A retrospective analysis of 65 patients with acrodermatitis continua of Hallopeau.

There are limited data on acrodermatitis continua of Hallopeau (ACH), particularly among Asian populations. The primary aim was to evaluate the clinical features of ACH and treatment approaches in a sizeable multicentre Asian cohort. We analysed data from adult patients diagnosed with ACH. Of 65 patients with ACH, seven patients had ACH with GPP. Females were more frequently affected in both conditions. Five (71.4%) developed GPP 5-33 years after ACH onset, while two (28.6%) developed GPP concurrently with ACH. The onset age for ACH with GPP (27.9 ± 13.6 years) was earlier than that of isolated ACH (39.8 ± 17.3 years). Metabolic comorbidities were common. ACH exhibited a chronic persistent course. Among systemic non-biologics, acitretin was the most frequently prescribed, followed by ciclosporin and methotrexate. Acitretin and ciclosporin demonstrated similar marked response rates, which surpassed that of methotrexate. Regarding biologics, a marked response was more commonly observed with interleukin-17 inhibitors than with tumour necrosis factor inhibitors. Females are predominant in both conditions. The onset age for ACH among Asian patients is earlier (late 30s) than that for Caucasian patients (late 40s). Interleukin-17 inhibitors may be more effective than tumour necrosis factor inhibitors in managing ACH.

Distinct skin microbiome modulation following different topical acne treatments in mild acne vulgaris patients: A randomized, investigator-blinded exploratory study.

The effects of topical non-antibiotic acne treatment on skin microbiota have rarely been demonstrated. In the study, we randomized 45 mild acne vulgaris participants into three treatment groups, including a cream-gel dermocosmetic containing Aqua Posae Filiformis, lipohydroxy acid, salicylic acid, linoleic acid, niacinamide and piroctone olamine (DC), retinoic acid 0.025% cream (VAA) and benzoyl peroxide 2.5% gel (BP). At months 0, 1 and 3, skin specimens were swabbed from the cheek and forehead and sequenced by targeting V3-V4 regions of the 16 S rRNA gene. QIIME2 was used to characterize bacterial communities. Acne severity, sebum level and tolerability were assessed concomitantly in each visit. We found that both VAA and BP could significantly reduce the bacterial diversity at month 1 (p-value = 0.010 and 0.004 respectively), while no significant reduction was observed in DC group. The microbiota compositions also significantly altered for beta diversity in all treatments (all p-value = 0.001). An increased Cutibacterium with decreased Staphylococcus relative abundance was observed at months 1 and 3 in DC group, while an opposite trend was demonstrated in VAA and BP groups. These findings suggest a potential impact of DC, VAA and BP on the diversity and composition profiles of the skin microbiota in mild acne participants.

Real-world experience of secukinumab in moderate to severe psoriasis patients in Thailand: Characteristics, effectiveness, and safety.

Secukinumab demonstrated high efficacy and favorable safety profile in patients with moderate-to-severe plaque psoriasis (PsO) in clinical trials. However, understanding of patient characteristics and clinical outcomes in real world in Thailand is still limited. To describe patient characteristics, effectiveness and safety of secukinumab in Thai PsO patients. This retrospective study analyzed data from medical records of adult PsO patients who initiated secukinumab at 7 dermatology centers from September 2017 to April 2021. Study outcomes included patient characteristics and changes in Psoriasis Area and Severity Index (PASI) score from baseline at weeks 4 and 16 after secukinumab initiation. Adverse events were recorded. Subgroup analyses by adherence rate and completeness of loading dose were performed. Of 163 patients, the mean (SD) age was 44.0 (14.0) years. Most patients (84.7%) were previously treated with topical therapy while 62.0% and 21.5% of patients had received systemic and biologic therapy, respectively. The mean baseline PASI score was 15.4 (9.3). Overall, the mean PASI score improved by 58.0% at week 4 and 78.4% at week 16. Statistically significant differences in PASI approvement were revealed among subgroups of patients with different loading dose and adherence rate. Adverse effects were reported in 8.0% of patients. The characteristics of patients in this study were slightly different from clinical trials in terms of demographic and clinical characteristics, as well as PsO treatment. Secukinumab was effective and safe in Thai patients with PsO, especially among those with complete loading dose and a higher adherence rate.

