Dermatology最新文献

Introduction: Accurate visualization of nail-matrix psoriasis remains challenging. Ultraviolet-fluorescence dermoscopy (UVF-D) may enhance detection, yet rigorous comparative data are scarce. The aim of this study was to compare the diagnostic yield of UVF-D with standard dermoscopy and naked-eye clinical examination for matrix and bed involvement in nail psoriasis.

Methods: In this single-centre prospective pilot study (March-July 2024), 35 consecutive adults with plaque psoriasis underwent triplicate assessment (clinical, dermoscopy, UVF-D) of all fingernails. Each nail quadrant was scored for matrix-Nail Psoriasis Severity Index (NAPSI) and bed-NAPSI by two blinded dermatologists in randomized order. The study was powered (80%, α = 0.05) to detect a ≥3-point mean difference in matrix-NAPSI between modalities.

Results: UVF-D identified matrix involvement in 550/1,400 quadrants (39.3%) versus 448/1,400 (32.0%) with standard dermoscopy and 441/1,400 (31.5%) clinically (p < 0.001; Kendall's W = 0.42). Mean ± SD matrix-NAPSI scores were 15.7 ± 5.3 (UVF-D), 12.8 ± 5.2 (dermoscopy), and 12.6 ± 4.8 (clinical). Thus, UVF-D detected roughly one additional matrix-affected quadrant for every seven examined and produced a higher matrix-NAPSI, underscoring its added sensitivity over conventional methods.

Conclusions: UVF-D significantly improves visualization of nail-matrix psoriasis versus standard approaches. Larger multicentre studies should validate its diagnostic and longitudinal utility.

Introduction: Pediatric-onset generalized pustular psoriasis (PGPP) is a rare inflammatory disorder characterized by recurrent flares and challenging management. This study aimed to review the clinical features, flare patterns, and treatment options.

Methods: We analyzed PGPP patients diagnosed at Beijing Children's Hospital from 2006 to 2023 who had complete medical record. Data on clinical characteristics, flare numbers, and flare duration were collected through medical record and telephone survey. The flare frequency was calculated by dividing the flare numbers by the years in each age range. Flare duration was categorized as ≤4 weeks or >4 weeks. In addition, we investigated the factors associated with flare frequency in PGPP patients.

Results: A total of 109 patients with PGPP were included in the study, with a follow-up duration ranging from 1.90 to 22.80 years. The median age of onset was 6.00 years, with a higher prevalence in males (73, 66.97%). Most patients (55, 50.46%) experienced their first flare between the ages of 7 and 12 years. A total of 45 patients (41.28%) had history of psoriasis vulgaris, 16 (14.68%) had history of acrodermatitis continua of Hallopeau, and 4 (3.67%) had history of psoriatic arthritis. Respiratory infection was the most common trigger, affecting 35 patients (32.11% of cases). The annual flare frequency was 0.68. The frequency and duration of flares showed a decreasing trend with increasing age. Earlier onset age is associated with a higher flare frequency. Before 2020, conventional therapies were most commonly used, with acitretin used in 67 patients (61.47%). Following 2020, secukinumab became the most often used medication (44 patients, 40.37%).

Conclusion: PGPP exhibits a trend toward flare decrease with age, yet recurrence remains common. Earlier onset age may be associated with higher flare frequency. At present, biologic agents are the main treatment. These findings provide new insights into PGPP.

Introduction: An acne-specific questionnaire Quality of Life Relevance-Acne (QOLRELEVANCE-ACNE) was developed to evaluate health-related quality of life based on the most relevant topics for acne patients. The aim of the present study was to undertake an international validation of the QOLRELEVANCE-ACNE questionnaire and to propose a severity grading system for its scores.

