Pub Date : 2022-07-01DOI: 10.4103/1027-8117.354329
Jedpakorn Laopakorn, Sujirod Hanthavichai
Background: The importance of the geriatric population has been increasing expeditiously in the health-care system. The epidemiology of skin disorders is an interesting subject to challenge physicians to comprehensively manage the elderly. Objectives: The objective of the study was to determine the prevalence of the most frequent dermatologic disorders among elderly outpatients and identify major associated determinants. Methods: This retrospective observational study recruited subjects aged 60 years and older attending the dermatologic clinic at the Faculty of Medicine, Vajira Hospital, in Thailand. The medical records were collected between January 2017 and December 2020. The data were analyzed according to age, sex, season, underlying medical diseases, and areas of involvement to identify the associated factors for the frequently presented dermatologic diagnoses. Results: In this study, 521 outpatients (including 218 males and 303 females) with a mean age of 71.34 years (range, 60–04 years) were enrolled. The most common dermatoses were eczematous dermatitis (35.7%), cutaneous infection (18.2%), xerosis (15.5%), and psoriasis (7.3%). The distribution of the prevalent dermatologic disorders still did not change during the COVID-19 pandemic. A significant association was found between xerosis and age of 80 years and older (odds ratio [OR], 2.03; 95% confidence interval [CI], 1.09–3.78; P = 0.026). The risk of developing xerosis cutis significantly decreased with dyslipidemia (OR, 0.45; 95% CI, 0.26–0.78; P = 0.004). Conclusion: The three foremost cutaneous disease groups are eczematous dermatitis, skin infection, and xerosis cutis. Dry skin is strongly connected with the age of 80 years and above; however, xerosis is coincidentally correlated with dyslipidemia.
{"title":"Prevalence and associated factors of skin diseases among geriatric outpatients from a metropolitan dermatologic clinic in Thailand","authors":"Jedpakorn Laopakorn, Sujirod Hanthavichai","doi":"10.4103/1027-8117.354329","DOIUrl":"https://doi.org/10.4103/1027-8117.354329","url":null,"abstract":"Background: The importance of the geriatric population has been increasing expeditiously in the health-care system. The epidemiology of skin disorders is an interesting subject to challenge physicians to comprehensively manage the elderly. Objectives: The objective of the study was to determine the prevalence of the most frequent dermatologic disorders among elderly outpatients and identify major associated determinants. Methods: This retrospective observational study recruited subjects aged 60 years and older attending the dermatologic clinic at the Faculty of Medicine, Vajira Hospital, in Thailand. The medical records were collected between January 2017 and December 2020. The data were analyzed according to age, sex, season, underlying medical diseases, and areas of involvement to identify the associated factors for the frequently presented dermatologic diagnoses. Results: In this study, 521 outpatients (including 218 males and 303 females) with a mean age of 71.34 years (range, 60–04 years) were enrolled. The most common dermatoses were eczematous dermatitis (35.7%), cutaneous infection (18.2%), xerosis (15.5%), and psoriasis (7.3%). The distribution of the prevalent dermatologic disorders still did not change during the COVID-19 pandemic. A significant association was found between xerosis and age of 80 years and older (odds ratio [OR], 2.03; 95% confidence interval [CI], 1.09–3.78; P = 0.026). The risk of developing xerosis cutis significantly decreased with dyslipidemia (OR, 0.45; 95% CI, 0.26–0.78; P = 0.004). Conclusion: The three foremost cutaneous disease groups are eczematous dermatitis, skin infection, and xerosis cutis. Dry skin is strongly connected with the age of 80 years and above; however, xerosis is coincidentally correlated with dyslipidemia.","PeriodicalId":11107,"journal":{"name":"Dermatologica Sinica","volume":"44 10","pages":"168 - 173"},"PeriodicalIF":2.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72409503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chengwen Luo, C. Geng, Yung-Hsien Tung, Bing-Long Wang, T. Tung
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has become a major public exigency of international concern. The COVID-19 epidemic has spread rapidly around the world, profoundly impacting people's lives. Patients are among those most affected by the pandemic. COVID-19 has adversely affected health-care systems, and the effects are long-lasting and devastating. Most medical institutions in the impacted countries and regions have been imbued with COVID-19 cases, both confirmed and suspected, leading to an overburdened health-care workforce like never before. While most of the critical situations involved internal medicine departments, such as infectious diseases, and intensive care units, other specialties, including dermatology, have also been profoundly affected by this pandemic. Dermatoepidemiology, the application of epidemiological methods to dermatology practice, is an important emerging discipline in dermatology. In this review, we discussed the influence of the COVID-19 epidemic on dermatology practice, as well as the application of public health strategies in dermatology. These findings from genetic epidemiological research, clinical trial networks, and pharmacovigilance research suggested that further research in dermatology requires collaborative studies across different fields, institutions, and countries. To solve the highly complex unsolved problems that we face, dermatologists and epidemiologists should be dynamic team members with multiple approach skills.
