Dermatology practical & conceptual最新文献

Introduction: In many Western countries, access to a dermatologist can be difficult, while the incidence of skin cancer has risen steadily over the past 50 years.

Objective: We reviewed the published literature to determine whether training primary care practitioners (PCPs) in dermoscopy through brief interventions based on diagnostic algorithms could improve patient care by improving their diagnostic accuracy of suspect lesions.

Methods: A scoping review of the literature was conducted, focusing on studies published in the period 2003-2023 that assessed the ability of low-experienced PCPs to triage suspicious dermatological lesions using dermoscopic diagnostic algorithms. Regarding outcomes, we focused on quantitative variables relevant to screening practice in general practice, including sensitivity, specificity, referrals to specialists, and unnecessary lesion excisions.

Results: Of the 926 studies initially identified, 13 were eventually selected: 10 cross-sectional observational studies and three randomized controlled trials. The studies were carried out in North America (N=6), Western Europe (N=4), and Australia (N=3). There was heterogeneity in the training interventions and the criteria used to assess diagnostic accuracy of PCPs after training; however, all studies showed an improvement in this parameter. The preferred algorithms for training PCPs were the 3-point checklist, the 7-point checklist, and the Triage Amalgamated Dermoscopy Algorithm.

Conclusion: This review demonstrates the value of training PCPs in dermoscopic diagnostic algorithms through short courses to improve triage of suspicious lesions. However, it is still necessary to define a territorial organization, a precise working framework and limits for PCPs who take on this role.

Introduction: Dimethyl fumarate (DMF) is an approved conventional systemic treatment for psoriasis that does not exhibit any drug-drug interactions or cumulative organ toxicities.

Aim: This retrospective real-world study aimed to analyze the long-term efficacy, safety, and tolerability of DMF in patients with moderate psoriasis.

Methods: Data on safety and efficacy were collected from medical charts. The effect on disease severity was assessed using the Psoriasis Area Severity Index.

Results: Our study included 148 patients over a 48-week treatment period, confirming DMF as an effective option in the treatment of moderate psoriasis. Adverse events were only mild or moderate, principally flushing, epigastralgia, and diarrhea. However, DMF exhibited a delayed onset of action, and the dropout rate was high. These aspects highlight the importance of educating patients about the activity profile of DMF, the potential occurrence of side effects, and their management. However, side effects are self-limiting with discontinuation of treatment and generally occur early, allowing patients to be promptly switched to other therapies if DMF is not tolerated.

Conclusions: Our results confirm that DMF may be offered as a first-line treatment for moderate psoriasis as it demonstrated efficacy even in the long-term, when treatment is tolerated, especially in patients with a disease duration of less than five years. DMF may also be proposed when the patient presents comorbidities, when immunosuppression is undesired, and/or before the initiation of biological therapies.

Introduction: Psoriasis and eczema are chronic inflammatory skin diseases. Environmental factors play an important role in the pathogenesis and exacerbation of both conditions.

Objective: This study aimed to investigate factors associated with exacerbation of psoriasis and eczema and compare those factors between both diseases, with the aim of identifying the significant differences between the two conditions.

Methods: A cross-sectional study was conducted on adult patients diagnosed with psoriasis and eczema in Thailand. Demographic characteristics, clinical data, and aggravating factors were collected and compared between both groups. Demographic characteristics and clinical data were analyzed using descriptive statistics, while aggravating factors were analyzed by logistic regression analysis.

Results: A total of 280 patients participated in this study: 192 psoriasis patients and 88 eczema patients. In 97.3% of psoriasis patients and 99.7% of eczema patients, aggravating factors were reported during disease exacerbation. Mental stress and inadequate sleep were significantly associated with psoriasis exacerbation, while humid environment and dust were significantly associated with eczema exacerbation rather than psoriasis exacerbation.

Conclusion: Internal factors, such as mental stress and inadequate sleep, have a greater influence on the worsening of psoriasis, whereas external factors, including a humid environment and dust, have a more significant impact on eczema flare-ups than on psoriasis exacerbation.

Introduction: Receiving gifts, especially during the Christmas festivities, is a common experience for healthcare providers. Gift-giving, being a spontaneous expression of gratitude, could enable the assessment of true patient satisfaction.

Objective: In this study we used the Gifts Received durINg Christmas Holidays (GRINCH) as a potential index of patient satisfaction.

Methods: GRINCH is an Italian national survey that started on 13 December 2022 and lasted until 6 January 2023. Fifty dermatologists, equally divided between males and females working in university hospitals, general hospitals, or private or public offices and covering almost all the Italian regions participated in data collection. The participants were asked to fill out a structured data sheet collecting the type and the estimated gift value, the demographic characteristics of the patient, and the type of condition that led the patient to seek medical attention.

Results: A total of 659 gifts were recorded during the study period. The mean ratio of gifts/dermatologist, GRINCH index, was 13.7. Notably, the Grinch index increased as the dermatologists' ages increased in both sexes, and the same trend was confirmed by the data concerning the doctors' number of years of professional activity. We observed a greater mean GRINCH value in male dermatologists compared to their female colleagues. Patients with chronic diseases were more prone to gifting; those affected by psoriasis, atopic dermatitis, or acne showed above-average GRINCH values. However, this finding seems unrelated to the dermatologist's field of expertise.

