Clinical and Experimental Dermatology最新文献

Background: In countries with well-resourced primary care, most children with eczema are managed by their General Practitioner (GP) but we know little about how often they are seen or how they are treated.

Objectives: To describe patterns of consultations and prescribing by eczema severity for children with eczema.

Methods: Analysis of electronic medical record data from 422/483 participants in the BATHE study. We used descriptive statistics to compare participants characteristics, consultation and prescribing patterns. We explored associations with eczema severity (POEM), age and gender using Poisson and linear regression models.

Results: Mean (SD) age 4.8 (2.9) years and POEM 10.0 (5.8). Over 12 months, 386 children had a median (IQR) of 4.0 (2-7) consultations. Of 2049 encounters, 1421 (69.4%) were for an eczema flare. Emollients were the most commonly prescribed item, with a mean of 4.6 prescriptions (507.9 g/ml) per child, yet 32.0% were not prescribed any. On average, children were prescribed 1.3 different emollient-types, with cream being most common (79.5% children, 66.5% prescriptions). 51.4% were prescribed a topical corticosteroid (TCS) with a mean of 2.8 prescriptions (50.6 g) per child and a mean of 1.4 different TCS potency-types (mild being the most common 73.3% children, 56.7% prescriptions). Number of consultations but not quantity of emollients and TCS prescribed were associated to age and eczema severity.

Conclusions: Children with eczema are seen frequently in primary care but are prescribed less emollient and TCS than might be appropriate for age and severity.

Psoriasis and psoriatic arthritis (PsA) are chronic inflammatory diseases, affecting patients' quality of life, particularly when involving difficult-to-treat areas. While randomized controlled trials (RCTs) have shown that ixekizumab is effective for psoriatic disease, real-world evidence (RWE) is essential for assessing its broader applicability. This retrospective, single-center study evaluated the effectiveness and safety of ixekizumab in 37 Greek patients with psoriasis and/or PsA, including involvement of difficult-to-treat areas, over 52 weeks of treatment. Ixekizumab led to significant and sustained improvements in skin disease up to week 52. Joint manifestations and difficult sites showed marked improvement, as did patient-reported quality of life. Biologic-naïve patients and those with early disease onset showed better responses. No serious adverse events were reported, and cardiovascular parameters remained stable. These findings support ixekizumab's strong efficacy and safety in routine clinical use, including patients with prior biologic exposure and complex disease, reinforcing its role as a cornerstone therapy.

Background: Penile squamous cell carcinoma (PeSCC) is thought to arise through two principal pathogenic pathways, via lichen sclerosus and high-risk human papillomavirus. Molecular alterations in morphologically normal peri tumoral environment are known as 'field effect' and are recognised in other epithelial cancers. Whether similar field effects exist around PeSCC is unknown. As Wnt signaling is a key driver of carcinogenesis, including in PeSCC, perturbations in this pathway may represent an early event in penile tumour evolution.

Objectives: To determine whether a peritumoral molecular field exists around PeSCC by assessing expression and spatial colocalisation of key Wnt-related proteins in cancer-adjacent versus normal penile skin.

Methods: A specialist genitourinary histopathologist reviewed haematoxylin and eosin-stained sections and identified tumour-involved regions, demarcating them from adjacent epithelium that appeared morphologically normal. In this study, immunofluorescence-stained formalin fixed paraffin embedded tissue arrays were probed for Wnt4, cyclin D1, MMP7 and c-MYC proteins. The expression intensity and spatial colocalisation metrics were quantified. Comparisons between normal and cancer-adjacent tissues from 41 patients were conducted for the epidermis and dermis.

Results: Cancer-adjacent tissue showed significant downregulation of Wnt4 in both epidermis and dermis (p < 0.001), and marked upregulation of c-MYC (epidermis: Cohen's d = 2.05; dermis: d = 1.37). MMP7 and Cyclin D1 expression was not significantly changed. Colocalisation analysis revealed significantly increased Global Intersection Coefficients for five combinations within the epidermis (Wnt4/cyclin D1, Wnt4/MMP7, Wnt4/c-MYC, cyclin D1/c-MYC, MMP7/c-MYC), and for two within the dermis (Wnt4/MMP7, Wnt4/c-MYC), indicating enhanced signalling convergence in cancer-adjacent tissues.

Conclusions: This study provides the first evidence of molecular changes in peritumour tissue to demonstrate field effect in PeSCC, characterised by downregulation of Wnt4, upregulation of c-MYC, and altered spatial colocalisation of Wnt-related proteins in cancer-adjacent skin. These findings suggest that peritumoral tissues exhibit early molecular alterations that extend beyond the morphologically defined tumour margin. Recognising these changes may have implications for understanding tumour microenvironment conditioning and for the future development of biomarkers relevant to margin assessment in penile carcinogenesis.

Background: The long-term impact of SARS-CoV-2 infection on inflammatory dermatoses remain incompletely defined.

Objective: To evaluate the association between COVID-19 infection and a broad range of inflammatory dermatoses.

Methods: In this cohort study, electronic health-record data were analyzed for 204,241 patients seen at a tertiary medical center between March 2020 and May 2023, including 22,368 with confirmed COVID-19 and 181,873 controls with negative testing. Diagnoses of 16 inflammatory dermatoses were extracted from standardized documentation fields and verified diagnostic codes.

Results: Elevated risks were observed for atopic dermatitis (IRR, 1.35; 95% CI, 1.25-1.46; P < .001), acne vulgaris (IRR, 1.53; 95% CI, 1.17-1.98; P = .002), rosacea (IRR, 2.41; 95% CI, 1.53-3.66; P < .001), alopecia areata (IRR, 2.39; 95% CI, 1.44-3.80; P < .001), and seborrheic dermatitis (IRR, 1.74; 95% CI, 1.29-2.30; P < .001). No significant associations were observed for psoriasis, hidradenitis suppurativa, lupus erythematosus, pemphigus, or bullous pemphigoid.

Conclusions: Covid-19 infection emerged as a novel risk factor for several inflammatory dermatoses.