiency in harmonizing expert opinion on key clinical questions. This consensus delivers clear, clinically actionable recommendations for managing SD. The key clinical implications include prioritizing combined antifungal and anti-inflammatory strategies for both acute flares and long-term maintenance. Furthermore, the consensus provides a structured framework for therapeutic escalation to systemic agents in extensive or refractory cases, offering practical guidance where formal guidelines are lacking.

Psoriasis is an immune-mediated inflammatory disease driven by dysregulated crosstalk between immune cells and skin-resident cell populations, particularly keratinocytes and fibroblasts. However, transcriptomic findings across studies remain heterogeneous and incompletely integrated. To integrate transcriptomic evidence across independent studies to define reproducible immune-gene expression patterns in plaque psoriasis and identify hypothesis-generating pathways beyond canonical immune programmes. We performed a systematic review and meta-analysis of transcriptomic datasets comparing lesional psoriatic skin with non-lesional skin and healthy controls. All analyses were restricted a priori to a curated set of immune-related genes. Forty-four independent studies comprising 975 samples were harmonized; differential expression within each study was combined using random-effects models. Functional enrichment (Reactome/KEGG/GO) and a systematic comparison with curated resources were conducted. The meta-analysis identified 1780 immune-related genes consistently dysregulated in lesional psoriasis. Enrichment confirmed established immune programmes (e.g. IL-23/Th17 signalling, cytokine-mediated responses and type I interferon pathways). When cross-referenced with curated disease-gene resources, 1119 genes overlapped with previously reported psoriasis-associated genes, whereas 661 genes were not systematically highlighted. Exploratory enrichment among the less-characterized genes suggested additional processes involving glucose metabolism (gluconeogenesis), FoxO signalling and mitophagy, each supported by small gene sets and borderline adjusted p-values, and therefore interpreted as hypothesis-generating rather than definitive. By integrating 44 datasets under an explicit immune-gene framework, this study refines consensus immune signatures in psoriasis and prioritizes metabolic and mitochondrial processes as testable hypotheses for future functional work. These findings contextualize expected immune activation and point to potential interfaces between immunity, cellular energetics and mitochondrial quality control in lesional skin.

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