{"title":"Coronavirus disease 2019 in dermatology practice: Perspective of three levels of prevention on public health","authors":"Chengwen Luo, C. Geng, Yung-Hsien Tung, Bing-Long Wang, T. Tung","doi":"10.4103/ds.ds_33_22","DOIUrl":"https://doi.org/10.4103/ds.ds_33_22","url":null,"abstract":"Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has become a major public exigency of international concern. The COVID-19 epidemic has spread rapidly around the world, profoundly impacting people's lives. Patients are among those most affected by the pandemic. COVID-19 has adversely affected health-care systems, and the effects are long-lasting and devastating. Most medical institutions in the impacted countries and regions have been imbued with COVID-19 cases, both confirmed and suspected, leading to an overburdened health-care workforce like never before. While most of the critical situations involved internal medicine departments, such as infectious diseases, and intensive care units, other specialties, including dermatology, have also been profoundly affected by this pandemic. Dermatoepidemiology, the application of epidemiological methods to dermatology practice, is an important emerging discipline in dermatology. In this review, we discussed the influence of the COVID-19 epidemic on dermatology practice, as well as the application of public health strategies in dermatology. These findings from genetic epidemiological research, clinical trial networks, and pharmacovigilance research suggested that further research in dermatology requires collaborative studies across different fields, institutions, and countries. To solve the highly complex unsolved problems that we face, dermatologists and epidemiologists should be dynamic team members with multiple approach skills.","PeriodicalId":11107,"journal":{"name":"Dermatologica Sinica","volume":"15 1","pages":"143 - 147"},"PeriodicalIF":2.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86002560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/1027-8117.357355
Heng-An Lu, Chao-Chun Yang, Yu-Chen Chen
Alopecia areata (AA) is a common, nonscarring type of alopecia that can cause chronic and severe hair loss in some cases. Although there is no standard established protocol for the use of corticosteroid pulse therapy, it has been reported to be an effective and well-tolerated treatment option for patients with severe AA. This study retrospectively analyzed 29 patients who were diagnosed with severe AA (>50% hair loss) from January 2010 to December 2020 and treated with 3 monthly sessions of intravenous corticosteroids. Methylprednisolone (500 mg/day) was administered for 3 consecutive days during the first session, followed by a 1-day treatment regimen for the second and third sessions. The treatment had an overall satisfactory response rate of 58.6% and a complete response rate of 13.8%. Eleven of the 13 patients who achieved a satisfactory response experienced relapse. A subgroup analysis showed that patients with a shorter duration of AA (≤6 months) had a significantly better response to corticosteroid pulse therapy. This study highlights that 3 monthly sessions of corticosteroid therapy are sufficient to induce satisfactory but temporary response.