The Efficacy and Safety of Chitosan on Facial Skin Sebum.

INTRODUCTION: Seborrhea or oily skin has been one of the most common complaints affecting both men and women physically and psychologically. Chitosan is a biopolymer obtained from the alkaline deacetylation of chitin. Due to its positively charged nature, chitosan can effectively bind to lipids. Therefore, chitosan nanoparticle (CN) formulation may benefit in the reduction of skin sebum. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of CN formulation in the reduction of skin sebum. METHOD: The study was a randomized, double-blinded, placebo-controlled trial in 24 participants aged 18-40 years with clinical seborrhea. Participants were randomly assigned to apply the CN and gum (CN-G) or placebo (gum alone) twice daily for 4 weeks. Sebum level, corneometry, transepidermal water loss (TEWL), and clinical seborrhea grading were evaluated at baseline and week 2 and 4. RESULTS: In the T-zone, sebum levels in the CN-G group were significantly lower than the placebo group at week 4 (p = 0.043), while for the U-zone, sebum levels were not different between groups. There were no statistical differences in corneometry and TEWL at any visit. Although the clinical seborrhea grading in CN-G was lower, it was not significantly different from the placebo. A few cases reported mild and self-limiting scaling and acneiform eruption. CONCLUSION: The CN-G gel could significantly reduce sebum levels on seborrhea patients with acceptable safety profiles.

Methylene blue-mediated photodynamic therapy may be superior to 5% amorolfine nail lacquer for non-dermatophyte onychomycosis.

BACKGROUND: Methylene blue-mediated photodynamic therapy as an antimicrobial has been reported to improve onychomycosis. OBJECTIVES: To compare the short-term efficacy of methylene blue-mediated photodynamic therapy (MB-PDT) and 5% amorolfine nail lacquer (AMO) for toenail onychomycosis using higher intensity and shorter total treatment period than previously reported. METHODS: Twenty-seven toenails with onychomycosis were randomized to receive either six biweekly sessions of MB-PDT or AMO for twelve weeks. Dermoscopic photography was used for onychomycosis severity index assessment under a dermoscopic inspection (d-OSI) at baseline, weeks 6, 10, 14 and 22 as well as microscopic and microbiological tests. Adverse events were recorded. RESULTS: All subjects completed the study. Causative organisms found were exclusively non-dermatophytes including Fusarium spp., Asperillus spp.,and yeasts. Fifteen toenails received MB-PDT, whilst 12 received AMO. D-OSI showed greater improvement in MB-PDT than in AMO groups at weeks 6, 10, 14 as well as 22, with median changes of -2, -3, -4 (P = .055). and - 3 respectively in the MB-PDT group. The AMO group displayed the median d-OSI change of 0 throughout the study period. Mycological cure rate at 22 weeks in MB-PDT and AMO group was 73.3% and 66.67% (P > .05). Clinical cure rate at 22 weeks in MB-PDT (26.7%) was higher than AMO (16.7%), (P > .05). All patients only felt comfortably warm during the MB-PDT treatment. No major adverse events were found in both groups. CONCLUSIONS: MB-PDT appeared to be more efficacious for non-dermatophyte onychomycosis than AMO particularly in a limited period and moderately severe onychomycosis.

Topical 0.5% Timolol Maleate Significantly Enhances Skin-Barrier Restoration After Fractional Carbon Dioxide Laser Treatment for Acne Scars.

