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A Randomized, Double-Blind, Placebo-Controlled, Multicenter, 16-Week Trial to Evaluate the Efficacy and Safety of FB-401 in Children, Adolescents, and Adult Subjects (Ages 2 Years and Older) with Mild-to-Moderate Atopic Dermatitis. 一项为期 16 周的随机、双盲、安慰剂对照多中心试验,旨在评估 FB-401 对轻度至中度特应性皮炎儿童、青少年和成人受试者(2 岁及以上)的疗效和安全性。
IF 3 3区 医学 Q2 DERMATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-08-14 DOI: 10.1159/000532054
Michael E Jacobson, Ian A Myles, Amy S Paller, Lawrence F Eichenfield, Eric L Simpson

Background: Atopic dermatitis is a common chronic, relapsing, and remitting inflammatory skin disorder associated with cutaneous dysbiosis. Current treatment options often fail to adequately control the disease and have unfavorable safety profiles. There is a need for new options that address these treatment shortcomings.

Objective: The aim of the study was to evaluate the efficacy, safety, and tolerability of FB-401, a live therapeutic product of 3 strains of Roseomonas mucosa, compared to matching placebo applied topically 3 times per week to participants ages ≥2 years of age with mild-to-moderate atopic dermatitis.

Methods: A randomized, double-blind, placebo-controlled, parallel-group study was conducted. The primary outcome was the proportion of participants with 50% improvement in Eczema Area and Severity Index score from baseline at week 16. 154 subjects aged 2 or older with a clinical diagnosis of atopic dermatitis as defined by Hanifin and Rajka criteria with mild or moderate severity were randomized 1:1 via interactive web response system to FB-401 or placebo.

Results: The proportion of subjects who achieved the primary outcome was similar between both treatment groups, with no significant treatment group differences observed at any post-baseline visit. The number of treatment-emergent adverse events and the number of subjects with at least one were similar across treatment groups. One serious adverse event not related to treatment was reported. No treatment-emergent adverse events led to treatment discontinuation or study discontinuation.

Conclusions: FB-401 showed an acceptable safety profile but failed to prove superior to placebo in treating children and adults with mild-to-moderate atopic dermatitis.

背景:特应性皮炎是一种常见的慢性、复发性和缓解性炎症性皮肤病,与皮肤菌群失调有关。目前的治疗方案往往不能充分控制病情,而且安全性不佳。我们需要新的治疗方案来解决这些治疗缺陷:本研究旨在评估 FB-401 的疗效、安全性和耐受性,FB-401 是一种由 3 株玫瑰单胞菌粘膜组成的活治疗产品,与匹配的安慰剂相比,FB-401 用于年龄≥2 岁的轻度至中度特应性皮炎患者,每周局部用药 3 次:进行了一项随机、双盲、安慰剂对照、平行组研究。主要结果是第16周时湿疹面积和严重程度指数评分比基线值改善50%的受试者比例。154名年龄在2岁或以上、临床诊断为特应性皮炎(根据Hanifin和Rajka标准定义为轻度或中度)的受试者通过交互式网络响应系统以1:1的比例随机接受FB-401或安慰剂治疗:结果:两个治疗组达到主要结果的受试者比例相似,在基线后的任何访问中均未观察到明显的治疗组差异。各治疗组的治疗突发不良事件数量和至少出现一次不良事件的受试者人数相似。报告了一起与治疗无关的严重不良事件。没有治疗突发不良事件导致治疗中断或研究中止:结论:FB-401具有可接受的安全性,但在治疗儿童和成人轻度至中度特应性皮炎方面未能证明优于安慰剂。
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引用次数: 0
Metaverse in Dermatology Speciality Advancement: Future to Embrace. 皮肤病学专业发展的元宇宙:拥抱的未来。
IF 3.4 3区 医学 Q2 DERMATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-10-11 DOI: 10.1159/000534515
Anant Patil, Jacek C Szepietowski, Mohamad Goldust
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引用次数: 0
Early Organ Metastasis in Granulomatous Mycosis Fungoides: A Systematic Review. 肉芽肿性真菌病的早期器官转移:系统综述
IF 3 3区 医学 Q2 DERMATOLOGY Pub Date : 2024-01-01 Epub Date: 2024-02-29 DOI: 10.1159/000537893
Melika Motamedi, Maggie Z X Xiao, Jean Deschenes, Jori Hardin, Russell Sterrett, Lesley Street, Minakshi Taparia, Etienne Mahe, Giovanni Ferrara, James R Barrie, Robert Gniadecki

Background: Granulomatous mycosis fungoides (GMF) is a rare form of cutaneous T-cell lymphoma characterized by a granulomatous inflammatory infiltrate.