Methods: Patients with acne were asked to fill in the QOLRELEVANCE-ACNE and Dermatology Life Quality Index (DLQI) questionnaires. Global acne severity was assessed independently by both dermatologists and patients. Cronbach's alpha was used for assessment of internal consistency of the QOLRELEVANCE-ACNE questionnaire. Spearman rank correlation was used to study convergent validity and test-retest reliability of the QOLRELEVANCE-ACNE questionnaire. DLQI severity banding system and global acne severity grades were applied to develop variants of the scoring system for the QOLRELEVANCE-ACNE questionnaire.

Results: The results of 726 patients with acne across seven countries (Bulgaria, Ukraine, Greece, Spain, Sri Lanka, Croatia, and Malta) were analysed. Cronbach's alpha was 0.94 for the entire QOLRELEVANCE-ACNE questionnaire, 0.90 for the socioemotional, 0.88 for the symptoms, and 0.76 for the stigma and suicidal thoughts domains. The QOLRELEVANCE-ACNE questionnaire showed high test-retest reliability (r = 0.96, p < 0.001) and strong correlation with DLQI scores (r > 0.6, p < 0.001 in all countries). The following grading system of the QOLRELEVANCE-ACNE questionnaire scores was accepted: total scores <20 indicate a mild effect, scores from 20 to 30 indicate a moderate effect and scores >30 indicate a severe effect on a patient's life.

Conclusion: Simultaneous international validation of the QOLRELEVANCE-ACNE questionnaire confirmed its convergent validity, internal consistency and test-retest reliability. A grading system of the QOLRELEVANCE-ACNE questionnaire scores was accepted.

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory debilitating disorder showing ethnic heterogeneity in its clinical presentation and associated comorbidities. However, data on East Asian populations remain scarce.

Methods: We conducted a retrospective analysis of clinical records for patients with HS diagnosed between 2006 and 2022 at two tertiary referral hospitals in Taiwan. Age- and sex-matched reference individuals without HS (3:1 ratio) were randomly selected from dermatology outpatients. Association between comorbidities and HS were analyzed using conditional logistic regression, while logistic regression identified predictors for lesion distribution and disease severity.

Results: A total of 512 patients with HS and 1,536 reference individuals were identified. Comorbidities independently associated with HS were obesity, smoking, and diabetes. Men had 4.2 times the odds of developing gluteal lesions but only 0.5 times the odds of axillary or inguinal involvement compared to women. Current smokers had 2.8 times the odds of gluteal involvement but 0.6 times the odds of having axillary lesions. A significant association was observed between obesity and axillary involvement. Advanced disease (Hurley stage II and III) was significantly associated with male sex, smoking, and axillary involvement.

Conclusion: Our study highlights distinct lesion distribution in East Asian patients with HS. Male sex and active smoking could predict for gluteal involvement, while female sex and obesity for axillary involvement. Independent risk factors for advanced disease were male sex, smoking, and axillary involvement.

Introduction: Many treatments for multiple actinic keratoses (mAKs) have been proven effective in clinical trials. However, there is a lack of evidence regarding the long-term impact of therapies on disease progression in patients with mAKs. This study aimed to investigate the long-term clinical trajectory of mAKs patients undergoing repeated topical interventions and to evaluate the clinical effectiveness of these treatments and patients' adherence to an extended follow-up protocol in a real-world setting.

Methods: We conducted a prospective follow-up of a cohort comprising 81 treatment-naïve mAKs patients from 2012 to 2023. Patients received examinations and, when necessary, interventions every 6 months. Instances of treatment cycle discontinuation and refusals to continue with specific therapies were systematically recorded. Descriptive statistics alongside the Student's t test were employed to evaluate improvements in the Physician Global Assessment (PGA) scores following treatment with the same medication.

