Dermatology practical & conceptual最新文献

Introduction: Impetigo is a common, highly contagious bacterial skin infection primarily affecting children. Treatment usually involves topical or oral antibiotics, and numerous clinical trials have been published to support these therapeutic approaches.

Objectives: To evaluate the methodological quality of randomized clinical trials (RCTs) on the pharmacological treatment of impetigo in children and adolescents.

Methods: This meta-research evaluated RCTs on systemic or topical pharmacological treatments for impetigo in children and adolescents. A comprehensive literature search was conducted in September 2024 across MEDLINE, Embase, CENTRAL, and LILACS databases. The methodological quality of the included RCTs was assessed using the Cochrane Risk of Bias tool. Data are presented as percentages.

Results: Twenty-one RCTs on pharmacological treatments for impetigo were identified and assessed. The findings identified some methodological concerns: i) 53% to 57% of RCTs had an unclear risk of selection bias due to insufficient information on randomization and allocation concealment; ii) 71% were at high risk of bias for blinding of participants and personnel, while 57% had a high risk for blinding of outcome assessors; iii) 24% exhibited a high risk of attrition bias due to significant participant losses without justification; iv) 81% had an unclear risk of bias due to the lack of registered protocols available.

Conclusions: Based on the methodological quality of the assessed RCTs, this study highlights the need for more rigorous design and reporting standards in future research on pharmacological treatments for impetigo to enhance the reliability and validity of the evidence, thereby supporting more informed clinical decision-making.

Introduction: Omalizumab is an established treatment for chronic spontaneous urticaria (CSU), yet variability in therapeutic response remains a clinical challenge. Identifying baseline predictors of early response may help optimize patient selection and management strategies.

Objectives: To evaluate the predictive value of age, sex, baseline disease severity, and disease duration for early response to omalizumab and to assess their relationship with relapse risk.

Methods: This retrospective study included 274 patients with CSU treated with omalizumab between 2011 and 2024. Early response was defined as achieving a UAS7 score <7 at one month. Baseline variables included age, sex, UAS7, and disease duration. Binary logistic regression and ROC curve analyses were conducted to identify independent predictors of early response.

Results: Among 274 patients (mean age 42.96±15.54 years; 66.4% female), early response was achieved in 37.6%. Early responders had significantly lower baseline UAS7 and shorter disease duration (both P<0.001). Logistic regression confirmed both variables as independent predictors. Age and sex were not independently associated with early response, although univariate analysis showed a higher early response rate in patients aged <45 years. ROC analysis demonstrated strong inverse predictive value for UAS7 (AUC=0.917) and disease duration (AUC=0.940). Relapse risk was significantly lower in females and patients aged <45 years.

Conclusions: Lower baseline UAS7 and shorter disease duration independently predict early response to omalizumab. Younger age and female sex may be associated with lower relapse risk. These findings support earlier therapeutic intervention in patients with lower disease burden to improve outcomes.

Introduction: Recent reports of increased prevalence and treatment failure in scabies have raised concerns worldwide. Drug efficacy as well as adherence to treatment are important in treatment failure, and data on the latter are limited.

Objective: We aimed to determine the factors associated with treatment failure in scabies.

Methods: This prospective, multicenter observational study was conducted in three centers, enrolling 230 patients diagnosed with scabies. Treatment outcomes were assessed one month after treatment initiation. Patients completed a questionnaire evaluating factors potentially affecting treatment outcomes. Demographic and clinical characteristics and adherence to treatment recommendations were compared in two groups: successful treatment and treatment failure.

Results: The study included 125 males and 105 females, with a mean age of 24.6 ±17.6 years. Treatment failure was found in 58 patients (25.2%). No demographic parameter or medication was associated with treatment failure. Three independent risk factors for treatment failure (multivariate regression analysis) were lack of application of topical medication to the whole body, (odds ration (OR): 14.33; 95% confidence interval (CI): 2.9-71.4), lack of reapplication after washing hands (OR: 3.5; 95% CI: 1.5-8.0), and not reading of the information form (OR: 13.7; 95% CI: 1.3-80.6).

Conclusion: Treatment failure in scabies is quite common. Incorrect or incomplete application of topical treatment and lack of hygiene measures are the main factors leading to treatment failure. Providing a written information sheet with step-by-step treatment recommendations may contribute to treatment success.

Introduction: Cutaneous malignant melanoma is a neoplastic transformation of melanocytes and a major cause of skin cancer-related mortality. Ireland, with its fair-skinned population, continues to see rising incidence rates, highlighting the importance of identifying clinicopathological predictors of recurrence.

Objectives: To assess the relationship between excision margins and melanoma recurrence, with emphasis on anatomical distribution and clinicopathological features.

Methods: This retrospective observational study analyzed 565 patient records from University Hospital Waterford, Ireland, meeting predefined criteria. Data collected included age, sex, primary tumor site, disease stage, Breslow thickness, Clark level, mitotic figures, ulceration, lymphovascular invasion, sentinel lymph node involvement, and adequacy of excision margins. Statistical analysis was conducted using SPSS 26.0.

Results: Significant predictors of recurrence included age ≥65 years, Breslow thickness >4.0 mm, Clark level IV-V, ulceration, lymphovascular invasion (P<0.001), and positive sentinel lymph node biopsy (P=0.004). Inadequate excision margins were also linked to increased recurrence. Conversely, early-stage disease, thin Breslow lesions (≤1.0 mm), and Clark level II were associated with lower recurrence risk.

Conclusions: This study demonstrates a significant association between narrow excision margins and melanoma recurrence, particularly in anatomically complex areas like the head and neck. The findings underscore the importance of individualized surgical planning to ensure oncological safety while preserving function and appearance. Adherence to excision margin guidelines and long-term follow-up are essential, especially in patients with high-risk histological features.