Objective: The impact of granulomatous inflammation on the prognosis of the disease remains controversial as there have been both favorable and unfavorable outcomes documented.

Methods: We performed a systematic review of 116 GMF cases previously described in the literature.

Results: In contrast to the classic Alibert-Bazin type of mycosis fungoides (MF), cutaneous lesions in GMF tend to involve distal extremities (lower legs, feet, hands) early in the disease course. In the literature, 30% of GMF patients developed organ metastasis, most frequently to the lung. The median time to stage progression was 25 months.

Conclusion: GMF is an aggressive form of MF. Therefore, screening for distant metastases should be considered at presentation and repeated during follow-up.

背景:肉芽肿性真菌病(GMF)是一种罕见的皮肤T细胞淋巴瘤,以肉芽肿性炎症浸润为特征:肉芽肿性炎症对该病预后的影响仍存在争议,因为既有有利的结果,也有不利的结果:我们对以前文献中描述的116例GMF病例进行了系统回顾:与典型的阿利伯特-巴津型真菌病(MF)不同,GMF的皮肤病变往往在病程早期累及远端肢体(小腿、足、手)。文献显示,30%的GMF患者出现器官转移,最常见的是肺部转移。分期进展的中位时间为25个月:GMF是一种侵袭性真菌病。因此,在发病时就应考虑筛查远处转移,并在随访期间重复筛查。
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引用次数: 0
Online Depiction of Urticaria Is Often Flawed and Does Not Reflect the Spectrum of Clinical Manifestation. 网上对荨麻疹的描述往往存在缺陷,不能反映临床表现的范围。
IF 3.4 3区 医学 Q2 DERMATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-12-23 DOI: 10.1159/000535932
Ditte Georgina Zhang, Jennifer Astrup Sørensen, Nadja Højgaard Pedersen, Zarqa Ali, Emek Kocatürk, Marcus Maurer, Simon Francis Thomsen

Introduction: The internet is a popular source of health information including images of disease manifestations. Online photographs of skin lesions may aid patients in identifying their disease, if these pictures are of good quality and of the disease they claim to show. If not, patients may be at risk of delayed diagnosis, misdiagnosis, and suboptimal treatment. For urticaria, the mismatch rate and quality of online pictures are unknown. The objective of this study was therefore to evaluate the content and quality of online images of urticaria.

Methods: The search term "urticaria" was applied to Google Images and Shutterstock. The top 100 photographs from each search engine were retrieved on October 9th, 2022. Illustrations, drawings, and heavily edited photographs were excluded. Each image was evaluated for patient characteristics, characteristics of urticarial lesions, and image quality.

Results: Across 194 unique images of urticaria (after removing duplicates), 35 (18.0%) did not depict urticarial lesions, and 38 (19.6%) were ambiguous. Less than two-thirds of images 121 (62.4%) showed bona fide urticarial lesions. Pictures of urticarial lesions under-represented children and did not reflect female preponderance of the disease. Images predominantly depicted urticaria lesions on Caucasian skin (59.8%) and were typical of spontaneous rather than inducible urticaria. Only 3 (1.5%) pictures showed angioedema, a common clinical sign in patients with urticaria. The overall quality of online urticaria pictures was mostly good or very good.

Conclusion: Physicians and patients should be aware that one in five online pictures of urticaria does not show urticarial skin lesions, and children, females, non-Caucasian patients, inducible urticaria, and angioedema are under-represented. These findings should prompt efforts to improve the accuracy and representativeness of online urticaria pictures.

