Dermatology最新文献

Introduction: Cutaneous malignant melanoma (CMM) is the most lethal form of skin cancer worldwide. The precise prediction of lymph node metastasis is critical for personalized treatment and improved patient outcomes. However, no prior study has employed interpretable machine learning techniques to predict lymph node metastasis in CMM. This study aimed to utilize interpretable machine learning to integrate multidimensional data from the Surveillance, Epidemiology, and End Results (SEER) database - encompassing clinical characteristics, pathological information, and biomarkers of CMM - to construct various predictive models for lymph node metastasis.

Methods: We constructed six machine learning models to predict lymph node metastasis using clinical, pathological, and biomarker data from 2,448 patients with CMM in the SEER database. These models comprise a support vector machine, random forest (RF), XGBoost, LightGBM, adaptive boosting, and gradient boosting decision tree. The primary influential factors were identified using Gaussian Naive Bayes and gradient boosting algorithms. Shapley additive explanations (SHAP) analysis facilitates visual interpretation in individual patients. Model performance was evaluated based on accuracy, sensitivity, specificity, Brier score, and area under the receiver operating characteristic curve (AUC).

Results: The RF algorithm exhibited the highest predictive performance with an AUC of 0.897, accuracy of 0.821, sensitivity of 0.876, specificity of 0.765, and Brier score of 0.086. The primary influential variables were T stage, chemotherapy, ulceration, pretreatment lactate dehydrogenase (LDH) levels, and radiation therapy. SHAP analysis confirmed a significant association and highlighted the critical function of (LDH) as a predictive biomarker.

Conclusion: This study successfully established an accurate predictive model for lymph node metastasis in patients with CMM using machine learning techniques, offering a significant reference to aid clinician treatment decisions.

Introduction: Limited data are available on the effectiveness and safety of dimethyl fumarate (DMF) for the treatment of moderate-to-severe psoriasis in real-world clinical practice. The objectives were to assess the effectiveness and safety of DMF in patients with moderate-to-severe plaque psoriasis in Switzerland.

Methods: Data from 28 adults enrolled in the Swiss Dermatology Network for Targeted Therapies registry who started DMF treatment as first line or subsequence therapy at registry entry and had ≥3 months of follow-up were analysed. No missing imputation was performed.

Results: The median Psoriasis Area and Severity Index (PASI) decreased from 9.3 to 2.0 (p = 0.0136) and 2.3 (p = 0.0156) after 6 and 12 months of DMF treatment, respectively. At month 6, 61.5%/61.5%/15.4% of patients achieved a PASI <5/<3/<1 and at month 12, 75.0%/50.0%/37.5%. The proportions of patients achieving a PASI 75/90/100 response were 62.5%/25.0%/12.5% at month 12. At 12 months, median body surface area affected decreased from 10.3% to 1.5% (p < 0.01). The most common adverse events were abdominal pain (50.0%) and flushing (35.7%), which occurred in the first 3 months.

Conclusion: In a real-world setting, DMF significantly improves the severity and extent of disease in patients with moderate-to-severe psoriasis for up to 1 year with a safety profile consistent with previously published data on fumarates.

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disease with lifelong consequences for patients' well-being. Quality-of-life tools such as Dermatology Life Quality Index (DLQI) and Patient-Oriented Eczema Measure (POEM) assess disease burden at a specific time point but do not capture long-term life course impairment. The cumulative life course impairment (CLCI) model describes the multidimensional, cumulative effects of a chronic condition over an individual's life course, influencing their trajectory and fulfilment. Two instruments to assess CLCI were recently developed. The CLCI-R assesses retrospective, irreversible cumulative damage since disease onset, while the CLCI-P identifies patients at risk of future life course impairment. Both tools measure the psychosocial impact of chronic skin disease over time, extending beyond conventional cross-sectional quality-of-life measures. This study aimed to quantify the extent of CLCI in adult patients with moderate-to-severe AD seen at an academic medical centre.

Methods: A cross-sectional study was conducted at Singapore General Hospital among 82 adults with moderate-to-severe AD. Participants completed CLCI-R and CLCI-P questionnaires, while Eczema Area and Severity Index (EASI), DLQI, POEM, Itch, and sleep Visual Analogue Scale (VAS) scores were collected in the same visit. Spearman's correlation, Mann-Whitney U tests, and multiple linear regression were used to analyse associations and predictors of CLCI.

