Dermatology最新文献

Introduction: Lebrikizumab significantly reduced itch and itch interference on sleep in patients with moderate-to-severe atopic dermatitis (AD) at week 16 in two phase 3 trials. We investigated itch reduction and the efficacy of improving itch interference on sleep in lebrikizumab-treated patients over 52 weeks.

Methods: At week 16 in ADvocate1 and ADvocate2, patients who met protocol-defined response criteria to lebrikizumab 250 mg every 2 weeks (Q2W) were re-randomized 2:2:1 to lebrikizumab Q2W, lebrikizumab 250 mg every 4 weeks (Q4W), or placebo Q2W to week 52; patients who did not achieve protocol-defined response continued open-label lebrikizumab Q2W. The Pruritus Numeric Rating Scale (NRS) evaluated the worst itch intensity over the previous 24 h in daily electronic diaries; the Sleep-Loss Scale measured the interference of itch on sleep over the last night. For week 16 responders, data after systemic rescue medication or discontinuation due to lack of efficacy were imputed with non-responder imputation; data after topical corticosteroid usage and discontinuation due to other reasons were set as missing; all missing data were imputed with multiple imputation. Descriptive statistics using observed data are reported for week 16 by non-responders.

Results: At week 52 among patients who met week-16 protocol-defined response criteria, 73.4% and 71.8% receiving lebrikizumab Q4W and Q2W, respectively, reported ≥3-point improvement in the Pruritus NRS. Mean percent improvement from baseline to week 52 in the Pruritus NRS was 59.9% and 59.6% with lebrikizumab Q4W and Q2W, respectively. For patients who did not achieve a week-16 protocol-defined response, 73.3% achieved ≥3-point improvement on the Pruritus NRS at week 52, with mean percent improvement from baseline to week 52 of 59.2%. At week 52 in responders, ≥1-point improvement in the Sleep-Loss Scale was achieved by 77.9% and 78.9% of patients receiving lebrikizumab Q4W and Q2W, respectively, with a mean percent improvement from baseline to week 52 of 64.4% and 65.9%. For week-16 non-responders, 86.1% of patients achieved ≥1-point improvement in the Sleep-Loss Scale at week 52, with a mean percent improvement of 74.9%.

Conclusion: These findings indicate that lebrikizumab is an effective AD treatment to reduce itch and improve sleep loss due to itch over the long term for both patients who did and did not meet protocol-defined response criteria at week 16.

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition. The prevalence of HS is underreported worldwide; moreover, the epidemiological studies about HS in Saudi Arabia are scarce. Therefore, this study was performed to explore the prevalence in Saudi Arabia.

Methods: This study was a part of the Global Hidradenitis Suppurativa Atlas (GHiSA) initiative. This study was a single-center study in tertiary care center in Riyadh, Saudi Arabia. All relevant data were collected after obtaining a written informed consent, and data were analyzed accordingly. The study was conducted between March and May 2023. The participants were healthy adults accompanying a child or adult in internal medicine or pediatrics outpatient clinics. The diagnosis was done clinically by an expert physician.

Results: In total, 688 individuals were included; the estimated prevalence of HS is a minimum of 4.07% within the sample. The utilized questionnaire has a sensitivity of 100% and a specificity of 15%.

Conclusion: The high prevalence of HS in Saudi population necessitates more education to the community and health care providers for early diagnosis and management.

Background: Hidradenitis suppurativa (HS), a chronic inflammatory skin disease affecting intertriginous areas, presents a recurring and debilitating challenge. Even though recent efforts have been made to estimate the overall HS prevalence, variations in screening modalities and missing data from the Global South warrant further investigation. Understanding the HS prevalence is crucial for treatment approaches and pathogenesis. Thus, we aimed to estimate a global HS prevalence based on studies using homogeneous validated questions.

Methods: This systematic review was prospectively registered on PROSPERO and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Searches in PubMed, Embase, and CINAHL were performed on August 9, 2023. Original reports assessing the HS prevalence in adults using the following two questions were included: "Do you have recurrent boils of the skin?" and "Have you for the past 6 months had 2 or more boils/abscesses in any of the below locations: in the axilla, in the groin, around your genitals, on the buttocks, several locations i.e., first the buttocks then the axilla, etc.?" A pooled prevalence with 95% confidence interval (CI) was calculated with a random-effects model.

Results: Eight studies qualified for inclusion, of which the prevalence estimate ranged from 0.7% to 6.4%. The meta-analysis encompassing 49,971 participants revealed a global HS prevalence of 2.5% (95% CI, 1.8-3.5%).