背景:互联网是一个流行的健康信息来源,其中包括疾病表现的图片。如果这些图片质量上乘,且所显示的疾病为真,那么网上的皮损照片可能有助于患者识别自己的疾病。否则,患者可能面临诊断延误、误诊和治疗效果不佳的风险。对于荨麻疹,网上图片的错配率和质量尚不清楚。因此,本研究旨在评估荨麻疹在线图片的内容和质量:在 Google Images 和 Shutterstock 上使用 "荨麻疹 "进行搜索。2022 年 10 月 9 日,在每个搜索引擎上检索了排名前 100 位的照片。不包括插图、图画和经过大量编辑的照片。对每张图片的患者特征、荨麻疹病变特征和图片质量进行了评估:在 194 张独特的荨麻疹图片中(去除重复图片后),35 张(18.0%)没有描述荨麻疹病变,38 张(19.6%)模糊不清。不到三分之二的图片 121 张(62.4%)显示了真正的荨麻疹病变。荨麻疹病变的图片中儿童所占比例较低,也没有反映出这种疾病以女性居多。图片主要描绘的是白种人皮肤上的荨麻疹病变(59.8%),是典型的自发性荨麻疹而非诱发性荨麻疹。只有 3 张(1.5%)图片显示血管性水肿,这是荨麻疹患者常见的临床症状。在线荨麻疹图片的总体质量大多为良好或非常好:医生和患者应该意识到,每五张在线荨麻疹图片中就有一张没有显示荨麻疹皮损,而且儿童、女性、非白种人患者、诱发性荨麻疹和血管性水肿的比例偏低。这些发现应促使人们努力提高在线荨麻疹图片的准确性和代表性。
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引用次数: 0
Post-Excision Soft X-Ray Radiotherapy for Keloids: Experience in a Tertiary Referral Center. 瘢痕疙瘩切除术后软X射线放射治疗:一家三级转诊中心的经验。
IF 3 3区 医学 Q2 DERMATOLOGY Pub Date : 2024-01-01 Epub Date: 2024-06-19 DOI: 10.1159/000539782
Egle Ramelyte, Michèle Welti, Fabian Gardin, Julia-Tatjana Maul, Reinhard Dummer, Laurence Imhof

Introduction: Keloid is an abnormal proliferation of scar tissue that grows beyond the original margins of the injury. Even after complete resection, recurrences are common and pose a poorly understood challenge in dermatology. There is lack of large prospective clinical trials; thus, treatment recommendations are based on retrospective analyses and small cohort studies. Superficial radiotherapy is recommended in recurrent keloids; however, the successful treatment rates vary greatly. The aim of this study was to evaluate the keloid recurrence rate after post-excision soft X-ray radiotherapy and the associated factors.

Methods: We reviewed retrospective data of all patients, treated with adjuvant post-excision soft X-ray radiotherapy with 12 Gy in 6 sessions at the tertiary referral center, Department of Dermatology, University Hospital Zurich, Switzerland, between 2005 and 2018. We analyzed individual keloids as separate cases. Successful treatment was defined as no sign of recurrence within 2 years.

Results: Of the 200 identified patients, 90 met the inclusion criteria and were included in the final analysis. In 90 patients, 104 cases of treated keloids were analyzed. Keloids were mainly located on the trunk (49%) and were mostly caused by previous surgery (52.2%). 50% of the keloids did not relapse within 2 years after therapy. A significant factor leading to recurrence was the presence of previous therapy, with prior topical therapies, such as steroid injections or 5-fluorouracil, leading to most relapses. 69.2% of keloid cases who relapsed were pretreated. Soft X-ray radiotherapy was well tolerated, with posttreatment hyperpigmentation noted in 34% of patients, particularly in patients with non-Caucasian origin (61.3%).

Conclusion: Treatment of refractory keloids is difficult. Post-excision radiotherapy is an established adjuvant treatment option; nevertheless, recurrence rates are high, especially in pretreated keloids. Prospective studies determining the exact dosage and fraction of post-excisional radiotherapy are needed to determine the optimal radiation parameters.

