Relationship Between Family History and Quality of Life in Patients with Psoriasis: A Cross-Sectional Study from China.

Purpose: The purpose of this study was to investigate the comprehensive impact of family history of psoriasis, lesion size, disease severity, and the possibility of joint involvement on patients' quality of life(QoL). Patients and Methods: Data from 5961 patients with psoriasis recruited from 440 hospitals throughout China were analyzed. The effects of family history of psoriasis, Body Surface Area(BSA), Psoriasis Area and Severity Index(PASI), and Psoriasis Epidemiology Screening Tool(PEST) on their Dermatology Life Quality Index(DLQI) were studied using a moderated chained mediated effects test. Results: A total of 912 patients (15.30%) had a family history of psoriasis, and 5071 patients (85.10%) had plaque psoriasis. In patients with plaque psoriasis, the variables of family history, PASI, PEST, and DLQI were positively correlated with each other. Additionally, in patients with other types of psoriasis, PASI was positively correlated with PEST and DLQI. Age was positively correlated with PASI and PEST and negatively correlated with DLQI in patients with plaque psoriasis; their Body Mass Index(BMI) and disease duration were in positive correlation with PASI and PEST. The mediation effect of PASI and PEST between family history and DLQI was remarkable in patients with plaque psoriasis and not in those with other types of psoriasis. BSA moderated the association between family history and PASI in patients with plaque psoriasis. Conclusion: PASI and PEST play a chain mediating role in the relationship between family history and DLQI in patients with plaque psoriasis, and high levels of BSA increase the ability of family history to positively predict PASI in plaque psoriasis, thereby affecting the patient's QoL.

The Safety of Ixekizumab in Chinese Adults with Moderate-to-Severe Plaque Psoriasis: Analyses from a Prospective, Single-Arm, Multicenter, 12-Week Observational Study.

INTRODUCTION: Ixekizumab, a monoclonal antibody against interleukin-17A, is efficacious and well tolerated for the treatment of moderate-to-severe plaque psoriasis. However, there are limited data on the real-world safety of ixekizumab in Chinese patient populations. We performed an observational study of ixekizumab for the treatment of moderate-to-severe plaque psoriasis in routine clinical practice in China. Here we present a further safety analysis of this study. METHODS: In this prospective, observational, single-arm, multicenter, post-marketing safety study, adults (≥18 years) with moderate-to-severe plaque psoriasis receiving ixekizumab were enroled at dermatology departments in hospitals across China and prospectively followed for 12 weeks or until their last dose of ixekizumab. In this analysis, we evaluated adverse events (AEs) of special interest (AESIs) identified using MedDRA® search strategies. We also analyzed AEs and AESIs occurring in greater than ten patients in subgroups by age (< 65/≥ 65 years), sex, body weight (< 60/60 kg to < 80/≥ 80 kg), renal impairment, hepatic impairment, history of tuberculosis, history of HBV infection, recent or active infection, history of allergic reaction/hypersensitivity, and number (0-1/2-4/5-7) of ixekizumab 80 mg injections after baseline until day 105. RESULTS: This analysis included 663/666 patients enrolled in the primary study. At least one AESI was reported in 224 (33.8%) patients and considered related to ixekizumab in 181 (27.3%); the most common were injection site reactions (n = 131, 19.8%), infections (n = 80, 12.1%), and allergic reactions/hypersensitivity events (n = 59, 8.9%). The proportion of patients with ≥ 1 AE was higher for females versus males (99/186, 53.2% versus 184/477, 38.6%, p = 0.0006). The proportion of patients with ≥ 1 AE increased with the number of ixekizumab injections after baseline [61/188 (32.4%) for zero to one injection, 151/338 (44.7%) for two to four injections, and 61/106 (57.5%) for five to seven injections; p = 0.0001]. CONCLUSIONS: In this real-world study, ixekizumab was well tolerated in Chinese patients with moderate-to-severe plaque psoriasis, with no difference in safety across most patient subgroups.

Identification of an anoikis-related gene signature and characterization of immune infiltration in skin cutaneous melanoma.

