Clinical and Experimental Dermatology最新文献

Infantile scabies can be challenging to treat because of behavioural and anatomical factors that reduce the efficacy of topical therapies. In this small prospective cohort study, there were 22 neonates and infants with persistent palmoplantar scabies. Patients were treated exclusively with permethrin 5% cream. All patients initially failed the standard regimen consisting of one full-body application, followed by a second -application after 7 days. In 1 group, 11 infants received an intensified regimen with 3 additional nights of targeted application to the hands and feet (intervention group), while in a second group, 11 continued with the standard regimen only (control group). Complete resolution was observed in all 11 patients in the intervention group, compared with none in the control group. Frequent infant behaviours, including spontaneous kicking, leg movements and habitual fist clenching, probably reduced drug contact time on the palms and soles. These findings indicate that standard topical regimens may be insufficient in this population and that targeted reapplication, combined with caregiver education, can optimize treatment outcomes in infants.

Background: The use of Janus kinase inhibitors (JAKis) is growing in dermatology with approvals for atopic dermatitis, alopecia areata, plaque psoriasis and psoriatic arthritis.

Objectives: To evaluate infectious adverse events (iAEs) associated with abrocitinib, baricitinib, deucravacitinib, ritlecitinib, tofacitinib and upadacitinib.

Methods: Data were retrieved from the US Food and Drug Administration's Adverse Event Reporting System (FAERS) database via the open-source AERSMine platform (Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA). Reports from the first quarter of 2004 to the second quarter of 2024 were screened under the MedDRA System Organ Class 'Infections and infestations' categorization. The analysis encompassed all indications, not solely dermatological use. Disproportionality metrics, including reporting odds ratio, proportional reporting ratio and information component, were calculated.

Results: Tofacitinib had the highest number of iAE reports (n = 68 669), followed by upadacitinib (n = 17 822). When stratified by sex, most reports related to women and girls. When stratified by age, iAEs were most frequently reported in individuals aged 25-65 years, except baricitinib, for which iAEs were more frequently reported in individuals aged ≥ 66 years. Disproportionality analysis revealed sex- and age-related differences in iAE risk, with male sex generally associated with lower risk. Paediatric patients (0-14 years) had an elevated iAE risk with abrocitinib and upadacitinib, while adults aged ≥ 66 years showed increased risk with baricitinib and tofacitinib. Commonly reported iAEs included COVID-19, herpes zoster, nasopharyngitis, influenza, urinary tract infection, pneumonia and sinusitis. Each JAKi was associated with distinct high-signal iAEs.

Conclusions: To our knowledge, this is the most comprehensive real-world analysis of iAEs linked to oral JAKis to date. While infection risks varied across agents, both common and rare but serious events were identified. Findings highlight the importance of individualized monitoring and preventive strategies, and reinforce the value of postmarketing surveillance in ensuring safe JAKi use.

Background: Reflectance confocal microscopy (RCM) criteria for the in vivo diagnosis of superficial basal cell carcinoma (sBCC) lesions have been validated, with studies indicating a high level of diagnostic sensitivity. However, there remains a paucity of data regarding the preservation of or changes in RCM features following biopsy or treatment.

Objective: To use RCM to prospectively image biopsy-confirmed sBCC at baseline and 12 weeks post-treatment to determine clearance and identify any associated RCM features.

Methods: Ten patients with biopsy-confirmed sBCC participated in this study. Clinical examination, dermoscopy and RCM imaging were performed at baseline, prior to treatment and 12 weeks post-treatment, with a 1064 Nd-YAG laser. Following treatment, RCM features were compared with clinical and histological findings.

Results: Statistically significant changes in RCM features at baseline and follow-up included tumour islands with hyperreflective aggregates, dark silhouettes, peripheral palisading, peritumoral clefting, and dermal inflammatory cells. There were no significant changes in nuclear streaming, fibrosis or vasculature.

Conclusions: The features of nuclear streaming, fibrosis and dilated vessels may be observed during RCM imaging of biopsy-confirmed sBCC at baseline and post-treatment and should be interpreted with caution. Additional studies are needed to further validate these findings.

Background: Acute generalized exanthematous pustulosis (AGEP) is a rare skin condition often triggered by medications. Many case reports have been published, but few studies with large cohorts have been reported to date.

Objectives: To investigate the association between AGEP EuroSCAR score and clinical and laboratory findings, and histopathological examination in a large cohort.

Methods: This retrospective, multicentre study analysed 51 cases of patients with AGEP across 4 academic institutions.

Results: The study found that in the majority of patients AGEP was drug-induced, particularly as a result of antibiotics such as amoxicillin. The average time from drug exposure to symptom onset was 10.7 (SD 11.7) days, with hospital admissions lasting an average of 14.5 (SD 11.8) days and recovery averaging 33.3 (SD 4.9) days. Key features included widespread itching, fever and elevated inflammatory markers. Histopathological analysis frequently revealed spongiform pustules and eosinophilic infiltration. Importantly, this study is the first, to our knowledge, to demonstrate a significant association between higher EuroSCAR scores and elevated lactate dehydrogenase (LDH) levels, suggesting a more intense inflammatory response in patients with higher EuroSCAR scores. The findings underscore the need for early diagnosis and management of AGEP, with a particular focus on discontinuing the offending drug and administering corticosteroids.

Conclusions: Despite its retrospective design, this study contributes valuable insights into the systemic implications and histopathological characteristics of AGEP, highlighting the possible role of LDH, and the importance of further research to refine diagnosis, treatment protocols and improve patient outcomes.