ABSTRACT
Primary studies have presented conflicting results on the efficacy of Janus kinase (JAK) inhibitors in treating atopic dermatitis. Hence, it is important to determine the summary effect of JAK inhibitors in order to guide the clinical application of this potentially beneficial drug. To determine the efficacy of JAK inhibitors in treating atopic dermatitis in all age groups. A systematic review with meta-analyses of randomized controlled trials (RCTs) reporting on the effect of JAK inhibitors on the signs and symptoms of atopic dermatitis were conducted. Six electronic databases, registries, and search engines (PubMed, Cochrane Central Register of Controlled Trials [CENTRAL], Google Scholar, ScienceDirect, Clinical.gov, and WHO ICTRP) were searched from inception to September, 2019. The search terms include "atopic dermatitis," "eczema," and "Janus kinase inhibitor." The search was restricted to humans. A total of 413 studies were identified through the database search and hand-searching. After the selection process, five RCTs were included in this systematic review. A meta-analysis of three studies showed that JAK inhibitors were effective in reducing Eczema Area and Severity Index (P = .0001) and pruritus scores (P = .0001). JAK inhibitors appear to be effective in treating atopic dermatitis. Future studies should aim to evaluate its cost-effectiveness and availability to patients especially in developing countries.
Subject(s)
Dermatitis, Atopic , Eczema , Janus Kinase Inhibitors , Dermatitis, Atopic/diagnosis , Dermatitis, Atopic/drug therapy , Humans , Janus Kinase Inhibitors/adverse effects , Protein Kinase Inhibitors/adverse effects , PruritusABSTRACT
There is currently no definitive treatment for vitiligo; various modalities include immune modulators phototherapy and skin camouflage. We investigated the efficacy and safety of topical tacrolimus either as monotherapy or combined therapy in the treatment of vitiligo. Electronic systematic search of the literature was carried out using four major databases. Randomised clinical trials (RCTs) that reported the use of topical tacrolimus in the treatment of human vitiligo have been included in a systematic review and meta-analysis. Meta-analysis was conducted via RevMan, and risk of bias was assessed through the Cochrane quality assessment tool. The protocol was published through PROSPERO (CRD42018112430). A total of 19 studies including 814 patients were included in our systematic review. The random-effects-model meta-analysis of two studies revealed that the tacrolimus and narrowband ultraviolet B (NB-UVB) combination therapy rates is better than NB-UVB alone in inducing >75% repigmentation [RR 1.34 (95% CI: 01.05-1.71), P = 0.02]. Tacrolimus and steroids had similar potency in acheiving >75% repigmentation [RR 1.02 (95% CI: 0.19-5.51), P = 0.98]. Meta-analysis of two studies revealed that the fractional laser and tacrolimus combination therapy is no better than tacrolimus alone in causing >75% repigmentation [RR 2.11 (95% CI: 0.87-5.09), P = 0.10]. Further investigating tacrolimus as mono- or adjuvant therapy for vitiligo is highly recommended. Combining tacrolimus to other treatment options such as steroids, phototherapy and laser may be superior to using tacrolimus alone.
Subject(s)
Immunosuppressive Agents/therapeutic use , Tacrolimus/therapeutic use , Vitiligo/therapy , Administration, Topical , Combined Modality Therapy , Humans , Laser Therapy , PhototherapyABSTRACT
BACKGROUND: Clinical photography is a fundamental component of visually oriented medical fields. The ubiquity of digital technology has brought the capacity to capture clinical photographs to the palm of a practitioner's hand. It is important for general practitioners (GPs) who take clinical photographs of skin lesions to be aware of the associated legal and ethical obligations. OBJECTIVE: The aim of this article is to explore and explain current professional and legal considerations related to the use of clinical photography in general practice. DISCUSSION: Ensuring compliance with professional and legal standards when using clinical photography in general practice requires a firm grasp of the obligations associated with image capture, use, sharing, storage and security. GPs should ensure that before employing clinical photography, they have adequate consent-obtaining practices, regular habits of uploading images to the patient record, and sufficient device security. This will help to ensure that patient images are protected from being compromised.
