Clinical and Experimental Dermatology最新文献

Background: Real-world data regarding the use of dupilumab in children with atopic dermatitis (AD) are limited.

Objectives: To evaluate the real-world efficacy of dupilumab in children with moderate-to-severe AD over an extended follow-up period.

Methods: This was a retrospective study of patients (≤ 18 years) with moderate-to-severe AD treated with dupilumab in four Israeli tertiary centres. Efficacy and safety were assessed using descriptive statistics.

Results: In total, 230 patients were included in the analysis [age 9.9 years (SD 4.3), male/female 1 : 1 ratio)]. Of them, 59.6% (137/230) had ≥ 1 atopic comorbidity. The follow-up duration ranged from 2 to 248 weeks, with a median of 52 weeks (interquartile range 24-96). Within 12 weeks of treatment, 41.7% (68/163) of patients had reached Investigator Global Assessment 0-1. The mean body surface area was reduced from 58.0% (SD 20.5%) at baseline to 27.8% (SD 20.2%) at 12 weeks. The average Pruritus Numeric Rating Scale score was reduced from 7.9 (SD 2.2) at baseline to 2.3 (SD 2.8) at 12 weeks. Adverse events, in 210 patients, included conjunctivitis in 34 patients (16.2%), injection-site reactions in 11 patients (5.2%) and dupilumab-associated head and neck dermatitis in 6 patients (2.9%). Overall, 26 of 210 patients (12.3%) discontinued the treatment: 9 of the 26 patients (35%) because of adverse events and 15 patients (58%) because of inadequate efficacy. The overall probability of dupilumab survival at 52 weeks was 94.0%.

Conclusions: Real-world data presented here for 230 paediatric and adolescents with moderate-to-severe AD reinforce dupilumab's efficacy and safety and highlight dupilumab's high survival rate after 1 year of treatment in the paediatric population.

Both alopecia areata (AA) and celiac disease are common immune-mediated diseases. Despite accumulating evidence of bi-directional associations between the two disorders, data remains unclear and inconsistent. In this study we explored the association between alopecia areata and celiac disease in a large representative population cohort. Patients with alopecia areata diagnosed during 2005-2019 were compared with age and gender matched healthy controls for celiac autoimmunity. A total of 33,401 patients with alopecia areata and 66,802 controls were included in the analysis. Overall, 754 patients (0.85) had celiac disease. Compared to controls, celiac prevalence increased twofold among AA patients (1.1% Vs 0.6%, Odds ratio (OR) 1.95, 95% Confidence Interval (CI) 1.69-2.25). Higher prevalence rates were observed among all age groups, with the highest risk in AA patients older than 40 years and older. Alopecia areata may be associated with a significant increased risk for celiac disease, suggesting early diagnostic and preventive measures.

The intersection of dermatology and psychiatry has gained significant attention in recent years. Psychocutaneous disease affect patient population, who have undiagnosed and undertreated ailments related to the body and mind. These patients suffer a reduce quality of life due to knowledge gaps and reduce awareness about psycho dermatology. This review aims to assess the integration of psychopharmacology topics in continuing medical education programs (CME) and its relevance in clinical practice, it's impact on healthcare professionals' quality of care, and existing knowledge gaps among trainees and young dermatologists. To identify data from inception up to December 2023, a systematic literature review and search was conducted following PRISMA guidelines. Pubmed, Cochrane, and Embase databases were searched using predefined terms including "continuing medical education", "dermatology", "psychology", "psychodermatology", "psychocutaneous", "awareness" and "practice patterns". Inclusion criteria comprised studies evaluating CME programs, clinical studies and reviews published in English language. Studies were excluded if they were single case reports. A total of 93 studies were identified and 12 were included in this review following screening, removal of duplicates, and application of inclusion criteria. Studies revealed lower level of confidence among professionals in handling psycho cutaneous conditions, limited awareness of available resources and high interest in CME programs. Initiatives like video mentoring and clinical skills lessons showed promise but are currently scarce. Examined data from selected studies demonstrate that current CME programs in psychodermatology lack depth, leaving practitioners feeling ill equipped and unaware of available resources. There is substantial global interest in enhancing these programs. Given the breadth of conditions covered, educating dermatologists is crucial for enhanced patient outcomes and satisfaction. Addressing resource scarcity and patient stigma is imperative to develop specialized programs. Improvement to education can drive stronger outcomes and holistic patient care. Future efforts should prioritize refining program strategies and conducting thorough assessments to maximize impact.

Background: The diagnostic challenges in early mycosis fungoides (MF) and other cutaneous T-cell lymphomas (CTCL) persist despite advancements in molecular methods.

Aim: The study aims to provide a preliminary assessment of next-generation sequencing in analyzing T-cell receptor gamma (TRG) sequences for distinguishing CTCL from benign inflammatory disorders.

Methods: Skin samples from CTCL and benign inflammatory skin disorders proven clinicopathologically were assessed for TRG by NGS.

Results: Our study analyzed skin samples from a total of 36 subjects, comprising 22 cases of CTCL, including 14 MF and 8 other CTCLs, alongside 14 cases of benign inflammatory skin disorders. According to the LymphoTrack criteria, monoclonality was detected in 75.0 % of the overall 24 CTCL patients. Specifically, in MF cases, 10 out of 14 were identified as monoclonality, with all four non-monoclonal cases being in the patch stage. For the other CTCL, 6 out of 8 cases displayed monoclonality. Among the overall 22 CTCL patients, 11 had multiple biopsies, with 9 displaying the same dominant clone across different sites. Among the 14 benign cases, only the case with erythrodermic psoriasis exhibited monoclonality. Our decision tree analysis suggests that a high frequency of the most abundant clone, its ratio to the third most abundant clone, and TRG V-I segment usage are effective markers aiding in diagnosing CTCL.

Conclusion: Combination of the clone frequencies, and TRG V segment usage may enhance diagnosis for MF and other CTCLs, aiding in differentiating them from benign conditions. However, molecular diagnosis for patch-stage MF remains challenging.