Results: The average total number of medical examinations and treatments administered per patient was 23.0 ± 0.4 and 16.1 ± 2.4, respectively. Annually, the average number of examinations and treatments per patient was 1.9 ± 0.1 and 1.3 ± 0.2, respectively. We completed 539 (41.6%) treatment cycles using photodynamic therapy with red light and methyl aminolevulinate (MAL-PDT), 182 (14.0%) with diclofenac plus hyaluronate (DHA), 97 (7.5%) with imiquimod (IMI), 101 (7.8%) with 5-fluorouracil (5-FU), 25 (1.9%) with FU, and 353 (27.2%) with cryosurgery. PGA values indicated a statistically significant reduction following each treatment at the 30-day post-treatment mark; however, these values exhibited an increase by the 6-month follow-up visit. The rates of treatment cycle discontinuation were as follows: 28.0% with MAL-PDT, 22.0% with DHA, 27.8% with IMI, 22.8% with 5-FU, and 24.0% with FU. Refusal rates for subsequent treatment cycles with the same drug were documented as 32.7% for MAL-PDT, 17.6% for DHA, 24.7% for IMI, 21.8% for 5-FU, 20.0% for FU, and 12.2% for cryotherapy. Throughout the study duration, 223 cases of squamous cell carcinoma (SCC), 46 cases of basal cell carcinoma (BCC), and 4 malignant melanomas (MMs) emerged on the face or scalp, along with 71 SCCs, 64 BCCs, and 8 MMs in other body regions.

Conclusion: Immunocompetent patients with mAKs require lifelong follow-up accompanied by repeated treatment cycles, as the clearance rates, regardless of the degree achieved after a single treatment cycle, tend to be temporary. These patients are at a heightened risk of developing skin tumors.

Introduction: Pruritus exerts a substantial negative impact on the quality of life of patients, yet comprehensive evaluations of its global disease burden remain limited. This study assessed the temporal trends in the burden of pruritus at global, regional, and national levels from 1990 to 2021.

Methods: Data were extracted from the Global Burden of Disease 2021 database. Trends in age-standardized rate (ASR) of incidence, prevalence, and disability-adjusted life years (DALYs) associated with pruritus were analyzed across geographic regions, sociodemographic index (SDI) levels, sex, and age groups. Further analyses included decomposition analysis, assessment of social inequalities, frontier analysis, and Bayesian age-period-cohort modeling.

Results: In 2021, the global ASR of incidence, prevalence, and DALYs due to pruritus were 767.02 (95% uncertainty interval [UI]: 685.95-861.45), 986.45 (95% UI: 883.65-1,090.80), and 10.42 (95% UI: 5.05-19.04) cases per 100,000 population, respectively. Corresponding estimated annual percentage changes were 0.35 (95% confidence interval [CI]: 0.34-0.36), 0.36 (95% CI: 0.35-0.37), and 0.36 (95% CI: 0.35-0.38). The burden was highest among females, elderly people, and populations in Southeast Asia and middle SDI regions. Population growth represented the primary driver of the increased burden. Over time, high SDI regions experienced a progressive rise in burden, while low SDI regions demonstrated closer alignment with burden control targets. Future projections indicate a substantial increase in incidence, particularly among patients aged over 60 years.

Conclusion: An upward trend in the global burden of pruritus was observed between 1990 and 2021, mainly caused by population growth. Moreover, the global incidence of pruritus will increase significantly in future. Public health management strategies need to pay particular attention to women, the elderly, Southeast Asia, the middle and high SDI region, and some countries with overly rapid growth rates, such as China, India, and Myanmar.

Introduction: Tattooing is an increasingly prevalent practice that is associated with various clinical complications. The carcinogenic potential of tattoo pigments remains unclear. While 45 case reports have described melanomas colocalizing with tattoos thus far, a pathogenetic link between tattoos and melanomas remains unproven. No nationwide epidemiological study has investigated the incidence of tattoo-associated melanoma (TAM). This study's objectives are to determine the incidence of TAM in the Netherlands from 1991 to 2023, analyse TAM characteristics and patient demographics, and compare these findings with melanoma data from the general Dutch population during the same period.

Methods: Data were obtained from the nationwide network and registry of histo- and cytopathology in the Netherlands (PALGA). Malignant and benign melanocytic lesions on the tattooed skin were included. Patient demographics and melanoma characteristics were extracted and analysed. Data from the Netherlands Cancer Registry (NKR) were used for comparison.

