Clinical and Experimental Dermatology最新文献

Background: While pressures on the National Health Service skin cancer services have predated the COVID pandemic, the two -week-wait (2WW) skin cancer standards have deteriorated post-pandemic.

Methods: The 2WW skin cancer pathway is analysed in this report utilising 4V typology and volume-variety matrix. Performance matrix of the 2WW skin cancer pathway and SIPOC analysis are also examined. Recommendations are provided following analysis and redesign of the process map of the pathway.

Results: Process analysis has enabled identification of some of the limitations of the 2WW skin cancer pathway. This has led to recommendations including lesion assessment using artificial intelligence, single lesion assessment clinics and direct access skin surgery, all of which aim to expedite patient care and increase capacity in 2WW clinics.

Conclusions: Process analysis of the 2WW skin cancer pathway provides useful insights and helps identify bottlenecks in the system. Recommendations following remapping the process offer potential solutions to help reducing time to referral and increasing capacity. These recommendations should help reduce waiting times for patients receiving initial diagnosis and subsequent definitive treatment for suspected skin cancers.

In the last decade, dupilumab, a monoclonal human antibody inhibiting IL-4/IL-13 signaling, has revolutionized the therapeutic management of moderate-to-severe atopic dermatitis (AD), permitting a long-term control of its signs and symptoms. The aim of this study was to identify histologic predictors of dupilumab efficacy after 16 weeks of treatment in a cohort of forty adult patients with moderate to severe AD who had undergone a skin biopsy for diagnostic purposes prior to treatment initiation. We found that EASI 75 and EASI 90 responses at week 16 were significantly associated with perivascular localization (OR=17.6, p=0.038) and lichenoid distribution (OR=31.8, p=0.025) of the immune infiltrate. Moreover, for each unit increase in the number (cells/m2) of CD4+ cells, the likelihood to achieve EASI75 response decreased by 1% (OR=0.99, p=0.037). In conclusion our study suggested a few pre-treatments qualitative and quantitative immunohistochemical features as promising markers predicting dupilumab response in AD patients.

Clinician-reported outcome measures (ClinROMs) are an important part of disease assessment in daily practice and clinical trials. There is a broad disagreement on the most appropriate ClinROM for a comprehensive assessment of alopecia areata (AA) severity. This paper aims to identify the currently available ClinROMs for AA through a systematic literature search, address their practical strengths and weaknesses, and identify the road ahead for future research. A search was conducted of the published, peer-reviewed literature via PubMed (Medline) and EMBASE (via Ovid) databases. Articles published in English within the last 23 years (post-2000) that objectively measured AA severity were included. We did not select scoring systems that were solely based on patient-reported outcomes (PROs). The literature search identified 1376 articles, of which 27 were chosen for full-text review. Based on our eligibility criteria, fourteen articles were identified, describing sixteen different ClinROMs. Five ClinROMs solely measured scalp hair loss (SALT, SALTⅡ, ALODEX, pSALT, and AA-IGA). Three trichoscopy-based ClinROMs assessed disease activity (AAPI, AAPS, and Coudability hair score). Six ClinROMs exclusively assessed non-scalp areas (BETA, BELA, ALBAS, ClinRO for Eyelash, Eyebrow, and Nail assessment). Two ClinROMs assessed both the scalp and beyond-scalp areas (AASI and AASc). The practical strengths and weaknesses of each assessment tool were described. Various practical limitations associated with established tools have impeded their universal implementation in routine clinical practice. There is a significant need for a holistic clinical severity scoring system to capture all the key severity identifiers beyond the involvement of the scalp.

Objectives: Although cutaneous lupus erythematosus (CLE) has been treated with topical agents, there was no high-quality evidence of which agents were more effective, and which clinical scores were more suitable.

Methods: On December 22nd, 2023, a search was conducted across five databases to identify randomized controlled trials (RCTs). Two authors independently screened the titles and abstracts of articles based on predetermined criteria. Selected articles were then assessed for inclusion in a blinded manner, with any disagreements resolved through consensus. Data were abstracted in duplicate, and a random-effects model was utilized for network meta-analysis. The certainty of the evidence was evaluated according to PRISMA guidelines, using the Grading of Recommendations Assessment, Development and Evaluation approach. The analysis was finalized in January 2024, with the primary outcome focused on the change in cutaneous lupus erythematosus disease area and severity index (CLASI) from baseline.

Results: Seven RCTs involving 231 participants were analyzed. The network meta-analysis (NMA) revealed that 4% nicotinamide demonstrated the highest probability of achieving the intended outcomes, with a mean difference (MD) of 3.10 and a 95% confidence interval (CI) of 1.99-4.21. Additionally, 0.05% clobetasol, 2% nicotinamide, and 0.1% tacrolimus also exhibited statistically significant differences, with MDs of 2.30 and 95% CIs of 0.73-3.88; 2.30 and 0.97-3.63; and 1.30 and 0.03-2.57, respectively.

Conclusion: As data with a high level of evidence, NMAs demonstrated that 4% nicotinamide, 0.05% clobetasol, 2% nicotinamide, and 0.1% tacrolimus are statistically significant topical agents. CLASI may be an appropriate outcome to evaluate drug efficacy in CLE.

Digital papillary adenocarcinoma (DPAc) is a rare, aggressive cutaneous malignancy of sweat gland derivation. Herein, we conduct a retrospective study of 213 DPAc patients using the 17 registries of the Surveillance, Epidemiology, and End Results (SEER) program. We estimate the incidence of DPAc to be 0.11 per million persons per year, with the incidence rising over the past two decades. Our study shows DPAc to most commonly afflict White males, typically in their 40s-60s. We note a 5-year disease-specific survival of 98.3% and 5-year overall survival of 95.7%. We also show advanced age to be associated with more aggressive disease and identify tumor size as an independent risk factor impacting disease-specific survival. Our results also suggest that patients with DPAc have an elevated risk of developing subsequent primary malignancies, with males being at increased risk of developing lung/bronchial neoplasms and females being at increased risk of developing breast cancer.