Background Early identification of treatment response is clinically important in psoriasis management, as it may facilitate timely treatment modification and reduce exposure to ineffective therapies. Although early improvement in the Psoriasis Area and Severity Index (PASI) has been associated with long‐term outcomes for individual therapies, a broadly applicable early PASI threshold across different treatment modalities in real‐world practice remains unclear. Objectives To evaluate the predictive value of early PASI improvement for subsequent PASI90 achievement across multiple psoriasis treatment modalities and to identify a clinically meaningful early PASI response threshold. Methods This prospective, multicenter real‐world cohort study (approval no. 2020‐36) included adult patients with moderate‐to‐severe plaque psoriasis receiving methotrexate, phototherapy, interleukin (IL)‐17 inhibitors, or IL‐23 inhibitors. Receiver operating characteristic (ROC) curve analyses were used to evaluate the predictive performance of week‐4 PASI improvement for achieving PASI90 at 3 and 6 months. The optimal early response threshold was identified using the Youden Index. Multivariable logistic regression analyses were conducted to assess the independent association between early PASI response and subsequent PASI90 achievement. Results A total of 2023 patients were included in the analysis. The optimal week‐4 PASI improvement threshold for predicting PASI90 at 3 months was 62% for IL‐17 inhibitors, 62% for IL‐23 inhibitors, 59% for methotrexate, and 61% for phototherapy. Multivariable logistic regression analyses further demonstrated that a PASI improvement of approximately 60% at Week 4 was independently associated with a higher likelihood of achieving PASI90 at 3 months. Conclusions Achieving PASI60 at Week 4 serves as a consistent early indicator of subsequent PASI90 response across multiple psoriasis treatment modalities. These findings suggest that PASI60 may represent a potentially generalizable early‐response threshold; however, external validation in independent populations is required before its incorporation into routine clinical decision‐making. Trial Registration: Chinese Clinical Trial Registry: ChiCTR2000036186
Background Psoriasis has physical, psychological, and social consequences that extend beyond visible lesions. Quality of life (QoL) is frequently affected by fatigue, sleep disturbance, and impaired intimacy or social functioning. Although biologics can achieve durable skin clearance, their broader effects on daily well‐being in routine practice are less well documented. The CASSIOPEE study assessed these multidimensional outcomes in patients treated with guselkumab. Objectives To evaluate the impact of guselkumab on QoL and objectively measured sleep in adults with moderate‐to‐severe psoriasis treated in routine clinical practice. Methods CASSIOPEE was a prospective, noninterventional, multicentre French study. Adults with moderate‐to‐severe psoriasis initiating guselkumab were followed for 6 months. The primary endpoint was Dermatology Life Quality Index (DLQI) response at month 6 (M6). Secondary outcomes included patient‐reported measures of general health (EQ‐5D‐5L), fatigue (FACIT‐Fatigue), anhedonia (SHAPS), sexual QoL (RSS), cognitive function (PDQ‐5), alexithymia (TAS‐20), and monthly electronic ratings of pain and pruritus. Sleep and physical activity were continuously monitored using a wearable device. Results Among the 207 enrolled patients, 88.9% achieved the DLQI minimal clinically important difference (MCID) by M6 and 60.1% had a DLQI score of 0/1. Sleep duration and quality improved, with 74.5% of patients gaining > 15 min/night and the proportion with high sleep quality increasing from 4.2% to 23.8%. Patient‐reported outcomes showed marked reductions in pruritus, skin pain, and fatigue, together with improvements in general health, sexual QoL, cognitive function, and anhedonia. Clinical effectiveness was reflected by 88.1% of patients achieving a Physician’s Global Assessment (PGA) score ≤ 1 and 55.1% reaching complete skin clearance at M6. Guselkumab was well tolerated; most adverse events were mild and 1.8% led to treatment discontinuation. Conclusions In routine practice, guselkumab was associated with broad benefits across skin and QoL domains, including a marked improvement in wearable‐confirmed sleep outcomes that paraleled symptom relief.
