Dermatology最新文献

Introduction: Kaposi's Sarcoma (KS) is a rare soft tissue tumor linked to human herpesvirus 8 (HHV-8), a recognized oncogenic virus. Five distinct clinical presentations have been identified, with the epidemic type being the most prevalent and notably associated with Human Immunodeficiency Virus (HIV). A delayed diagnosis significantly compromises patient prognosis and survival rates.

Methods: This article aims to describe the epidemiological and clinical characteristics of KS cases diagnosed through histological examination between 2007 and 2023 in our dermatology department, after a comprehensive review of electronic medical records.

Results: A total of 52 cases were identified, with 51 cases corresponding to the epidemic type (associated with HIV infection) and only one to the classic type. Men were predominantly affected, all cases being of the epidemic type. The most prevalent topography was the lower extremities, with nodular lesions being the most frequent morphology. Half of the cases presented as a disseminated form, while the remaining half exhibited localized manifestations. In both groups, 50% had previously undergone combined antiretroviral therapy. Gastrointestinal involvement occurred in 8 cases. No deaths were associated with KS.

Conclusions: Due to its often asymptomatic nature, KS can easily go unnoticed. Recognizing the significance of early detection is crucial, emphasizing the necessity for prompt intervention, accurate staging, and vigilant follow-up protocols.

Introduction: Dermatomyositis (DM) is an uncommon idiopathic inflammatory myopathy resulting in characteristic patterns of cutaneous lesions and myositis. Observational evidence related to the disease is limited by small case cohorts. We aimed to evaluate the validity of specialist-specific diagnostic coding for DM in an outpatient clinical database.

Methods: Adults having an outpatient encounter between January 1, 2010, and June 30, 2023, at a US regional health system with ICD-9/-10 coding for DM were identified. We randomly sampled 156 patients with ≥1 code applied by a dermatologist or rheumatologist. The primary reference standard for case adjudication was a confirmed diagnosis of DM by the treating physician in the medical chart. Fulfilment of the 2017 European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ACR) criteria for "probable" or "definite" DM was used as a secondary, more stringent reference standard. Positive predictive values (PPVs) for several case definitions were calculated with 95% confidence intervals.

Results: Among eligible patients, the median age was 51.5 years, and 81% were female. Using the treating physician's diagnosis as reference, PPVs of ≥1 and ≥2 codes applied by a dermatologist were 93.2% (95% CI 82.0-98.3%) and 96.4% (82.2-99.8%), respectively. The PPVs of ≥1 and ≥2 codes from a rheumatologist were 82.0% (77.1-86.9%) and 85.8% (80.6-91.1%), respectively. At least one and at least two codes from a rheumatologist or dermatologist had PPVs of 82.1% (77.3-86.8%) and 85.7% (80.7-90.8%), respectively. The rate of confirmed cases based on EULAR/ACR criteria ranged from 44.9% to 57.1%.

Conclusion: All tested algorithms yielded an accurate case cohort with high PPV. Studies prioritizing sensitivity may use ≥1 code by dermatology or rheumatology to identify patients with DM.

Introduction: The new EU regulation on tattoo inks in force January 2022 in a hitherto unregulated market marks a historical change. The study aim was to register tattoo inks de facto used in studios before the new EU regulation and establish a historical reference to tattoo customer exposure, ink toxicology assessment, clinical complications, and the impact on tattooing businesses.

Method: A tattooist-operated electronic system (InkBase) for ink registration required by law is used in Denmark since 2018. A local database in studios refers to a central database. Clients, sessions, ink bottles, brand name, and pigment color index (CI) are registered. Person's data protection is respected. Tracing harmful inks is possible, with public warning.

Results: Registrations from 108 studios employing about 700 tattooists were collected from March 2018 to 2019. 39,687 clients were tattooed in 50,604 sessions, using colors from 109,720 ink bottles. 10,833 were CI-labelled identifying the pigment. 98.1% of inks originated from USA. Detailed statistics on inks and pigments used are provided as a benchmark showing the spontaneous use and preference of "old" tattoo inks before the EU regulation compulsory to member states introduced dramatic restrictions difficult to follow.

Conclusions: Denmark can, having detailed ink registration enforced by law and having a commonly used electronic registration system reporting to a central server, function as an index country in future surveillance of use of tattoo inks in studios, toxicology aspects and the impact of regulatory intervention on the tattooing industry, with a large sample of data collected in 2018-2019.

Introduction: Patients with hidradenitis suppurativa (HS) experience a 10-year diagnosis delay, on average. Accordingly, time to diagnosis represents one of the greatest unmet needs in HS, which to date has not been adequately addressed. A general lack of awareness about HS in the medical community and a notable heterogeneity in clinical presentation, which is most often confused with cutaneous abscess (CA), forms the basis of poor disease recognition and diagnosis delay. Our objective was to develop and validate a prediction model for diagnosis of HS versus site-specific CA.

Methods: We performed a cross-sectional study in which the model was developed using a large clinical database and externally validated using a sample of clinical records at Penn State Health. Prediction model discrimination and calibration were evaluated using the c-statistic, calibration intercept/slope, and a flexible calibration curve.

Results: Variable selection identified 15 predictors, 7 of which remained after model simplification. The following characteristics were predictive of HS relative to site-specific CA: female sex, increasing age up to 44 years, African American race, race other than white or African American, increasing body mass index, polycystic ovarian syndrome, and acne. The c-statistic of the 7-variable model in validation was 0.77 (95% CI: 0.73-0.80). Calibration intercept and slope were 0.29 (95% CI: 0.14, 0.43) and 1.09 (95% CI: 0.90, 1.28).