BACKGROUND AND OBJECTIVES: Skin barrier is often compromised following ablative fractional carbon dioxide laser (AFCO2 ) therapy for acne scarring. The resultant downtime, even of a few days' duration, can be of significant concern to patients. We evaluated the efficacy and safety of topical 0.5% timolol maleate (TM) for its role in short-term restoration of the skin's biophysical properties after laser treatments. STUDY DESIGN/MATERIALS AND METHODS: This double-blind, placebo-controlled trial included participants aged 18-50 years with atrophic acne scars for at least 3 months. After undergoing laser therapy, they applied 0.5% TM to one cheek and normal saline to the contralateral cheek (control) for 7 days. Corneometry, transepidermal water loss (TEWL) measurement, colorimetry, and clinical outcome parameters (erythema, edema, crusting, pruritus, and tightness scores) were evaluated at baseline and 48, 96, and 168 hours after AFCO2 treatment. RESULTS: Twenty-five healthy participants completed the study. Most participants had Fitzpatrick skin phototype IV. The TM-treated side showed statistically higher corneometry values and lower TEWL than the control side at every follow-up visit (P < 0.001). The crusting score at 96 hours post-AFCO2 treatment was also significantly better on the TM side. No adverse events occurred during the follow-up period. CONCLUSIONS: Application of topical 0.5% TM twice daily improves the skin-barrier function and might promote re-epithelialization after laser procedures. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Efficacy of a one-session fractional picosecond 1064-nm laser for the treatment of atrophic acne scar and enlarged facial pores.

A picosecond-domain laser reportedly elicits positive treatment outcomes for acne scar and enlarged pores, but multiple sessions are often required. We sought to evaluate the efficacy of one-session fractional picosecond 1064-nm laser in treating atrophic acne scar and conspicuous pores. Fifty-nine acne scar patients with skin phototypes III and IV were treated with picosecond 1064-nm laser with microlens array (MLA) (8 mm spot, 0.8 J/cm2, 10 Hz) for one session. The efficacy of acne scar was evaluated by Antera® 3D CS, whereas facial pore counts and diameter were evaluated by VISIA-CR and dermoscopic images, respectively. All measurements were performed at baseline, weeks 1, 2, 4 and 6. Acne scar volume and facial pore counts showed a statistically significant reduction at 1 week and subsequent follow-up period when compared to baseline (weeks 1-6; P < .001). The volume of acne scars and the number of enlarge pores decreased by 22.03% and 15.13%, respectively. Of note, there was no significant change in diameter of facial pores. The adverse events, including erythema and folliculitis, were mild and short-lived. A single session of picosecond 1064-nm laser with MLA was safe and effective in improving atrophic acne scar and the number of enlarged pores.

Snail Soothing and Repairing Cream Improves Skin Hydration after Ablative Fractional CO2 Laser: A Split-Face Randomized Double-Blinded Placebo-Controlled Trial.

BACKGROUND: Ablative fractional carbon dioxide laser (AFCO2) resurfacing causes transient skin barrier disruption characterized by decreased skin hydration and increased transepidermal water loss (TEWL). Snail Soothing and Repairing (SSR) cream, containing several glycoproteins with potential antimicrobial and antioxidant effects, may benefit skin hydration promotion after the laser treatment. OBJECTIVE: To evaluate the efficacy and safety of SSR cream in skin hydration promotion after AFCO2 resurfacing. METHOD: The study was a double-blinded, split-face, placebo-controlled trial in participants aged 18-50 years with atrophic acne scars on both cheeks. After AFCO2 resurfacing, participants applied the product or placebo on either cheek twice daily for 14 days. Corneometry, TEWL, colorimetry, and clinical assessments (edema, erythema, crusting, pruritus, and tightness score) were evaluated at baseline, day 7, and day 14 after AFCO2 resurfacing. RESULTS: From 22 participants in the study, the SSR cream-treated sides showed significantly higher corneometry levels than placebo-treated sides at day 14 (p = 0.033), while TEWL and colorimetry levels were not different at any study visits. Pruritus and tightness scores of the SSR side were lower, but not significant, than the placebo. Other clinical assessments (edema, erythema, and crusting) showed similar results. No significant adverse events took place. CONCLUSION: The SSR cream significantly improved skin hydration, highlighting skin barrier restoration after AFCO2 resurfacing, with a good safety profile.

