Clinical and Experimental Dermatology最新文献

Background: Treatment for atopic dermatitis (AD) has been revolutionised by therapies such as dupilumab and upadacitinib, though these drugs are more costly than standard immunosuppressants.

Objectives: To evaluate the cost-effectiveness of upadacitinib versus dupilumab as first-line therapy for adults with AD.

Methods: A cost-utility analysis was conducted from the Australian healthcare sector perspective. A Markov cohort model with 16-week cycles over a five-year time horizon was constructed to simulate disease progression following first-line therapy with upadacitinib or dupilumab. Patients who failed to achieve controlled disease on first-line therapy were switched to second-line therapy with the alternate medication, then third-line therapy with mycophenolate. Cost data were obtained from public reimbursement schedules. Efficacy and utility data were sourced from real-world clinical data, published literature, and expert consensus. Sensitivity analyses were conducted to account for uncertainties in parameter inputs. The primary outcomes were 2024 Australian dollars (A$), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).

Results: Compared to dupilumab, first-line upadacitinib gained 0.04 QALYs at an increased cost of A$3,213 over five years, resulting in an ICER of A$88,778/QALY. Upadacitinib is therefore not cost-effective compared with dupilumab at a A$50,000/QALY threshold, with marginally increased effectiveness at higher costs. These results were highly sensitive to variations in the probability of disease control on either therapy and medication costs but remained robust across a range of willingness-to-pay thresholds.

Conclusions: Upadacitinib is unlikely to be cost-effective compared with dupilumab, however, the minimal differences in outcomes suggest that both treatments may be comparable options for first-line therapy.

Early detection of thin, stage 1A melanoma is crucial in improving patient outcomes, but this can be clinically challenging in patients with multiple atypical naevi. We report an observational study evaluating the effectiveness of a UK based Clinical Nurse Specialist (CNS) led total body photography (TBP) and sequential digital dermoscopic imaging (SDDI) programme, for patients at high risk of developing melanoma. 1680 patients underwent 6890 TBP and SDDI sessions, with 345 excision biospsies of clinically suspcious melanocytic lesions performed (5% sessions). Twenty-one pT1a and pT1b melanomas (6.1% of biopsies), 20 melanoma-in-situ (5.8% biopsies) and 150 dysplastic naevi (43.5% biopsies) were identified. Mean Breslow Thickness (BT) was 0.52mm (range 0.2-1mm). 95.2% of melanomas had a BT of <0.8mm without ulceration (pT1a), and the number needed to biopsy (NNB) was 8.41. Our UK experience demonstrates that a nurse-led programme of TBP with SDDI can be a clinically effective strategy for detection of early melanoma and melanoma-in-situ.

Background: Despite ongoing advancements in medical aesthetics, there remains a lack of consensus regarding a standardized postoperative care protocol following laser treatment for skin pigmentation disorders.

Objectives: To evaluate the influence of postoperative facial cleansing practices on the efficacy and safety of laser therapy among patients diagnosed with pigmentary skin diseases.

Methods: Thirty patients diagnosed with pigmented lesions (freckles and/or solar lentigines) were randomly allocated to two distinct groups. Following treatment with a 755-nm alexandrite laser, patients in one group were instructed to perform water cleansing, while the other followed a water-avoidance care protocol. Follow-up visits were conducted on days 1, 3, 7 and 14 after treatment and 3 months postoperatively. These visits included taking standardized photographs, performing VISIA imaging assessments, collecting patient satisfaction questionnaires and recording any potential adverse events.

Results: No serious complications were reported in either group. Most patients demonstrated improvement in their lesions to varying degrees with a single treatment session. No statistically significant differences were identified between the two groups in terms of postoperative visual analogue scale scores (P = 0.17). VISIA analysis revealed a significant decrease in brown spot count in both groups at the 3-month follow-up compared with baseline, with no significant differences between groups (P = 0.99). The average score of patients' satisfaction in the water-cleansing group was significantly higher than that in the water-avoidance group (P = 0.039).

Conclusions: Our studies have demonstrated that laser treatment of epidermal hyperpigmentation disorders without strict water avoidance can have equally good results with no added adverse effects.