Dermatology最新文献

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.

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.