Results: From 1991 to 2023, 94 TAMs and 467 benign melanocytic lesions (BMLs) on tattoos were identified. The annual incidence of TAMs has increased over time. TAMs were diagnosed at an overall median age of 48.0 years, predominantly in males (64.9%). The median Breslow thickness was 0.9 mm, and most TAMs were TNM stage I (76.6%). The number needed to excise was 6.0.

Conclusion: Ninety-four unique TAMs were identified in the Netherlands, which makes the largest case series to date. However, TAM incidence remained low (0.07%) compared to the total melanoma incidence, indicating that tattoos likely do not increase the risk of melanoma. A diagnostic delay from obscuring was considered unlikely based on the presented findings. This nationwide cohort study found no evidence supporting a causal relationship between tattoos and melanoma.

Background: Vitiligo is a chronic, non-life-threatening skin disorder characterized by depigmented macules caused by the selective loss of melanocytes. Although its pathogenesis is multifactorial, encompassing autoimmune, genetic, and oxidative stress-related factors, it remains underdiagnosed, and patients frequently face delays in appropriate care. The visible nature of vitiligo, especially when it affects exposed areas like the face or hands, significantly impacts patients' psychological well-being and quality of life, often leading to social stigma, anxiety, and reduced self-esteem. A comprehensive understanding of the patient journey is crucial to improving outcomes.

Summary: The patient journey typically begins with the appearance of macules and psychological distress, often followed by unreliable self-directed research that delays proper diagnosis. Clinical examination supported by tools like Wood's lamp, dermoscopy, or biopsy enables correct classification, which is essential for treatment decisions. Disease severity is assessed using various scoring systems (e.g., VASI, BSA, VIDA), which guide therapy based on disease extent, activity, and patient-reported burden. Therapeutic strategies vary and may include topical corticosteroids or calcineurin inhibitors for localized disease, narrowband UVB phototherapy, or systemic corticosteroids for more extensive or active forms. Ruxolitinib cream, a JAK inhibitor, has recently emerged as the first approved targeted therapy for non-segmental vitiligo. In refractory cases, surgical interventions may be considered. The ideal care model involves a multidisciplinary unit coordinated by dermatologists and supported by psychologists, endocrinologists, and other specialists. This integrated approach addresses both clinical and psychosocial needs, facilitating timely diagnosis and personalized therapy.

Key messages: Optimizing the patient journey through structured care networks and early specialist involvement is essential to improving quality of life and clinical outcomes. With the advent of novel treatments, healthcare systems must adapt to provide more coordinated, patient-centered care for individuals living with vitiligo.

Introduction: Cutaneous lupus erythematosus (CLE) is a chronic and recurrent autoimmune disorder that predominantly affects the skin. It may cause alterations in appearance and psychological distress, thereby exerting an impact on the quality of life. Consequently, the pursuit of safer, more effective, and more convenient therapeutic approaches is of paramount importance.

Methods: A systematic electronic search was conducted in the following databases to identify clinical studies on the prevention and treatment of CLE: PubMed, MEDLINE (OVID), Web of Science, and CENTRAL. Search results were screened, and relevant studies were selected based on predefined inclusion and exclusion criteria.

Results: Our systematic review incorporated 19 randomized controlled trials and 34 controlled or uncontrolled clinical trials that investigated treatments for CLE.

Conclusion: Existing research evidence suggests that topical treatments are generally regarded as a first-line option for CLE owing to their convenience and safety, particularly for milder lesions or those limited to the skin. In contrast, systemic therapies are more appropriate for patients with severe conditions or those at risk of developing systemic LE. Currently, the precise mechanisms of action of CLE treatments have not been fully elucidated. The therapeutic potential of some novel therapies and their complex roles in disease progression remain unclear, necessitating further basic and clinical research for clarification.