Results: The mean CLCI-R score was 29.4 ± 1.9, with no significant difference between moderate and severe AD (p = 0.907), indicating substantial retrospective impairment in both. CLCI-P scores were significantly higher in severe AD patients (Mean: 28.4 ± 5.5 vs. 15.9 ± 2.0; p = 0.007), highlighting greater future impairment's association with severe disease. CLCI-P correlated significantly with DLQI (r = 0.611) and disease severity (r = 0.489). In multivariable analysis, greater prospective impairment was associated with higher DLQI, CLCI-R, and disease duration ≥21 years.

Conclusion: This study underscores the substantial cumulative burden faced by patients with AD, particularly in those with longer disease duration and more severe disease. Integrating CLCI into dermatology assessments may help identify patients at higher risk of life course impairment and offers an opportunity to mitigate future cumulative burden with treatment.

Background: The worldwide prevalence of hidradenitis suppurativa (HS) still remains unknown. In Latin America, there are scarce data regarding the prevalence of HS and in Chile, we do not have information about it. The aim of this study was to estimate the prevalence of HS in Santiago, Chile.

Methods: This study is part of the Global Hidradenitis Suppurativa Atlas (GHiSA) initiative. It was a multicenter center study in secondary care in Santiago, Chile. The inclusion criteria were apparently healthy adults accompanying a patient to the health center that were approached in the waiting room of internal medicine or pediatrics departments. A previously validated screening questionnaire for HS was used. Screen-positive and randomly selected screen-negative participants were clinically examined.

Results: 500 participants were included. The prevalence of HS in the sample was 2.4% (12/500; 95% CI: 1.4%-4.1%). In the HS group, all were female (100%; p = 0.019), with a median age of 35.5 years (p = 0.089) and 25% were smokers (p = 1). Body mass index (BMI) of patients with HS was significant higher than non-HS patients (30.9 kg/m2 and 28.1 kg/m2, respectively; p = 0.028). Axilla and groin were the predominant sites of affection (58.3% each one). 75% of HS patients were classified as Hurley stage I and 25% as Hurley stage II.

Conclusion: The estimated prevalence of HS in Santiago of Chile was 2.4%, which is high compared to other previous reports worldwide but similar to other countries participating in the GHiSA initiative. In our study, we only had female patients with HS, suggesting a clear predominance of women suffering HS in Chile. A high BMI appears to be a risk factor for HS in our population. The screening questionnaire for HS is a suitable tool for population surveys.

Introduction: Hidradenitis suppurativa is a chronic inflammatory disease of the apocrine gland-bearing areas frequently misdiagnosed or underdiagnosed. Its true prevalence is still unknown and there is an ongoing interest in this matter. The current study was a part of the Global Hidradenitis Suppurativa Atlas (GHiSA) initiative that is actively involved in better understanding the epidemiological characteristics of HS.

Methods: This study was a multicenter study in 2 tertiary care hospitals in Bucharest. After obtaining consent, data from 796 healthy accompanying adults were included. A validated screening questionnaire was used before the clinical examination of the screening-positive and randomly selected screening-negative participants, respectively.

Results: The prevalence of hidradenitis suppurativa in Bucharest, Romania was 0.75% (95% confidence interval: [0.35%-1.63%]).

Conclusion: There aren't any data available regarding the prevalence of hidradenitis suppurativa in Romania and the current report is the first paper addressing the prevalence of HS in the capital of Romania, Bucharest.

Introduction: Numerous imaging techniques, such as reflectance confocal microscopy (RCM), optical coherence tomography (OCT), and line-field confocal OCT (LC-OCT), are available for skin evaluation. However, there remains a need for improved imaging methods to better understand tumor histology and enhance surgical margin detection. This study aimed to evaluate the quality of ex vivo LC-OCT images in cutaneous tumors, describe their morphological features, and correlate the findings with dermoscopy, in vivo RCM, and histology.

Methods: A prospective study was conducted from June 2022 to July 2023, including patients aged ≥18 years with cutaneous tumors on the trunk or limbs. Clinical, dermoscopic, RCM, ex vivo LC-OCT, and histopathological images were collected from 10 tumors, including melanomas, seborrheic keratoses, basal cell carcinomas, and melanocytic nevi.

Results: Ex vivo LC-OCT produced high-quality images equivalent to those from in vivo devices, enabling three-dimensional visualization of excised tumors. The images displayed cellular resolution with strong correlations to confocal microscopy and histology.

Conclusion: Ex vivo LC-OCT shows promise for improving the evaluation of cutaneous tumors and may enhance dermato-oncological surgery, particularly in margin control.

