Background Secukinumab, an interleukin-17A inhibitor, has been widely used to treat psoriasis (PsO) and psoriatic arthritis (PsA). However, it remains unclear whether psoriasis patients with PsA achieve comparable effectiveness to those with psoriasis alone. Objective To compare secukinumab's effectiveness in treating psoriatic lesions in psoriasis patients and those with concomitant PsA and to analyse the disparities. Methods A retrospective longitudinal cohort study was conducted on patients treated with secukinumab for PsO and PsA between June 1, 2020 and December 1, 2022. Psoriasis area and severity index (PASI) scores were assessed at weeks 0, 4, 12, 24 and 48. The achievement of PASI 75, PASI 90 and PASI 100 were assessed between the PsO and PsA group with logistic generalised estimating equations using a logit link. Propensity score matching was used for sensitivity analysis. Results 336 psoriatic patients were enrolled, of whom 41 had PsA as well. After adjustment, patients with PsA demonstrated comparable PASI 75/90/100 responses at week 4 but significantly inferior outcomes at weeks 12, 24 and 48 compared to those with psoriasis alone. The treatment disparity in PASI 75 achievement emerged at week 12 (94.9% vs 82.5% odds ratio (OR) 0.264, 95% confidence interval (CI) 0.098-0.711, p =0.008); it was most pronounced at week 48 (95.0% vs 73.3% OR 0.139, 95% CI 0.054-0.356, p <0.001). Limitations Small sample size, retrospective data collection and single-centre validation. Conclusion Concomitant PsA was associated with reduced long-term effectiveness of secukinumab in terms of skin clearance. The difference in efficacy was evident as early as week 12, peaking at week 48, which establishes week 12 as a clinical decision node for reassessment in PsA patients.
Background Skin ageing is a complex biological process influenced by intrinsic and extrinsic factors, leading to progressive structural and functional alterations. High-frequency ultrasound (HFUS) has emerged as a non-invasive imaging modality that provides objective and quantitative information on cutaneous morphology. Objectives To systematically review the current evidence on the use of HFUS in the assessment of skin ageing and to summarise its diagnostic relevance and methodological limitations. Methods A systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines. Three databases (PubMed, Cochrane Library and Embase) were searched up to February 2025 for studies, reviews and meta-analyses employing HFUS to evaluate skin ageing. Twenty-two studies met the inclusion criteria. Results HFUS has been used to analyse the influence of age, sex and ethnicity on skin structure and to identify age-related changes. Consistent findings included a reduction in epidermal thickness and a variable pattern of dermal thickness depending on the anatomical site. Dermal echogenicity tended to decrease in the upper dermis and increase in deeper layers. The subepidermal low-echogenic band (SLEB) was confirmed as a sensitive marker of photoaging, although its interpretation may be influenced by physiological factors. Limitations The included studies were limited by substantial heterogeneity, small sample sizes, predominantly cross-sectional designs, and heterogeneous HFUS protocols, which limit quantitative synthesis. Conclusions HFUS is a valuable, non-invasive and reproducible tool for the objective evaluation of skin ageing. It provides quantitative data on structural skin changes and demonstrates potential clinical utility. Standardised imaging protocols, histologic correlation and longitudinal studies are needed to define consistent diagnostic criteria and assess the efficacy of interventions.
Background Non tuberculous mycobacterial (NTM) infections are a heterogenous group of infections caused by more than 200 species of mycobacteria other than M. tuberculosis complex and M. leprae . The existing guidelines for treatment of NTM infections focus primarily on pulmonary infection. This consensus statement has been formulated for the diagnosis and management of cutaneous NTM infections (excluding M. marinum and M. ulcerans ). Objectives The aim was to develop consensus guidelines for diagnosis and management of cutaneous NTM infections in situations where the organism is identified with known drug susceptibility pattern, and when treatment has to be given empirically. Methods The modified DELPHI method was used for developing the guidelines. Agreement by 3 75% experts was considered as consensus. The panel consisted of nine experts including dermatologists, internists and microbiologists. Initially, 50 statements based on Likert scale were drafted and internally and externally validated. Three rounds were conducted, first two were sent by mail and the third was a live discussion on an online platform. Results Consensus was met on 33 statements which have been discussed in this article. The statement focusses on four key areas: clinical features, diagnostic criteria, investigations and specific and empirical treatment plans. Clinical diagnostic criteria have been agreed upon. Limitations The statement is based on collective experience of experts rather than real-time data. Hence, it should be interpreted as a guideline. Conclusion The consensus statement provides a guideline for dermatologists to identify and diagnose NTM infections. It also provides a step-by-step approach to treating NTM infection when identification of the organism becomes difficult, due to the nature of the disease or due to lack of facilities.
