Daily Cosmetic Research Analysis
Three high-impact studies span surgery, dermatology, and genetic epidemiology. A drug-target Mendelian randomization suggests ANGPTL3 inhibition (evinacumab) may reduce psoriasis risk. A network meta-analysis identifies upadacitinib and dupilumab as leading options for adolescent atopic dermatitis, while a prospective fluorescence-guided technique (L-ICG) in breast-conserving surgery achieved low final positive margin rates with excellent cosmetic satisfaction.
Summary
Three high-impact studies span surgery, dermatology, and genetic epidemiology. A drug-target Mendelian randomization suggests ANGPTL3 inhibition (evinacumab) may reduce psoriasis risk. A network meta-analysis identifies upadacitinib and dupilumab as leading options for adolescent atopic dermatitis, while a prospective fluorescence-guided technique (L-ICG) in breast-conserving surgery achieved low final positive margin rates with excellent cosmetic satisfaction.
Research Themes
- Drug-target Mendelian randomization guiding therapeutic repurposing in dermatology
- Comparative effectiveness of systemic therapies for adolescent atopic dermatitis
- Fluorescence image-guided breast-conserving surgery optimizing margins and cosmesis
Selected Articles
1. Genetically mimicked effects of evinacumab on psoriasis: a drug target Mendelian randomization study.
Two-sample Mendelian randomization using large GWAS datasets indicates that genetically higher triglycerides and LDL-C increase psoriasis risk and that genetically mimicked ANGPTL3 inhibition (as with evinacumab) lowers risks of psoriasis and arthropathic psoriasis. These results support lipid modulation—particularly via ANGPTL3—as a potential preventive or therapeutic strategy in psoriasis.
Impact: Provides causal inference linking lipid pathways to psoriasis and nominates ANGPTL3 inhibition as a repurposable therapeutic target. Bridges cardiometabolic and dermatologic therapeutics via drug-target MR.
Clinical Implications: Supports consideration of clinical trials testing evinacumab or ANGPTL3 inhibitors for psoriasis and psoriatic arthritis prevention or control, particularly in dyslipidemic patients; encourages integrated management of lipid abnormalities in psoriasis.
Key Findings
- Each SD increase in triglycerides genetically increased psoriasis risk (OR 1.17; 95% CI 1.03–1.32).
- Each SD increase in LDL-C genetically increased psoriasis risk (OR 1.22; 95% CI 1.05–1.43) and was associated with arthropathic psoriasis (OR 1.30), psoriasis vulgaris (OR 1.87), and guttate psoriasis (OR 2.19).
- Genetically mimicked ANGPTL3 inhibition (evinacumab) reduced psoriasis risk (OR 0.752 per SD TG reduction) and arthropathic psoriasis risk (OR 0.266 per SD LDL-C reduction).
Methodological Strengths
- Two-sample Mendelian randomization leveraging large-scale GWAS (FinnGen and UK Biobank).
- Subtype analyses and lipid-specific instruments increase granularity and robustness.
Limitations
- MR assumptions (e.g., no horizontal pleiotropy) may be violated and cannot be fully tested.
- Findings reflect lifelong genetic exposure; translatability to short-term pharmacologic intervention remains uncertain and ancestry is largely European.
Future Directions: Conduct randomized or adaptive trials of evinacumab in psoriasis/psoriatic arthritis, investigate ANGPTL3’s immunodermatologic mechanisms, and assess benefit–risk in dyslipidemic phenotypes.
2. Upadacitinib and Dupilumab Demonstrate Superior Efficacy in the Treatment of Adolescent Atopic Dermatitis: A Network Meta-Analysis.
This PROSPERO-registered network meta-analysis of RCTs in adolescents with moderate-to-severe atopic dermatitis found upadacitinib (30 mg and 15 mg) and dupilumab (300 mg q2w) ranked highest for EASI75 and IGA0/1 responses. Dupilumab and tralokinumab topped itch improvement (PP-NRS4). Safety estimates were unstable due to limited sample sizes, underscoring the need for longer-term data.
Impact: Provides comparative efficacy across leading biologic and JAK inhibitor therapies specifically in adolescents, a population with fewer direct RCT comparisons. Offers actionable ranking to inform treatment selection.
Clinical Implications: Upadacitinib and dupilumab should be prioritized for adolescents with moderate-to-severe AD, with individualized risk–benefit assessments and vigilant safety monitoring. Clinicians should consider tralokinumab for itch improvement and recognize uncertainties in long-term safety.
Key Findings
- Upadacitinib 30 mg/day and 15 mg/day and dupilumab 300 mg q2w ranked highest for EASI75 and IGA0/1 vs placebo and other active comparators.
- Dupilumab 300 mg q2w and tralokinumab 300 mg q2w showed the greatest improvements in PP-NRS4 itch outcomes.
- Safety estimates (TEAEs, SAEs) were unstable due to limited sample sizes; adverse event profiles varied among drugs (e.g., nasopharyngitis, acne).
Methodological Strengths
- Systematic, multi-database search with PROSPERO registration (CRD42023480597).
- Network meta-analysis enabling indirect comparisons across multiple active treatments with sensitivity and bias assessments.
Limitations
- Long-term safety remains uncertain; safety estimates unstable due to limited adolescent sample sizes.
- Heterogeneity in trial designs and endpoints; adolescent-specific dosing and durations vary.
Future Directions: Undertake head-to-head adolescent RCTs with longer follow-up to refine efficacy/safety rankings, include patient-reported outcomes, and evaluate step-up/step-down and combination strategies.
3. L-ICG as an optical agent to improve intraoperative margin detection in breast-conserving surgery: a prospective study.
In a prospective cohort (n=54), local injection of L-ICG enabled fluorescence-guided BCS with low final positive margin rate (1.9%), wide margins, excellent cosmetic satisfaction, and no serious adverse events over a median 12.8-month follow-up. This technique may reduce re-excisions while preserving cosmetic outcomes.
Impact: Demonstrates a practical fluorescence-guided approach with strong cosmetic satisfaction and low residual disease risk, addressing two key goals in breast-conserving surgery.
Clinical Implications: Surgeons may consider incorporating L-ICG-based FIGS to improve intraoperative margin assessment, potentially reducing re-excision rates while optimizing patient-reported cosmetic outcomes.
Key Findings
- Final positive margin rate was 1.9% after intraoperative management (initial intraoperative positive margin 9.3%).
- Median margin widths were 8 mm (cranial), 5.5 mm (caudal), 6 mm (medial), and 8 mm (lateral).
- Cosmetic outcomes were highly favorable: 100% somewhat/very satisfied when clothed; 98% rated Good/Excellent appearance; no serious adverse events and no relapses at median 12.8 months.
Methodological Strengths
- Prospective design with standardized intraoperative frozen-section assessment.
- Patient-reported cosmetic outcomes and quantitative margin metrics collected.
Limitations
- Single-arm, single-center study without a randomized comparator; potential selection bias.
- Short to mid-term follow-up; oncologic durability and generalizability remain to be established.
Future Directions: Conduct multicenter randomized trials comparing L-ICG FIGS vs standard care on re-excision, local control, cosmesis, and cost-effectiveness; optimize dosing/timing and imaging protocols.