Conclusion: This meta-analysis suggests a global HS prevalence of 2.5% using a validated questionnaire. Due to heterogeneity and sparse data from the Global South, this estimate should be interpreted with caution.

Introduction: Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicles in the apocrine gland-bearing areas of the body. The global HS prevalence has been reported in the range of 0.00033-4.1%. It is reportedly rarer in Asia.

Methods: The study aimed to establish the prevalence of hidradenitis suppurativa (HS) in a Sri Lankan hospital setting. An explorative, cross-sectional, descriptive study was done on a sample of accompanying healthy persons to patients at Base Hospital, Balangoda, Sri Lanka. The study was conducted over a 6-month period (November 1st, 2022, to April 30th, 2023) and was a part of the Global Hidradenitis Suppurativa Atlas (GHiSA) initiative. The data were collected using validated self-administered questionnaire. When the questionnaire indicated HS (screen-positive), the study participant was referred to the consultant dermatologist, who examined the individual and confirmed the final diagnosis based on three obligatory diagnostic criteria (i.e., typical lesion, typical topography, and the chronicity and recurrence).

Results: Of 993 participants, the prevalence of HS was 0.2 (95% confidence interval 0.06%-0.73%). The difference in median age between two groups (i.e., individuals with HS - positive group and the control group) was statistically significant (p = 0.01802). The HS group was relatively younger with a median age of 26.5 (23.8-29.3) years, while that of the control group was 54.0 (48.0-59.0).

Conclusion: Hidradenitis suppurativa is rare in Sri Lanka as in other Asia-pacific countries.

Background: Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent and debilitating skin disease, with a poorly understood global burden. The prevalence of HS in Belgium is not yet known. We aimed to determine the prevalence of the disease in the Belgian context and validate a screening questionnaire.

Materials and methods: Conducted as part of the Global Hidradenitis Suppurativa Atlas (GHiSA) initiative, this monocenter cross-sectional study involved 500 healthy adults accompanying patients at the Erasme Hospital in Brussels. Participants gave their consent and completed a screening questionnaire. All screen-positive and a subset of some screen-negative participants underwent clinical examination by a dermatologist. The severity of the disease was assessed using the Hurley staging.

Results: The prevalence of HS in the sample was 1.6% (8/500; 95% Cl: 0.81%-3.13%). There were no statistically significant demographic differences between the group control and the HS group. The screening questionnaire demonstrated a sensitivity of 100%, a specificity of 89%, a positive predictive value of 56% and a negative predictive value of 100%. Most of the patients diagnosed with HS were Hurley I (6/8) and the axilla was the most affected area.

Conclusion: The study uncovered a 1.6% prevalence of HS among a cohort of 500 Belgian participants and contributed to the GHiSA project. The high sensitivity and specificity of the screening questionnaire suggests it is an effective tool for detecting HS in the general population.

Introduction: The knowledge of the epidemiology of hidradenitis suppurativa (HS) in Germany is currently insufficient. This study aimed to determine the prevalence of HS in Darmstadt, Germany, and contribute to the Global Hidradenitis Suppurativa Atlas (GHiSA).

Methods: This monocentric, cross-sectional study was conducted at the Klinikum Darmstadt, Germany, from January to February 2024. Data from 519 healthy accompanying adults were included after obtaining oral and written consent. A validated screening questionnaire, used as an index test before clinical examination, was performed on screening-positive and randomly selected screening-negative participants as a reference test.

Results: The prevalence of HS in Darmstadt, Germany, was 1.16% (6/519; confidence interval: 0.95: 0.53%-2.50%). The HS group had a median age of 37.5 years and a median BMI of 32.5. No predominance of sex or smoking status could be found in the HS group and there were no statistical differences between the groups in sex, age, or smoking status. However, the median BMI was significantly higher in the HS group.

Conclusion: The study found the prevalence of HS in Darmstadt, Germany, to be 1.16%, which is significantly higher than previously reported rates in Germany. This study found an association between BMI and HS. However, it did not observe the previously reported association between HS and sex or smoking status. The questionnaire used is a valid screening tool for HS in the assessment of the general population.

Introduction: Hidradenitis suppurativa (HS) is a chronic, debilitating condition that is underrecognized and poorly managed in South Africa. Hence, this study aimed to determine the prevalence of HS in KwaZulu-Natal, South Africa.

Methods: This multicenter, explorative, cross-sectional, and descriptive study was conducted on 500 persons accompanied by patients in a tertiary and private hospital in Ethekwini, KZN, South Africa, from 6th February to 16th March 2023. After obtaining consent, they were screened by a physician for HS on a validated questionnaire comprising questions for the presence of recurrent painful deep-seated boils in the axillae, breasts, groins, or perineum. Screened positive and selected (10%) negative persons were re-examined by a dermatologist. Relevant data on demographics, smoking, and body mass index (BMI) were also collected.

