Clinical and Experimental Dermatology最新文献

Background: In dermatology, the applications of machine learning (ML), an artificial intelligence (AI) subset that enables machines to learn from experience, have progressed past the diagnosis and classification of skin lesions. A lack of systematic reviews exists to explore the role of ML in predicting the severity of psoriasis.

Objectives: To identify and summarize the existing literature on predicting psoriasis severity using ML algorithms and to identify gaps in -current clinical applications of these tools.

Methods: OVID Embase, OVID MEDLINE, ACM Digital Library, Scopus and IEEE Xplore were searched from inception to August 2024.

Results: In total, 30 articles met our inclusion criteria and were included in this review. One article used serum biomarkers, while the remaining 29 used image-based models. The most common severity assessment score employed by these ML models was the Psoriasis Area and Severity Index score, followed by body surface area, with 15 and 5 articles, respectively.

Conclusions: The small size and heterogeneity of the existing body of literature are the primary limitations of this review. Progress in assessing skin lesion severity through ML in dermatology has advanced, but prospective clinical applications remain limited. ML and AI promise to improve psoriasis management, especially in nonimage-based applications requiring further exploration. Large-scale prospective trials using diverse image datasets are necessary to evaluate and predict the clinical value of these predictive AI models.

Background: SunSmart is the annual skin cancer prevention awareness campaign run by the National Cancer Control Programme in Ireland.

Objectives: To assess sun protection attitudes following the 2023 campaign and compare findings with those gathered in 2022.

Methods: An online survey was conducted in September 2023, repeating the 2022 survey. Data were collated and analysed.

Results: In 2023, 48.0% (n = 481/1002) of adults reported being sunburnt that summer. Younger adults (aged 18-24 years) were more likely than older adults (aged ≥ 55 years) to report sunburn [n = 71/115 (61.7%) vs. n = 99/345 (28.7%); P < 0.001]. In assessing the 'SunSmart 5Ss', 93.6% (n = 938/1002) rated sunscreen, 88.4% (n = 886/1002) rated shade, 83.9% (n = 841/1002) rated hats, 70.5% (n = 706/1002) rated long sleeves and 70.1% (n = 702/1002) rated sunglasses as important. Older adults were more likely than younger adults to rate each factor as important. A higher proportion reported each factor as important compared with 2022. Awareness of the campaign increased, with 32.2% (n = 323/1002) having heard of SunSmart vs. 20.5% in 2022 (n = 205/1000; P < 0.001). Awareness was higher in older adults than younger adults [n = 135/345 (39.1%) vs. n = 24/115 (20.9%); P < 0.001], and in those who reported no sunburn [n = 179/521 (34.4%) vs. n = 144/481 (29.9%); P = 0.02].

Conclusions: Awareness of the SunSmart campaign and the perceived importance of the sun protection factors have improved since 2022, with the perceived importance of the 'SunSmart 5Ss' being reasonably high. Reaching younger adults and improving their sun protection behaviours remain areas for progress.

Basal cell carcinomas (BCCs) are slow-growing keratinocyte tumours. There are few reports in the literature reporting the natural history of untreated BCCs. We evaluated the natural progression of BCCs and patient outcomes while awaiting surgical intervention. Only patients with histologically proven BCCs were included in our analysis. Retrospective data analysis was performed for a sample of 55 patients (in total, 70 lesions). There was a significant correlation between the average growth of BCCs and the time waiting for a procedure, with 20% of patients requiring a more complex procedure than originally planned at the time of booking. The top three most frequently reported symptoms were itching (39.4%), crusting (36.4%) and bleeding (30.3%). We report a positive relationship between BCC growth and the length of time from initial presentation to surgical treatment. Patients with long waits often exhibited more symptoms and required more complex surgical procedures than originally planned, especially for BCCs in the head and neck.

Background: Epidermolysis bullosa (EB) encompasses rare hereditary skin conditions marked by skin fragility, nail dystrophy and minor trauma-induced skin blisters.

Objectives: To identify genetic variants in patients with EB in India and to examine the relationship between genotypic and phenotypic manifestations.