Anoikis is considered strongly associated with a biological procession of tumors. Herein, we utilized anoikis-related genes (ARGs) to predict the prognosis and immunotherapeutic efficacy for skin cutaneous melanoma (SKCM). RNA-seq data were obtained from The Cancer Genome Atlas and Gene Expression Omnibus databases. After dividing patients into novel subtypes based on the expression of prognostic ARGs, K-M survival was conducted to compare the survival status. Subsequently, differentially expressed ARGs were identified and the predictive model was established. The predictive effects were validated using the areas under the curve about the receiver operating characteristic. Moreover, tumor mutation burden, the enriched functional pathway, immune cells and functions, and the immunotherapeutic response were also analyzed and compared. The distribution of model genes at cell level was visualized by the single-cell seq with tumor immune single-cell hub database. Patients of The Cancer Genome Atlas-SKCM cohort were divided into 2 clusters, the cluster 1 performed a better prognosis. Cluster 2 was more enriched in metabolism-related pathways whereas cluster 1 was more associated with immune pathways. A predictive risk model was established with 6 ARGs, showing the areas under the curves of 1-year, 3-year, and 5-year ROC were 0.715, 0,720, and 0.731, respectively. Moreover, risk score was negatively associated with tumor mutation burden and immune-related pathways enrichment. In addition, patients with high-risk scores performed immunosuppressive status but the decreasing scores enhanced immune cell infiltration, immune function activation, and immunotherapeutic response. In this study, we established a novel signature in predicting prognosis and immunotherapy. It can be considered reliable to formulate the complex treatment for SKCM patients.

Effectiveness of Ixekizumab in Chinese Patients with Moderate-Severe Plaque Psoriasis with Special Area Involvement: Subanalysis of a Prospective, Multicenter, Observational Real-World Study.

INTRODUCTION: Ixekizumab, a monoclonal antibody against interleukin-17A, demonstrated effectiveness in the treatment of psoriasis in a Chinese real-world study that was consistent with previous randomized controlled trials. Here, we report further analyses from this study to explore the effectiveness of ixekizumab for treating patients with psoriasis and the involvement of special body areas (scalp, nail, joint, palmoplantar, or genital areas). METHODS: A multicenter, prospective, observational, single-arm, post-marketing surveillance study was conducted in patients aged ≥ 18 years with moderate-to-severe plaque psoriasis and prescribed with ixekizumab in 26 Chinese hospitals. Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores were compared between patients with versus without psoriasis in special body areas in the overall study population and across subgroups by body area. RESULTS: In total, 612 patients were included. At baseline, most patients (93.6%) had psoriasis involvement in at least one special body area. Overall, patients with psoriasis in special body areas reported a worse quality of life (QoL) than those without. Patients with versus without psoriasis in special body areas achieved a comparable mean reduction from baseline in PASI score (10.9 vs. 9.2 at week 2, and 16.9 vs. 14.7 at week 12, respectively) and DLQI score (6.0 vs. 4.4 at week 2, and 9.9 vs. 7.5 at week 12, respectively); a similar proportion of patients also achieved PASI 50 at week 2, and PASI 75 and PASI 90 at week 12, and a DLQI (0/1) at weeks 2 and 12. Several significantly different results were reported between subgroups, the majority of which favored patients with special body area involvement. CONCLUSION: Most patients had psoriasis involvement in a special body area which was associated with worse QoL. Ixekizumab is similarly effective in reducing disease severity and improving QoL in patients with plaque psoriasis across different special body areas.

Factors Associated with Telemedicine Services Provision for Sexually Transmitted Disease Diagnosis and Treatment Among Dermatologists: Evidence from China.

Background: Telemedicine has experienced rapid growth in China, with wide applications for chronic disease management. Objective: This study examined a unique survey dataset to identify the provision of telemedicine services by dermatologists, and to explore its association with physician characteristics, perception of diagnosis, and physicians' perceptions of the advantages and disadvantages of telemedicine. Materials and Methods: Responses to an anonymous voluntary questionnaire were collected from 238 dermatologists in Zhejiang Province, China, via a mixed mode of online and in-person data collection. Data were analyzed using Stata 16.0. Empirical analyses utilized descriptive statistics and multivariable logistical regression. Results: Among a total of 238 physicians, 34.9% provided telemedicine services. Results from the multivariable logistic regression indicated that, if physicians can use their spare time to help patients, seniority and their perception of the benefit of telemedicine are the two most important factors determining their likelihood of providing telemedicine services among the studied sample. Conclusion: Telemedicine holds great promise, but its practices need to be more efficient to save time and reduce the risk of misdiagnosis so that more physicians may participate.

Use of the O-Z Flap to Repair Scalp Defects After Cancer Tumor Resection.

