I Hsin Huang

Hand–foot skin reaction (HFSR) is a common adverse effect of vascular endothelial growth factor receptor‐tyrosine kinase inhibitors (VEGFR‐TKIs), but its prognostic value remained disputable. In this study, we aimed to assess the association between HFSR and survival outcomes in cancer patients receiving VEGFR‐TKIs. MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from inception to 29 June 2025. Two authors independently selected cohort studies, extracted data and appraised the risk of bias of included studies using the Quality In Prognosis Studies checklist. The outcomes were overall survival (OS) and progression‐free survival (PFS). A random‐effects model meta‐analysis was performed to calculate pooled hazard ratio (HR) with 95% confidence intervals (CIs). Subgroup analyses based on various cancer types and VEGFR‐TKIs types were also conducted. Thirty‐two observational studies involving 6543 patients receiving VEGFR‐TKIs were included, of whom 2671 experienced HFSR. Patients who developed VEGFR‐TKI‐induced HFSR showed better OS (HR 0.54, 95% CI 0.49–0.60) and PFS (HR 0.59, 95% CI 0.53–0.65) compared with those who did not. Subgroup analysis revealed significantly improved OS and PFS in patients with hepatocellular carcinoma, colorectal cancer or non‐small cell lung cancer who developed VEGFR‐TKI‐induced HFSR. HFSR was also a positive prognostic factor for OS and PFS in patients receiving sorafenib, regorafenib, fruquintinib, anlotinib and cabozantinib. In conclusion, VEGFR‐TKI‐induced HFSR may serve as a positive surrogate marker for survival. Early detection and optimal management for HFSR in patients receiving VEGFR‐TKI therapy is needed to maintain treatment efficacy and life quality. Systematic Review Protocol Registration: PROSPERO CRD42024598845.

The outbreak of COVID-19 pandemic has raised urgent vaccine development to prevent viral transmission. Cutaneous adverse events such as erythema multiforme (EM), Stevens–Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) have been observed following COVID-19 vaccination. In this systematic review, we aimed to investigate the clinical features and outcomes of EM/SJS/TEN following COVID-19 vaccination. A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and Cochrane databases up to July 3, 2022. We included studies reporting patients who developed EM, SJS, or TEN following COVID-19 vaccination. A total of 47 studies involving 90 patients with EM and 16 patients with SJS/TEN were reviewed and outlined. EM predominantly occurred after the messenger ribonucleic acid vaccines (70.4%), mostly after the first (47.5%) and second doses (42.4%), with delayed onsets ranging from 1 day to 30 days. SJS/TEN were observed following either the first (55.6%)- or second-dose (33.3%) vaccination, with onset times ranging from 6 hours to 14 weeks. Three EM cases and 1 SJS case showed recurrence upon reexposure to the same vaccines. No mortality was reported. Most patients exhibited improvement or resolution after treatment, with resolution times ranging from 6 days to 8 weeks. In conclusion, EM and epidermal necrolysis, including SJS and TEN, have emerged as potential cutaneous adverse events following COVID-19 vaccine administration. Further research is warranted to elucidate the pathogenesis and casual relationship between COVID-19 vaccines and EM/SJS/TEN.

Background: Cases of autoimmune bullous dermatosis (AIBD) have been reported following COVID-19 vaccination. Objective: We aimed to provide an overview of clinical characteristics, treatments, and outcomes of AIBDs following COVID-19 vaccination. Methods: We conducted a systematic review and searched the Embase, Cochrane Library, and Medline databases from their inception to 27 March 2024. We included all studies reporting ≥ 1 patient who developed new-onset AIBD or experienced flare of AIBD following at least one dose of any COVID-19 vaccine. Results: We included 98 studies with 229 patients in the new-onset group and 216 in the flare group. Among the new-onset cases, bullous pemphigoid (BP) was the most frequently reported subtype. Notably, mRNA vaccines were commonly associated with the development of AIBD. Regarding the flare group, pemphigus was the most frequently reported subtype, with the mRNA vaccines being the predominant vaccine type. The onset of AIBD ranged from 1 to 123 days post-vaccination, with most patients displaying favorable outcomes and showing improvement or resolution from 1 week to 8 months after treatment initiation. Conclusions: Both new-onset AIBD and exacerbation of pre-existing AIBD may occur following COVID-19 vaccination. Healthcare practitioners should be alert, and post-vaccination monitoring may be essential.

