Clinical and Experimental Dermatology最新文献

Background: While Skin Picking Disorder (SPD) is a well-described neuropsychiatric disorder that causes severe stress and impairment, there is no clear protocol for treating patients and a relatively small body of literature evaluating treatment approaches.

Objective: This review aims to summarize and compare recent publications and provide an up-to-date guide of current non-pharmacological treatments for SPD.

Methods: A literature review was conducted on all non-pharmacological SPD treatment studies published between 2017-2023 using PubMed, CINAHL Plus with Full text (EBSCO), and Scopus. Search terms included skin picking, excoriation, psychiatry, treatment, and psychodermatology. Studies including SPD within other body-focused repetitive behaviors (BFRBs), studies using pharmacological agents, and studies not available in English were excluded. A minimum of 2 authors screened each abstract while blinded to minimize bias to assess for inclusion.

Results: 11 studies (2068 participants) were included, with a variety of study designs including feasibility, randomized control trial, longitudinal cohort, multiple baseline experimental, naturalistic trial, and controlled single case design with multiple baseline studies. The treatments include cognitive behavioral therapy (CBT), Acceptance and Commitment Therapy (ACT), ACT-Enhanced Group Behavioral Therapy (AE-GBT), ACT-Informed Exposure Therapy, group therapy, psychotherapy, Repetitive Transcranial Magnetic Stimulation (rTMS), online self-help modules, and Expressive Writing (EW). Studies implementing CBT, Habit Reversal Therapy (HRT), AE-GBT, online self-help modules, and EW demonstrated the best results in treating SPD.

Conclusion: Several studies achieved significant outcomes for SPD participants, confirming the usefulness of non-pharmacological treatment in SPD. Based on our results, CBT, AE-GBT, online self-help modules, and EW appear to be the most effective in treating SPD. Additionally, most of these treatment modalities can be tailored to meet patient-specific needs. Some limitations of the studies include small sample sizes, lack of control groups/randomization, limited long-term follow-up data, and lack of gender variability.

Background: Acquired idiopathic generalized anhidrosis (AIGA) is a rare disorder primarily observed in Asian populations, particularly in Japan. Although pulse methylprednisolone therapy is an effective treatment for AIGA, predictors of therapeutic response remain poorly defined.

Objectives: This study sought to identify factors that predict the efficacy of pulse methylprednisolone therapy in patients with AIGA.

Methods: Data obtained from 32 patients with AIGA were assessed based on clinical, histopathological, and serological examinations. Statistical analyses were conducted to explore predictors of response to pulse methylprednisolone therapy.

Results: The average age of participants was 32.1 years (SD = 12.3), with a male predominance (66%). Response to pulse methylprednisolone therapy was closely associated with the time from the onset to start of therapy (Wilcoxson's rank sum test, p = 0.016, n = 27), with earlier intervention resulting in better outcome. Notably, males and patients presenting with severe symptoms at diagnosis responded better to treatment. High serum carcinoembryonic antigen (CEA) levels and histological evidence of inflammation around sweat glands also correlated with a positive therapeutic response.

Conclusions: Earlier intervention, elevated serum CEA levels, and inflammation around sweat glands are potential indicators of successful response to pulse methylprednisolone therapy in patients with AIGA.

Background: In the UK, few (12%) anal squamous cell carcinomas (aSCC) are diagnosed early at stage 1 (T1N0M0). The Homerton Anogenital Neoplasia Service (HANS) is a highly specialised tertiary centre where high resolution anoscopy (HRA) is performed to diagnose and treat anal intraepithelial neoplasia (AIN), a precursor to cancer. In some cases, aSCC (here defined as anal canal cancers and perianal cancers up to 5cm from the anal verge) is found on referral for AIN; in others, aSCC may develop while undergoing AIN management. We reviewed aSCC diagnoses at our specialist unit to establish whether HRA offers added value in the early detection of aSCC in a high-risk cohort.

Methods: A cross-sectional analysis was performed of all primary aSCC diagnoses at HANS between January 2016 and June 2021. Patient records, histopathology and radiology reports were reviewed to define anal cancer stage per TNM classification (AJCC version 8). Results were compared with national anal cancer data published by the Office for National Statistics (AJCC version 8).

Results: Fifty-three aSCC diagnoses were made at HANS; 35 (66%) were stage 1 (14 prevalent, 21 incident), 11 (21%) stage 2 (9 prevalent, 2 incident) and 6 (11%) stage 3 (5 prevalent, 1 incident). None were stage 4; 1 cancer was unstageable due to further management at another unit. By comparison, 5836 aSCCs were diagnosed in the UK between 2013-2017; of these, 12.0% were stage 1, 22.8% stage 2, 33.0% stage 3 and 8.46% stage 4; 23.8% were unknown or unstageable. There was a statistically significant difference in the proportion of early (i.e. stage 1) HRA-detected cancers (HDCs) compared with national statistics (p < 0.001).

Conclusion: Our results suggest that surveillance and examination within an HRA programme may lead to detection of aSCC at an earlier stage allowing for less morbid treatment and potentially a lower mortality.

Background: Demographic changes impose a number of issues regarding the biological treatment of elderly patients with moderate-to-severe psoriasis.

Patients and methods: A retrospective, single-center study was conducted on patients aged 65 years or older with moderate-severe psoriasis who had been undergoing treatment with biologic drugs for at least 60 weeks.

Results: A total of 168 patients aged 65 years or older with moderate-to-severe psoriasis undergoing biologic therapy were retrieved: 45 were women and with a mean age of 73.23 ± 6.53 years. The decline in mean PASI, BSA, DLQI and NAPSI values over the 60 weeks of treatment was found to be statistically significant at each interval (p < 0.05). Multivariate statistical analysis showed that nearly all the considered independent variables did not influence the response to therapy in terms of PASI score reduction, except for psoriatic arthritis (p = 0.03).

Discussion: We observed a better response by YOs, with 72.84% of subjects achieving PASI 75 and 71.6% achieving PASI 90 and 100 at the 60th week of treatment. The worst result was obtained by the MOs, with 60 percent of subjects reaching PASI 75 at the end of follow-up, while the OOs had a more mixed performance. The results obtained seem to indicate greater efficacy of anti-TNFα drugs, followed by the other classes of interleukin inhibitors.

Conclusions: These results could provide a starting point for new and larger studies and guidelines for biologic treatment.

Lichen planus (LP) is an inflammatory disease that afflicts skin, mucous membranes, cutaneous appendages. Moreover, LP represents a prototype of lichenoid dermatosis, being characterized by the presence of a dense dermal cell infiltrate. Although most cases of LP are idiopathic, infectious and drug-related factors must also be considered in the etiology. In this context, the occurrence of LP and lichenoid drug eruption following different types of vaccination is a possible event. Therefore, the aim of our review is to provide a broad perspective to clinicians by analyzing the current literature cases of LP and lichenoid eruptions following COVID-19 vaccination, also investigating the possible pathogenetic mechanisms underlying this phenomenon. A total of 61 cases of LP and lichenoid eruption following COVID-19 vaccination have been collected. However, the number of cases of LP and lichenoid drug eruption is extremely low if compared to the number of vaccines administered overall, suggesting that the risk of LP and lichenoid eruption following COVID-19 vaccination is extremely low. Certainly, further studies are desirable to identify the population most at risk and the possibility of taking preventive measures.