{"title":"Three monthly doses of corticosteroid pulse therapy yields a satisfactory but temporary response in severe alopecia areata patients","authors":"Heng-An Lu, Chao-Chun Yang, Yu-Chen Chen","doi":"10.4103/1027-8117.357355","DOIUrl":"https://doi.org/10.4103/1027-8117.357355","url":null,"abstract":"Alopecia areata (AA) is a common, nonscarring type of alopecia that can cause chronic and severe hair loss in some cases. Although there is no standard established protocol for the use of corticosteroid pulse therapy, it has been reported to be an effective and well-tolerated treatment option for patients with severe AA. This study retrospectively analyzed 29 patients who were diagnosed with severe AA (>50% hair loss) from January 2010 to December 2020 and treated with 3 monthly sessions of intravenous corticosteroids. Methylprednisolone (500 mg/day) was administered for 3 consecutive days during the first session, followed by a 1-day treatment regimen for the second and third sessions. The treatment had an overall satisfactory response rate of 58.6% and a complete response rate of 13.8%. Eleven of the 13 patients who achieved a satisfactory response experienced relapse. A subgroup analysis showed that patients with a shorter duration of AA (≤6 months) had a significantly better response to corticosteroid pulse therapy. This study highlights that 3 monthly sessions of corticosteroid therapy are sufficient to induce satisfactory but temporary response.","PeriodicalId":11107,"journal":{"name":"Dermatologica Sinica","volume":"154 1","pages":"178 - 181"},"PeriodicalIF":2.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74318671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Papuloerythroderma of Ofuji as a paraneoplastic phenomenon in a patient with lung cancer","authors":"Wei-Yao Wang, Yue-Chiu Su, Cheng-Che Lan, S. Chiu","doi":"10.4103/ds.ds_25_22","DOIUrl":"https://doi.org/10.4103/ds.ds_25_22","url":null,"abstract":"","PeriodicalId":11107,"journal":{"name":"Dermatologica Sinica","volume":"109 1","pages":"182 - 183"},"PeriodicalIF":2.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85483017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/1027-8117.354330
P. Wu, Ying-Xiu Dai, Yu-Ju Chou, Yung-Ting Chang, Chih-Chiang Chen, Sheng-Hsiang Ma
Polypoid basal cell carcinoma (BCC) is characterized by a stalk connecting the tumor and skin surfaces, with neoplastic cells restricted in the polypoid zone microscopically. A thorough review of polypoid BCC is still lacking. Thus, we performed this scoping review to investigate the clinical manifestations, dermoscopic features, histopathology, treatment, and prognosis of polypoid BCC. A literature search was conducted in the PubMed, Embase, Web of Science, and Cochrane databases until December 23, 2021. Studies reporting at least one patient with polypoid BCC following the pathology and clinical criteria were included. A total of 47 studies with 54 patients with solitary polypoid BCC and 13 patients with multiple polypoid BCCs were included. Solitary polypoid BCC occurred at a relatively younger age, with an equal sex ratio. These tumors most commonly presented as red or flesh-colored pedunculated papules and were commonly distributed over nonsun-exposed areas. Most tumors were managed with excision, and recurrence or metastasis was seldom reported. Most patients with multiple polypoid BCCs had basal cell nevus syndrome and presented with generalized distributed, flesh-colored, or brown papules mimicking skin tags. Typical dermoscopic features of BCC could still be observed in these lesions, including arborizing vessels, blue-gray globules, and ovoid nests, which could aid in early diagnosis. In conclusion, polypoid BCC is a distinct variant of BCC with pedunculated morphology. Physicians should be aware of polypoid BCC and may use dermoscopy to aid in early diagnosis and treatment.