Gefitinib-associated lichen planus pigmentosus-like eruption.

The epidermal growth factor receptor (EGFR) signaling pathway is one of the oncogenic pathways in non-small cell lung cancer. Gefitinib is classified as a first-generation EGFR-tyrosine kinase inhibitor (TKI). A variety of cutaneous adverse effects related to the drug has been reported. Cutaneous hyperpigmentation is a rare side effect of EGFR inhibitor (EGFRi). Herein, we report a 62-year-old woman with non-small cell lung carcinoma who presented with symmetrical, slate-gray-to-brownish-black macular pigmentation on sun-exposed and non-sun-exposed areas after eight months of gefitinib administration. The clinical features were consistent with lichen planus pigmentosus. This case highlights the unusual hyperpigmented condition occurring in patients taking EGFR-TKIs.

Innovative 1064-nm Nd:YAG Laser Significantly Improves Keratosis Pilaris, A Randomized, Double-Blind, Sham-Irradiation-Controlled Trial.

BACKGROUND AND OBJECTIVE: Keratosis pilaris (KP) is a common follicular disorder for which various topical agents and energy-based devices have been used with some efficacy. To evaluate the efficacy of a novel 1064-nm Nd:YAG laser for the reduction of skin roughness, erythema, and hyperpigmentation in KP subjects. STUDY DESIGN/MATERIALS AND METHODS: Twenty-three subjects with untreated KP on the upper outer arms participated in a randomized, single-blind fashion. One arm of each subject was divided into upper and lower parts. One part was randomized to be treated with an innovative 1064-nm Nd:YAG laser, while the other part received sham irradiation. Subjects received four consecutive treatments at 4-week intervals. Antera3D was used to measure skin roughness, erythema, and hyperpigmentation at baseline and 4 weeks after the last treatment. Moreover, clinical outcomes were also evaluated by subjects' Global Improvement Score (GIS) and subjects' satisfaction grading scores. RESULTS: Twenty-three subjects completed the study. There was statistically significant reduction of skin roughness measured by Antera3D compared with control group (P < 0.001). There were statistically significant improvements of skin roughness, erythema, hyperpigmentation, and overall appearances graded by subjects' Global Improvement Score (P < 0.001 all). Subjects' satisfaction scores were graded significantly better in treatment parts (P < 0.001). No adverse events including burning, bulla, erosion, post-inflammatory hyper/hypopigmentation, and scar formation developed in any subjects throughout the study period. CONCLUSION: This innovative 1064-nm Nd:YAG laser has proved to significantly and safely reduce skin roughness in Thai KP subjects compared with control after four sessions. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Skin manifestations after bariatric surgery.

BACKGROUND: Skin signs observed in morbid obesity may change as the weight reduces, especially post-bariatric surgery (BaS). Data concerning the skin findings exclusively in post-BaS patients remain limited. METHODS: Seventy post-BaS patients were examined for cutaneous abnormalities. The patients were divided into those with successful weight loss (% excessive body weight loss (EBWL) of at least 50%) and a non-successful group (%EBWL < 50%). RESULTS: Forty-six patients with successful weight loss demonstrated a significantly lower prevalence of acanthosis nigricans on the neck, axillae and inguinal areas, keratosis pilaris (KP) and pebble fingers. However, a higher prevalence of alopecia was observed. After adjustment with patients' factors, KP (adjusted odds ratio (aOR) = 0.21, 95%CI 0.06-0.74, p = 0.02) and pebble fingers (aOR = 0.09, 95%CI 0.01-0.89, p = 0.04) remained significantly less likely in patients with successful weight loss. Laboratory results comparing pre- and post-surgery values revealed significant decreases in fasting plasma glucose, hemoglobin A1c, and triglyceride and an increase of high-density lipoproteins in both groups. However, significant decreases of liver aminotransferases (AST and ALT) were observed only in the successful group (p = 0.04, 0.003). Nonetheless, a decrease in vitamin B12 (p = 0.01) was observed in the successful group. CONCLUSION: Weight loss after BaS provided an improvement for metabolic profiles. Successful weight reduction resulted in better skin improvement. However, nutritional supplements may be necessary. TRIAL REGISTRATION: Thai Clinical Trials Registry TCTR20171003002 . Registered October 3. 2017, retrospectively registered.

