Risk of Candida Infection and Serious Infections in Patients with Moderate-to-Severe Psoriasis Receiving Biologics: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Biological agents used to treat moderate-to-severe plaque psoriasis have been associated with Candida infection and other serious infections. It is, however, necessary to verify whether biologic agents increase the risk of Candida infection and serious infections and whether these risks vary among biologics. Methods: PubMed, EMBASE, and Cochrane Library were searched for eligible randomized controlled trials (RCTs) from their inception to December 2021. Results from individual RCT were pooled using Peto's method with a fixed-effects model, and I 2 was calculated to assess the heterogeneity. A Cochrane collaboration tool was used to examine bias risk, and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) were used to assess the quality of evidence. Results: This study included 48 published articles with data from 52 RCTs involving 27297 participants. The anti-interleukin (IL)-17 agents (95% confidence interval (CI) = 1.54-3.45, P < 0.0001) and anti-IL-12/23 agents (95% CI = 1.69-3.83, P < 0.0001) were associated with an increased risk of Candida infection compared with placebos, but there was no difference in Candida infection risk between anti-IL-17 agents and tumor necrosis factor inhibitors (TNFi) (95% CI = 0.92-3.07, P=0.09). There was no evidence that the biological agents increased the risk of serious infections in adult psoriasis (95% CI = 0.93-2.06, P=0.11) or that the biologics differed in the risk of serious infections. Conclusions: Our results indicated that anti-IL-17 agents, especially secukinumab, were associated with the increased risk of Candida infection. The clinically used biological agents did not increase the risk of serious infections.

Three-step irradiance schedule versus two-step irradiance schedule for pain control during topical 5-aminolevulinic acid-photodynamic therapy of facial acne in Chinese patients: A prospective randomized comparative study.

BACKGROUND: A two-step irradiance schedule has been found to be useful for pain control during photodynamic therapy (PDT) on nonmelanotic skin cancer and condyloma acuminatum. OBJECTIVES: To evaluate the efficacy of a new three-step irradiance schedule derived from the psychological "peak-end rule" and two-step irradiance schedule in relieving pain during 5-aminolevulinic acid PDT (ALA-PDT) on acne. METHODS: A total of 90 moderate to severe acne patients were enrolled in our study and randomly divided into two groups with a ratio of 1:1. They were treated by a light-emitting diode light source of 633 ± 10 nm after being incubated with 5% ALA for an hour using a two-step or three-step irradiance schedule, respectively. The total irradiance intensity was 84 J/cm2 of each session and the treatment interval was 2 weeks. Pain was recorded 30 min after each PDT using a visual analog scale (VAS). Follow-up was done at baseline and 2 weeks after each treatment. The numbers of lesions were counted after the third treatment through the pictures taken before and all the side effects were recorded at each follow-up visit. RESULTS: Eighty-seven subjects completed the total three treatments (44 cases in Group A and 43 cases in Group B). The average VAS of Group B (1.61 ± 0.67) was significantly lower than that of Group A (3.14 ± 0.67), with a difference of 1.52 ± 0.08 (p < 0.0001) between them. Both groups received a similar effective rate after the total three sessions (88.64% vs. 88.37%, p > 0.05). CONCLUSIONS: The new three-step irradiance method could relieve pain during ALA-PDT more significantly than the two-step schedule with a similar effective rate.

The action of a dietary retinoid on gene expression and cancer induction in electron-irradiated rat skin.

Current models of radiation carcinogenesis generally assume that the DNA is damaged in a variety of ways by the radiation and that subsequent cell divisions contribute to the conversion of the damage to heritable mutations. Cancer may seem complex and intractable, but its complexity provides multiple opportunities for preventive interventions. Mitotic inhibitors are among the strongest cancer preventive agents, not only slowing the growth rate of preneoplasias but also increasing the fidelity of DNA repair processes. Ionizing radiation, including electrons, is a strong inducer of cancer in rat skin, and dietary retinoids have shown potent cancer preventive activity in the same system. A non-toxic dietary dose of retinyl acetate altered gene expression levels 24 hours after electron irradiation of rat skin. Of the 8740 genes on an Affymetrix rat expression array, the radiation significantly (5 fold or higher) altered 188, while the retinoid altered 231, including 16 radiation-altered genes that were reversely altered. While radiation strongly affected the expression of stress response, immune/inflammation and nucleic acid metabolism genes, the retinoid most strongly affected proliferation-related genes, including some significant reversals, such as, keratin 14, retinol binding protein, and calcium binding proteins. These results point to reversal of proliferation-relevant genes as a likely basis for the anti-radiogenic effects of dietary retinyl acetate.