息肉样基底细胞癌(Polypoid basal cell carcinoma, BCC)的特征是肿瘤与皮肤表面有一根茎连接，显微镜下肿瘤细胞局限于息肉区。对息肉样基底细胞癌的全面回顾仍然缺乏。因此，我们对息肉样细胞癌的临床表现、皮肤镜特征、组织病理学、治疗和预后进行了综述。文献检索在PubMed, Embase, Web of Science和Cochrane数据库中进行，直到2021年12月23日。研究报告至少有一例息肉样BCC患者符合病理和临床标准。共纳入47项研究，54例单发息肉样BCC和13例多发息肉样BCC。孤立性息肉样BCC发生于相对年轻的年龄，性别比例相等。这些肿瘤最常表现为红色或肉色的带梗丘疹，通常分布在非阳光照射的区域。大多数肿瘤以切除治疗，很少有复发或转移的报道。大多数多发性息肉样bcc患者有基底细胞痣综合征，表现为广泛性分布的肉色或棕色丘疹，类似于皮赘。在这些病变中仍然可以观察到典型的BCC皮肤镜特征，包括树状血管，蓝灰色小球和卵形巢，有助于早期诊断。总之，息肉样BCC是具有带梗形态的BCC的不同变体。医生应注意息肉样基底细胞癌，并可使用皮肤镜辅助早期诊断和治疗。
{"title":"Polypoid basal cell carcinoma: A scoping review","authors":"P. Wu, Ying-Xiu Dai, Yu-Ju Chou, Yung-Ting Chang, Chih-Chiang Chen, Sheng-Hsiang Ma","doi":"10.4103/1027-8117.354330","DOIUrl":"https://doi.org/10.4103/1027-8117.354330","url":null,"abstract":"Polypoid basal cell carcinoma (BCC) is characterized by a stalk connecting the tumor and skin surfaces, with neoplastic cells restricted in the polypoid zone microscopically. A thorough review of polypoid BCC is still lacking. Thus, we performed this scoping review to investigate the clinical manifestations, dermoscopic features, histopathology, treatment, and prognosis of polypoid BCC. A literature search was conducted in the PubMed, Embase, Web of Science, and Cochrane databases until December 23, 2021. Studies reporting at least one patient with polypoid BCC following the pathology and clinical criteria were included. A total of 47 studies with 54 patients with solitary polypoid BCC and 13 patients with multiple polypoid BCCs were included. Solitary polypoid BCC occurred at a relatively younger age, with an equal sex ratio. These tumors most commonly presented as red or flesh-colored pedunculated papules and were commonly distributed over nonsun-exposed areas. Most tumors were managed with excision, and recurrence or metastasis was seldom reported. Most patients with multiple polypoid BCCs had basal cell nevus syndrome and presented with generalized distributed, flesh-colored, or brown papules mimicking skin tags. Typical dermoscopic features of BCC could still be observed in these lesions, including arborizing vessels, blue-gray globules, and ovoid nests, which could aid in early diagnosis. In conclusion, polypoid BCC is a distinct variant of BCC with pedunculated morphology. Physicians should be aware of polypoid BCC and may use dermoscopy to aid in early diagnosis and treatment.","PeriodicalId":11107,"journal":{"name":"Dermatologica Sinica","volume":"46 1","pages":"148 - 155"},"PeriodicalIF":2.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90777605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/1027-8117.357357
Hsin-Jou Wang, Jui-Wen Yeh, Yin-Fan Chang, J. Wu, Chao-Chun Yang
Background: Female pattern hair loss (FPHL) is the main cause of alopecia in women and has a debilitating impact on the quality of life. However, certain comorbid conditions causing hair loss are often masked by FPHL and may remain undetected. Hence, it is imperative to identify them to administer appropriate treatment. The necessity of laboratory tests to evaluate these comorbidities in patients with FPHL has not been established. Objectives: This study aimed to identify the frequency of comorbid abnormalities detected by laboratory tests in patients with FPHL. Methods: Routine laboratory test results of patients with FPHL, who visit our hair clinic for the first time, were retrospectively collected and analyzed. These tests assessed the serum testosterone, thyroid-stimulating hormone, free thyroxin, zinc and ferritin levels, hemoglobin, as well as antinuclear antibody (ANA), and rapid plasma reagin test results. The correlation between age and hair loss severity and the frequency of comorbidities was evaluated using subgroup analysis. Results: Among the 356 patients with FPHL, coexisting zinc deficiency, iron depletion, and thyroid abnormalities were common and present in 41.7%, 39.7%, and 11.3% of them, respectively. The rate of concomitantly increased ANA titers was relatively low (4.4%), while that of syphilis and high serum testosterone levels was extremely low (0.3% and 0%, respectively). Younger patients (<50 years) with FPHL had a higher rate of coexisting iron deficiency than patients in the older age group. Conclusion: Testing for concomitant iron depletion, zinc deficiency, and thyroid disease is recommended in female patients with FPHL.
