Clinical and Experimental Dermatology最新文献

A female in fifties, presented with grouped multiple, skin-coloured asymptomatic, slowly growing nodules on right buttock for 2 years. Cutaneous examination, multiple discrete to confluent skin coloured firm subcutaneous nodules of size ranging from 1x1 cm to 4x3 cm on right buttock. Histopathological examination showed ectopic mature adipocytes in the dermis.

Background: Emollients and topical corticosteroids (TCS) prevent and treat flares in eczema. However, topical treatment use is poorly recorded and reported in clinical trials. There is no clear consensus of how best to capture and summarise topical treatment use.

Objectives: To explore different ways of capturing and reporting topical treatment use in childhood eczema.

Methods: Secondary data analysis using 450 participants from the Best Emollients for Eczema (BEE) trial. Participants were allocated to use one type of emollient (lotion, cream, gel, or ointment) 'twice daily and when required' for 16 weeks. Otherwise, clinical management remained unchanged. Parents completed weekly questions about topical therapy use and eczema symptoms. Two versions of topical treatment use questionnaires were used. The first (n=202, 44.9%) asked parents to report treatment use on days 1-7, starting completion on the day they were randomised. The second (n=248, 55.1%) reported use by day of the week (Monday to Sunday), starting completion the first Monday after randomisation. Both underwent Patient and Public Involvement (PPI) review, but the second version was tested more thoroughly using cognitive interviewing techniques, following parent feedback that questions on the first version were confusing. Descriptive statistics compared questionnaire completion and differences in emollient and TCS use.

Results: Overall, questionnaire completion for both emollient and TCS use decreased with time: but at weeks 1 and 16 were 84.7% (381/450) and 58.9% (265/450) for emollient use, and 94.2% (424/450) and 80.4% (362/450) for TCS use, respectively. Fewer emollient use questionnaires were completed with first (33.5%) than the second (87.9%) version (p<0.001). TCS use questionnaire completion were similar for both (84.9% and 87.4%, p=0.002). We present different ways of summarising topical treatment use.

Conclusions: While questionnaire completion was similar for TCS use, emollient use data completeness was higher in the second version. When designing questionnaires, balancing the detail and complexity of questions is important, especially if being collected as a secondary outcome measure. Numerous ways of summarising the same data can provide different information. Future collection and reporting of treatment use should reflect specific trial aims.

Background: Metabolic syndrome (MetS) is a common comorbidity in psoriasis. However, the associations between MetS, psoriasis, and mortality remain largely unclear.

Objectives: To investigate the synergistic effect of MetS and psoriasis on total and cardiovascular disease (CVD) mortality in a representative sample of US adults.

Methods: 14,930 participants from the 2003-2006 & 2009-2014 National Health and Nutrition Examination Survey were included in this prospective, nationwide cohort study. Participants were stratified into the psoriasis-/MetS- (reference) group, psoriasis-/MetS+ group, psoriasis+/MetS- group, and psoriasis+/MetS+ group.

Results: Overall, 14,930 participants, including 50.71% males and mean age of 43 years, were included in the final analysis. The weighted percentages of participants in the psoriasis-/MetS- group, psoriasis-/MetS+ group, psoriasis+/MetS- group and psoriasis+/MetS+ group were 72.77%, 24.36%, 1.94%, and 0.93%, respectively. A total of 874 deaths (246 CVD-related) occurred during a median follow-up of 110 months. Compared to the reference group, the hazard ratios (95% confidence intervals) in psoriasis-/MetS+, psoriasis+/MetS- and psoriasis+/MetS+ groups were 1.788 (1.486-2.152), 0.858 (0.431-1.707), and 2.050 (1.028-4.092), respectively, for all-cause mortality, and 1.856 (1.350-2.552), 1.229 (0.292-5.181) and 4.571 (1.724-12.119), respectively, for CVD mortality. Subgroup analysis showed that this association was not influenced by participants' age, sex, physical activity, smoking, estimated glomerular filtration rate, and urinary albumin/creatinine ratio. Similar results were obtained in the sensitivity analysis of the main results.

Conclusions: Presence of comorbid MetS significantly increases all-cause and CVD mortality in psoriasis patients. Dermatologists can potentially aid in reducing mortality rate in psoriasis patients through targeted screening for MetS.

Background: A retrospective cohort study was undertaken to examine the management of basal cell carcinoma (BCC) in older patients.

Objectives: The aim was to identify subgroups where intervention could be minimised, based on frailty and trends in survival.

Methods: All patients aged 90 years and over with histologically confirmed BCC during 2017 and 2018 were included within the study (n = 319).

Results: Age was the most significant predictor of survival (HR=1.10 (95% CIs: 1.04-1.17); p=0.001). Maximum threshold analysis identified 93 years as the significant age cutpoint. Median survival was 40 months for ≤93 years and 28 months for >93 years (p=0.002). Patients with dementia had a worse survival than those without (median survival: 25 months versus 35 months, respectively; HR=1.92 (95% CIs: 1.18-3.13); p=0.009). There was a statistically significant difference in survival for patients who received treatment for their BCC (n=294) compared those observed (n=25) (median survival 34 months versus 21 months, respectively; HR= 0.54 (95% CIs: 0.34-0.85); p=0.007). All other comorbidities examined had no influence on survival.

Conclusions: This study provides evidence in support of active treatment of BCC in individuals aged ≥90 years, seen in secondary care. Conservative options may be preferable in patients with dementia or those >93 years old.

Lichen planopilaris (LPP) and its variants, mainly frontal fibrosing alopecia (FFA), affect the hair follicles causing cicatricial alopecia with a significant negative impact on self-confidence and quality of life (QoL). This systematic review investigates the psycho-emotional impact of LPP and its variants using PRISMA guidelines. The review revealed that LPP and FFA cause significant psychological distress and impaired QoL. Higher LPP disease activity and severity were associated with higher depression, higher anxiety scores, lower quality-of-life scores, and higher scores of role limitations (physical and emotional). Additionally, facial lesions in FFA patients, especially the eyebrows involvement can be very distressing, leading to impaired self-esteem and QoL. this negative impact of active and severe LPP and FFA on QoL and self-esteem of patients causes psychiatric conditions including anxiety and depression. Therefore, an early diagnosis must be encouraged in these patients.

Ferritin is a commonly measured laboratory test in dermatology. It is a marker of iron storage in the human body but also elevated in inflammatory states. Changes in ferritin are therefore non-specific and correlation of specific clinical findings and risk factors with ferritin concentration and other biomarkers e.g. iron studies or CRP are recommended. The article discusses iron metabolism and the indications for ferritin measurement in dermatology and how to interpret the results.

Background: Global and trichoscopic photography are fundamental in the clinical assessment of hair loss. Standardised protocols in this respect are lacking.

Objectives: To create novel, pragmatic and flexible standardised photography protocols for hair loss, which are practical to use for clinicians and medical photographers alike.

Methods: Published disease severity scales for a variety of hair loss conditions were utilised to create standardised photography protocols. There were reviewed and refined by a national clinical working group of consultant dermatologists specialising in hair loss.

Results: Three main presentation-based protocols are presented, defined by the type of hair loss a patient may present with; including pattern loss, frontal fibrosing alopecia/traction alopecia and alopecia areata and other patchy hair loss disorders. Additional supplementary protocols facilitate further specific views for a variety of individualised clinical scenarios, based on user discretion.

Conclusions: We present novel, pragmatic, standardised photography protocols for hair loss disorders. These can be used by clinicians even where formal medical photography units are unavailable. Standardisation allows high-quality, informative images for objective assessment and monitoring of hair loss in clinical practice, as well as in research settings.