Dermatology最新文献

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: Given the increasing incidence of Bowen's disease, treatment leads to a substantial economic burden for healthcare services. There are several treatment options for Bowen's disease, of which surgical excision, 5-fluorouracil (5-FU) and methyl aminolevulinate photodynamic therapy (MAL-PDT) are the most commonly used. Recently, results from a randomized controlled non-inferiority trial showed that 5-FU was non-inferior to excision and was associated with a better cosmetic outcome. MAL-PDT was not shown to be non-inferior to excision. Although 5-FU and MAL-PDT were expected to be cheaper than excision, it remains to be determined whether the potential cost savings compensate for the loss of effectiveness. The aim of this study was to determine the most cost-effective treatment for Bowen's disease when comparing surgical excision, MAL-PDT, and 5% 5-FU cream from a healthcare perspective.

Methods: Data were collected alongside a randomized controlled trial with 250 patients in the Netherlands. Valuation of treatment costs was based on documented resource use and Dutch cost prices. A cost-effectiveness analysis was performed from a healthcare perspective. The primary outcome was the decremental cost-effectiveness ratio (DCER), expressed as the cost-savings per additional recurrence or residual Bowen's disease. Bootstrap analysis and sensitivity analysis were performed to address uncertainty. This trial is registered with ClinicalTrials.gov number, NCT03909646.

Results: At 12 months after treatment, the costs for 5-FU cream were significantly lower (EUR 311 [CI: -240 to -378]) and the costs for MAL-PDT were higher (EUR 3 [CI: -74 to 65]) compared to excision. 5-FU cream offers cost savings compared to excision, but is less effective although within the non-inferiority margin of 22%. Our results showed that 5-FU has the highest probability of being cost-effective at willingness to accept threshold values of EUR 2,500 and lower compared to MAL-PDT and surgical excision.

Conclusion: 5-FU cream is a cost-effective treatment at a threshold value of EUR 2,500 and lower when compared to surgical excision and MAL-PDT. Therefore, from a cost-effectiveness point of view, 5-FU is considered the first-choice treatment option for Bowen's disease.

Introduction: Oral isotretinoin is the only effective treatment for severe acne without an alternative. Isotretinoin has been linked to the occurrence of acute psychiatric disorders outside suicidal behaviors. There are few large-scale epidemiological studies in this area, and the putative associations are unclear. Our objective was to determine whether adolescents and young adults have an elevated risk of acute-onset psychiatric disorder requiring hospital treatment within 2 months of starting isotretinoin treatment.

Methods: Our data source was the French national health insurance database (Système National des Données de Santé, SNDS), 2010-2015. We performed a case-time-control study nested in an exhaustive, nationwide cohort of all French adolescents and young adults aged 10-25 years treated with isotretinoin. The outcome was an acute-onset psychiatric disorder requiring hospitalization (including anxiety, depressive, mood, adjustment, and psychotic disorders). A conditional logistic model was used to estimate odds ratios (ORs) with their 95% confidence interval (CI) for acute psychiatric events.

Results: 2,284 acute-onset psychiatric disorder requiring hospitalization were recorded for the study population of 262,786 patients. Among the patients with at least one psychiatric event, 88 had started taking isotretinoin in the risk period (0-2 months before the date of the event), versus 81 in the reference period (2-4 months before the event). A comparison with the 383 and 355 time-trend matched controls who started taking isotretinoin in the risk and reference periods, respectively, yielded a case-time-control OR (95% CI) of 1.01 (0.72-1.41).

Conclusion: Psychiatric events managed outside the hospital system were not recorded. Our findings are reassuring for clinicians concerning the risk of severe acute-onset psychiatric events after isotretinoin initiation.

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by recurrent boils or abscesses. Its prevalence varies globally, yet specific data from Poland are limited. This study aimed to determine the prevalence of HS among adults in Poland, utilizing standardized methods as part of the Global Hidradenitis Suppurativa Atlas (GHiSA) initiative.

Methods: This monocenter study was conducted at the Internal Medicine Departments of University Hospital of Wroclaw. In the study, participants were individuals accompanying patients administered to the hospital, excluding individuals under 18 years old, pregnant women, and those deemed incapable of participating. A self-administered screening questionnaire for HS diagnosis was utilized. Physical examinations and Hurley score assessments were conducted for participants reporting HS symptoms. In addition, approximately 10% of participants who did not report any HS symptoms were tested to determine the false-negative response rate. Statistical analysis was performed using R Project for Statistical Computing and Statistica 13.3 software.

Results: Out of 940 adults approached, 932 participated in the study. 21 participants reported HS symptoms, with 14 individuals diagnosed with HS upon examination. Additionally, 1 participant without reported symptoms was diagnosed with HS. The estimated prevalence of HS among the Polish adult population was 1.61% (95% CI: 0.90-2.50%). The screening questionnaire exhibited a sensitivity and specificity of 93%, with a positive predictive value of 67% and a negative predictive value of 99%.

