Dermatology最新文献

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.

Background: Maintaining homeostasis in the upper pilosebaceous unit in acne-prone skin has emerged as the primary goal for effective and long-term acne management.

Summary: In this review, we describe advances in acne research that have helped redefine the strategic targets for new topical acne treatments, providing the basis for new therapeutic strategies that may allow this goal to be achieved.

Key messages: First, we describe the results of studies analyzing apparently uninvolved skin from individuals with acne, using sequential skin surface biopsies. These studies led to the identification of subclinical lesions, referred to as microcomedones, as the root of all subsequent acne lesions, and thus clinically non-lesional acne skin as the strategic target for new acne therapies. We then describe the concept of the comedo switch, in which exposure of progenitor cells in the pilosebaceous unit to comedogenic factors in acne-prone skin leads to the formation of microcomedones. Previously considered as an "inert plug", the microcomedone rather appears to be "an egg" that can grow into acne lesions.

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that disproportionately affects women and skin of color. In this single-center study, we investigate the epidemiologic landscape of HS individuals in South Florida, which possesses a large and diverse Hispanic population.

Methods: A retrospective chart review from the University of Miami Hospitals and Clinics was conducted, identifying HS patients between 2010 and 2023 according to the pertinent International Classification of Diseases (ICD) codes. Data extraction included demographic information, past medical history, and laboratory results. Chi-squared tests and logistic regression analyses were performed to detect statistically significant relationships.

Results: Among the 3,515 identified charts, almost half were identified as Hispanic or Latino (47.0%), and 31.7% identified as Black or African American (AA). Over 50% of patients had elevated haptoglobin and C-reactive protein (CRP) levels (51.2% and 53.4%, respectively). There were also trends of hyperuricemia in HS patients, though this did not reach statistical significance. Female sex was associated with a higher prevalence of pilonidal disease (PD) (odds ratio [OR] 2.99, p < 0.001), particularly in Hispanic females compared to non-Hispanic females (OR 3.22, p < 0.001, and OR 2.74, p < 0.001, respectively).

Conclusion: In South Florida, HS disproportionately affects AA and Hispanic/Latino women. Obesity and metabolic syndrome are commonly associated with HS, and uric acid may serve as a potential marker for metabolic derangement, although larger studies are needed to investigate this relationship. Female patients with HS are at increased risk of developing PD, highlighting the need for personalized comorbidity screening and therapeutic management of HS.

Introduction: The coexistence of multiple immune-mediated inflammatory diseases (IMIDs) in a single patient represents a growing clinical challenge, yet comprehensive data on patients with more than two IMIDs remain limited. The aim of this study was to characterize the clinical profiles, therapeutic responses, and quality of life outcomes in patients presenting with complex IMID associations involving cutaneous manifestations.

Methods: We established the CIMID-Skin registry, a prospective observational study enrolling adult patients with multiple IMIDs including at least one dermatological condition. Patients were stratified into control (2 IMIDs) and complex (>2 IMIDs) groups. Clinical data validated severity scores, and patient-reported outcomes were systematically collected.

Results: The cohort (n = 54) was predominantly female (77.8%), with a mean age of 45.4 years and overweight range body mass index (27.4 kg/m2). Patients frequently presented with multiple IMIDs, with 59.3% having ≥3 conditions. The most common diseases were psoriasis and hidradenitis suppurativa (42.6% each) and psoriatic arthritis (40.7%). Paradoxical reactions were observed in a significant proportion of patients, with paradoxical psoriasis reported in 24.1% of the cohort. Quality of life was markedly impaired, with 65.2% showing moderate-to-extreme DLQI impact, and 24.1% reaching the WHO-5 depression threshold.

Conclusions: Patients with complex IMID associations demonstrate distinct clinical patterns and therapeutic challenges. The high prevalence of paradoxical reactions and the specific clustering of certain IMIDs suggest shared pathophysiological mechanisms that warrant further investigation.

Introduction: Pemphigus is a rare group of autoimmune blistering diseases, most often mediated by IgG autoantibodies but occasionally involving IgA or other immunoglobulin classes, characterized by the loss of epidermal cell adhesion due to desmoglein-targeted autoantibodies. Rituximab, an anti-CD20 monoclonal antibody, has emerged as a novel and effective treatment, offering targeted B-cell depletion.

Methods: A prospective observational study was conducted on 51 patients with confirmed pemphigus. Patients received either the RA protocol (1 g rituximab 2 weeks apart) or the lymphoma protocol (375 mg/m2 weekly for 4 weeks). Disease stages were defined according to the international consensus on pemphigus [Murrell et al., J Am Acad Dermatol. 2008;58(6):1043-6]. Desmoglein 1 and 3 levels were measured using ELISA at baseline and at 6 months. Patients receiving DCP therapy were analyzed separately but excluded from primary rituximab remission analysis. Clinical remission, relapse, and adverse events were recorded.