Conclusion: Overall, these data strongly underline the importance of the doctor-patient relationship. A structured and prolonged mutual knowledge determines a trustful relationship that appears to be one of the fundamental bases of patient satisfaction.

Introduction: Conjunctival nevi (CN) represent the majority of benign conjunctival melanocytic lesions (CML), followed by complexion-associated melanosis (CAM). Noninvasive methods like dermoscopy could be of importance to increase diagnostic accuracy in this biopsy-sensitive area. Because of the unique anatomy of the conjunctiva, dermoscopic findings differ significantly compared to the skin or other mucosae.

Objective: Our objective was to analyze epidemiological, clinical, and dermoscopic characteristics of benign conjunctival melanocytic lesions and to explore their correlation to total body nevus count (TBNC).

Methods: This retrospective study involved the collection and analysis of demographic data, patient information, and clinical and dermoscopic images from individuals with long-standing, stable, pigmented conjunctival lesions.

Results: A total of 30 benign conjunctival melanocytic lesions in 28 patients (female/male:18/10) with a median age of 32 (range 16-68) years were evaluated. The prevalent dermoscopic pattern was a mixed, globular, homogeneous pattern (36.6%). Clear cysts were identified via dermoscopy in 60% of the lesions, and a reticular pattern was observed in all cases involving cysts (P<0.05). The presence of benign CML was associated with a low TBNC (<10) in 64.3%.

Conclusions: The present study provides a detailed overview of the clinical and dermoscopic characteristics of benign CML. It highlights consistent patterns such as cyst-associated reticular features and a low TBNC among affected individuals. These findings support the clinical utility of dermoscopy as a noninvasive tool for differentiating between benign and suspicious conjunctival lesions. The observed association with low TBNC may warrant increased vigilance during ocular examination in patients with few cutaneous nevi. Prospective studies with larger cohorts are needed to confirm and extend these observations.

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by pruritic, dry, eczematous lesions. Traditionally regarded primarily as a cutaneous disorder influenced by genetic and environmental factors, AD is increasingly recognized as a multisystem condition involving immune, microbial, and neuroendocrine interactions.

Objectives: This review proposes the Skin-Immune-Neuro-Gastro-Endocrine (SINGE) network as a comprehensive framework to explore the interconnected pathophysiology of AD. The aim is to highlight how changes across various systems contribute to disease development, presentation, and treatment.

Methods: A comprehensive review of current literature was performed, examining the roles of skin barrier dysfunction, immune signaling, neuroendocrine pathways, and gut microbial dysbiosis. These domains were integrated into a unified model that describes bidirectional interactions and their clinical implications.

Results: The SINGE model reveals that epidermal barrier disruption activates a cascade of immune responses. Microbial dysbiosis, in concert with the gut-skin axis, further exacerbates AD symptoms, highlighting how alterations in one organ affect the other. Neuroinflammation further contributes to AD symptoms by perpetuating the itch-scratch cycle. Neuroendocrine factors amplify the inflammatory dysregulation, particularly through endocrine involvement involving cortisol signaling in the hypothalamic-pituitary-adrenal (HPA) axis and the paradoxical inflammatory effects on the skin barrier. Together, these intertwined pathways perpetuate the chronic inflammation and skin barrier dysfunction in AD.

Conclusion: By examining these elements as an intricate, intertwined system, the SINGE network reframes AD as a multisystem condition. This apprach not only shifts the understanding of the disease, but also serves as a foundation for exploration of targeted therapies.

Introduction: Microbiota refers to the microorganisms inhabiting specific environments, while the microbiome encompasses these organisms, their metabolites, and environmental factors. Variations in microbiota composition across body regions influence physiological processes, including metabolism, immunity, and skin health. Trimethylamine N-oxide (TMAO), a metabolite linked to gut dysbiosis, inflammation, and systemic diseases, has not been previously investigated in acne patients.

Objective: We aimed to investigate the potential relationship between gut dysbiosis and acne vulgaris by assessing serum TMAO levels in acne patients compared to healthy controls.

Methods: This case-control, cross-sectional study involved 70 acne patients and 70 age- and sex-matched healthy controls. Serum TMAO levels were measured, and acne severity was graded using the Global Acne Grading System (GAGS). Statistical analysis was performed using SPSS 20.0, with p-values <0.05 considered significant.

Results: Acne patients exhibited significantly higher serum TMAO levels (16.74 ± 10.10 ng/ml) compared to controls (13.11 ± 4.28 ng/ml, P=0.007). While no significant correlation was found between TMAO levels and acne severity, a weak negative trend was observed (P=0.062). Similarly, TMAO levels showed no significant correlation with body mass index (BMI) (P=0.933).

Conclusion: This study identified elevated serum TMAO levels in acne vulgaris patients, suggesting a potential link between gut dysbiosis, diet, and acne pathogenesis. While these findings emphasize the role of systemic inflammation and microbiota, further research is necessary to establish causal relationships and to evaluate the impact of dietary and microbial interventions in acne management.