Conclusion: This study shed some light on the prevalence of HS in Poland, indicating that it is a more common condition than previously reported in the literature. It can contribute to understanding the epidemiology of HS in Poland and may aid in improving diagnosis and management strategies for affected individuals.

Introduction: Migration is an increasing phenomenon and associated with a physical and psychosocial burden on individuals. Little is known about migration and skin health. The objective of this study was to describe the characteristics of patients regarding migration background and dermatological morbidity among adults seen in a dermatological out-patient clinic in Malmö, Sweden.

Methods: An observational cross-sectional study was performed in 2017. Dermatological out-patients completed questionnaires and were examined by a dermatologist. Sociodemographic variables including ethnicity and migration status were assessed by self-report. Ethnicity was assessed with country of birth. General and physical health and details about skin disease were self-reported. Stress was assessed by the Perceived Stress Scale (PSS) and with items assessing stressful life events and economic difficulties. Depression and anxiety were assessed with the Patient Health Questionnaire-2 (PHQ-2) and the General Anxiety Disorder Assessment-2 (GAD-2).

Results: 250 patients were included. 24% were foreign-born (FB) reporting 41 different countries of birth. Mean duration of living in Sweden was 24.4 years. Compared to non-foreign-born (NFB) patients, FB patients were more stressed (PSS mean 17.5 vs. 15.3, p = 0.044), had more economic difficulties (31.0% vs. 14.6%, p = 0.005) and more anxiety (39.7% vs. 24.9%, p = 0.03). There were significantly fewer patients with psoriasis in FB and more with connective tissue disease. FB rated skin disease severity significantly higher than NFB patients.

Conclusion: This study reports the multi-ethnic population in an out-patient dermatological clinic in Malmö, Sweden and the difference in distribution of dermatological conditions among FB patients and NFB patients as well as the burden of disease, with higher levels of stress and anxiety in FB patients. These issues will be investigated further by our group in a larger multicentre study.

Introduction: Psoriasis is associated with lung diseases, but there have been no studies on full pulmonary function tests (PFTs) in patients with psoriasis. The aim of this study was to compare pulmonary function measurements in patients with psoriasis and controls.

Methods: Sixty-eight patients with psoriasis and sixty-eight sex- and age-matched controls fulfilling the inclusion criteria were included in this study. Spirometric PFT, body plethysmography, and diffusion capacity for carbon monoxide (DLCO) testing were performed on all study participants.

Results: The mean forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio was significantly lower in the psoriasis patients than in the controls (98 ± 6.6 vs. 100.3 ± 3.2, p < 0.05). In the subgroup analysis, the FEV1/FVC ratio in non-smoking and non-obese subjects was significantly lower in psoriasis patients than controls (98.2 ± 5 vs. 100.6 ± 2.7; p < 0.05 and 98 ± 6.8 vs. 100 ± 3.1; p < 0.05, respectively). There was no statistically significant difference in body plethysmography or the DLCO test parameters between groups.

Conclusion: Psoriasis patients had a lower mean FEV1/FVC ratio compared to the control subjects. The FEV1/FVC ratio was independently associated with the presence of psoriasis.

Introduction: This study, conducted as part of the Global Hidradenitis Suppurativa Atlas (GHiSA) initiative, aimed to ascertain the prevalence of hidradenitis suppurativa (HS) in Oman and to assess its demographic distribution, adhering to standardized methodology for consistency across participating sites.

Methods: A multicenter approach was undertaken, encompassing primary care within a general practice clinic, along with two secondary surgical clinics at Sumail Hospital and Seeb polyclinic in Oman. Informed written and oral consent were diligently obtained from study participants. Data collection involved the translation of the questionnaire into Arabic and meticulous examination conducted by qualified physicians. Recruitment transpired from July 2022 to September 2022, targeting healthy adults accompanying patients, with rigorous adherence to predefined exclusion criteria.

Results: Among the 500 initially selected participants, 484 questionnaires were subjected to rigorous analysis, following the exclusion of 16 due to data incompleteness. The estimated prevalence of HS in Oman was found to be 2.1% (95% CI: 1.1-3.8%), with a pronounced predilection toward the female demographic. Notably, the median age of participants with HS was significantly lower than that of their healthy counterparts. Regional distribution analysis revealed the axillary region as the most commonly affected site for both genders. The questionnaire-based diagnostic approach exhibited a sensitivity of 1.00 and a specificity of 0.73, indicating its efficacy in HS diagnosis.

Conclusion: This study yields critical insights into the epidemiology of HS in Oman, conclusively establishing a prevalence rate of 2.1%. The high sensitivity and specificity of the questionnaire-based diagnostic tool emphasize its clinical utility. These findings collectively emphasize the imperative for comprehensive education and awareness campaigns among healthcare professionals to foster early detection and tailored intervention strategies. To further enrich our understanding of HS pathophysiology and optimize patient management, larger prospective investigations are warranted.