ABSTRACT
Psoriasis is a widespread inflammatory skin disease affecting about 2% of the general population. Recently, treatments that specifically target key proinflammatory cytokines driving the disease have been developed to complement conventional therapies with unspecific antiproliferative or anti-inflammatory effects. Efficient monitoring of treatment efficacy in the context of precision medicine and the assessment of new therapeutics require accurate noninvasive readouts of disease progression. However, characterization of psoriasis treatment remains subjective based on visual and palpatory clinical assessment of features observed on the skin surface. We hypothesized that optoacoustic (photoacoustic) mesoscopy could offer label-free assessment of inflammation biomarkers, extracted from three-dimensional (3D) high-resolution images of the human skin, not attainable by other noninvasive methods. We developed a second-generation ultra-broadband optoacoustic mesoscopy system, featuring sub-10-µm resolution and advanced motion correction technology, and performed 80 longitudinal measurements of 20 psoriatic skin plaques in humans under conventional inpatient treatment or receiving biologics with concomitant topical corticosteroid treatment. Optoacoustic image analysis revealed inflammatory and morphological skin features that indicated treatment efficacy with sensitivity, accuracy, and precision that was not possible using clinical metrics. We identify 3D imaging biomarkers that reveal responses to treatment and offer the potential to facilitate disease and treatment characterization. Our findings suggest that optoacoustic mesoscopy may offer a method of choice for yielding both qualitative and quantitative evaluations of skin treatments that are inaccessible by other methods, potentially enabling optimized therapies and precision medicine in dermatology.
Subject(s)
Photoacoustic Techniques , Psoriasis , Humans , Image Processing, Computer-Assisted/methods , Imaging, Three-Dimensional , Photoacoustic Techniques/methods , Psoriasis/diagnostic imaging , Psoriasis/drug therapy , SkinABSTRACT
Human hands are complex structures essential for a variety of functions in everyday life. This study prospectively investigated the clinical features of hand pruritus and the resulting functional impairment and disease-related burden in 395 patients with chronic pruritus (210 females, median age 59 years). Moderate to very severe hand pruritus was reported by 91.2% of patients, while 79% perceived additional sensory symptoms, such as burning, pain or tingling. A long duration of pruritus occurred in most cases (>6 months: 71.4%). A considerable proportion of patients showed moderate to severe impairment in the use of their hands (40.2%), performance of daily activities (65.0%) and quality of life (45.2%). Disease severity and burden is particularly high when both the palms and the backs of the hands are affected, and when pain is present simultaneously. Pruritus located on the hands is impairing and burdensome due to the functional relevance of the hands in everyday life.
Subject(s)
Pruritus , Quality of Life , Cost of Illness , Female , Humans , Middle Aged , Prospective Studies , Pruritus/diagnosis , Pruritus/epidemiology , Pruritus/etiology , Severity of Illness IndexABSTRACT
Chronic nodular prurigo is characterized by recalcitrant itch. Patient perspectives on therapeutic goals, satisfaction with therapy and efficacy of therapeutic regimens for this condition are unknown. This questionnaire study examined these issues in 406 patients with chronic nodular prurigo from 15 European dermatological centres. Improvements in itch, skin lesions and sleep were the most important goals. Emollients, topical corticosteroids and antihistamines were the most frequently used treatments, while a minority of patients were prescribed potent medications, such as systemic immunosuppressants and gabapentinoids. Most patients were not satisfied with their previous therapy (56.8%), while 9.8% did not receive any therapy despite having active disease. A substantial number of respondents (28.7%) considered none of the therapeutic options effective. Although chronic nodular prurigo is a severe disease, most patients were not treated with potent systemic drugs, which may contribute to the high levels of dissatisfaction and disbelief in available therapies. Specific guidelines for chronic nodular prurigo and the development of novel therapies are necessary to improve care.
Subject(s)
Prurigo , Chronic Disease , Cross-Sectional Studies , Goals , Humans , Patient Satisfaction , Personal Satisfaction , Prurigo/diagnosis , Prurigo/drug therapyABSTRACT
PURPOSE: The aim of our study was to compare thymus sizes in foetuses conceived using assisted reproductive technologies (ART) to those conceived naturally (control group). METHODS: Sonographic foetal thymus size was assessed retrospectively in 162 pregnancies conceived using ART and in 774 pregnancies conceived naturally. The anteroposterior thymic and the intrathoracic mediastinal diameter were measured to calculate the thymic-thoracic ratio (TT-ratio). The ART cases were subdivided into two groups: (1) intracytoplasmic sperm injection (ICSI; n = 109) and (2) in vitro fertilisation (IVF; n = 53). RESULTS: The TT-ratio was smaller in pregnancies conceived using ART (p < 0.001). In both ART subgroups (ICSI and IVF), the TT-ratio was lower compared to the control group (p < 0.001). However, no difference between the two subgroups could be detected (p = 0.203). CONCLUSIONS: Our data show reduced thymus size in foetuses conceived using ART compared to controls. These findings indicate that the use of ART may lead to certain deviations in organogenesis.