Methods: Patients with EB seen consecutively over a period of 5 years at an outpatient department of dermatology (Postgraduate Institute of Medical Education and Research, Chandigarh, India) were included in the study. Baseline demographic data, birth history, family history, skin manifestations at birth, medical history, current cutaneous manifestations and the evolution of the disease were assessed and recorded. Genetic variants were identified using targeted gene panel sequencing for 23 EB-related genes and a genetic-phenotype analysis was performed.

Results: Our study included 65 patients with EB. Among these 65 patients with EB, 38 had dystrophic EB (DEB, 58%), 12 had junctional EB (JEB, 18%), 12 had EB simplex (EBS, 18%) and 3 had Kindler EB (KEB, 5%). Dominant and recessive forms of dystrophic EB accounted for 17% (n = 11) and 42% (n = 27), respectively, of the 65 individuals with EB. We identified 75 genetic variants, 59% (n = 44) newly discovered and 41% (n = 31) previously reported. Compound heterozygous variants were more frequent (56%; 15/27) than homozygous ones (44%; 12/27) in individuals with recessive DEB. Patients with JEB harboured LAMB3 mutations more frequently, whereas patients with EBS harboured KRT5 and KRT14 missense heterozygous mutations. Patients with KEB had homozygous mutations in FERTM1.

Conclusions: Our study has unveiled several novel genetic variants and severe phenotypes associated with nonsense genetic variants. These findings offer valuable insights for future clinical assessments and tailored management strategies.

Background: The basophil activation test (BAT) is considered to be the best biomarker to predict autoimmune chronic spontaneous urticaria (aiCSU). To date, few studies have investigated the utility of BAT in real-world clinical practice, the role of aiCSU biomarkers in relation to omalizumab therapy and the degree of association between different aiCSU tests.

Objectives: To analyse the clinical and laboratory features of a prospective cohort with chronic spontaneous urticaria (CSU) according to their BAT status, as well as to study omalizumab efficacy according to aiCSU biomarkers.

Methods: A prospective study was conducted from 2010 to 2024 in patients with CSU. BAT alongside other laboratory tests were performed, and clinical and therapeutic features were prospectively collected. Data obtained were compared according to BAT status (positive vs. negative). Furthermore, omalizumab drug survival was typified according to aiCSU biomarkers.

Results: In total, 240 patients were included in the study. Patients who were BAT positive presented more frequently with low IgE levels, higher occurrence of IgG antithyroid peroxidase (anti-TPO) positivity, autologous serum skin test (ASST) positivity, basopenia and eosinopenia. Multivariate logistic regression revealed that ASST [odds ratio (OR) 7.69, 95% confidence interval (CI) 2.81-21.0] and anti-TPO (OR 2.63, 95% CI 1.05-6.61) were associated with BAT positivity. All aiCSU biomarkers (BAT, ASST, combined ASST/BAT positivity and low IgE/anti-TPO+) were associated with significantly shorter omalizumab survival because of treatment failure. In the cohort, both low IgE/anti-TPO+ and ASST were associated with BAT positivity.

Conclusions: The use of BAT in clinical practice delineates a subgroup of patients with specific clinical, laboratory and therapeutic features, including increased omalizumab failure.

This two-part review addresses the pressing need for environmental sustainability in dermatological surgery, driven by the National Health Service's commitment to net-zero emissions. Part 2 of this review extends the discussion of sustainability in dermatological surgery by focusing on system-wide changes in service delivery and identifying future opportunities for reducing environmental impact. Building on the strategies outlined in Part 1, which explored low-carbon alternatives and operational resource optimization, Part 2 advocates for a comprehensive shift in the skin surgery service. Key strategies include reducing overall surgical activity, advancing research and innovation, and enhancing management practices to align with sustainability goals. Reducing surgical activity mainly involves the prevention of skin cancers, in addition to optimizing current patient pathways and empowering patients to take ownership of their follow-up. Outside of immediate clinical decision making at the individual level, the review highlights the importance of managerial policy, procurement practices and supply chain factors in driving broader national and international sustainability efforts. Advancing the sustainability agenda will also require targeted research and innovation, particularly in digital health solutions using evidence-based practices. By integrating these strategies, this review aims to provide a framework for reducing the environmental footprint of dermatological surgery and advancing towards a more sustainable healthcare system.