简介瘢痕疙瘩是一种异常增生的瘢痕组织,它的生长超出了原有的损伤边缘。即使完全切除后,复发也很常见,是皮肤病学中一个鲜为人知的难题。目前缺乏大型的前瞻性临床试验,因此治疗建议都是基于回顾性分析和小型队列研究。对于复发性瘢痕疙瘩,建议采用表皮放射治疗,但治疗成功率差别很大。本研究旨在评估切除术后软X光放射治疗后瘢痕疙瘩的复发率及其相关因素:我们回顾了 2005 年至 2018 年间在瑞士苏黎世大学医院皮肤科三级转诊中心接受辅助性切除后软 X 射线放射治疗的所有患者的数据,这些患者在 6 个疗程中接受了 12 次放射治疗。我们将单个瘢痕疙瘩作为独立病例进行分析。治疗成功的定义是 2 年内无复发迹象:在已确认的 200 名患者中,有 90 人符合纳入标准并被纳入最终分析。对 90 名患者中的 104 例瘢痕疙瘩进行了分析。瘢痕疙瘩主要位于躯干(49%),大部分由之前的手术引起(52.2%)。50%的瘢痕疙瘩在治疗后两年内没有复发。导致复发的一个重要因素是之前接受过治疗,而之前的局部治疗(如类固醇注射或5FU)导致了大多数瘢痕疙瘩的复发。在复发的瘢痕疙瘩病例中,69.2%接受过前期治疗。软X射线放射治疗的耐受性良好,34%的患者在治疗后出现色素沉着,尤其是非白种人患者(61.3%):结论:难治性瘢痕疙瘩的治疗非常困难。结论:难治性瘢痕疙瘩的治疗非常困难,切除术后放疗是一种成熟的辅助治疗方法,但复发率很高,尤其是在预处理的瘢痕疙瘩中。需要进行前瞻性研究,确定切除术后放疗的确切剂量和比例,以确定最佳放疗参数。
{"title":"Post-Excision Soft X-Ray Radiotherapy for Keloids: Experience in a Tertiary Referral Center.","authors":"Egle Ramelyte, Michèle Welti, Fabian Gardin, Julia-Tatjana Maul, Reinhard Dummer, Laurence Imhof","doi":"10.1159/000539782","DOIUrl":"10.1159/000539782","url":null,"abstract":"<p><strong>Introduction: </strong>Keloid is an abnormal proliferation of scar tissue that grows beyond the original margins of the injury. Even after complete resection, recurrences are common and pose a poorly understood challenge in dermatology. There is lack of large prospective clinical trials; thus, treatment recommendations are based on retrospective analyses and small cohort studies. Superficial radiotherapy is recommended in recurrent keloids; however, the successful treatment rates vary greatly. The aim of this study was to evaluate the keloid recurrence rate after post-excision soft X-ray radiotherapy and the associated factors.</p><p><strong>Methods: </strong>We reviewed retrospective data of all patients, treated with adjuvant post-excision soft X-ray radiotherapy with 12 Gy in 6 sessions at the tertiary referral center, Department of Dermatology, University Hospital Zurich, Switzerland, between 2005 and 2018. We analyzed individual keloids as separate cases. Successful treatment was defined as no sign of recurrence within 2 years.</p><p><strong>Results: </strong>Of the 200 identified patients, 90 met the inclusion criteria and were included in the final analysis. In 90 patients, 104 cases of treated keloids were analyzed. Keloids were mainly located on the trunk (49%) and were mostly caused by previous surgery (52.2%). 50% of the keloids did not relapse within 2 years after therapy. A significant factor leading to recurrence was the presence of previous therapy, with prior topical therapies, such as steroid injections or 5-fluorouracil, leading to most relapses. 69.2% of keloid cases who relapsed were pretreated. Soft X-ray radiotherapy was well tolerated, with posttreatment hyperpigmentation noted in 34% of patients, particularly in patients with non-Caucasian origin (61.3%).</p><p><strong>Conclusion: </strong>Treatment of refractory keloids is difficult. Post-excision radiotherapy is an established adjuvant treatment option; nevertheless, recurrence rates are high, especially in pretreated keloids. Prospective studies determining the exact dosage and fraction of post-excisional radiotherapy are needed to determine the optimal radiation parameters.</p>","PeriodicalId":11185,"journal":{"name":"Dermatology","volume":" ","pages":"572-580"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11309064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Three-Dimensional Total Body Photography, Digital Dermoscopy, and in vivo Reflectance Confocal Microscopy for Follow-Up Assessments of High-Risk Patients for Melanoma: A Prospective, Controlled Study. 用三维全身摄影、数字皮肤镜和活体反射共聚焦显微镜对黑色素瘤高危患者进行随访评估:一项前瞻性对照研究。
IF 3 3区 医学 Q2 DERMATOLOGY Pub Date : 2024-01-01 Epub Date: 2024-10-08 DOI: 10.1159/000541894
Sarah Hobelsberger, Julian Steininger, Friedegund Elke Meier, Stefan Beissert, Frank Friedrich Gellrich

Introduction: The combination of total body photography (TBP) and digital dermoscopy (DD) for monitoring patients with a high risk for melanoma can allow early detection of melanoma. This study aimed to examine if the use of three-dimensional (3D)-TBP, DD, and reflectance confocal microscopy (RCM) for regular monitoring of patients at high risk for melanoma was beneficial in comparison to monitoring using dermoscopy alone.

