Dermatology practical & conceptual最新文献

Actinic keratosis (AK) is considered a chronic skin disease mostly caused by long-term exposure to UV radiation and other risk factors such as immunosuppression, leading to an individual susceptibility for skin cancer manifestation. The treatment of AK is laborious and costly, and the incidence of skin cancer is forecasted to double until the year 2030 in an aging society.Risk factors in AK for malignant transformation in cutaneous squamous cell carcinoma (cSCC) are not fully understood, but studies suggest that histological features, such as atypia in the basal epidermal third and basal proliferation (PRO score) in AK play a pivotal role for development of malignancy. As the clinical appearance of AK does not correlate with the risk for malignancy, guidelines suggest treating every single AK lesion upon diagnosis. Skin imaging techniques, such as line-field confocal optical coherence tomography (LC-OCT) can help to provide an individual holistic follow-up for AK lesions by non-invasive visualization of atypia and basal proliferation. A follow-up for patients with AK may be critical for treatment success in terms of strengthening therapy adherence. When AK presents therapy refractory, cSCC manifests in nearly 30% of the cases after several years. Patients with AK suffering from field cancerization and immunosuppression are susceptible for a severe course of disease including metastasis and high mortality rates. Those vulnerable subgroups benefit from close skin cancer screening, early adequate treatment and chemoprevention, such as niacinamide or acitretin. Skin cancer prevention is substantial. Primary prevention should include chemical and physical UV-light protection and avoidance of indoor tanning. Secondary prevention is essential in high-risk populations, such as fair skin type elderly men and STORs. Tertiary prevention should comprise adequate treatment strategies to prevent therapy resistance, reoccurrence and cSCC, especially when field cancerization and immunosuppression are present.

Introduction: Warts, benign skin growths caused by various human papillomavirus strains, are categorized as genital and non-genital. Non-genital warts often lack noticeable symptoms but can lead to psychological distress due to factors like embarrassment. Traditional treatments, including physical and chemical methods, show limitations, prompting the exploration of novel approaches like intralesional immunotherapy. The clinical challenge lies in selecting the most effective modality.

Objective: In our study, we used the network meta-analysis (NMA) as a statistical tool to explore the most effective intralesional immunotherapy interventions.

Methods: Comprehensive searches of Web of Science, PubMed, Cochrane, and Scopus databases were conducted until December 2023. Eligible studies were analyzed for outcomes presented as risk ratios (RRs) with 95% confidence intervals (CI). Treatments were ranked using the P-score in an NMA performed with R software.

Results: We included 68 RCTs in our study. For complete response, needling showed a significant difference compared to Candida albicans antigen (RR= 0.13, 95% CI [0.02; 0.99]) and Mw (RR= 0.12, 95% CI [0.02; 0.94]). In overall response, both bleomycin and furosemide with digoxin were significant compared to autoimplantation (RR= 0.46, 95% CI [0.24; 0.88]) and (RR= 0.40, 95% CI [0.18; 0.91]) respectively. Similarly, both were significant compared to cryotherapy (RR= 0.45, 95% CI [0.27; 0.76]) and (RR= 0.40, 95% CI [0.19; 0.82]) respectively.

Conclusion: This NMA indicates needling, furosemide with digoxin, and PBP antigen stimulants as effective for non-genital warts, surpassing traditional treatments in complete and overall response. Direct comparisons in future research are warranted to confirm their superiority.

Introduction: Adult female acne is a chronic condition that significantly impacts quality of life. The content on social media can influence patients perception of their disease and serve as a channel through which they may seek or obtain treatment options.

Objectives: This study aims to evaluate the impact of social media usage habits on treatment decisions among adult female acne patients.

Methods: A cross-sectional, multicenter survey study involved 358 females aged 25 or above, diagnosed with acne. Sociodemographic data were collected, and social media behavior, treatment choices, outcomes, and motivation were explored.