Introduction: New biologic treatments are increasingly used for the treatment of moderate-to-severe atopic dermatitis (AD). This study examined clinical characteristics of patients with Dupilumab-associated ocular surface disease (DAOSD).

Methods: A total of 382 patients were included in a retrospective nationwide cohort study of all Danish adults treated with Dupilumab for AD for more than 16 weeks.

Results: The frequency of DAOSD was 37.7% with a median follow-up of 1.6 years. Before initiating treatment, 61.3% of the DAOSD patients already had preexisting ocular surface disease (OSD), why the DAOSD group was then subdivided in two groups: one with preexisting OSD and one without preexisting OSD. Patients who developed DAOSD had a longer median duration of AD (41.5 and 44 for patients with preexisting OSD and patients without preexisting OSD) vs. 33 years (non-DAOSD), p = 0.005, a higher median reduction in EASI score (93.3% and 90.2% vs. 83.8%, p = 0.006) and more frequently rhinitis (49.4% and 52.7% vs. 37.1%, p = 0.031). In 75% of cases, DAOSD presented before week nine, conjunctivitis was the most common sign of DAOSD (73.2%) and to treat DAOSD, ophthalmologists prescribed lubricating eye drops to patients with preexisting OSD and patients without preexisting OSD drops in 88.5% and 87.3 of the cases, and mild (e.g., hydrocortisone) and strong (e.g., dexamethasone) corticosteroid eye drops equally frequent (24.1 and 25.3% vs. 16.4% and 29.1%). In 5% of the cohort, Dupilumab treatment was discontinued due to DAOSD (n = 19), even though these patients received lubricating eye drops (84%), mild steroids (41.1), and strong steroids (31.6%).

Conclusion: DAOSD should be recognized by dermatologists and should lead to consideration of early referral to ophthalmologists.

Introduction: Adolescent acne poses unique therapeutic challenges and imposes a substantial burden. However, the study of its global impact has been limited and neglected.

Objective: The objective of the study was to analyze the global disease burden and epidemiologic trend of adolescent acne.

Methods: Data were extracted from the Global Burden of Disease Study 2021 database. All the analysis procedures and graphic representation were undertaken by R statistical software and GraphPad Prism 9.

Results: The global burden of adolescent acne increased significantly from 1990 to 2021, with consistently higher rates observed in females compared to males. Meanwhile, both the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized YLD rate (ASDR) continued to rise significantly, with an average annual percentage change (AAPC) of 0.7%, 0.6%, and 0.6%, respectively. Population analysis revealed a unimodal age distribution, characterized by a high burden among adolescents with the age of 11-14 years. In both, national and regional, the distribution of the disease burden was highly uneven. The global burden can be mostly attributed to epidemiological changes (58.7%) and aging (40.0%). Significant regional disparities grouped by the socio-demographic index were observed. Projections indicate that by 2050, the incidence, ASIR, prevalence, ASPR, disability-adjusted life years, and ASDR of adolescent acne will rise to 122 million, 4,265 per 100,000, 201 million, 7,015 per 100,000, and 4.326 million, 151.2 per 100,000, respectively.

Conclusion: The study demonstrates a significant and growing global burden of adolescent acne from 1990 to 2021, underscoring the urgent need for targeted prevention and management strategies worldwide.

Introduction: Hidradenitis suppurativa (HS) prevalence studies show considerable regional discrepancies due to various methodological and/or ethnic factors. The prevalence of HS in Türkiye has yet to be examined. This study aimed to assess the HS prevalence with a validated screening questionnaire in Antalya-Türkiye as part of the major project to determine the global prevalence of HS.

Methods: This single-center, cross-sectional study in a tertiary health institution was conducted among healthy volunteer adults accompanying patients in the internal medicine outpatient clinics of Akdeniz University between July and November 2022.

Results: The study included 1,012 participants, 544 females, and 468 males. Seven participants (4 females and 3 males, median age 44.0 [IQR 40.5-54.5] years old) had HS, and the prevalence was 0.69% (95% confidence interval [0.33%-1.4%]). The proportion of HS at an early stage was higher than the rate previously reported from the same center in a registry research (Hurley I, 28.57% vs 16%). The examination of 110 screen-negative participants did not reveal any HS. There was no difference between HS patients and non-HS participants regarding gender, age, BMI, and daily smoking rate.

Conclusion: HS prevalence in Antalya seems compatible with the global prevalence of the disease. This study did not confirm the male dominance observed in Türkiye in earlier studies. The HS patients diagnosed in the study represent a milder spectrum of the disease.