Results: Most patients (70.59%) were diagnosed with pemphigus vulgaris, and 72.55% achieved complete remission. Mean Dsg1 levels significantly reduced from 211.96 ± 109.10 to 10.95 ± 25.43 and Dsg3 from 206.08 ± 105.11 to 17.69 ± 47.79 (p < 0.001). Patients receiving the RA protocol demonstrated a slightly greater reduction in Dsg3 titers compared to the lymphoma group, though not statistically significant. Recalcitrant disease was noted in 21.57% of cases. The low RA protocol was the most commonly used (70.59%). Adverse events were minimal and included mild infusion reactions. Mortality was reported in 5.88% of cases.

Conclusion: Rituximab therapy demonstrates robust clinical and immunological efficacy in pemphigus, with substantial reductions in Dsg1 and Dsg3 antibody levels and high remission rates. Its use, particularly with the low RA protocol, offers a safer and more effective alternative to conventional immunosuppressive regimens. Patients on DCP therapy had slower antibody decline and greater treatment toxicity compared to rituximab, reaffirming rituximab's superiority.

Introduction: Artificial intelligence (AI) can potentially assist in triaging suspicious skin lesions as malignant or benign. General-purpose multimodal large language models (LLMs), such as GPT-4o, have not been rigorously evaluated for this task. This study assessed GPT-4o's ability to triage skin lesions and compared its performance to specialised neural networks.

Methods: We evaluated GPT-4o using 1,000 random cases from the PAD-UFES-20 dataset with 50 repeated trials. GPT-4o was tested using clinical data-only, image-only, and multimodal inputs. GPT-4o's performance, consistency, and fairness across different demographic subgroups was evaluated. Its performance metrics were compared against specialised unimodal and multimodal neural networks trained on a separate subset of the PAD-UFES-20 dataset.

Results: GPT-4o exhibited poor triage performance across all modalities, with average balanced accuracies of 0.571, 0.602, and 0.622 for clinical data, image, and multimodal inputs, respectively. Sensitivity was consistently high (>0.95) with the trade-off of very low specificity. Mean agreement rates were high (>0.90); however, Fleiss' κ indicated only moderate consistency due to a strong bias toward malignant classifications. Fairness evaluations showed poorer discriminative performance in younger patients compared to middle-aged and elderly patients but no notable differences between different sex and skin tone subgroups. Specialised neural networks significantly outperformed GPT-4o on most pairwise comparisons. Multimodal inputs significantly improved GPT-4o performance over unimodal inputs.

Conclusion: Although GPT-4o consistently triaged skin lesions with high sensitivity, its very low specificity limits clinical utility. Thus, general-purpose LLMs like GPT-4o are currently unsuitable for clinical dermatological diagnostics without significant field-specific developments and validation.

Introduction: The differences in all-cause and cause-specific mortality among patients with generalized pustular psoriasis (GPP), palmoplantar pustulosis (PPP), and psoriasis vulgaris (PV) are not well understood. The aim of our study was to compare all-cause and cause-specific mortality in patients with GPP, PPP, and PV.

Methods: We conducted a nationwide, retrospective cohort study using data from the Korean National Health Insurance Service and National Death Registry between 2002 and 2022. Patients with GPP, PPP, and PV aged ≥18 years were identified based on ≥3 visits with principal diagnosis codes. Baseline characteristics, including demographics, general health data, socioeconomic status, and comorbidity profiles, were balanced using inverse probability weighting. Participants were followed up from the index date until the occurrence of death, emigration, or the end of the observation period to investigate all-cause and cause-specific mortality.

Results: Multivariate regression analysis showed that patients with GPP had significantly higher all-cause mortality than those with PV (adjusted hazard ratio [aHR], 1.23; 95% confidence interval [CI], 1.20-1.25), while patients with PPP had lower all-cause mortality (aHR, 0.89; 95% CI, 0.87-0.91). GPP was associated with higher cause-specific mortality, particularly from hematologic (aHR, 1.76; 95% CI, 1.27-2.44) and respiratory diseases (aHR, 1.37; 95% CI, 1.30-1.46), whereas PPP patients had lower mortality from gastrointestinal (aHR, 0.57; 95% CI, 0.52-0.63) and infectious diseases (aHR, 0.71; 95% CI, 0.63-0.80). Subgroup and sensitivity analyses confirmed these findings.

Conclusions: GPP is associated with higher all-cause and cause-specific mortality than PV, while PPP is linked to lower mortality, indicating potential epidemiological and biological differences among these subtypes.