Chronic spontaneous urticaria (CSU) is a common autoimmune skin disorder characterized by recurrent wheals and/or angioedema lasting more than 6 weeks. A substantial proportion of patients remain symptomatic despite treatment with standard or high‐dose H1‐antihistamines, defined as antihistamine‐refractory CSU. This condition is associated with significant disease burden, reduced quality of life, and limited therapeutic options. The pathogenesis of refractory CSU is complex and heterogeneous, involving aberrant mast cell activation through IgE‐dependent and IgE‐independent pathways, dysregulated cytokine networks, and contributions from basophils, eosinophils, and T cells. Such immune imbalance underlies variable responses to conventional therapies. Current management primarily relies on omalizumab and cyclosporine, but their efficacy is limited in a subset of patients. Advances in understanding the disease mechanisms have led to the development of novel therapeutic strategies, including biologics targeting interleukins (IL‐4, IL‐5, IL‐17, and TSLP), Bruton’s tyrosine kinase inhibitors, anti‐KIT antibodies, MRGPRX2 antagonists, and Janus kinase inhibitors. These emerging agents show promising efficacy in clinical trials and may help refine individualized treatment approaches. Further large‐scale studies are warranted to validate their safety and effectiveness, ultimately improving outcomes for patients with refractory CSU.
Background and Objectives Traditional postinflammatory hyperpigmentation (PIH) management delays laser intervention until lesion stabilization, potentially forfeiting a critical therapeutic window. This study aimed to evaluate the efficacy and safety of early active (EA) phase initiation of low‐fluence Q‐switched 1064‐nm Nd:YAG laser treatment (4–8 weeks postonset) versus the relatively stable (RS) phase (> 8 weeks postonset). Materials and Methods In this single‐center retrospective cohort, 48 PIH patients were stratified by disease duration: 4–8 weeks postonset for the EA‐phase group (n = 28) and > 8 weeks postonset for the RS‐phase group (n = 20). All patients received three low‐fluence (1.8–3.0 J/cm2) Q‐switched 1064‐nm sessions at 4‐week intervals. The primary endpoint was objective lesion diameter reduction at 3 months posttreatment, quantified via a multispectral imaging device. Secondary endpoints included the modified Post‐Acne Hyperpigmentation Index (mPAHPI), Physician Global Assessment (PGA), patient satisfaction scores, and safety. Results Early intervention was associated with significantly greater objective lesion diameter reduction rate (median 54.46% vs. 13.13%; p < 0.001), greater mPAHPI improvement rate (41.39% vs. 12.13%; p = 0.003), and greater PGA improvement rate (60.00% vs. 25.00%; p = 0.001). Primary multivariable linear regression identified early intervention as an independent predictor for greater objective diameter reduction (unstandardized B = 39.60; p < 0.001), mPAHPI improvement (B = 23.68; p = 0.001), and PGA improvement (B = 27.14; p = 0.001). Supporting logistic regression consistently indicated early intervention as an independent predictor of dichotomized clinical success (adjusted odds ratios: 4.815–14.108; all ps < 0.05). Early treatment was associated with significant resolution of baseline erythema (82.1% improvement; p = 0.016). Mild hypopigmentation occurred exclusively in the RS‐phase group (25.0%). Conclusions Initiating low‐fluence Q‐switched 1064‐nm laser therapy at 4–8 weeks after PIH onset is associated with enhanced pigment clearance and inflammation resolution compared with delayed intervention, suggesting the potential utility of a stage‐specific paradigm for PIH management.
Increased awareness in women’s health has taken place over the last 5 to 10 years, especially associated with aging, where perimenopause and menopause have been highlighted topics. This review examines how changes with age in women during perimenopause and menopause lead to estrogen-deficient skin and impaired quality of life (QOL). The topics presented include: (1) the reasons why women’s health (perimenopause and menopause) is finally taking a prominent position in the public and medical mindset, (2) chronological (intrinsic) and photo (extrinsic) skin aging characteristics and skin changes by each decade of life, (3) the importance of and the changes to estrogen levels in aging women (especially with perimenopause and menopause) that lead to estrogen-deficient skin, (4) in brief, hormonal and selective estrogen receptor modulators (SERMs), including polyphenolic and isoflavonoid treatments, plus influencing lifestyle factors, and (5) using skin changes, as the “observable organ” and a reflective mirror of internal aging in women that may signal the potential decline of various unseen tissue/organ systems. This represents a different paradigm for the functional aspects in the body associated with the shifts in and loss of estrogen. Thus, skin health with aging (and the decline in and loss of estrogen) may provide nutritional and medical professionals, especially dermatologists, with a unique position to lead a discussion with patients to consider healthiness beyond dermal changes. Finally, potential treatments to assist and/or enhance women’s healthspan and longevity may be part of this exchange in a collaborative examination. Graphical abstract available for this article.
