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Background: Melasma is a prevalent, persistent hyperpigmentation disorder that negatively affects the psychological health of patients. However, the treatment outcome remains unsatisfactory due to the complexity of pathogenesis, recurrence characteristics, and relatively high morbidity. Objectives: To compare the performance of laser‐related therapies in improving the melasma area severity index (MASI) score of melasma and the occurrence of adverse effects by network meta‐analysis (NMA). Methods: From the inception to November 2022, eligible randomized controlled trials were identified. Two investigators independently searched relevant studies from PUBMED, EMBASE, and the Cochrane Library database. Results: A total of 39 clinical studies with 1394 participants were eligible for enrollment. For efficacy, the NMA demonstrated that Q‐switched Nd: YAG laser + topical medications (QSND+TM) was superior to Q‐switched Nd:YAG laser (QSND) [MD = −4.21 (−6.80, −1.63)], Er: YAG laser + topical medications (ERYL+TM) [MD = ‐3.52 (−6.84, −0.19)], and picosecond laser + topical medications (PICO+TM) [MD = −4.80 (−9.33, −0.27)]. The microneedling + topical medications (MN+TM) was superior to picosecond laser (PICO) [MD = −5.26 (−10.44, −0.08)] and topical medications (TM) [MD = −5.22 (−9.20, −1.23)]. The top five of the surface under the cumulative ranking curve value (SUCRA) are Q‐switched Nd:YAG laser + topical medications (QSND+TM 85.9%), oral tranexamic acid (oTA 80.1%), microneedling + topical medications (MN+TM 79.7%), Q‐switched Nd:YAG laser + intense pulse light (QSND+IPL 78.9%), and fractional carbon dioxide laser + topical medications (FCDL+TM 70.5%). Conclusions: In conclusion, the Qs‐Nd:YAG laser with topical medications is the first choice for treating melasma according to the SUCRA value. Among the three treatment modalities, namely MN + TM, PICO, and TM, our recommendation favors MN+TM as the superior choice for enhancing the curative efficacy in melasma. However, the actual clinical choice should also take into account the adverse effects, the skin type of the patient, the duration of the disease, and other relevant factors. [ABSTRACT FROM AUTHOR]

Pressure ulcers often become chronic wounds that are difficult to treat and that tend to recur after healing. In China, convincing data from randomised trials have demonstrated that the pharmaceutical preparations of Periplaneta americana (KangFuXin Liquid, KFX) have a significant efficacy for pressure ulcers. To provide more reference to the clinicians and experts, we conducted a meta‐analysis based on the existing randomised controlled trials (RCTs). We searched the RCTs about KFX for the treatment of pressure ulcers published up to July 2022 in major English and Chinese databases with no language restriction, including PubMed, EMBASE, Web of Science (WOS), Cochrane Central Register of Controlled Trials (CENTRAL), China Network Knowledge Infrastructure (CNKI), Chinese Biomedicine (CBM), Chinese Scientific Journals Database (VIP), and WanFang database. Cochrane Handbook guidelines were used to assess the risk of bias and to evaluate the methodological quality of included RCTs. Estimates of the intervention's effects are expressed as the risk ratio (RR) (95% CI) for binary outcomes and mean difference or standardised mean difference (95% CI) for continuous outcomes. We applied fixed or random effects models, and all analyses were performed using Review Manager version 5.4 and Stata/SE version 12.0. We included 22 studies with a total of 1575 participants. Compared with controls, KFX combined with basic wound care or KFX combined with basic wound care and another topical drug or physical treatment significantly increase clinical efficacy (RR: 1.17; 95% CI, 1.06‐1.28; P = 0.001; I2 = 81%) and shorten the complete healing time (MD = −5.11; 95% CI [−8.19, −2.02]; P = 0.001) for pressure ulcers. Subgroup analysis showed a significant difference in the total clinical effect rate between KFX combined with basic wound care and controls. (n = 1018, RR 1.21, 95% CI [1.07, 1.36], I2 = 82%, P = 0.003). No difference was found in the total clinical effective rate between patients using KFX combined with basic wound care and another topical drug or physical treatment with controls (KFX combined with basic wound care and topical physical treatment: n = 267, RR 1.15, 95% CI [0.86, 1.52], I2 = 87%, P = 0.34; KFX combined with basic wound care and topical drug: n = 290, RR 1.05, 95% CI [0.80, 1.37], I2 = 86%, P = 0.71). Based on treatment duration, subgroup analysis indicated that increasing treatment duration increased the total clinical effective rate when treatment duration was not long. (treatment duration: 14 days: n = 158, OR 5.48, 95% CI [1.47, 20.43], I2 = 0%, P = 0.01; 21 days: n = 132, OR 5.93, 95% CI [1.86, 18.91], I2 = 65%, P = 0.003). When treatment duration was 28 days or 30 days, the results showed that there was no significant difference in total clinical effective rate between interventions and controls (treatment duration: 28 days: n = 107, OR 3.04, 95% CI [0.25, 37.32], I2 = 50%, P = 0.38; 30 days: n = 256, OR 0.58, 95% CI [0.11, 3.15], I2 = 65%, P = 0.53). No data on side effects were reported in any of the 22 studies. The conclusion is that the combination of KFX and basic wound care is effective in increasing the total clinical effectiveness and shortening the complete healing time of pressure ulcers. [ABSTRACT FROM AUTHOR]