Results: From 500 participants, 9 were confirmed as HS and the point prevalence was 1.8%. The HS group comprised 8 females and 1 male, with a median interquartile range age of 36 years (IQR 29-42) and BMI of 27.3 kg/m2 (IQR 26.8-29.9). Four HS patients were of African ethnic origin (44.4%), and 5 were of Asian ethnic origin (55.6%). The majority of HS cases were graded as Hurley stage I (7/9 cases) and 2 were Hurley stage III. The sensitivity from the HS questionnaire was 100% and the specificity was 80%. The positive predictive value was 0.4 while the negative predictive value was 1.0.

Conclusion: The prevalence of HS in KwaZulu-Natal South Africa is 1.8%, with those of African and Indian ethnicity being more predisposed.

Introduction: Kaposi's sarcoma (KS) is a rare soft tissue tumor linked to human herpesvirus 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 aimed 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: Inherited ichthyosis comprises a group of rare keratinization disorders caused by abnormal epidermal barrier function. Ichthyosis is yet incurable and current treatments mainly focus on alleviating symptoms such as scaling, erythema and pruritus. Recent developments show promising results for interventions based on the immune-phenotype like biologicals or pathogenesis-based therapies such as gene therapy. However, the lack of uniform reporting and variety of treatment outcomes may complicate performing and comparing efficacy studies. The core outcome set for inherited ichthyosis (COSII) aims to develop a core outcome set (COS), i.e., the minimum of outcomes that should be measured and reported in observational and interventional studies, including a minimum set of baseline characteristics. Methods: The COSII project will follow the guidelines from the Core Outcome Measures in Effectiveness Trials (COMET) initiative, including the Core Outcome Set-Standards for Development (COS-STAD) recommendations and the Core Outcome Set Standardised Protocol (COS-STAP) checklist. The COS development methodology, including this protocol, follows the guidance of the CHORD COUSIN Collaboration 'C3'. The first stage of this project involves identifying a possible list of outcomes through performing a scoping literature review and conducting interviews with patient(s) (representatives). This list will be presented to five different stakeholder groups: healthcare professionals, researchers, patient(s) (representatives), industry representatives, and regulators. All stakeholders will rate the importance of each outcome in a three-round eDelphi survey. Ultimately, a virtual consensus meeting will be convened to finalize the COS. Ethical approval was obtained prior to the start of this project from the Medical Ethics Committee Board at Maastricht University Medical Centre (METC 2022-3192). Informed consent will be asked prior to enrolment in the eDelphi. This study is registered with the COMET. The results will be distributed via a peer-reviewed journal, communicated to all relevant parties and showcased at national and international conferences. Conclusion: This will be the first COS for inherited ichthyosis research in accordance with the Core Outcome Measures in Effectiveness Trials initiative. The development of a COS aims to improve the consistency of reporting and the heterogeneity of outcomes in ichthyosis research.

Introduction: The aim of this study was to identify whether high-frequency ultrasound (HFUS) could correct the misdiagnosis, confirm equivocal skin lesions, and improve the management after clinical examination.

Methods: In this study, a total of 574 skin lesions from 552 patients were prospectively enrolled. The specific diagnosis and management decisions (treatment/excision, observation) determined by HFUS after clinical examination were recorded during the clinical practice. The area under the receiver operating characteristic curve, accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and the number needed to excise (NNE) before and after HFUS were also evaluated. The pathological results were conducted as golden standards to compare the performance.

Results: Among the 574 skin lesions, 290 (50.5%) were malignancies and 284 (49.5%) were benign. The diagnostic accuracy was improved from 77.5% to 90.8% after the HFUS examination. There were 44 lesions wrongfully diagnosed by the initial clinical diagnosis, whereas 28 of 44 (63.6%) lesions were correctly identified by HFUS examination. Of 85 lesions categorized as equivocal skin lesions by clinical examination, 65 (76.5%) were diagnosed correctly after HFUS. Lesion management changed in 72 of 574 (12.5%) after HFUS. Among these lesions, HFUS saved 22 unnecessary excisions and prompted the treatment of 30 malignancies that would be observed based on clinical examination alone. Additionally, the NNE was reduced by 15.4% (NNE, 0.828) after HFUS and 4.6% (NNE, 0.933) before HFUS.

Conclusions: HFUS could be a valuable tool in diagnosing equivocal skin lesions, identifying skin cancers missed by clinical examination, and reducing unnecessary excision of benign lesions while improving NNE.