BACKGROUND: Large benign and malignant tumors in the scalp cannot be sutured directly after resection. Instead, skin grafting or skin flap repair is the most commonly used techniques. Local tissue depression and lack of hair growth are some of the drawbacks associated with these techniques. The use of a modified local flap (the O-Z flap) may effectively overcome these issues. OBJECTIVE: To explore the application of O-Z flap in wound repair after excision of benign and malignant tumors of the scalp. METHODS: Between April 2016 and November 2017, the authors treated 6 patients with scalp tumors. They underwent round or oval radical tumor resection with negative margins. Tumor specimens were diagnosed by cryosection during operation. According to the wound defect size and location, surrounding scalp looseness, and hair distribution, 2 rotating flaps in opposite directions were formed on the left and right sides or front and back of the wound. Subsequently, the skin flaps were rotated in opposite directions to repair the wound. RESULTS: The scalp tumors comprised 2 cases of basal cell carcinoma, 2 cases of squamous cell carcinoma, 1 case of hair sheath carcinoma, and 1 case of epidermoid cyst. After complete tumor resection, the wound defect area was between 3.0 cm × 3.5 cm and 5.0 cm × 6.0 cm. After operation, approximately 6% of the tip of the skin flap was necrotized. The wounds healed after 4 weeks of dressing treatment. All skin flaps survived in stage I and no complications occurred. All patients were followed up for 3 to 12 months; the scalps were in good condition and no tumor recurrence was found. CONCLUSIONS: The use of the O-Z flap to repair scalp wounds offers flexible design, good blood circulation, uniform tension, and good hair growth after operation; thus, this technique is suitable for wound repair following scalp tumor resection.

Depression and Anxiety in Rosacea Patients: A Systematic Review and Meta-Analysis.

INTRODUCTION: Depression and anxiety are common among people with rosacea. However, the exact magnitude of the prevalence rate and odds ratios (ORs) for depression and anxiety, respectively, in rosacea patients is unclear, and no systematic review or meta-analysis of published data has yet been performed. We therefore performed as systematic review and meta-analysis to determine the prevalence rates and ORs for depression and anxiety in rosacea patients. METHODS: We performed a systematic search of the PubMed, Embase and Medline databases for all observational studies published up to October 2020 that reported the prevalence rates and ORs for depression and anxiety in patients with rosacea. The primary outcome measures were prevalence rates and ORs for depression and anxiety in patients with rosacea. Heterogeneity across studies was assessed with the I2 statistic. Sources of heterogeneity were explored through subgroup and meta-regression analyses. RESULTS: A total of 14 studies involving 14,134,021 patients with rosacea were included in the systematic review and meta-analysis. The pooled prevalence of depression was 19.6% (95% confidence interval [CI] 15.0-24.3%) and that of anxiety was 15.6% (95% CI 11.8-19.3%). The prevalence of depression and anxiety was significantly lower in studies using clinical criteria to diagnose depression and anxiety (9.2 and 10.2%, respectively) than in those studies using screening tools (26.2% [P < 0.01] and 22.7% [P = 0.03], respectively). The methodological quality of the included studies greatly contributed to the heterogeneity. Patients with rosacea were more likely to experience depression (OR 2.21, 95% CI 1.79-2.72) and anxiety (OR 2.31, 95% CI 1.56-3.44) than healthy controls. CONCLUSIONS: This systematic review and meta-analysis indicates that patients with rosacea are at a higher risk of experiencing depression and anxiety. More efforts are warranted to recognize and manage depression and anxiety in patients with rosacea.

Breastfeeding and Atopic Dermatitis Risk: A Systematic Review and Meta-Analysis of Prospective Cohort Studies.

OBJECTIVES: The effect of breastfeeding on atopic dermatitis (AD) remains controversial. To determine the association -between breastfeeding and AD, we conducted an updated meta-analysis of prospective cohort studies. METHODS: A comprehensive search of PubMed, EMBASE, MEDLINE and Cochrane Library was conducted. Studies meeting the predetermined criteria were evaluated by 2 authors independently. The pooled relative risk (RR) adjusted for confounders with its 95% CI was calculated by a random-effects model. Heterogeneity was explored by subgroup analysis and meta-regression. RESULTS: A total of 27 studies were included for meta-analysis. The pooled estimates for the effect of total and exclusive breastfeeding on AD were 1.01 (95% CI 0.93-1.10) and 0.99 (95% CI 0.88-1.11), respectively. Heterogeneity was substantial across studies (total: p < 0.01 or I2 = 65.2%; exclusive: p < 0.01 or I2 = 72.3%). There was a weak evidence for a protective effect of breastfeeding against AD in cohorts with atopic heredity (total: RR 0.85, 95% CI 0.74-0.98; exclusive: RR 0.83, 95% CI 0.70-0.97). In cohorts without atopic heredity, the effect shifted to the risk side when limited to exclusive breastfeeding (RR 1.19, 95% CI 1.02-1.40) while it dropped towards null when limited to total breastfeeding (RR 1.11, 95% CI 0.94-1.31). CONCLUSIONS: There is no association between AD and breastfeeding, regardless of total or exclusive breastfeeding patterns. There is some evidence for a protective function of exclusive and total breastfeeding in a cohort with atopic heredity. The effect shifts to the risk side in cohorts without atopic heredity. However, these findings should be interpreted with caution because heterogeneity is evident.