Pulsed-dye laser as an adjuvant treatment for papulopustular eruptions from epidermal growth factor receptor inhibitors, a randomized blinded split-faced controlled trial.

OBJECTIVES: To investigate the efficacy of pulsed-dye laser (PDL) as an adjunctive treatment for facial papulopustular eruptions from EGFR inhibitors (EGFRi). METHODS: Fourteen patients with facial acneiform eruptions were recruited. Half side of the face was randomized to receive PDL treatment while the other side served as a control. The treatments were delivered every 2 weeks for 4 sessions. The patients were seen at baseline, weeks 2, 4, 6, 8, and 10. Erythema index (EI) measured by colorimeter, the papulopustular lesion count and physician global assessment (PGA) were obtained. Patients were allowed to use their standard treatments for their eruptions. RESULTS: Both arms had a significant decrease in EI from baseline at each subsequent visit. In the laser treated side, the mean (95%CI) EI decreased from 23.5 (22.24-24.76) at baseline to 16.3 (15.01-17.59) at week 10, while those of the sham were 23.49 (22.23-24.75) to 20.51 (19.22-21.8), respectively. The mean change was significantly lower in the PDL arm from week 4 onwards. The lesion counts in both groups also decreased significantly, but the mean difference between the arms was not different. PGA scores followed the same pattern as EI. CONCLUSIONS: Adjunctive treatment with PDL was a safe and effective treatment. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Nitric Oxide Synthesis Inhibition and Anti-Inflammatory Effectof Polypeptide Isolated from Chicken Feather Mealin Lipopolysaccharide-Stimulated RAW 264.7 Macrophages.

Nitric oxide (NO) plays a key role in the pathogenesis of inflammation and has been implicated in endotoxin-induced tissue injury. Chicken feather meal is a rich source of amino acids that may serve as a peptide hydrolysate to inhibit NO activity. Anti-inflammatory hydrolysates of chicken feather meal were prepared and fractionated into five samples based on molecular mass. The smallest fraction (<0.65 kDa) exhibited the highest NO inhibitory activity without cytotoxicity towards macrophage RAW 264.7 cells. Further subfractions were sufficient to obtain amino acid sequences by Q-TOF LC-MS/MS ESI analysis. Of these, the SNPSVAGVR (885.97 Da) peptide and its corresponding pure synthetic peptide have inhibitory activity against NO production by RAW 264.7 cells (IC50=(55.2±0.2) mM) without cytotoxicity. Reverse transcriptase polymerase chain reaction (RT-PCR) and quantitative real-time RT-PCR results revealed that the peptide of the obtained fraction reduced transcript expression levels of the pro-inflammatory cytokines iNOS, TNF-α, COX-2 and IL-6 in lipopolysaccharide-stimulated RAW 264.7 cells. These results suggest that the peptides derived from the chicken feather meal protein could potentially be used as a promising ingredient in functional foods or nutraceuticals against inflammatory diseases.

Skin Manifestations in Patients with Adult-onset Immunodeficiency due to Anti-interferon-gamma Autoantibody: A Relationship with Systemic Infections.