{"title":"Comorbid laboratory abnormalities in female pattern hair loss patients","authors":"Hsin-Jou Wang, Jui-Wen Yeh, Yin-Fan Chang, J. Wu, Chao-Chun Yang","doi":"10.4103/1027-8117.357357","DOIUrl":"https://doi.org/10.4103/1027-8117.357357","url":null,"abstract":"Background: Female pattern hair loss (FPHL) is the main cause of alopecia in women and has a debilitating impact on the quality of life. However, certain comorbid conditions causing hair loss are often masked by FPHL and may remain undetected. Hence, it is imperative to identify them to administer appropriate treatment. The necessity of laboratory tests to evaluate these comorbidities in patients with FPHL has not been established. Objectives: This study aimed to identify the frequency of comorbid abnormalities detected by laboratory tests in patients with FPHL. Methods: Routine laboratory test results of patients with FPHL, who visit our hair clinic for the first time, were retrospectively collected and analyzed. These tests assessed the serum testosterone, thyroid-stimulating hormone, free thyroxin, zinc and ferritin levels, hemoglobin, as well as antinuclear antibody (ANA), and rapid plasma reagin test results. The correlation between age and hair loss severity and the frequency of comorbidities was evaluated using subgroup analysis. Results: Among the 356 patients with FPHL, coexisting zinc deficiency, iron depletion, and thyroid abnormalities were common and present in 41.7%, 39.7%, and 11.3% of them, respectively. The rate of concomitantly increased ANA titers was relatively low (4.4%), while that of syphilis and high serum testosterone levels was extremely low (0.3% and 0%, respectively). Younger patients (<50 years) with FPHL had a higher rate of coexisting iron deficiency than patients in the older age group. Conclusion: Testing for concomitant iron depletion, zinc deficiency, and thyroid disease is recommended in female patients with FPHL.","PeriodicalId":11107,"journal":{"name":"Dermatologica Sinica","volume":"55 1","pages":"174 - 177"},"PeriodicalIF":2.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83890221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Miłosz Lewandowski, Zuzanna Świerczewska, W. Barańska-Rybak
Background: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease characterized by a significant decrease in the patients' quality of life. Patients are increasingly looking for information about HS on social media, including YouTube (YT). However, the quality of the videos in some other diseases has been often scored as poor. Objectives: The aim of this study was to evaluate the usefulness and the quality of the most viewed acne inversa videos on YT. Methods: YT was searched for the keywords “HS” and “acne inversa.” For videos, quality assessment validated DISCERN instrument and the global quality score (GQS) were applied. Furthermore, the popularity of each video using the video power index (VPI) score was evaluated. Results: After applying the exclusion criteria, 34 videos were analyzed. We found that video quality was poor regardless of video type. The mean DISCERN score between the raters was 34.65 ± 10.7, and the mean GQS score was 2.6 ± 0.98. There was no significant correlation between the DISCERN, GQS and VPI, the number of views, likes, dislikes, comments, and video duration. Conclusion: Our study highlights the gaps in knowledge regarding HS treatment on YT. Hence, this information can be used to create superior educational content in the future.
