Introduction: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions. However, only a few studies have investigated the clinicodemographic and laboratory parameters predicting SJS and TEN outcomes other than mortality, such as severe complications or increased length of hospital stays. Our objectives are to identify admission risk factors predictive of severe complications and the accompanying clinical or biochemical markers associated with prolonged hospitalization.
Methods: A retrospective cohort study over a 9-year period (2013-2022).
Results: The study included 216 patients with SJS (n = 122), SJS/TEN overlap (n = 71), and TEN (n = 23). On multivariate analysis, the clinical factor on admission that was predictive of severe complications was blood urea nitrogen (BUN) >8.3 mmol/L (p = 0.007). Furthermore, BSA epidermal detachment >10% (p < 0.001), Severity-of-illness score for TEN (SCORTEN-1) ≥2 (p = 0.04), and positive skin culture (p = 0.04), from which the Prolonged Hospitalization Risk Score was created, were predictive of length of hospital stays >10 days. Using systemic methylprednisolone at a mean dose ≥1 mg/kg/day for a median duration of 10.5 days was not shown to increase or reduce complication rates of SJS/TEN and shorten hospital stays.
Conclusion: BUN >8.3 mmol/L present at admission is a risk factor for severe complications of SJS/TEN. BSA involvement >10%, SCORTEN-1 ≥2, and positive skin culture on admission are useful markers to predict extended hospitalization.
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: 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.
Background: Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic, recurrent, and inflammatory disease. HS is fairly rare among the population. This study was a part of the Global Hidradenitis Suppurativa Atlas (GHiSA) initiative, aiming to establish the prevalence of HS, based on a questionnaire and subsequent clinical examination targeting healthy adults accompanying patients undergoing care in a tertiary hospital.
Objective and methods: This study was a monocenter study in tertiary care in, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China, and was conducted by the Department of Dermatology. Healthy adults accompanying a patient to the outpatient clinic or hospitalized (Department of Dermatology excluded) were approached and surveyed after agreeing to participation. The data were collected by residents and students and the questionnaire was translated into Chinese.
Results: A total of 552 Chinese participants were eligible for inclusion, consisting of 246 males and 306 females. A total of 515 participants were screened negative through the questionnaire. Twenty-two of the participants screened positive. Of these, four participants who were highly suspected to have HS declined a physical exam. The possibility of HS was ruled out by the collection of detailed medical histories of other participants (n = 16) screened positive. The confirmed prevalence of HS in the remaining 552 participants was 0.36% (95% confidence interval 0.10%-1.31%). Two participants, one male and one female, respectively, were diagnosed with HS. There were no significant differences in the median age, BMI and the percentage of smokers between the control group and the HS group.
Conclusion: The estimated adult HS prevalence rate in Xi'an, China is 0.36%.
Introduction: Only a few studies analysed the prognosis significance of erythema nodosum (EN) in sarcoidosis. Our objective was to analyse the prevalence of EN in sarcoidosis, its possible association of EN with extrathoracic sarcoidosis, and its prognostic significance.
Methods: Retrospective study included patients diagnosed with sarcoidosis at Bellvitge University Hospital, Barcelona, Spain, between 1980 and 2017. Patients were followed up prospectively at the sarcoid clinic of the hospital. Patients' medical records were reviewed to obtain the clinical data.
Results: A total of 728 patients (494 women and 234 men, mean age 43.45 years, SD 13,833) were diagnosed with sarcoidosis. Radiological stages were 0 in 68 patients (9.34%), 1 in 434 (59.62%), 2 in 167 (22.94%), 3 in 45 (6.18%), and 4 in 14 (1.92%). Pulmonary fibrosis at 5 years of follow-up was documented in 44 patients. EN was diagnosed in 269 (37%). In 265 cases (98.5%), EN lesions were present at the onset of sarcoidosis and mostly corresponded to radiological stage 1 at diagnosis (82.52%). Among patients with EN, 3/269 (1.11%) had pulmonary fibrosis at 5 years of follow-up (p < 0.001), sarcoidosis activity persisted for more than 5 years in 28/269 (10.41%) (p < 0.001), and oral corticosteroids were required in 48/269 patients (17.84%) (p < 0.001). Patients with EN had a low incidence of severe extrapulmonary involvement.
Conclusion: EN was observed in 37% of sarcoidosis patients, usually at the onset of the disease. Patients with EN-associated sarcoidosis have mainly radiological stage 1 at diagnosis and are at lower risk of chronicity, pulmonary fibrosis, and severe forms of extrathoracic organ involvement.