Results: Among 358 participants, 95.3% used at least 1 social media platform; 72.1% sought acne information online. Top platforms used to seek acne information were Google (75.6%), Instagram (72.3%), YouTube (60%), and TikTok (29.4%). For advice, 67.4% consulted doctor accounts, 53.5% non-medical influencers, 53.5% patient accounts, and 36.1% product promotion accounts. Commonly followed advice included skincare products (88%), dietary changes (42.3%), home remedies (38.8%), exercise (30.3%), topical medications (25.2%), and dietary supplements (17.4%). Notably, 20.9% were willing to alter prescribed treatment by their physician for acne based on social media advice. Patient motivations included quick information access (84.1%) and difficulty in securing dermatologist appointments (54.3%).

Conclusions: The study reveals widespread social media use among adult female acne patients, highlighting concerns about potentially misleading information. Dermatologists can enhance the impact of social media by providing reliable sources for patients.

Introduction: This was an observational, retrospective, multicenter study, enrolling elderly patients (>65 years old) treated with ixekizumab with a diagnosis of psoriasis (PsO) and/or psoriatic arthritis (PsA) during the period 2020 to 2023.

Objectives: Efficacy of ixekizumab in elderly patients in the treatment of moderate to severe psoriasis.

Methods: We included 73 patients with psoriasis (32.9%), psoriatic arthritis (1.4%) and both of them (PsO-PsA 65.8%), attending the outpatient clinics of seven Italian referral center for psoriasis in Lazio region: Policlinico Umberto I Università Roma La Sapienza, Sant'Andrea Università di Roma La Sapienza, Polo Pontino Università Roma La Sapienza, Fondazione Policlinico Universitario A. Gemelli, Università Campus Biomedico Roma, Istituto Dermopatico dell'Immacolata - IDI and Policlinico Tor Vergata. We collected data related to the characteristics of the patients (age, sex, body mass index) and of the disease (age at onset, duration of psoriasis, previous treatments). The severity of psoriasis was measured with the Psoriasis Area and Severity Index (PASI) score at baseline and after 16, 24, 52, 104 and 156 weeks of treatment.

Results: PASI90 was achieved by all the patients in week 16 and remained stable until the end of the study. PASI100 has been achieved by 55.1% of patients at weeks 16 and by 81.3% at week 104. A statistically significant difference has been showed between baseline and all the other time points (P < 0.0001) for PASI score. A similar trend was observed for Visual Analogue Scale score and Dermatology Life Quality Index score.

Conclusions: Ixekizumab was effective and with a good safety profile in psoriatic patients over 65 years. No significant adverse events were reported.

Introduction: Palmoplantar psoriasis is a rare variant of psoriasis. Its impact on quality of life has been poorly investigated.

Objectives: Our aim was to investigate the prevalence of localized palmoplantar psoriasis (PPP), to assess its severity using the modified Palmoplantar Pustular Psoriasis Area and Severity Index (m-PPPASI), and to evaluate the correlation with the Dermatology Life Quality Index (DLQI).

Methods: We conducted a descriptive study with prospective data collection from January to June 2021. We enrolled 223 patients with psoriasis. We excluded patients without palmar/plantar involvement and those with a body surface area (BSA) greater than or equal to 10%.

Results: We included 33 patients with PPP. This corresponded to a 14.8% prevalence among all psoriasis phenotypes. The mean age was 45 years. The male-to-female ratio was 2.3. Pruritus was present in 27 cases. The mean m-PPPASI was 11.77. The mean DLQI was 8.33. A significant correlation was found between DLQI and m-PPPASI: mean DLQI scores for patients with m-PPPASI less than or equal to 10 and m-PPPASI greater than 10 were 5.6 and 11.3, respectively (P = 0.002). Only 11.8% of patients with m-PPPASI less than or equal to 10 had a DLQI greater than 10, whereas 50% of those with m-PPPASI greater than 10 had a DLQI greater than 10 (P = 0.026).

Conclusions: Based on the present work, we confirm that, although affecting a reduced BSA, PPP is a severe form of psoriasis. We consider the m-PPPASI to be a reliable tool which can be used to assess the severity of PPP.