Methods: The intervention group (IG) underwent 3D-TBP examinations at every visit, along with DD and/or RCM for diagnosis and/or monitoring of pigmented lesions if necessary. The control group (CG) underwent dermoscopy examinations alone.

Results: A total of 600 patients (324 male and 276 female) were followed up over a median period of 23 months (mean, 2.85 visits) in the IG and 22 months (mean, 2.74 visits) in the CG (p = 0.009). DD and RCM monitoring were performed for 166 and 105 lesions, respectively. The number needed to treat (NNT) to diagnose melanoma with RCM was 2.83. The IG included more second primary melanomas (22 vs. 1, p = 0.022) and more excised nevi (186 vs. 10, p < 0.001), which consisted of more dysplastic nevi (137 vs. 2, p < 0.001). Among the melanomas diagnosed in the IG, three were diagnosed directly with RCM, nine with a combination of 3D-TBP and RCM, and 10 with dermoscopy alone.

Conclusion: Follow-up assessments with a combination of 3D-TBP, DD, and RCM led to the detection of more melanomas in comparison to the CG. The use of RCM reduced the NNT for melanocytic lesions.

简介结合全身摄影(TBP)和数字皮肤镜(DD)对黑色素瘤高危患者进行监测,可以及早发现黑色素瘤。本研究旨在探讨使用三维(3D)-TBP、DD 和反射共聚焦显微镜(RCM)对黑色素瘤高危患者进行定期监测与仅使用皮肤镜监测相比是否有益:干预组(IG)每次就诊时都接受 3D-TBP 检查,必要时还接受 DD 和/或 RCM 诊断和/或监测色素性病变。对照组(CG)仅进行皮肤镜检查:共对 600 名患者(324 名男性和 276 名女性)进行了随访,IG 组的中位随访时间为 23 个月(平均 2.85 次),CG 组为 22 个月(平均 2.74 次)(P=0.009)。分别对 166 个和 105 个病灶进行了 DD 和 RCM 监测。使用 RCM 诊断黑色素瘤的治疗需要量 (NNT) 为 2.83。IG 包括更多的第二原发性黑色素瘤(22 对 1,p=0.022)和更多的切除痣(186 对 10,p<0.001),其中包括更多的发育不良痣(137 对 2,p<0.001)。在 IG 诊断出的黑色素瘤中,3 例直接通过 RCM 诊断出,9 例结合 3D-TBP 和 RCM 诊断出,10 例仅通过皮肤镜诊 断出:结论:与 CG 相比,采用 3D-TBP 、DD 和 RCM 组合进行随访评估可发现更多黑色素瘤。使用 RCM 降低了黑色素细胞病变的 NNT。
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引用次数: 0
Systemic Therapy for Atopic Dermatitis in Children and Adolescents: A US Expert Consensus. 儿童和青少年特应性皮炎的系统治疗:美国专家共识。
IF 3 3区 医学 Q2 DERMATOLOGY Pub Date : 2024-01-01 Epub Date: 2024-10-15 DOI: 10.1159/000540920
Lawrence F Eichenfield, Mark Boguniewicz, Christine T Lauren, Donald Y M Leung, Moise L Levy, Lynda C Schneider, Elaine C Siegfried, Wynnis L Tom, Amy S Paller

Atopic dermatitis (AD) is a chronic, type-2 mediated, inflammatory skin disease characterized by intense pruritus, disruption of skin barrier function, and immune dysregulation. Management strategies for AD are routinely determined based on disease severity. First-line treatment begins with basic skin care and topical anti-inflammatory medication, which is typically sufficient for the management of mild-to-moderate disease. For those patients with moderate-to-severe disease, systemic therapy is often required. This can involve off-label treatment with conventional immunosuppressant medications. However, this approach is limited by a lack of robust clinical trial data and safety concerns that necessitate close monitoring. The emergence of novel targeted biologics and small molecules to treat AD presents an opportunity to optimize AD management and patient outcomes by offering greater efficacy than traditional immunosuppressants and a favorable safety profile. As the treatment landscape shifts, clinicians can benefit from a standardized process of patient assessment and treatment, along with resources to help maintain contemporary knowledge of available therapeutic options. This US-based, expert-led consensus used a modified Delphi process to develop core recommendations for the use of systemic medications for the management of pediatric patients <18 years of age with moderate-to-severe AD.