Adult-onset immunodeficiency due to anti-interferon-γ autoantibody is an emerging acquired immunodeficiency with frequent skin manifestations. A retrospective chart review was conducted and identified 41 patients with the syndrome. Skin involvement was detected in 33 (80%) patients, 15 (45%) with infective skin diseases and 27 (82%) with reactive skin disorders. Reactive lesions were mostly neutrophilic dermatoses, e.g. Sweet syndrome. Of note, the presence of neutrophilic dermatoses was highly associated with infections of other sites. An adjusted odds ratio for the existence of infections in patients with neutrophilic dermatoses was 14.79 (95% CI: 5.13, 42.70; p < 0.001). Moreover, neutrophilic dermatoses were significantly correlated with opportunistic infections observed in those with defects in cell-mediated immunity including non-tuberculous mycobacterium and disseminated fungal infection. The odds ratio for opportunistic infections in the presence of neutrophilic dermatoses was 12.35 (95% CI: 5.00, 30.55; p <0.001). Thus, the presence of neutrophilic dermatoses in patients with the syndrome can signal opportunistic infections that warrant physician attention.

Silicone gel enhances the efficacy of Er:YAG laser treatment for atrophic acne scars: A randomized, split-face, evaluator-blinded, placebo-controlled, comparative trial.

BACKGROUND: The effect of topical silicone gel has been studied to prevent scars from burn, postoperative wound and to treat hypertrophic scars. No previous studies have been done to evaluate the efficacy of topical silicone gel on atrophic acne scars. MATERIAL AND METHODS: Nineteen patients were treated with three sessions of ablative Er:YAG laser with 1-month intervals. Following each laser treatment, the randomlyassigned silicone gel or placebo was applied in split-face manner. Objective assessments, which included roughness, smoothness, hydration, transepidermal water loss were measured at baseline and prior to each treatment. Subjective assessments by dermatologists and subjects were done at baseline and 1 month after last laser treatment. RESULTS: The laser treatments were well tolerated and resulted in clinical improvements. Topical silicone gel treatment resulted in significantly less roughness at weeks 4 and 12 compared with placebo (p < 0.05). CONCLUSION: Adding topical silicone gel to ablative Er:YAG laser treatment may provide additional benefits in improving acne scars.

Insulin-like growth factor-1: roles in androgenetic alopecia.

Of all the cytokines or growth factors that have been postulated to play a role in hair follicle, insulin-like growth factor-1 (IGF-1) is known to be regulated by androgens. However, how IGF-1 is altered in the balding scalp has not yet been investigated. In this study, expressions of IGF-1 and its binding proteins by dermal papilla (DP) cells obtained from balding versus non-balding hair follicles were quantified using growth factor array. DP cells from balding scalp follicles were found to secrete significantly less IGF-1, IGFBP-2 and IGFBP-4 (P < 0.05) than their non-balding counterparts. Our data confirmed that the downregulation of IGF-1 may be one of the important mechanisms contributing to male pattern baldness.

Efficacy and Safety of Cannabis Transdermal Patch for Alleviating Psoriasis Symptoms: Protocol for a Randomized Controlled Trial (CanPatch).

Introduction: Current topical treatments for psoriasis offer limited efficacy and are associated with long-term adverse effects in a subset of patients, highlighting the need for new therapeutic options. Cannabidiol (CBD), a non-psychoactive cannabinoid derived from Cannabis sativa L., has shown potential in reversing psoriasis pathology through its action on skin receptors in preclinical studies. Given the promising properties of CBD, transdermal patches containing this compound represent a novel approach to psoriasis treatment. However, comprehensive data on their efficacy and safety remain scarce. Methods: We outline a randomized, double-blind, placebo-controlled trial to assess the efficacy and safety of CBD transdermal patches with minimal tetrahydrocannabinol (THC) in 60 patients with mild to moderate plaque-type psoriasis at a university hospital in Thailand (n = 60). This study aims to evaluate the changes in the local psoriasis severity index (LPSI), itch score via a visual analog scale, and occurrence of adverse events on day 0, 30, 60, and 90 of the study. Additionally, we will examine the alteration in the skin, gut, and oral microbiome in a subset of participants to explore potential correlations with treatment outcomes. The primary outcome will focus on the difference in LPSI scores at the end of the study period, employing an intention-to-treat analysis. Multivariate logistic regression will be used to identify baseline clinical and microbiological predictors of treatment response. Conclusion: This study aims to investigate the efficacy and safety of CBD transdermal patches in alleviating the symptoms of psoriasis. The results of this study may highlight a novel topical treatment option that reduces suffering in patients with psoriasis. We also designed to provide a holistic evaluation by considering both clinical outcomes and the underlying biological mechanisms, including the interaction with the human microbiome. Through this trial, we aim to contribute valuable insights into personalized psoriasis management strategies.

