BACKGROUND:Atopic dermatitis (AD) and psoriasis (PSO) can share clinical and histopathologic features, complicating differentiation. Epithelial membrane antigen (EMA), a marker of epithelial differentiation, is used primarily in neoplastic diseases but is rarely assessed in inflammatory dermatoses. EMA expression in AD remains poorly defined. OBJECTIVE:To evaluate whether EMA immunohistochemistry (IHC) helps distinguish PSO from AD with psoriasiform hyperplasia. METHODS:We retrospectively reviewed 15 AD and 15 PSO patients showing psoriasiform hyperplasia. Clinical, histopathologic features, and EMA IHC patterns were assessed to compare AD and PSO. RESULTS:Clinically, lichenification was more frequent in AD (80.0%) than in PSO (20.0%). Histopathologically, dilated capillaries were more frequent in PSO (100.0%) than in AD (46.7%), whereas dermal eosinophils were present in AD (73.3%) but not in PSO (0%); both differences were statistically significant. Moderate-to-severe acanthosis, parakeratosis, suprapapillary plate thinning, pallor of the upper epidermis, Munro's microabscesses, and diminished granular layer tended to be more frequently observed in PSO, without statistical significance. Regarding EMA, strong expression was more common in AD (73.3%) than in PSO (6.7%), with overlap in moderate staining intensity. The mean intensity grade was significantly higher in AD than in PSO (3.93 vs. 1.93). Diffuse epidermal expression was also more frequent in AD (86.7% vs. 16.7%) among EMA-positive cases. CONCLUSION:EMA IHC may provide adjunctive evidence when distinguishing PSO from AD with psoriasiform hyperplasia. Strong and diffuse epidermal EMA expression may favor AD. Because intensity patterns can overlap, EMA should be interpreted in conjunction with clinical and histopathologic features.
BACKGROUND:Deucravacitinib, an oral tyrosine kinase 2 inhibitor, has demonstrated efficacy and safety in clinical trials; however, real-world evidence remains limited. OBJECTIVE:To evaluate real-world effectiveness, safety, and treatment persistence of deucravacitinib in Korean patients with plaque psoriasis. METHODS:This retrospective multicenter study included adults with plaque psoriasis treated with deucravacitinib at 3 tertiary hospitals. Efficacy was assessed using Psoriasis Area and Severity Index (PASI), body surface area, and Psoriasis Scalp Severity Index at baseline, 4-6, 10-12, and ≥13 months. PASI75 and PASI90 responses were analyzed using observed case (OC) and modified non-responder imputation (mNRI). Adverse events (AEs) and persistence were analyzed descriptively. Univariable and multivariable logistic regression analyses were performed to identify predictors of efficacy and AEs. RESULTS:Forty-two patients (baseline PASI: 12.18±4.01) were included. PASI score decreased significantly to 3.42±3.10 at 4-6 months and 1.72±2.29 at 10-12 months. At 10-12 months, PASI75 and PASI90 response rates were 90.0% and 70.0% (OC; 18/20 and 14/20), and 75.0% and 58.3% (mNRI; 18/24 and 14/24). Thirteen patients (31.0%) reported AEs, primarily mucocutaneous and infectious; 3 patients discontinued deucravacitinib due to AEs. In both univariable and exploratory multivariable analyses, prior antihistamine use showed consistent borderline trends for PASI75 response, while male sex, increasing age, and shorter psoriasis duration showed borderline trends in either model. Treatment persistence was 73.2% at the last follow-up. CONCLUSION:Deucravacitinib demonstrated consistent effectiveness, acceptable safety, and favorable persistence in routine Korean clinical practice, supporting its role as an oral treatment option for psoriasis.
BACKGROUND:Hand eczema is a common inflammatory dermatosis that can severely impair quality of life. Chronic or refractory cases often require systemic therapy. Alitretinoin, a vitamin A derivative, is approved for patients unresponsive to potent topical corticosteroids. OBJECTIVE:This meta-analysis aimed to evaluate its efficacy and safety in chronic hand eczema. METHODS:A PubMed search up to April 10, 2023, identified relevant studies. Outcomes included therapeutic response, adverse events, and laboratory changes. Efficacy was assessed using Physician Global Assessment (PGA), Patient Global Assessment (PaGA), and modified Total Lesion Symptom Score (mTLSS). Subgroup analyses by dosage and treatment duration, with meta-regression, were performed. RESULTS:Twenty-four studies were included. Overall improvement rates were 47.8% for PGA and 36.4% for PaGA, with greater benefit observed in PGA. Higher dosages produced superior efficacy in both PGA and PaGA, and meta-regression confirmed significant differences between 10 mg and 30 mg groups. Longer treatment in 30 mg subgroup was associated with better outcomes for PGA, PaGA, and mTLSS. Adverse events occurred in 48.3% of cases, most commonly headache, skin fissure, back pain, and dry eye. Triglyceride elevation was the most frequent laboratory abnormality. CONCLUSION:Alitretinoin showed favorable efficacy in chronic hand eczema. Consistent with previous studies, we observed a trend of increasing efficacy with higher dosages. Furthermore, at high dosage, greater efficacy was observed with longer durations of use. Adverse events were generally tolerable, supporting its role as a therapeutic option in refractory cases.