{"title":"YouTube as a source of information for hidradenitis suppurativa treatment","authors":"Miłosz Lewandowski, Zuzanna Świerczewska, W. Barańska-Rybak","doi":"10.4103/ds.ds_27_22","DOIUrl":"https://doi.org/10.4103/ds.ds_27_22","url":null,"abstract":"Background: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease characterized by a significant decrease in the patients' quality of life. Patients are increasingly looking for information about HS on social media, including YouTube (YT). However, the quality of the videos in some other diseases has been often scored as poor. Objectives: The aim of this study was to evaluate the usefulness and the quality of the most viewed acne inversa videos on YT. Methods: YT was searched for the keywords “HS” and “acne inversa.” For videos, quality assessment validated DISCERN instrument and the global quality score (GQS) were applied. Furthermore, the popularity of each video using the video power index (VPI) score was evaluated. Results: After applying the exclusion criteria, 34 videos were analyzed. We found that video quality was poor regardless of video type. The mean DISCERN score between the raters was 34.65 ± 10.7, and the mean GQS score was 2.6 ± 0.98. There was no significant correlation between the DISCERN, GQS and VPI, the number of views, likes, dislikes, comments, and video duration. Conclusion: Our study highlights the gaps in knowledge regarding HS treatment on YT. Hence, this information can be used to create superior educational content in the future.","PeriodicalId":11107,"journal":{"name":"Dermatologica Sinica","volume":"40 1","pages":"156 - 161"},"PeriodicalIF":2.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76201973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vogt–Koyanagi–Harada disease (VKHD) is a major vision-threatening autoimmune disease. One of its associated features is vitiligo. Little study has been done on the association between vitiligo and the disease activity of VKHD. The authors searched available literature on the relationship between vitiligo and ophthalmic disease activity in VKHD in terms of pathogenesis, clinical presentations, risk factors as well as disease activity. Among the findings is that early treatment of VKHD may be associated with full recovery. The reversal of poliosis and vitiligo is associated with the remission of uveitis, but the reverse does not hold true, whereby the worsening of vitiligo may not reflect the worsening of uveitis. It is also found that there may be an association between immunotherapy and Vogt–Koyanagi–Harada-like disease. In summary, vitiligo is an immune-mediated cutaneous manifestation which may contribute to diagnostic and treatment strategies in VKHD. Future research on genetic differences in vitiligo is still needed and may contribute to specific monitoring and therapeutic approach in this disease.
{"title":"Hints from the skin beneath: Vitiligo in Vogt–Koyanagi–Harada disease","authors":"Jong Ho Lim, Wooi-Chiang Tan, N. Nor","doi":"10.4103/ds.ds_23_22","DOIUrl":"https://doi.org/10.4103/ds.ds_23_22","url":null,"abstract":"Vogt–Koyanagi–Harada disease (VKHD) is a major vision-threatening autoimmune disease. One of its associated features is vitiligo. Little study has been done on the association between vitiligo and the disease activity of VKHD. The authors searched available literature on the relationship between vitiligo and ophthalmic disease activity in VKHD in terms of pathogenesis, clinical presentations, risk factors as well as disease activity. Among the findings is that early treatment of VKHD may be associated with full recovery. The reversal of poliosis and vitiligo is associated with the remission of uveitis, but the reverse does not hold true, whereby the worsening of vitiligo may not reflect the worsening of uveitis. It is also found that there may be an association between immunotherapy and Vogt–Koyanagi–Harada-like disease. In summary, vitiligo is an immune-mediated cutaneous manifestation which may contribute to diagnostic and treatment strategies in VKHD. Future research on genetic differences in vitiligo is still needed and may contribute to specific monitoring and therapeutic approach in this disease.","PeriodicalId":11107,"journal":{"name":"Dermatologica Sinica","volume":"52 1","pages":"78 - 84"},"PeriodicalIF":2.5,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83869152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Intralesional steroid treatment for alopecia areata (AA) has been developed for decades, yet the optimal concentration of triamcinolone acetonide (TrA) is not well-established. Objectives: This review aims to determine the optimal concentration of intralesional TrA in treating patchy AA. Methods: We conducted a systematic review and meta-analysis, and searched the Cochrane Library, Embase, and PubMed databases on July 4, 2021, to identify randomized or nonrandomized comparative studies reporting the response rates and/or adverse events among AA patients treated with various concentrations of TrA. The meta-analysis of proportions and odds ratios was analyzed using random-effects modeling. Results: Nineteen studies and a total of 783 participants were included. The estimated response rate of 5 mg/dl (74.82%, 95% confidence interval [CI] 64.99%–83.50%) was shown to be more efficacious than 2.5/3.33 mg/dl (38.64%, 95% CI 16.98%–62.99%) but similar to 10 mg/dl (71.06%, 95% CI 59.72%–81.20%), while pooled estimate of odds ratios revealed higher efficacy with 10 mg/dl than 5 mg/dl (odds ratio = 1.64, 95% CI 1.05–2.58, P = 0.031). The rates of skin atrophy were 18.05% (95% CI, 10.32%–27.38%), 11.49% (95% CI, 2.86%–24.84%), and 3.85% (95% CI, 1.27%–14.01%) in groups 10, 5, and 2.5/3.33 mg/dl, respectively. Higher concentration is associated with more skin atrophy in a dose-dependent fashion (P = 0.012). Heterogeneity among studies in the meta-analyses was high. Conclusion: The optimal intralesional concentration of TrA for patchy AA is probably 10 mg/dl with acceptable adverse events.
