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Szczegielniak M, Lesiak A, Reich A, Opalińska A, Zakrzewski B, Arasiewicz H, Grabowski K, Nolberczak D, Narbutt J. Inflammation-Related Markers in Pediatric Psoriasis: Resistin as a Potential Marker of Psoriasis Severity. J Clin Med 2025; 14:1689. [PMID: 40095687 PMCID: PMC11900389 DOI: 10.3390/jcm14051689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Revised: 02/20/2025] [Accepted: 02/26/2025] [Indexed: 03/19/2025] Open
Abstract
Background/Objective: Psoriasis is a chronic inflammatory skin disease. Studies on adult population have confirmed that there is an association between psoriasis and metabolic as well as cardiovascular diseases. The aim of this study was to evaluate the inflammatory potential and the association of psoriasis with metabolic and cardiovascular risk by analyzing serum concentrations of homocysteine, adiponectin, resistin, leptin, and pentraxin 3 in pediatric patients with psoriasis. Additionally, the study explored correlations between these biomarkers and psoriasis severity. Methods: The study included 75 pediatric patients (47 girls and 28 boys) aged 2-17 years with clinically confirmed psoriasis. In addition, 28 healthy children (15 girls and 13 boys) without psoriasis, metabolic or inflammatory diseases made up the control group. Psoriasis severity was evaluated using the scales psoriasis area and severity index (PASI) and the body surface area (BSA). Serum concentrations of homocysteine, adiponectin, pentraxin 3, resistin, and leptin were measured in both groups. Results: Children with psoriasis exhibited higher serum levels of homocysteine, resistin, leptin, and pentraxin 3 and lower serum levels of adiponectin compared to the control group. A positive correlation was observed between resistin serum concentration and psoriasis severity. Elevated resistin levels were associated with higher PASI and BSA scores. Conclusions: Psoriasis is an inflammatory disease that is potentially linked to metabolic disorders. Resistin may serve as a biomarker for psoriasis severity; however, this relationship requires further research.
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Affiliation(s)
- Magdalena Szczegielniak
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, 90-419 Lodz, Poland; (A.L.); (K.G.); (D.N.); (J.N.)
| | - Aleksandra Lesiak
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, 90-419 Lodz, Poland; (A.L.); (K.G.); (D.N.); (J.N.)
| | - Adam Reich
- Department of Dermatology, Medical College of Rzeszow University, 35-055 Rzeszow, Poland; (A.R.); (A.O.)
| | - Aleksandra Opalińska
- Department of Dermatology, Medical College of Rzeszow University, 35-055 Rzeszow, Poland; (A.R.); (A.O.)
| | - Bartosz Zakrzewski
- Zakrzewscy Clinic of Aesthetic Medicine and Dermatology, 40-246 Katowice, Poland;
| | - Hubert Arasiewicz
- Department of Dermatology and Vascular Anomalies, John Paul II Centre of Pediatrics, 41-200 Sosnowiec, Poland;
| | - Kamil Grabowski
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, 90-419 Lodz, Poland; (A.L.); (K.G.); (D.N.); (J.N.)
| | - Daniel Nolberczak
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, 90-419 Lodz, Poland; (A.L.); (K.G.); (D.N.); (J.N.)
| | - Joanna Narbutt
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, 90-419 Lodz, Poland; (A.L.); (K.G.); (D.N.); (J.N.)
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Petković-Dabić J, Binić I, Carić B, Božić L, Umičević-Šipka S, Bednarčuk N, Dabić S, Šitum M, Popović-Pejičić S, Stojiljković MP, Škrbić R. Effects of Semaglutide Treatment on Psoriatic Lesions in Obese Patients with Type 2 Diabetes Mellitus: An Open-Label, Randomized Clinical Trial. Biomolecules 2025; 15:46. [PMID: 39858442 PMCID: PMC11763288 DOI: 10.3390/biom15010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 12/25/2024] [Accepted: 12/30/2024] [Indexed: 01/27/2025] Open
Abstract
Psoriasis is a chronic inflammatory skin disease with relapsing nature. Estimates are that approximately 2-3% of the world's population suffers from this disease. More severe forms of psoriasis are conditions of high inflammation, which is confirmed by the clinical picture and numerous inflammatory parameters such as C-reactive protein (CRP), cytokines and homocysteine, which vary with disease activity. The objective of this clinical study was to investigate the effect of GLP-1 receptor agonist semaglutide therapy on pro-inflammatory factors in the serum and the severity of the clinical picture of psoriasis in obese patients with type 2 diabetes mellitus (T2DM) on chronic metformin therapy. This randomized clinical study was conducted on 31 psoriatic patients with T2DM that were randomized into two groups: one that received semaglutide during the 12-week trial (n = 15), while the second was control (n = 16). The results demonstrated that the severity of the clinical picture of psoriasis, determined by the Psoriasis Area and Severity Index (PASI) score, was significantly better after the administration of semaglutide (the median baseline PASI score in patients treated with semaglutide was 21 (IQR = 19.8), while after 12 weeks of therapy the score was 10 (IQR = 6; p = 0.002). Also, the quality of life in the group of patients who received the drug, measured by the Dermatology Life Quality Index (DLQI), improved significantly after 3 months (a median baseline DLQI score in the semaglutide group was 14 (IQR = 5) at the beginning of the study, and after 12 weeks of treatment the median DLQI score was 4 (IQR = 4; p = 0.002)). The use of semaglutide led to a significant decrease in pro-inflammatory cytokines in the serum (IL6), as well as a significant decrease in CRP values (p < 0.05). A significant decrease in the body mass index (BMI) value in the semaglutide-treated group was also identified, as well as a significant decrease in the level of low-density cholesterol (LDL) (p < 0.05). In conclusion, semaglutide, based on its systemic anti-inflammatory characteristics, could contribute to the treatment of psoriatic obese patients with T2DM.
