Dermatology最新文献

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.

Introduction: Brodalumab, a human monoclonal antibody that selectively inhibits the interleukin (IL)-17 receptor subunit A, has been approved for the treatment of moderate-to-severe plaque psoriasis. The treatment benefit of brodalumab has been clearly demonstrated in multiple clinical studies. However, data on effectiveness for difficult-to-treat body regions, especially in everyday clinical practice, are still limited.

Methods: In this exploratory observational clinical study, psoriasis patients suffering from nail and scalp involvement who received brodalumab during routine clinical care were enrolled at 7 centers in Germany. Patients were observed for over 60 weeks. The co-primary endpoints were 75% improvement in Psoriasis Scalp Severity Index (PSSI75) at week 12 and 75% improvement in Nail Psoriasis Severity Index (NAPSI75) at week 24. Secondary endpoints included assessment of general skin and disease outcomes, quality-of-life, and patient satisfaction with treatment.

Results: Eighty-seven patients were included. Mean age was 46.8 years, 70.1% patients were male, and mean body mass index was 28.9 kg/m2. The co-primary endpoints were achieved by more than 90% of patients who met criteria for effectiveness analyses (n = 62): 93.6% of patients achieved PSSI75 at week 12 and 90.3% of patients achieved NAPSI75 at week 24. Median body surface area involvement improved from 14% at baseline to 1.5% and 1% at weeks 12 and 24, respectively. Median Dermatology Life Quality Index scores improved from 16 at baseline to 2 and 1 at weeks 12 and 24, respectively. Improvements were maintained in the majority of patients throughout the 60-week study. Brodalumab was well tolerated and patients were highly satisfied with the treatment.

Conclusion: Outcomes assessed in this study, including assessments of scalp and nail symptoms, improved following initiation of brodalumab therapy. This study of psoriasis patients in a real-world setting supports the long-term clinical effectiveness of brodalumab on difficult-to-treat body regions.

Introduction: Brodalumab, a human monoclonal antibody that selectively inhibits the interleukin (IL)-17 receptor subunit A, has been approved for the treatment of moderate-to-severe plaque psoriasis. The treatment benefit of brodalumab has been clearly demonstrated in multiple clinical studies. However, data on effectiveness for difficult-to-treat body regions, especially in everyday clinical practice, are still limited.

Methods: In this exploratory observational clinical study, psoriasis patients suffering from nail and scalp involvement who received brodalumab during routine clinical care were enrolled at 7 centers in Germany. Patients were observed for over 60 weeks. The co-primary endpoints were 75% improvement in Psoriasis Scalp Severity Index (PSSI75) at week 12 and 75% improvement in Nail Psor

Introduction: Various healthcare professionals (HCPs) deliver care for patients with atopic dermatitis (AD). Although pivotal, management strategies and the relation with corticophobia among HCPs have not been investigated. This study aimed to investigate management strategies for AD and its relation with corticophobia among HCPs.

Methods: Dutch general practitioners (GPs), youth healthcare physicians (YHPs), pediatricians, dermatologists, pharmacists, and pharmacy assistants participated in a survey on management strategies and corticophobia. The Topical Corticosteroid Phobia questionnaire for professionals (TOPICOP-P) was used to measure attitudes toward topical corticosteroids (TCSs). Higher scores reflect a more negative attitude.

Results: A total of 407 HCPs (124 GPs, 33 YHPs, 51 pediatricians, 56 dermatologists, 58 pharmacists, and 85 pharmacy assistants) participated. Compared to dermatologists, other HCPs showed greater reluctance to TCS. This difference was highlighted by the finding that half of GPs reported to prescribed only TCS of mild potency for infants with severe AD, while few dermatologists (9%) reported a similar approach. Dermatologists had lowest TOPICOP-P scores (median: 19, IQR: 12-28). GPs and pharmacy assistants had highest scores (GPs median: 36, IQR: 31-44, pharmacy assistants: median: 36, IQR: 31-42). More corticophobia was significantly associated with prescription of a lower TC potency class in prescribing HCPs (B -0.04, 95% CI: -0.07 to 0.01, p = 0.01), and a trend was found between more corticophobia and longer perceived durability of one TCS tube.

Conclusions: This study shows the differences in management of AD and reluctance toward TCS in HCPs. Furthermore, corticophobia among HCPs and its influence on the selection of TCS potency class and recommendations were demonstrated. To reduce corticophobia and improve care for AD, more education is needed.

Introduction: Various healthcare professionals (HCPs) deliver care for patients with atopic dermatitis (AD). Although pivotal, management strategies and the relation with corticophobia among HCPs have not been investigated. This study aimed to investigate management strategies for AD and its relation with corticophobia among HCPs.

Methods: Dutch general practitioners (GPs), youth healthcare physicians (YHPs), pediatricians, dermatologists, pharmacists, and pharmacy assistants participated in a survey on management strategies and corticophobia. The Topical Corticosteroid Phobia questionnaire for professionals (TOPICOP-P) was used to measure attitudes toward topical corticosteroids (TCSs). Higher scores reflect a more negative attitude.