Background The comparative efficacy of biologics and small-molecule inhibitors in treating palmoplantar psoriasis (PP) and palmoplantar pustulosis (PPP) remains uncertain. Objective The aim was to perform a systematic review and network meta-analysis (NMA) to compare the efficacy of biologics and small-molecule inhibitors for the treatment of PP and PPP. Methods MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched for eligible studies from inception to May 13, 2023. This NMA was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension Statement for Network Meta-Analyses guidelines. Frequentist random-effects models NMA was performed with the surface under the cumulative ranking curve calculated for ranking. Our primary outcome was the proportion of patients achieving a clear/minimal Palmoplantar Psoriasis/Pustulosis Physician Global Assessment score (PPPGA 0/1 or PPPPGA 0/1) response at 12–16 weeks. Secondary outcomes consisted of the percentage of overall improvement in palmoplantar score and of improvement ≥ 75%, at 12–16 weeks. Results The study comprised a total of 29 randomized controlled trials (RCTs), involving 4798 psoriasis patients with palmoplantar diseases. For PP, 16 RCTs with nine different treatments, including adalimumab, apremilast, bimekizumab, etanercept, guselkumab, infliximab, ixekizumab, secukinumab, and ustekinumab were included for the analysis. In the NMA of PP, secukinumab 300 mg ranked highest (odds ratio [OR] 33.50, 95% confidence interval [CI] 4.37–256.86) in achieving PPPGA 0/1, followed by guselkumab 100 mg (OR 18.68, 95% CI 10.07–34.65). In the case of PPP, seven RCTs with six treatments, including apremilast, etanercept, guselkumab, imsidolimab, spesolimab, and ustekinumab, were included for the analysis. In the NMA of PPP, although no treatment demonstrated a significant difference compared to placebo in achieving PPPPGA 0/1, guselkumab 100 mg showed the greatest statistically significant improvement in the palmoplantar score (weighted mean difference 31.73, 95% CI 19.89–43.57) as a secondary outcome. Conclusion Among all available biologics and small-molecule inhibitors, secukinumab 300 mg and guselkumab 100 mg had the most favorable efficacy in treating PP and PPP, respectively.

Background: The treatment guidelines for hidradenitis suppurativa (HS) vary among different countries, and several biologics and small molecule inhibitors have been tested for treating moderate-to-severe HS over the past few years. However, treatment guidelines for HS vary among different countries. Methods: A systematic review and meta-analysis was performed to exam the efficacy and serious adverse events (SAEs) of biologics and small-molecule inhibitors in treating moderate-to-severe HS. Binary outcomes were presented as risk ratio (RR) with 95% confidence interval (CI). Results: We included 16 RCTs with a total of 2076 participants on nine biologics and three small-molecule inhibitors for treating moderate-to-severe HS, including adalimumab, anakinra, apremilast, avacopan, bimekizumab, CJM112, etanercept, guselkumab, IFX-1, INCB054707, infliximab, and MABp1. The meta-analysis revealed only adalimumab (RR 1.77, 95% CI, 1.44–2.17) and bimekizumab (RR 2.25, 95% CI, 1.03–4.92) achieved significant improvement on hidradenitis suppurativa clinical response (HiSCR), and adalimumab was superior to placebo in achieving dermatology life quality index (DLQI) 0/1 (RR 3.97; 95% CI, 1.70–9.28). No increase in SAEs was found for all included active treatments when compared with placebo. Conclusions: Adalimumab and bimekizumab are the only two biologics effective in achieving HiSCR with acceptable safety profile, whereas adalimumab is the only biologic effective in achieving DLQI 0/1.

Background Clinical practice guidelines (CPGs) developed with rigorous methods can help optimize clinical care for psoriasis patients. Objectives To conduct an updated systematic review and comprehensive critical appraisal of global psoriasis CPGs. Methods A search of MEDLINE and Embase for psoriasis CPGs published between January 1^st 2015 and March 31^st 2021 was performed. Other guideline repositories were also searched for relevant CPGs. Descriptive analysis was conducted to summarize included guidelines. Three critical appraisal tools were used to assess the quality of included CPGs: the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, Lenzer’s red flags, and United States Institute of Medicine’s (IOM) criteria of trustworthiness. Results We included 33 psoriasis CPGs, with 25 openly accessible. Most CPGs were from high socio-demographic index countries in North America and Europe. 5 CPGs received ‘excellent quality’ appraisals across all six AGREE II domains. Stakeholder involvement, rigour of development, and applicability were the three domains with the lowest appraisal scores for AGREE II. 22 CPGs raised at least one red flag indicative of potential bias. By IOM’s standards, external review of the guideline draft prior to publication and clear updating procedures were most often not addressed by guidelines, and only 3 CPGs were assessed as having higher overall trustworthiness. Conclusions Most psoriasis guidelines were unable to consistently demonstrate high quality across multiple appraisal tools. The EuroGuiDerm guideline on the systemic treatment of psoriasis vulgaris was the only CPG to receive ‘excellent quality’ across all six AGREE II domains, raise no Lenzer’s red flags, and have higher trustworthiness by IOM criteria.