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Affiliation(s)
- Jelena Petković-Dabić
- Center for Biomedical Research, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (J.P.-D.); (B.C.); (S.U.-Š.); (N.B.); (S.P.-P.); (M.P.S.)
- Clinic of Skin and Venereal Diseases, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Ivana Binić
- Faculty of Medicine, University of Niš, 18000 Niš, Serbia;
| | - Bojana Carić
- Center for Biomedical Research, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (J.P.-D.); (B.C.); (S.U.-Š.); (N.B.); (S.P.-P.); (M.P.S.)
- Department of Internal Medicine, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Ljiljana Božić
- Department of Microbiology and Immunology, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina;
| | - Sanja Umičević-Šipka
- Center for Biomedical Research, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (J.P.-D.); (B.C.); (S.U.-Š.); (N.B.); (S.P.-P.); (M.P.S.)
- Clinic of Skin and Venereal Diseases, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Nataša Bednarčuk
- Center for Biomedical Research, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (J.P.-D.); (B.C.); (S.U.-Š.); (N.B.); (S.P.-P.); (M.P.S.)
| | - Saša Dabić
- Faculty of Medicine Foča, University of East Sarajevo, 71123 Istočno Sarajevo, Bosnia and Herzegovina;
| | - Mirna Šitum
- Department of Dermatology and Venerology, University Hospital Center “Sestre Milosrdnice”, University of Zagreb, 10000 Zagreb, Croatia;
- Croatian Academy of Science and Arts, 10000 Zagreb, Croatia
| | - Snježana Popović-Pejičić
- Center for Biomedical Research, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (J.P.-D.); (B.C.); (S.U.-Š.); (N.B.); (S.P.-P.); (M.P.S.)
- Department of Internal Medicine, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
- Academy of Science and Arts of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Miloš P. Stojiljković
- Center for Biomedical Research, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (J.P.-D.); (B.C.); (S.U.-Š.); (N.B.); (S.P.-P.); (M.P.S.)
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Ranko Škrbić
- Center for Biomedical Research, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (J.P.-D.); (B.C.); (S.U.-Š.); (N.B.); (S.P.-P.); (M.P.S.)
- Academy of Science and Arts of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
- Department of Pathologic Physiology, First Moscow State Medical University I.M. Sechenov, 119435 Moscow, Russia
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Cintoni M, Palombaro M, Maramao FS, Raoul P, Egidi G, Leonardi E, Bianchi L, Campione E, Rinninella E, Gasbarrini A, Mele MC. Metabolic Disorders and Psoriasis: Exploring the Role of Nutritional Interventions. Nutrients 2023; 15:3876. [PMID: 37764660 PMCID: PMC10535393 DOI: 10.3390/nu15183876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Psoriasis is a chronic autoimmune disease with a close relationship with metabolic diseases such as obesity, diabetes, and dyslipidemia. The aim of this review was to identify the relationship between psoriasis, metabolic diseases, and dietetic therapies. According to recent findings, there is a strong association between psoriasis and obesity as well as vitamin D and micronutrient deficiencies. (2) Methods: This review was conducted via PubMed, aiming to search for studies involving psoriasis linked with metabolic disorders or with nutritional treatments. (3) Results: Our review shows that a healthy lifestyle can positively influence the course of the disease. The maintaining of a proper body weight together with physical activity and good nutritional choices are associated with an improvement in psoriasis severity. A Mediterranean diet rich in fiber, vitamins, and polyphenols may indeed be a strategy for controlling psoriasis symptoms. The effectiveness of this diet lies not only in its anti-inflammatory power, but also in its ability to favorably influence the intestinal microbiota and counteract dysbiosis, which is a risk factor for many autoimmune diseases. (4) Conclusions: In synergy with standard therapy, the adoption of an appropriate diet can be recommended to improve the clinical expression of psoriasis and reduce the incidence of comorbidities.