Results: A total of 407 HCPs (124 GPs, 33 YHPs, 51 pediatricians, 56 dermatologists, 58 pharmacists, and 85 pharmacy assistants) participated. Compared to dermatologists, other HCPs

Introduction: While an association between hidradenitis suppurativa (HS) and inflammatory arthritis has been reported in clinical studies, the potential link between HS and gout remains uncertain. As HS and gout share common immunological pathways, we conducted a retrospective cohort study to determine whether HS patients are at an increased risk of developing gout in the future.

Methods: This retrospective multicenter cohort study obtained information through the US collaborative network, a subset of the TriNetX research network. Patients diagnosed with HS between January 01, 2005, and December 31, 2017, were recruited, and a 1:1 propensity score matching was conducted to identify appropriate controls. The hazard ratio (HR) for the new-onset gout in HS patients was subsequently calculated.

Results: Compared to individuals without HS, those with HS were associated with a 1.39-fold higher risk (95% confidence interval [CI], 1.20, 1.62) of developing new-onset gout within 5 years after the index date. This association remained significant in shorter follow-up times and sensitivity analyses utilizing different matching models. For both male and female HS patients, the risk of developing new-onset gout within 5 years after the index date was statistically significant, with respective HRs of 1.61 (95% CI, 1.28, 2.02) for males and 1.41 (95% CI, 1.11,1.78) for females.

Conclusion: HS patients are at a high risk of developing gout within 5 years after an HS diagnosis while comparing with non-HS controls.

Introduction: Dermatomyositis (DM) is an uncommon idiopathic inflammatory myopathy resulting in characteristic patterns of cutaneous lesions and myositis. Observational evidence related to the disease is limited by small case cohorts. We aimed to evaluate the validity of specialist-specific diagnostic coding for DM in an outpatient clinical database.

Methods: Adults having an outpatient encounter between January 1, 2010, and June 30, 2023, at a US regional health system with ICD-9/-10 coding for DM were identified. We randomly sampled 156 patients with ≥1 code applied by a dermatologist or rheumatologist. The primary reference standard for case adjudication was a confirmed diagnosis of DM by the treating physician in the medical chart. Fulfilment of the 2017 European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ACR) criteria for "probable" or "definite" DM was used as a secondary, more stringent reference standard. Positive predictive values (PPVs) for several case definitions were calculated with 95% confidence intervals.

Results: Among eligible patients, the median age was 51.5 years, and 81% were female. Using the treating physician's diagnosis as reference, PPVs of ≥1 and ≥2 codes applied by a dermatologist were 93.2% (95% CI 82.0-98.3%) and 96.4% (82.2-99.8%), respectively. The PPVs of ≥1 and ≥2 codes from a rheumatologist were 82.0% (77.1-86.9%) and 85.8% (80.6-91.1%), respectively. At least one and at least two codes from a rheumatologist or dermatologist had PPVs of 82.1% (77.3-86.8%) and 85.7% (80.7-90.8%), respectively. The rate of confirmed cases based on EULAR/ACR criteria ranged from 44.9% to 57.1%.

Conclusion: All tested algorithms yielded an accurate case cohort with high PPV. Studies prioritizing sensitivity may use ≥1 code by dermatology or rheumatology to identify patients with DM.

Introduction: Surgery is a crucial part in the treatment of hidradenitis suppurativa (HS). The integration of surgical and medical treatment is sometimes difficult to achieve as it involves different specialists. The aim of this study was to describe and evaluate the role of a multidisciplinary medical-surgical consultation for patients with HS.

Methods: We performed a cohort study to describe patient characteristics, assess referral reasons, analyze decisions made during the multidisciplinary consultation, and evaluate its impact on time to surgery and disease control.

Results: The profile of the patient referred to the multidisciplinary consultation is a man with severe disease. The lesions prompting referral were usually located on the lower part of the body. Surgery was indicated in 73.91% of patients. In terms of medical treatment, 30.43% of patients underwent modifications to their biological therapy, including the introduction of a new biologic drug and target (23.91%) or dosage changes (6.52%). There was a significant reduction in the waiting time to be operated by general surgery after the implementation of this consultation (420.65 vs. 167 days).

Conclusions: The results of this study suggest that the presence of a multidisciplinary surgical consultation in HS may be useful in treating patients with complex structural disease, optimizing resources and improving comprehensive patient care. Additionally, it can have a positive impact on time to surgery, which is highly relevant for a progressive disease such as HS.

Introduction: The frequency and type of nevus association in histology in melanoma in situ (MIS) is unclear.

Methods: We performed a retrospective study to investigate the characteristics, frequency, and type of adjacent nevus in histology (common or dysplastic) in MIS. Lentigo maligna (LM) and in situ acral lentiginous melanomas (ALMs) were excluded.

Results: From 1991 to 2023, there were 448 available non-LM/non-ALM MIS. MIS was nevus associated (NAM-MIS) in 353 cases (79%). Of these cases, 326 NAM-MIS cases (94%) had dysplastic nevus remnants. Among the dysplastic nevus MIS, 176 (54%) were adjacent with severely dysplastic nevus. Nevus-associated MIS versus de novo MIS was more frequently located on the trunk (54% vs. 36%) and less frequently located on the head/neck (8% vs. 11%) (p = 0.02).

Conclusions: Nevus association is a common finding in MIS and almost all nevus-associated MIS was associated with a dysplastic nevus. These findings may indicate an evolution from severely dysplastic nevus to MIS and also reflect the equivalent histopathological classification and support their previously proposed biological equivalence as not obligate precursors of invasive melanomas.