Increased Plasma Levels of S100A8, S100A9, and S100A12 in Chronic Spontaneous Urticaria.

BACKGROUND: Chronic spontaneous urticaria (CSU) is a skin disorder with an important immunologic profile. S100A8, S100A9, and S100A12 are the members of S100 family that have been reported to play important role in autoimmune diseases, but the characteristics of these three S100 members have not been defined in CSU. AIMS: This study was performed to investigate the levels of these three S100s in patients with CSU and to study whether they were associated with the severity and clinical characteristics of CSU. MATERIALS AND METHODS: The levels of plasma S100A8, S100A9, and S100A12 were measured in 51 CSU patients and 20 healthy controls using enzyme linked immunosorbent assay kits. The values in the patient group and that of the healthy controls were statistically compared. The relationships between the different markers were evaluated by correlation analysis. RESULTS: The plasma levels of S100A8, S100A9, and S100A12 were significantly higher in CSU patients than those in controls. Interestingly, the level of S100A12 was significantly correlated with S100A8 and S100A9 in CSU patients (P < 0.05 and P < 0.001, respectively). In addition, S100A8, S100A9, and S100A12 were all significantly inversely correlated with blood basophil percentage. CONCLUSIONS: Plasma S100A8, S100A9, and S100A12 levels were elevated in CSU patients. They might be useful biomarkers of CSU, with the potential role in the pathogenesis of CSU.

Proteomic Analysis and Functional Studies of Baicalin on Proteins Associated with Skin Cancer.

Abundant evidence supports the key role of ultraviolet radiation (UVR) in skin cancer development. The human skin, especially the epidermal layer, is the main defense against UV radiation. Baicalin is a major bioactive component of Scutellaria baicalensis Georgi, a plant which has been found to exhibit antitumor activity. The anticarcinogenic mechanism of baicalin is not completely understood. We have reported that baicalin inhibited UVB-induced photo-damage and apoptosis in HaCaT cells (human skin keratinocytes). The aim of the present study is to investigate the cellular gene targets responsible for baicalin's antitumor activity by performing two-dimensional electrophoresis liquid chromatography-mass spectrometry/mass spectrometry (2-DE LC-MS/MS) with HaCaT cells following UVB and baicalin exposure. Two-DE for protein separation was performed, followed by matrix-assisted laser desorption/ionization mass spectrometry and database searches. Nucleophosmin (NPM)-specific siRNA was designed and synthesized, and the small interfering RNA was transfected into skin squamous cancer A431 cells to knockdown the NPM expression. Proliferation and cell cycle status were assessed by CCK8 and flow cytometric analyses, respectively. We have identified 38 protein spots that are differentially expressed in HaCaT cells exposed to baicalin and/or UVB irradiation These proteins are involved in detoxification, proliferation, metabolism, cytoskeleton and motility. In particular, we found several proteins that have been linked to tumor progression and resistance, such as NPM. Baicalin treatment reduced the cellular proliferation rate and induced arrest during the S-phase of the cell cycle in A431 cells. NPM1 silencing significantly enhanced the effect of baicalin. Our data indicated that baicalin results in the significant inhibition of tumor growth in the A431 cell line, which may be associated with the regulation of the NPM gene expression.

Effects of baicalin against UVA-induced photoaging in skin fibroblasts.

Ultraviolet A (UVA) radiation contributes to skin photoaging. Baicalin, a plant-derived flavonoid, effectively absorbs UV rays and has been shown to have anti-oxidant and anti-inflammatory properties that may delay the photoaging process. In the current study, cultured human skin fibroblasts were incubated with 50 µg/ml baicalin 24 hours prior to 10 J/cm(2) UVA irradiation. In order to examine the efficacy of baicalin treatment in delaying UVA-induced photoaging, we investigated aging-related markers, cell cycle changes, anti-oxidant activity, telomere length, and DNA damage markers. UVA radiation caused an increased proportion of ß-Gal positive cells and reduced telomere length in human skin fibroblasts. In addition, UVA radiation inhibited TGF-ß1 secretion, induced G1 phase arrest, reduced SOD and GSH-Px levels, increased MDA levels, enhanced the expression of MMP-1, TIMP-1, p66, p53, and p16 mRNA, reduced c-myc mRNA expression, elevated p53 and p16 protein expression, and reduced c-myc protein expression. Baicalin treatment effectively protected human fibroblasts from these UVA radiation-induced aging responses, suggesting that the underlying mechanism involves the inhibition of oxidative damage and regulation of the expression of senescence-related genes, including those encoding for p53, p66(Shc) and p16.

