Dermatology practical & conceptual最新文献

Introduction: Patients with mycosis fungoides (MF) have a higher risk of developing second primary malignancy. The type of second malignancy varies across the studies, and no established guidelines currently exist for screening MF patients.

Objective: To identify MF and Sézary syndrome (SS) patients at a potentially higher risk of developing a secondary primary malignancy, assess the prevalence of other secondary malignancies, and evaluate whether MF with other primary malignancies leads to a worse prognosis based on MF variants.

Methods: This observational single-center retrospective study followed 84 patients for a minimum of five years.

Results: We identified 16 patients (19%) with second malignancy, of whom eight (50%) had hematological neoplasms. Among other malignancies, breast cancer was the most common (N=5), followed by other malignancies, including lung cancer, prostate cancer, kidney cancer, and so on. The median age at disease onset was 53.0 years, while median age at second malignancy diagnosis was 60.5 years. No sex predominance was observed. Although not statistically significant, seven of sixteen patients (43.75%) who developed second malignancy had MF variant (such as folliculotropic MF) or Sezary syndrome. Disease progression was more common in patients with MF variant.

Conclusion: A higher risk for developing a second primary neoplasm was observed. However, additional cancer screening beyond routine age-and sex-appropriate examinations is not yet included in the current guidelines. Based on our findings, we recommend that MF patients undergo regular preventive screenings for the early detection of other primary malignancies.

Introduction: As the pandemic plateaus, post-COVID alopecia is resurfacing in India. COVID-19 remains a pivotal cause of alopecia, and the diagnosis of post-COVID alopecia aids in better treatment outcomes.

Objectives: To estimate the prevalence of post-COVID alopecia and to evaluate the association between alopecia and COVID severity among other factors.

Methods: A retrospective cross-sectional study was conducted among patients admitted to the COVID ward. Patients willing to participate were asked to fill in a pretested semi-structured questionnaire, and the PSS-10 (Perceived Stress Scale) was used to evaluate stress. Data were analyzed using the SPSS version 24.

Results: Prevalence of COVID-19-induced hair loss was 37.8%. Age, sex, COVID severity, and higher stress were the significant factors, with p-value <0.05. Female sex, COVID severity, and high stress levels came to be significant independent predictors of hair loss. A majority of participants (46.9%) noticed hair loss within three months of contracting the disease.

Conclusion: This study stands to be a pioneer project to investigate the prevalence of COVID-19-induced alopecia in India. The prevalence rate of 37.8% with a significant association with severity of COVID-19 highlights the importance of reviewing patient history to provide proper treatment and reassurance.

Introduction: Skin imaging has transformed dermatology by enabling non-invasive diagnosis, monitoring, and treatment of various skin conditions. However, imaging skin of color presents unique challenges and opportunities due to variations in melanin content and skin structure.

Objectives: By focusing on the unique aspects of skin of color, this review aims to promote equitable healthcare and encourage the adoption of advanced imaging technologies across all skin types.

Methods: This review paper provides a comprehensive overview of the current state of skin imaging technologies, including optical, non-optical, and hybrid modalities, and their specific applications in dermatology.

Results: We discuss the diagnostic complexities associated with skin cancers, inflammatory conditions, and infectious diseases in diverse skin tones, underscoring the need for tailored imaging techniques. The review also explores advances in artificial intelligence and machine learning, highlighting their potential to enhance image analysis and diagnostic accuracy for skin of color.

Conclusion: We address the technical limitations, biological variability, and ethical considerations in skin imaging, ultimately advocating for more inclusive research and development. Future directions include the development of innovative imaging modalities and personalized medicine approaches that consider the diverse spectrum of human skin.

Introduction: Well-differentiated squamous cell skin cancer (WDSCC) is common in sun-exposed populations. Guidelines promote active treatment, with excision preferred. Isolated cases of spontaneous regression (SR) have been reported. Having observed multiple patients with apparent SR following partial, diagnostic biopsy, we did a retrospective cohort study to explore this further.