特应性皮炎(AD)是一种由 2 型介导的慢性炎症性皮肤病,以剧烈瘙痒、皮肤屏障功能破坏和免疫调节失调为特征。特应性皮炎的治疗策略通常根据疾病的严重程度而定。一线治疗从基本的皮肤护理和局部抗炎药物开始,这通常足以治疗轻度至中度疾病。对于中度至重度患者,通常需要进行系统治疗。这可能需要使用传统的免疫抑制剂进行标签外治疗。然而,由于缺乏可靠的临床试验数据以及需要密切监测的安全性问题,这种方法受到了限制。治疗 AD 的新型靶向生物制剂和小分子药物的出现为优化 AD 管理和患者预后提供了机会,因为它们比传统的免疫抑制剂具有更高的疗效和良好的安全性。随着治疗方式的转变,临床医生可以从患者评估和治疗的标准化流程中获益,同时还可以利用各种资源帮助保持对现有治疗方案的了解。这项以美国为基地、由专家主导的共识采用了改良的德尔菲程序,为治疗18岁中重度AD儿科患者的全身用药制定了核心建议。
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引用次数: 0
Effectiveness and Safety of Dupilumab in Children Under 6 Years of Age with Moderate-to-Severe Atopic Dermatitis: A Retrospective Real-World Study. dupilumab治疗6岁以下中度至重度特应性皮炎儿童的有效性和安全性:一项回顾性现实世界研究
IF 3 3区 医学 Q2 DERMATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-11-30 DOI: 10.1159/000535282
Emilio Berna-Rico, Esther Fiz-Benito, Jose Manuel Busto-Leis, Guillermo Servera-Negre, Raul de Lucas-Laguna, Marta Feito-Rodriguez

Introduction: Dupilumab has recently been shown to be effective in children under 6 years of age with atopic dermatitis (AD). Nevertheless, real-life and long-term follow-up data are scarce. We aimed to assess the effectiveness, safety, and long-term outcomes of dupilumab in a daily-practice setting in this age group.

Method: This was a retrospective observational cohort study. Only patients with 16 or more weeks of treatment were included in the analysis. The proportion of patients who achieved ≥75% or 90% reduction from baseline EASI (EASI75 and EASI90, respectively) and the percentage of patients who achieved vIGA 0-1 were analyzed at 4, 16, 48, 72, and 96 weeks (when available). Adverse events were recorded during follow-up.

Results: A total of 19 patients <6 years old with moderate-to-severe AD were included in the cohort, with a median age of 4.7 years (range: 2.6-5.9). The median weeks on dupilumab were 51.3 (IQR: 24.6-79.3). EASI75 was achieved in 11/19 patients (57.9%) at w4, 16/19 (84.2%) at w16, 9/12 (75%) at w48, 6/6 (100%) at w72, and in 2/2 (100%) at week 96. The objective of vIGA 0-1 was reached by 10/19 patients (51.6%) at w4, by 14/19 (73.7%) at w16, by 9/12 (75%) at w48, by 5/6 (83.3%) at w72, and by 2/2 (100%) at w96. Dupilumab was discontinued in 3 patients (15.8%) due to loss of response. One patient developed a paradoxical palmo-plantar eruption. We found no cases of conjunctivitis, facial erythema, or injection-site reactions related to dupilumab.

Conclusions: Dupilumab was effective and safe in our cohort of patients with moderate-to-severe AD under 6 years of age. Response was maintained in the long term in most patients with longer follow-up. Its adverse effect profile was similar to that found in older children and adults.