背景:斑秃(AA)的病灶内类固醇治疗已经发展了几十年，但曲安奈德(TrA)的最佳浓度尚未确定。目的:本综述旨在确定局斑性AA治疗的最佳局斑内TrA浓度。方法:我们于2021年7月4日进行了系统回顾和荟萃分析，并检索了Cochrane图书馆、Embase和PubMed数据库，以确定报告不同浓度TrA治疗AA患者的缓解率和/或不良事件的随机或非随机比较研究。采用随机效应模型对比例和优势比进行meta分析。结果:19项研究共纳入783名受试者。5 mg/dl的估计有效率(74.82%，95%可信区间[CI] 64.99%-83.50%)比2.5/3.33 mg/dl更有效(38.64%，95% CI 16.98%-62.99%)，但与10 mg/dl相似(71.06%，95% CI 59.72%-81.20%)，而合并估计的优势比显示10 mg/dl的疗效高于5 mg/dl(优势比= 1.64,95% CI 1.05-2.58, P = 0.031)。10、5和2.5/3.33 mg/dl组的皮肤萎缩率分别为18.05% (95% CI, 10.32% ~ 27.38%)、11.49% (95% CI, 2.86% ~ 24.84%)和3.85% (95% CI, 1.27% ~ 14.01%)。浓度越高，皮肤萎缩越严重，呈剂量依赖性(P = 0.012)。meta分析中各研究的异质性较高。结论:局部AA的最佳局灶内TrA浓度为10 mg/dl，不良反应可接受。
{"title":"The optimal concentration of intralesional triamcinolone acetonide for patchy alopecia areata: A systematic review and meta-analysis","authors":"Hsuan-An Su, Yu-Tsung Chen, Yu-Chia Chen","doi":"10.4103/ds.ds_15_22","DOIUrl":"https://doi.org/10.4103/ds.ds_15_22","url":null,"abstract":"Background: Intralesional steroid treatment for alopecia areata (AA) has been developed for decades, yet the optimal concentration of triamcinolone acetonide (TrA) is not well-established. Objectives: This review aims to determine the optimal concentration of intralesional TrA in treating patchy AA. Methods: We conducted a systematic review and meta-analysis, and searched the Cochrane Library, Embase, and PubMed databases on July 4, 2021, to identify randomized or nonrandomized comparative studies reporting the response rates and/or adverse events among AA patients treated with various concentrations of TrA. The meta-analysis of proportions and odds ratios was analyzed using random-effects modeling. Results: Nineteen studies and a total of 783 participants were included. The estimated response rate of 5 mg/dl (74.82%, 95% confidence interval [CI] 64.99%–83.50%) was shown to be more efficacious than 2.5/3.33 mg/dl (38.64%, 95% CI 16.98%–62.99%) but similar to 10 mg/dl (71.06%, 95% CI 59.72%–81.20%), while pooled estimate of odds ratios revealed higher efficacy with 10 mg/dl than 5 mg/dl (odds ratio = 1.64, 95% CI 1.05–2.58, P = 0.031). The rates of skin atrophy were 18.05% (95% CI, 10.32%–27.38%), 11.49% (95% CI, 2.86%–24.84%), and 3.85% (95% CI, 1.27%–14.01%) in groups 10, 5, and 2.5/3.33 mg/dl, respectively. Higher concentration is associated with more skin atrophy in a dose-dependent fashion (P = 0.012). Heterogeneity among studies in the meta-analyses was high. Conclusion: The optimal intralesional concentration of TrA for patchy AA is probably 10 mg/dl with acceptable adverse events.","PeriodicalId":11107,"journal":{"name":"Dermatologica Sinica","volume":"198 1","pages":"85 - 93"},"PeriodicalIF":2.5,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89010984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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