Background: Lichen simplex chronicus (LSC) is characterized by localized lichenification and intense itching. It has been reported that the added use of liquid nitrogen cryotherapy (LNC) for LSC has significant efficacy and notable safety. Therefore, we conducted a meta-analysis based on existing randomized controlled trials (RCTs). Method: We searched RCTs on LNC for LSC published up to August 2020 using various databases, including PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, China Network Knowledge Infrastructure (CNKI), Chinese Biomedicine (CBM), Chinese Scientific Journals Database (VIP), and WanFang Database. Other studies were manually identified using the references cited in reviews. We applied fixed- or random-effects models, and all analyses were performed using Review Manager 5.4 software. Results: Twelve RCTs involving 1,066 participants provided eligible data for the meta-analysis. Based on the clinical effective rate, LNC treatment of LSC (risk ratio, RR 1.25, p = 0.005, I2 = 82%) was superior to controls. Subgroup analysis showed that the use of LNC alone (RR 1.04, I2 = 95%, p > 0.05) is not more effective than other therapies in the treatment of LSC, but the addition of LNC to the existing treatment increases the total clinical efficacy. Furthermore, the combined effect of LNC and topical medication (RR 1.39, I2 = 0%, p < 0.0001) was better than that of LNC and oral medication (RR 1.30, I2 = 0%, p < 0.00001). Greater frequency of LNC treatment did not improve the efficacy (thrice a week: RR 1.39 [1.21, 1.60]; twice a week: RR 1.27; once every 2 weeks: RR 1.32). Data from 6 RCTs with 508 participants showed no significant difference in AEs (p = 0.31) associated with added LNC treatment. Conclusion: The addition of LNC (applying a cotton swab soaked with liquid nitrogen to wipe the lesion for approximately 10 s each time) to topical ointments, is effective and safe in the treatment of LSC. Increasing the treatment frequency of LNC did not necessarily improve the efficacy. [ABSTRACT FROM AUTHOR]

In psoriasis, keratinocytes are triggered by factors, such as infection or tissue damage, to release DNA, which thereby activates plasmacytoid dendritic cells and macrophages to induce inflammation, thickened epidermis, and parakeratosis. The recognition of double-stranded (ds)DNA facilitates the activation of cytoplasmic DNA sensors absent in melanoma 2 (AIM2) inflammasome assembly and cyclic guanosine monophosphate adenosine monophosphate (cGAMP) synthase (cGAS) - stimulator of interferon gene (STING) pathway, both of which play a pivotal role in mediating the inflammatory response and driving the progression of psoriasis. Additionally, secreted proinflammatory cytokines can stimulate further DNA release from keratinocytes. Notably, the activation of AIM2 and cGAS-STING signaling pathways also mediates programmed cell death, potentially enhancing DNA overproduction. As a result, excessive DNA can activate these pathways, amplifying persistent inflammatory responses that contribute to the maintenance of psoriasis. Several studies have validated that targeting DNA and its mediated activation of AIM2 and cGAS-STING offers promising therapeutic strategies for psoriasis. Here, we postulate a hypothesis that excessive cytosolic DNA can activate AIM2 and cGAS-STING, mediating inflammation and programmed cell death, ultimately fostering DNA accumulation and contributing to the development of psoriasis., Competing Interests: The authors declare that there are no competing interests associated with the manuscript., (© 2024 Xu et al.)