Dupilumab最近被证明对6岁以下患有特应性皮炎(AD)的儿童有效。然而,现实生活和长期随访数据很少。我们的目的是评估dupilumab在该年龄组日常实践中的有效性、安全性和长期结果。方法:回顾性观察队列研究。只有接受16周或更长时间治疗的患者被纳入分析。从基线EASI(分别为EASI75和EASI90)降低≥75%或90%的患者比例和达到vIGA 0-1的患者比例分别在4、16、48、72和96周(如有)进行分析。随访期间记录不良事件。结果:共纳入19例6岁以下中重度特应性皮炎患者,中位年龄4.7岁(范围2.6 - 5.9)。dupilumab治疗的中位周数为51.3周(IQR 24.6-79.3)。在第4周,11/19(57.9%)患者达到EASI75, 16/19(84.2%)患者达到EASI75, 48周,9/12(75%)患者达到EASI75, 72周,6/6(100%)患者达到EASI75, 96周,2/2(100%)患者达到EASI75。在w4时,10/19(51.6%)患者达到了vIGA 0-1的目标,在w16时,14/19(73.7%)患者达到了,在w48时,9/12(75%)患者达到了,在w72时,5/6(83.3%)患者达到了,在w96时,2/2(100%)患者达到了。3例患者(15.8%)因反应丧失而停用Dupilumab。一名患者出现了反常的手掌-足底喷发。我们没有发现与dupilumab相关的结膜炎、面部红斑或注射部位反应的病例。结论:在我们的6岁以下中重度AD患者队列中,Dupilumab是有效且安全的。大多数患者在较长时间的随访中长期保持疗效。其副作用与在年龄较大的儿童和成人中发现的相似。
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引用次数: 0
Rosacea and Gastrointestinal Diseases: A Case-Control Study in the All of Us Database. 红斑痤疮与胃肠道疾病:我们所有人 "数据库中的一项病例对照研究。
IF 3 3区 医学 Q2 DERMATOLOGY Pub Date : 2024-01-01 Epub Date: 2024-09-26 DOI: 10.1159/000541469
Austin J Piontkowski, Divija Sharma, Benjamin Ungar

Introduction: Recent reports have suggested a link between rosacea and several gastrointestinal diseases, although the evidence has largely been limited to European and Asian populations. This study seeks to confirm and expand upon the connection between rosacea and gastrointestinal conditions using the diverse All of Us database.

Methods: We identified 8,319 rosacea patients and selected 4:1 controls matched (n = 33,276) based on age, race, gender, smoking status, insurance status, annual income, education, and alcohol use. Conditional logistic regression was then performed on the matched cohort to assess the relationship between rosacea and Crohn's disease (CD), microscopic colitis, ulcerative colitis (UC), celiac disease (CED), irritable bowel syndrome (IBS), Helicobacter-associated disease, and gastroesophageal reflux disease (GERD).

Results: On logistic regression, rosacea patients were significantly more likely than matched controls to be diagnosed with IBS (odds ratio [OR]: 2.35, 95% confidence interval [CI]: 2.18-2.53, p < 0.001), CD (OR: 1.82, 95% CI: 1.53-2.15, p < 0.001), UC (OR: 1.70, 95% CI: 1.44-2.02, p < 0.001), CED (OR: 1.93, 95% CI: 1.59-2.34, p < 0.001), Helicobacter-associated disease (OR: 1.79, 95% CI: 1.50-2.14, p < 0.001), and GERD (OR: 2.07, 95% CI: 1.97-2.18, p < 0.001). However, there was no statistically significant association between rosacea and microscopic colitis (OR: 1.47, 95% CI: 0.91-2.37, p = 0.12).

Conclusion: This study highlights the presence of notable gastrointestinal comorbidities among individuals with rosacea in a diverse cohort. Consequently, more targeted monitoring of gastrointestinal diseases in rosacea patients may be warranted, as well as potential further investigation into the gut-skin axis in terms of rosacea pathophysiology.

导言:最近有报道称红斑痤疮与几种胃肠道疾病有关,尽管这些证据主要局限于欧洲和亚洲人群。本研究试图利用多样化的 "我们所有人 "数据库来证实并扩展红斑痤疮与胃肠道疾病之间的联系。方法 我们根据年龄、种族、性别、吸烟状况、保险状况、年收入、教育程度和酗酒情况,确定了 8,319 名酒糟鼻患者,并选择了 4:1 匹配的对照组(n= 33,276 人)。然后对配对队列进行条件逻辑回归,以评估酒糟鼻与克罗恩病(CD)、显微镜下结肠炎、溃疡性结肠炎(UC)、乳糜泻、肠易激综合征(IBS)、螺旋杆菌相关疾病和胃食管反流病(GERD)之间的关系。结果 在逻辑回归中,酒糟鼻患者被诊断出患有肠易激综合征(IBS)(几率比 [OR] 2.35,95% 置信区间 [CI] 2.18-2.53,p<0.001)、乳糜泻(CD)(OR 1.82,95% CI 1.53-2.15,p<0.001)和胃食管反流病(GERD)的几率明显高于匹配对照组。15,p<0.001)、UC(OR 1.70,95% CI 1.44-2.02,p<0.001)、乳糜泻(OR 1.93,95% CI 1.59-2.34,p<0.001)、螺旋杆菌相关疾病(OR 1.79,95% CI 1.50-2.14,p<0.001)和胃食管反流病(OR 2.07,95% CI 1.97-2.18,p<0.001)。然而,酒糟鼻与显微镜下结肠炎之间没有统计学意义上的显著关联(OR 1.47,95% CI 0.91-2.37,p=0.12)。结论 本研究强调,在不同人群中,酒糟鼻患者存在明显的胃肠道合并症。因此,有必要对酒糟鼻患者的胃肠道疾病进行更有针对性的监测,并对酒糟鼻病理生理学方面的肠道-皮肤轴进行潜在的进一步研究。
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引用次数: 0
Hematological Markers in Children and Adults with Atopic Dermatitis: A Retrospective Cohort Study. 特应性皮炎儿童和成人的血液标记物:回顾性队列研究
IF 3 3区 医学 Q2 DERMATOLOGY Pub Date : 2024-01-01 Epub Date: 2024-05-28 DOI: 10.1159/000539365
Sarah Weissmann, Amit Shira Babyev, Michal Gordon, Inbal Golan-Tripto, Amir Horev

