Dermatology practical & conceptual最新文献

Introduction: Solid organ transplant recipients (SOTRs) have a significantly higher risk of developing cutaneous squamous cell carcinoma. Identifying predictive markers for response to non-surgical treatments such as photodynamic therapy (PDT) may help optimize management strategies.

Objectives: To evaluate the association between dermatoscopic features in actinic keratoses (AK) and Bowen's disease (BD) and response to PDT in SOTRs.

Methods: A prospective observational study was conducted, including 35 SOTRs with clinically and histologically confirmed AK or BD treated with methyl aminolevulinate-PDT. Thirteen dermatoscopic features were analyzed to assess their correlation with treatment response.

Results: Response rates were 62.5% for AK and 89.47% for BD. Among the dermatoscopic features evaluated, white structureless areas in AK and rosettes in BD were significantly associated with resistance to PDT.

Conclusions: Dermoscopy may serve as a valuable tool to predict PDT response in SOTRs with AK and BD, potentially improving patient selection and treatment outcomes.

Introduction: Palmoplantar nevi (PPN) are common and sometimes difficult to diagnose because of their unusual clinical, dermoscopic, and histological features, often mistaken for acral lentiginous melanoma.

Objective: This study aimed to investigate the different dermoscopic patterns of palmoplantar nevi and their correlation with age and location.

Methods: This was a retrospective-prospective cohort study of a sample of the Moroccan population collected over 2 years. The diagnosis was based mainly on clinical and dermoscopic evaluation, and a biopsy performed in a single patient.

Results: A total of 140 patients with 144 PPNs were included in this study. PPNs were more frequently located on the palms (64%) than on the soles (36%). The parallel furrow pattern (PFP) was the most frequent in 44% of patients, followed by the lattice pattern (17,4%), then the homogeneous pattern (16.7%), the fibrillar pattern (10,4%), the compound pattern (7%), the globular pattern (2 %), the dotted pattern (2 %), and finally, the atypical pattern (0.7%). We found a correlation between fibrillar and globular patterns with younger patients (P <0.05) lattice pattern with pressure-free regions such as the arch and palmar region. In contrast, the fibrillar pattern was associated with heels and PFP with digital location.

Conclusion: Recognition of these patterns is crucial for accurate diagnosis and to avoid unnecessary excisions.

Introduction: Prurigo nodularis (PN) management remains a significant challenge due to its chronicity, treatment resistance, and scarcity of approved treatments and to its impact on patients' quality of life.

Objective: The aim of this study was to assess PN therapeutic management in a real-life setting.

Methods: In this prospective observational study, 90 patients diagnosed with moderate-to-severe PN were included. Patients were each prescribed therapies available for PN according to symptom severity, consistent with treatment guidelines; only those undergoing systemic therapies were included. Disease severity was evaluated through the measurements of Investigator's Global Assessment (IGA) score, Numeric Rating Scale (NRS) for pruritus, and Dermatology Life Quality Index (DLQI) at the beginning of the study (week 0 - W0 ) and after a 6-month period of treatment (W24).

Results: At W0, patients were prescribed antidepressants (41.0%), dupilumab (34.0%), antihistamines (23.0%), phototherapy (4.0%) or nemolizumab (2.0%). At W24, patients on dupilumab achieved an IGA score of 0 or 1 and a ≥4-point NRS reduction, more than those on antidepressants (44.5% vs 16.7% and 54.4% vs 16.7%, respectively). The average DLQI score was reduced by 14 points in the dupilumab group, compared to a 6-point reduction in the antidepressant group.

Conclusions: Our findings reflect the real-world practice of treating PN and support the use of dupilumab as a new effective treatment option, with significant improvements in pruritus, quality of life, and disease severity compared to antidepressant therapy, suggesting its potential as a preferred therapeutic option for PN.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by painful nodules, abscesses, and draining tunnels commonly occurring in body folds. The IL-17A inhibitor, secukinumab, has shown efficacy in reducing HS lesions in clinical studies, but data on epidemiologic and patient-specific factors influencing response remain limited.

Objectives: To assess how baseline disease severity, treatment initiation delay, and prior biologics exposure influence clinical response to secukinumab and patterns of antibiotic use.

Materials and methods: This 48-week real-world prospective trial enrolled 10 Korean patients with moderate-to-severe HS. Patients received secukinumab 300 mg subcutaneously at weeks 0, 1, 2, 3, and 4, then every two weeks. Outcomes included Hidradenitis Suppurativa Clinical Response (HiSCR), a 55% reduction in the International HS Severity Score System (IHS4-55), mean change in abscesses and inflammatory nodules, a ≥ 30% reduction in pain score on a numeric rating scale (NRS30), and duration of concomitant antibiotic use.

Results: At week 48, 90% of patients achieved HiSCR, with 90% meeting the IHS4-55 threshold and 60% reaching the NRS30 criteria. Faster responses were recorded in subjects with Hurley stage II, treatment delays of <10 years, or no prior biologics use, although response rates equalized by week 48. All patients, particularly moderate cases, either discontinued or transitioned to monotherapy with systemic antibiotics.

Conclusions: Secukinumab demonstrated efficacy in alleviating HS symptoms in moderate-to-severe cases. Patients with less severe disease, shorter treatment delays, and/or no prior biologic therapy exhibited more rapid initial responses. Additionally, the majority of patients experienced a significant duration of antibiotic cessation, underscoring the importance of early intervention. Future studies with larger populations are required to substantiate these findings.

Introduction: Pseudoxanthoma elasticum (PXE) is a rare genetic disorder characterized by progressive mineralization and fragmentation of elastic fibers, leading to multisystem involvement. Diagnosis relies on clinical features, histopathology, and, in selected cases, genetic testing, with cutaneous manifestations often representing the earliest signs.

Objective: To validate dynamic optical coherence tomography (D-OCT) as a noninvasive diagnostic method for detecting PXE-related dermal abnormalities.

Methods: In this case-control study, PXE patients evaluated at Umberto I Policlinic (Rome, Italy) between May 2023 and September 2024 underwent clinical and instrumental assessment. The left lateral cervical, retrocervical, left axillary, and periumbilical folds were analyzed using a standardized 0-3 clinical severity scale and D-OCT imaging. Control subjects were individuals undergoing routine mole checks. D-OCT quantified fiber density, attenuation, and vessel density at 300 μm and 500 μm depths. Statistical analysis included Spearman's correlation and the Mann-Whitney U test, with p < 0.05 considered significant.

Results: Twenty-three PXE patients and eleven controls were included. Cutaneous involvement was observed in 91.30% of patients, predominantly in retrocervical (86.95%) and lateral cervical (82.60%) areas. Clinical severity significantly correlated with D-OCT fiber density in the retrocervical region (ρ = 0.507). Compared with controls, PXE patients showed reduced fiber density and increased attenuation across most regions, except the axillae. At 500 μm depth, vessel density was markedly decreased in the axillary area, with approximately 2.5-fold fewer vessels in PXE skin.

Conclusion: D-OCT effectively detects dermal alterations in PXE, including subclinical changes, providing a promising noninvasive alternative to skin biopsy.