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Affiliation(s)
- Marco Cintoni
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche Endocrino-Metaboliche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (M.C.); (M.P.); (G.E.); (E.L.); (E.R.); (M.C.M.)
- Centro di Ricerca e Formazione in Nutrizione Umana, Università Cattolica Del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Marta Palombaro
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche Endocrino-Metaboliche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (M.C.); (M.P.); (G.E.); (E.L.); (E.R.); (M.C.M.)
| | - Fabio Stefano Maramao
- UOSD di Dermatologia, Fondazione Policlinico Tor Vergata, Università degli Studi di Roma Tor Vergata, 00133 Rome, Italy; (F.S.M.); (L.B.); (E.C.)
| | - Pauline Raoul
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche Endocrino-Metaboliche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (M.C.); (M.P.); (G.E.); (E.L.); (E.R.); (M.C.M.)
| | - Gabriele Egidi
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche Endocrino-Metaboliche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (M.C.); (M.P.); (G.E.); (E.L.); (E.R.); (M.C.M.)
| | - Elena Leonardi
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche Endocrino-Metaboliche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (M.C.); (M.P.); (G.E.); (E.L.); (E.R.); (M.C.M.)
| | - Luca Bianchi
- UOSD di Dermatologia, Fondazione Policlinico Tor Vergata, Università degli Studi di Roma Tor Vergata, 00133 Rome, Italy; (F.S.M.); (L.B.); (E.C.)
| | - Elena Campione
- UOSD di Dermatologia, Fondazione Policlinico Tor Vergata, Università degli Studi di Roma Tor Vergata, 00133 Rome, Italy; (F.S.M.); (L.B.); (E.C.)
| | - Emanuele Rinninella
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche Endocrino-Metaboliche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (M.C.); (M.P.); (G.E.); (E.L.); (E.R.); (M.C.M.)
- Centro di Ricerca e Formazione in Nutrizione Umana, Università Cattolica Del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy;
| | - Antonio Gasbarrini
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy;
- UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche Endocrino-Metaboliche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Maria Cristina Mele
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche Endocrino-Metaboliche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (M.C.); (M.P.); (G.E.); (E.L.); (E.R.); (M.C.M.)
- Centro di Ricerca e Formazione in Nutrizione Umana, Università Cattolica Del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy;
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Lee SW, Koo HYR, Han KD, Lee YB. Association between Retinal Vein Occlusion and Psoriasis in Korea: A Nationwide Population-based Prospective Cohort Study. Acta Derm Venereol 2022. [DOI: 10.2340/actadv.v101.2299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Psoriasis is a chronic inflammatory skin disease imparting increased risk of cardiovascular diseases. Until now, few studies have reported an increased incidence of ophthalmological retinal vasculopathy in individuals with psoriasis. This study aimed to investigate the association between psoriasis and retinal vein occlusion in the Korean population. Data collected by the National Health Insurance Service between 2009 and 2015 in Korea were analysed. Participants who underwent national health examinations from 2009 to 2012 were enrolled in this study and were divided into either the psoriasis group (n = 3,088) or the control group (n = 465,205). All occurrences of retinal vein occlusion were observed, and the incidence rate of retinal vein occlusion was compared between the psoriasis and control groups. A Cox proportional hazards regression analysis was used to assess the association between psoriasis and newly developed retinal vein occlusion. During a mean 4.37-year follow-up period, 2,034 patients developed retinal vein occlusion. According to multivariable Cox proportional hazard models, individuals with psoriasis had a significantly higher risk of retinal vein occlusion compared with controls (hazard ratio 1.72, 95% confidence interval 1.18–2.51) after adjustments for covariates. This study found that psoriasis was positively associated with retinal vein occlusion.