Introduction: Atopic dermatitis (AD) is a common chronic skin disease with an inflammatory pathophysiology that includes the activation of the innate and adaptive immune systems. We aimed to investigate the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), eosinophil-to-lymphocyte ratio (ELR), and eosinophil-to-neutrophil ratio (ENR) in AD patients, according to age and disease severity.

Methods: This is a retrospective, population-based cohort study conducted between the years 2005 and 2020, comparing hematological markers of AD patients and sex-age-ethnicity-matched controls. AD patients were further divided by age and disease severity (mild, moderate-to-severe AD). We created a decision tree to predict moderate-severe AD.

Results: A total of 13,928 patients with AD were included in this study: 6,828 adults and 7,100 children, with 13,548 controls. NLR, PLR, and ELR were lower in children compared to adults (p values <0.001). NLR, PLR, ELR, and ENR were increased in moderate-severe AD patients compared to mild AD patients (p values <0.001). PLR, ELR, and ENR were increased in AD patients versus controls (p values <0.001), with an additional increase in the NLR of moderate-to-severe AD patients. Patients with an ELR <0.21, a PLR >161, and ENR ≤0.016 should be considered high risk for developing severe AD, as well as patients with an ELR >0.21 and age at diagnosis <30 or age >30 years and mean platelet volume ≤9.

Conclusion: Hematological ratios were significantly higher in moderate-to-severe AD patients, compared to mild AD patients. Hematological markers were lower in children with AD compared to adults, except for ENR, likely reflecting age-related changes in blood count parameters. These markers can assist in the management and follow-up of AD patients.

背景 特应性皮炎(AD)是一种常见的慢性皮肤病,其炎症性病理生理学包括先天性免疫系统和适应性免疫系统的激活。目的 我们旨在研究特应性皮炎患者的中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、嗜酸性粒细胞与淋巴细胞比值(ELR)和嗜酸性粒细胞与中性粒细胞比值(ENR),并根据年龄和疾病严重程度进行分类。方法 这是一项基于人群的回顾性队列研究,时间跨度为 2005 年至 2020 年,比较了 AD 患者和性别-年龄-种族匹配的对照组的血液学指标。AD患者按年龄和疾病严重程度(轻度、中度至重度AD)进一步划分。我们创建了一棵决策树来预测中重度 AD。结果 本研究共纳入 13928 名 AD 患者:其中成人 6828 人,儿童 7100 人,对照组 13548 人。与成人相比,儿童的 NLR、PLR 和 ELR 更低(P 值为 0.001)。与轻度 AD 患者相比,中重度 AD 患者的 NLR、PLR、ELR 和 ENR 均有所增加(p 值为 0.001)。与对照组相比,AD 患者的 PLR、ELR 和 ENR 均有所增加(p 值为 0.001),中重度 AD 患者的 NLR 进一步增加。ELR为0.21、PLR为161、ENR  0.016的患者,以及ELR为0.21、诊断年龄为30岁或年龄为30岁、平均血小板体积(MPV) 9的患者,应被视为重度AD的高危人群。结论 与轻度自闭症患者相比,中重度自闭症患者的血液学比率明显较高。除 ENR 外,AD 儿童的血液学指标低于成人,这可能反映了与年龄有关的血细胞计数参数变化。这些指标有助于对注意力缺失症患者进行管理和随访。
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Dermatology
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