Objectives: We sought to report frequency of SR of WDSCC following partial biopsy by a general practitioner (GP) in a primary care setting and referral to a public hospital general surgery service for excision, to report patient characteristics, and to estimate the time interval between biopsy and SR.

Methods: Retrospective cohort study (22 months) of patients in Queensland, Australia, with a diagnosis of WD-SCC following a partial biopsy by a GP. SR was defined as no clinical or dermoscopy evidence of squamous cell carcinoma (SCC).

Results: Among 153 consecutive patients with WDSCC referred for excision, 51 showed SR at consultation (33.3%, 95% CI: 25.6-41). There was no significant difference in age or sex of the SR and non-SR groups. In almost all patients with SR (N=49, 96.1%), lesions were located below the knee, compared with 90 (88.2%, P=0.042) without SR. Average interval between biopsy and surgical consultation was 13.6 weeks (range 2.7-24.7 weeks).

Conclusions: WDSCC may spontaneously resolve following partial, diagnostic biopsy more often than previously reported. These preliminary observations may have implications for treatment options, especially among frail patients with comorbidities.

Introduction: Randomized controlled trials have suggested that tretinoin, a topical retinoid, can improve wrinkling in photodamaged skin; however, its overall effectiveness remains subject of debate.

Objectives: This study evaluated the efficacy and safety of tretinoin in treating facial wrinkles induced by photodamage.

Method: We systematically searched the PubMed, EMBASE, and Cochrane CENTRAL databases from their inception to 16 January 2024 to identify randomized controlled trials comparing topical tretinoin with vehicle treatments. Data were synthesized using a random effects model, and sensitivity analyses were performed to evaluate the robustness of the results in the presence of potential bias.

Results: This study identified eight trials (1,361 patients; median age range 29-76 years; average follow-up duration, 16 weeks to 2 years) that met the inclusion criteria. Compared with the vehicle, topical tretinoin significantly improved clinical signs of facial photodamage. Improvements were observed in both fine wrinkles (mean difference [MD]: 0.412; 95% confidence interval [CI]: 0.233- 0.590; P<0.001) and coarse wrinkles (MD: 0.245; 95% CI: 0.119-0.370; P<0.001). Sensitivity analyses confirmed the robustness of these findings.

Conclusion: Topical tretinoin is a safe and effective treatment for fine and coarse facial wrinkles resulting from photodamage.

Introduction: Grover's disease (GD) is a rare acantholytic skin disorder typically characterized by pruritic vesicular or keratotic truncal papules, most commonly affecting older Caucasian males. Ultraviolet-induced fluorescence dermatoscopy (UVFD) and sub-ultraviolet reflectance dermatoscopy (sUVRD) are novel imaging techniques with potential diagnostic value in dermatology.

Objectives: The objective of this study was to evaluate the dermatoscopic patterns of GD using UVFD and sUVRD techniques.

Methods: A retrospective observational single-center cohort study was conducted including consecutive adult patients diagnosed with GD. Dermatoscopic images were obtained using a Dermlite DL5 dermatoscope paired with a smartphone for UVFD and a Casio DZ-D100 Dermocamera for sUVRD.

Results: Among the 23 investigated patients (15 females, 8 males; mean age 49.13 years), UVFD images frequently showed central polygonal bright scales with a greenish background. sUVRD images demonstrated hyporeflective polygonal scales, hyperreflective halos, and vascular patterns at the periphery. sUVRD was superior to UVFD and CD in the detection of semi-specific polygonal scales in GD. Eccrine duct involvement was observed in 76.31% of sUVRD images and 57.89% of matching conventional polarized dermatoscopy images. Contrary to the existing literature, female patients represented a higher percentage of the cohort. Twelve GD patients (52.2%) had a personal history of skin cancer.

Conclusion: UVFD and sUVRD effectively characterized the unique features of GD lesions. Our findings suggest that GD may affect younger individuals and females more frequently than previously reported, potentially indicating underdiagnosis in this population. Incorporating dermatoscopy into routine examinations may improve the detection and management of GD.