[Mechanism of telomere shortening in photoaging model induced by 8-methoxypsoralen and ultraviolet A].

OBJECTIVE: To investigate the mechanism of telomere shortening through 8-methoxypsoralen (8-MOP) and subsequent ultraviolet A (UVA) irradiation-induced photoaging model in human dermal fibroblasts (HDFs). METHODS: Photoaging model was established by 8-MOP + UVA in skin HDFs. Flow cytometer, enzyme cytochemistry, immunofluorescence, Western blot and Real-time PCR were employed. RESULTS: The percentage of G1 blockage of 8-MOP + UVA group were higher than that of control group at 24, 48, 72 h and 7 d (61.4% +/- 1.5% vs. 32.8% +/- 1.5%, 69.5% +/- 2.2% vs. 44.9% +/- 2.3%, 88.2% +/- 1.6% vs. 59.8% +/- 1.4%, 90.7% +/- 2.5% vs. 68.5% +/- 2.6%, all P < 0.01). The expression of SA-beta-Gal of 8-MOP + UVA group were higher than that of control group at 24, 48, 72 h and 7 d (34.87% +/- 0.59% vs. 7.11% +/- 0.78%, 59.38% +/- 0.46% vs. 10.57% +/- 0.47%, 72.46% +/- 0.98% vs. 11.67% +/- 0.87%, 94.33% +/- 0.13% vs. 12.04% +/- 0.12%, all P < 0.01). 8-MOP + UVA treatment could significantly aggravate the oxidative DNA damages, the percentage of 8-oxo-dG positive cell of 8-MOP + UVA group (95.78% +/- 0.14%) were significantly higher than that of control group (7.69% +/- 0.09%, P < 0.01), 8-MOP group (9.76% +/- 0.11%, P < 0.01) and UVA group (35.29% +/- 0.14%, P < 0.05). 8-MOP + UVA treatment could accelerate the telomere shortening ,the relative length of telomere of 8-MOP + UVA group were 2.57 +/- 0.05 lower than that of control group (6.63 +/- 0.12, P < 0.01). The levels of P53, P21(WAF-1) and P16(INK-4a) of 8-MOP + UVA group were higher than that of control group (3.00 +/- 0.88 vs. 0.54 +/- 0.10, 2.50 +/- 0.51 vs. 0.42 +/- 0.06, 2.21 +/- 0.34 vs. 0.38 +/- 0.05, all P < 0.01). CONCLUSION: 8-MOP + UVA-induced photoaging of HDFs can be mediated though the regulation of telomere and subsequent P53-dependent signaling pathways.

Mitigation of acute ultraviolet B radiation-mediated damages by baicalin in mouse skin.

BACKGROUND: Solar ultraviolet (UV) irradiation, in particular UVB with a wavelength range between 290 and 320 nm, induces different hazardous effects on the skin, including sunburn, photoaging and cancer. Protection against sun-induced damage is therefore a highly desirable goal. Chemoprevention is being investigated as a potential approach for the management of UV damages including skin cancer. AIM: In this study, to determine the relevance of our in vitro findings to in vivo situations, we assessed the effects of baicalin on UVB-mediated damages in mice skin. METHODS: Balb/C hairless mice were topically pretreated (24 h before UVB) or post-treated (5 min after UVB) with baicalin (1 mg/cm(2) skin area/mouse/100 microl acetone) and were exposed to UVB 24 h later (180 mJ/cm(2)). The animals were sacrificed 1 and 24 h after the UVB exposure. Skin edema, histopathology changes, hydrogen peroxide (H2O2) and cyclobutane pyrimidine dimers (CPDs)-positive cells were assessed to determine the UVB-induced photodamage. RESULTS: Our data demonstrated that a topical application of baicalin, either as a pretreatment or as a post-treatment, resulted in a significant decrease in UVB mediated increases in skin edema, skin hyperplasia and infiltration of leukocytes. Further, baicalin treatments (pre and post) also resulted in a significant decrease in UVB mediated (1) generation of H2O2 and (2) formation of DNA photolesions: CPDs. CONCLUSION: Based on these data, we suggest that baicalin could be developed as an agent for the management of conditions elicited by UV exposure including skin cancer.