Conclusion: Clinical characteristics can predict diagnosis of HS over CA in practice without reliance on a specialty-specific examination to identify disease and potentially reduce diagnosis delay.

Introduction: Health literacy plays an important role in the management of chronic and debilitating skin diseases like hidradenitis suppurativa (HS). Adequate health literacy empowers patients to understand their disease, manage it effectively, and make informed decisions about their health. Exploring the interplay between health literacy and HS is essential to improve healthcare outcomes in this population. This study aimed to assess the prevalence of limited health literacy among HS patients and its associated factors which has never been studied before.

Methods: In this epidemiological cross-sectional study, data were collected via a population-wide survey within the Lifelines Cohort Study in the Netherlands. Health literacy of participants with HS was compared to non-HS controls. The health literacy was measured using six validated questions covering functional, communicative, and critical health literacy. Associations between the characteristics of the HS group and limited health literacy were examined.

Results: Out of 56,084 adult respondents, 1,156 participants with HS were identified. The prevalence of limited functional health literacy was 24.5% in the non-HS group and 26.4% in the HS group. Our findings indicate that limited health literacy among HS patients is associated with higher body mass index (BMI) (26.9 vs. 25.8) (OR: 0.969, 95% CI: 0.941-0.998), lower education level (34.5% vs. 19.9%) (OR: 0.495, 95% CI: 0.350-0.701), lower socioeconomic status (-0.68 vs. -0.58) (OR: 1.194, 95% CI: 1.029-1.386), and more severe disease stage according to the Hurley stage (33.0% vs. 25.8%) (OR: 1.400, 95% CI: 1.005-1.952).

Conclusions: Our study highlights the importance of addressing health literacy in HS patients, given the high prevalence of limited health literacy among this group and associations with higher BMI and more severe disease stage. Limited health literacy may contribute to poorer health outcomes, suboptimal healthcare utilization, elevated healthcare costs, and health disparities. Targeted interventions to improve health literacy could enhance care quality and outcomes for HS patients.

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common cause of chronic liver disease. Patients suffering from psoriasis are at an increased risk of developing MASLD. Psoriasis and MASLD share a pro-inflammatory cytokine milieu; however, it is still unclear whether these conditions are related through shared metainflammatory processes or shared comorbidities such as obesity, diabetes, insulin resistance, and metabolic syndrome. The aim of our study was to better characterize the anthropometric and metabolic profile of psoriatic patients with MASLD.

Methods: We conducted a prospective, single-center, cross-sectional study between June 2014 and August 2017. Recruitment was restricted to adult patients with psoriasis. Blood analysis, liver ultrasonography, and a FibroScan were performed. Blood investigations, baseline anthropometric measurements, and components of fatty liver disease (hepatic ultrasound, FibroScan) were assessed.

Results: A total of 100 patients were recruited, of which, 43% (65.1% men, n = 28) were diagnosed with MASLD. The mean BMI was significantly higher in MASLD than in non-MASLD (27.7 kg/m2 vs. 30.1 kg/m2, p =< 0.001). The mean waist circumference in MASLD patients was significantly higher than in non-MASLD patients (105.6 cm vs. 97.2 cm, p = 0.005). There was no significant difference between the mean age of both patient groups (50.4 vs. 47.3 years, p = 0.26). Psoriatic arthritis was more prevalent in MASLD than in the non-MASLD group (14.3% vs. 1.8%, p = 0.004). Biochemical analysis revealed significantly higher C-peptide level in patients with MASLD compared with patients without MASLD (2.5 vs. 1.6 ng/mL, p = 0.036). Moreover, MASLD patients were found to have a lower HDL level and higher glycemia, triglyceridemia, cholesterol, and LDL levels than non-MASLD patients. A total of 16.3% of patients with MASLD had fibrosis stage ranging from F2 to F4 based on liver stiffness measurement compared with only 10.6% of patients without MASLD.

Discussion: We identified parameters which were more prevalent in patients with psoriasis having MASLD, specifically a high BMI, elevated triglyceride levels, decreased HDL levels, and an elevated level of C-peptide. Patients with psoriasis and MASLD were more likely to suffer from comorbid psoriatic arthritis, despite having similar psoriasis disease severity as measured by PASI.

Conclusion: This study highlights the importance of screening patients with psoriasis for MASLD to prevent the progression to liver fibrosis.

Introduction: While an association between hidradenitis suppurativa (HS) and inflammatory arthritis has been reported in clinical studies, the potential link between HS and gout remains uncertain. As HS and gout share common immunological pathways, we conducted a retrospective cohort study to determine whether HS patients are at an increased risk of developing gout in the future.

Methods: This retrospective multicenter cohort study obtained information through the US collaborative network, a subset of the TriNetX research network. Patients diagnosed with HS between January 01, 2005, and December 31, 2017, were recruited, and a 1:1 propensity score matching was conducted to identify appropriate controls. The hazard ratio (HR) for the new-onset gout in HS patients was subsequently calculated.

Results: Compared to individuals without HS, those with HS were associated with a 1.39-fold higher risk (95% confidence interval [CI], 1.20, 1.62) of developing new-onset gout within 5 years after the index date. This association remained significant in shorter follow-up times and sensitivity analyses utilizing different matching models. For both male and female HS patients, the risk of developing new-onset gout within 5 years after the index date was statistically significant, with respective HRs of 1.61 (95% CI, 1.28, 2.02) for males and 1.41 (95% CI, 1.11,1.78) for females.

Conclusion: HS patients are at a high risk of developing gout within 5 years after an HS diagnosis while comparing with non-HS controls.