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Lee SW, Koo HYR, Han KD, Lee YB. Association between Retinal Vein Occlusion and Psoriasis in Korea: A Nationwide Population-based Prospective Cohort Study. Acta Derm Venereol 2022; 102:adv00767. [PMID: 36017679 PMCID: PMC9593496 DOI: 10.2340/actadv.v102.2299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Psoriasis is a chronic inflammatory skin disease imparting increased risk of cardiovascular diseases. Until now, few studies have reported an increased incidence of ophthalmological retinal vasculopathy in individuals with psoriasis. This study aimed to investigate the association between psoriasis and retinal vein occlusion in the Korean population. Data collected by the National Health Insurance Service between 2009 and 2015 in Korea were analysed. Participants who underwent national health examinations from 2009 to 2012 were enrolled in this study and were divided into either the psoriasis group (n = 3,088) or the control group (n = 465,205). All occurrences of retinal vein occlusion were observed, and the incidence rate of retinal vein occlusion was compared between the psoriasis and control groups. A Cox proportional hazards regression analysis was used to assess the association between psoriasis and newly developed retinal vein occlusion. During a mean 4.37-year follow-up period, 2,034 patients developed retinal vein occlusion. According to multivariable Cox proportional hazard models, individuals with psoriasis had a significantly higher risk of retinal vein occlusion compared with controls (hazard ratio 1.72, 95% confidence interval 1.18-2.51) after adjustments for covariates. This study found that psoriasis was positively associated with retinal vein occlusion.
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Affiliation(s)
| | | | | | - Young Bok Lee
- Department of Dermatology, Uijeongbu St Mary's Hospital, College of Medicine, The Catholic University of Korea, 271 Cheon Bo-ro, Uijeongbu, Gyeonggi-Do, 11765, Republic of Korea..
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Association between Genetic Polymorphisms in Methylenetetrahydrofolate Reductase and Risk of Autoimmune Diseases: A Systematic Review and Meta-Analysis. DISEASE MARKERS 2022; 2022:4568145. [PMID: 35686035 PMCID: PMC9173919 DOI: 10.1155/2022/4568145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/30/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022]
Abstract
Methylenetetrahydrofolate reductase (MTHFR) is a critical rate-limiting enzyme in the homocysteine/methionine metabolism pathway that is implicated in the pathogenesis and progression of autoimmune diseases. Previous association studies have been performed to investigate the effect of polymorphisms in MTHFR on the risk of autoimmune diseases with inconsistent results. Therefore, this meta-analysis was designed to assess the association between the MTHFR 677 C/T and 1298 A/C polymorphisms and the susceptibility to autoimmune diseases. We identified reports by a literature search in the following electronic databases: PubMed, Ovid, Web of science, and China National Knowledge Infrastructure. Statistical analyses of the summary odds ratios (ORs) and 95% confidence intervals (CIs) were done using STATA software. In a recessive genetic model, the MTHFR 677 C/T polymorphism was associated with an increased risk of Behcet's disease (OR = 1.97, 95% CI, 1.31-2.97), multiple sclerosis (OR = 1.57, 95% CI, 1.03-2.38), and ankylosing spondylitis (OR = 2.90, 95% CI, 1.92-4.38). The MTHFR 1298 A/C polymorphism was associated an increased risk of multiple sclerosis in a heterozygote comparison (OR = 2.36, 95% CI, 1.29-4.30) and in a dominant model (OR = 2.31, 95% CI, 1.24-4.29). This meta-analysis demonstrated that the MTHFR 677 C/T was a risk factor for Behcet's disease, multiple sclerosis, and ankylosing spondylitis, and the 1298 A/C was a risk factor for multiple sclerosis.
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Huh S. How Annals of Dermatology Has Improved the Scientific Quality and Ethical Standards of its Articles in the Two-Year Period since October 2018. Ann Dermatol 2020; 32:353-359. [PMID: 33911768 PMCID: PMC7992585 DOI: 10.5021/ad.2020.32.5.353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 11/27/2022] Open
Abstract
Annals of Dermatology has not been deposited in PubMed Central (PMC) since October 2018 due to inadequate scientific quality, including the absence of informed consent in three case reports with patients' photos. This study examined the readiness of Annals of Dermatology to be deposited in PMC again by analyzing the 13 issues published from October 2018 to August 2020. The journal's scientific quality and ethical standards were assessed, and adherence to these standards was documented. In total, 259 articles were analyzed for ethical standards, including institutional review board (IRB) approval, an informed consent statement, and disclosure of conflicts of interest. Scientific quality was also checked for each article. Of the 129 original articles or brief reports presenting research on human subjects or human-derived materials, 111 studies received IRB approval and/or obtained informed consent. The other seven studies were data analyses or studies of purchased cultured cells. One study that used a post-circumcision foreskin sample contained no statement describing permission from the patient's family, but the researchers were found to have obtained informed consent. In all 152 case presentations, the authors obtained informed consent. All seven animal experiments received Institutional Animal Care and Use Committee approval. One review article did not disclose conflicts of interest, but this was an editorial error. Two systematic reviews adopted the PRISMA guidelines. In conclusion, the present publication policies, scientific quality, and ethical standards of the journal are top-tier internationally. Annals of Dermatology may be ready to apply to PMC again.
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Affiliation(s)
- Sun Huh
- Department of Parasitology and Institute of Medical Education, College of Medicine, Hallym University, Chuncheon, Korea
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