Whey protein and male acne: A double-blind, randomized controlled trial.

BACKGROUND: Acne vulgaris (AV) exacerbation after whey protein (WP) consumption remains inconclusive among experts. OBJECTIVES: To investigate the association between WP consumption and acne severity in men with acne. METHODS: A noninferiority trial was conducted in men with mild to moderate facial and/or truncal acne. After randomization, participants in an intervention group took daily WP 30 g with a non-WP nutritional supplement 18 g (WP group, n = 25), while the control group took a non-WP nutritional supplement 46 g (non-WP group, n = 24). At each follow-up appointment, investigators evaluated acne count (total acne lesions, comedonal lesions, and inflammatory lesions) and severity. RESULTS: Forty-nine participants had a mean age of 19.7 years (standard deviation [SD], 0.9) and 20.3 years (SD, 1.4) in the WP and non-WP groups, respectively. The mean differences in the facial and truncal total acne lesions for the WP and non-WP group were -5.99 (95% confidence interval [CI], -13.18 to 1.19, p = 0.09) and -2.18 (95% CI, -11.83 to 7.48, p = 0.65), respectively. For severity changes, only one (4.3%) participant in the non-WP group reported an increase in the Investigator Global Assessment scale of at least two levels. CONCLUSIONS: In this 6-month trial, men with acne who undertook WP supplementation showed a noninferior difference in the changes in total acne lesions and severity of facial and truncal acne compared with the non-WP group.

International Consensus Definition and Diagnostic Criteria for Generalized Pustular Psoriasis From the International Psoriasis Council.

Importance: Generalized pustular psoriasis (GPP) lacks internationally accepted definitions and diagnostic criteria, impeding timely diagnosis and treatment and hindering cross-regional clinical and epidemiological study comparisons. Objective: To develop an international consensus definition and diagnostic criteria for GPP using the modified Delphi method. Evidence Review: The rarity of GPP presents a challenge in acquiring comprehensive published clinical data necessary for developing standardized definition and criteria. Instead of relying on a literature search, 43 statements that comprehensively addressed the fundamental aspects of the definitions and diagnostic criteria for GPP were formulated based on expert reviews of 64 challenging GPP cases. These statements were presented to a panel of 33 global GPP experts for voting, discussion, and refinements in 2 virtual consensus meetings. Consensus during voting was defined as at least 80% agreement; the definition and diagnostic criteria were accepted by all panelists after voting and in-depth discussion. Findings: In the first and second modified Delphi round, 30 (91%) and 25 (76%) experts participated. In the initial Delphi round, consensus was achieved for 53% of the statements, leading to the approval of 23 statements that were utilized to develop the proposed definitions and diagnostic criteria for GPP. During the second Delphi round, the final definition established was, "Generalized Pustular Psoriasis is a systemic inflammatory disease characterized by cutaneous erythema and macroscopically visible sterile pustules." It can occur with or without systemic symptoms, other psoriasis types, and laboratory abnormalities. GPP may manifest as an acute form with widespread pustules or a subacute variant with an annular phenotype. The identified essential criterion was, "Macroscopically visible sterile pustules on erythematous base and not restricted to the acral region or within psoriatic plaques." Conclusions and Relevance: The achievement of international consensus on the definition and diagnostic criteria for GPP underscores the importance of collaboration, innovative methodology, and expert engagement to address rare diseases. Although further validation is needed, these criteria can serve as a reference point for clinicians, researchers, and patients, which may contribute to more accurate diagnosis and improved management of GPP.