Dermatology最新文献

Introduction: The natural history, the progression of a disease process in an individual over time, has not yet been fully elucidated in hidradenitis suppurativa (HS). In this large multicenter study, we aimed to investigate the natural history of HS and its gender differences.

Methods: This cross-sectional study included 827 patients. The chronological order of the clinical manifestations for each patient was recorded retrospectively. Sociodemographic characteristics, triggering factors, clinical, treatment, and prognostic features were also evaluated.

Results: The mean age of disease onset was significantly younger in women than in men (22.42 ± 9.28 vs. 27.06 ± 20.56, p < 0.001) and those with a family history (p < 0.0001). The mean disease duration was 91.17 ± 83.64 months. The most common symptom was purulent discharge (81%). The mean duration of abscess was shorter in women than in men (3.11 ± 2.65 vs. 3.75 ± 3.75, p = 0.01). The axilla was the most common onset area followed by the inguinal and gluteal regions. The disease ran a more severe course in men. Abscess/inflammatory nodule was defined in the last 6 months in 88.6% of the patients; however, the first 5 years of the disease were the most active disease period in 67.5% of the patients. Multivariate analysis revealed being male, older age, family history, involvement of the axillary, inguinal, and perianal regions independently associated with HS severity. While antibiotic use was the most important factor in improving the disease symptoms, stress was the most common aggravating factor. Biological therapy in men, laser epilation and pregnancy in women were significant alleviating factors, whereas weight gain was a more common aggravating factor for women.

Conclusion: HS shows a relentlessly progressive course with inflammatory attacks, but the first years of the disease are the most active period. This study confirms that environmental and hormonal factors may play an important role in the disease course, probably with other endogenous or exogenous factors.

Introduction: The treatment of atopic dermatitis (AD) affecting sensitive areas (head and neck, hands, and genitalia) remains a significant challenge, even with the advent of the current range of biologic therapies. Upadacitinib, a selective inhibitor of the JAK1 enzyme, showed promising results in the treatment of AD located in sensitive areas in clinical trials. The aim of this multicenter observational study was to better characterize the effectiveness of upadacitinib in sensitive areas, using specific clinimetric tools.

Methods: In this multicenter observational retrospective and prospective study, we enrolled 74 adult patients (41 women and 37 men, with a mean age of 33.8 years), affected by moderate to severe AD with the involvement of at least one sensitive area, treated with upadacitinib with at least 16 weeks.

Results: Over the course of the 52-week study period, upadacitinib demonstrated remarkable efficacy in the reduction of AD symptoms and associated clinical manifestations in sensitive areas.

Conclusion: Our study demonstrates a significant benefit for patients with AD affecting sensitive areas when treated with upadacitinib, supporting its use first-line therapeutic choice for this specific subset of patients.

Introduction: The new EU regulation on tattoo inks in force January 2022 in a hitherto unregulated market marks a historical change. The study aim was to register tattoo inks de facto used in studios before the new EU regulation and establish a historical reference to tattoo customer exposure, ink toxicology assessment, clinical complications, and the impact on tattooing businesses.

Method: A tattooist-operated electronic system (InkBase) for ink registration required by law is used in Denmark since 2018. A local database in studios refers to a central database. Clients, sessions, ink bottles, brand name, and pigment color index (CI) are registered. Person's data protection is respected. Tracing harmful inks is possible, with public warning.

Results: Registrations from 108 studios employing about 700 tattooists were collected from March 2018 to 2019. 39,687 clients were tattooed in 50,604 sessions, using colors from 109,720 ink bottles. 10,833 were CI-labelled identifying the pigment. 98.1% of inks originated from USA. Detailed statistics on inks and pigments used are provided as a benchmark showing the spontaneous use and preference of "old" tattoo inks before the EU regulation compulsory to member states introduced dramatic restrictions difficult to follow.

Conclusions: Denmark can, having detailed ink registration enforced by law and having a commonly used electronic registration system reporting to a central server, function as an index country in future surveillance of use of tattoo inks in studios, toxicology aspects and the impact of regulatory intervention on the tattooing industry, with a large sample of data collected in 2018-2019.

Introduction: Acute generalized exanthematous pustulosis (AGEP) is a rare cutaneous drug reaction characterized by the sudden appearance of non-follicular sterile pustules on an erythematous background which is accompanied by fever and peripheral blood neutrophilia. While the clinical differentiation between AGEP and common delayed-type drug hypersensitivity reactions, such as maculopapular rash (MPR), is well defined, the pathomechanism, causative drugs, and other possible contributing factors remain poorly studied to date.

Methods: In this retrospective case-control study, we compared clinical data on suggested causative drugs, drug testing, and comorbidities between a group of 52 patients with a confirmed diagnosis of AGEP (both clinically and histologically) and a group of 63 patients with confirmed MPR.

Results: Evaluation of the causative drugs revealed that beta-lactam antibiotics represent the most common culprit drug in both AGEP and MPR, while antimycotics (p = 0.002), glucocorticoids (p = 0.0106) and NSAIDs (p = 0.0064) were significantly more frequent in AGEP. Skin patch tests and in vitro lymphocyte transformation tests (LTTs) showed higher positivity rates in MPR compared to AGEP, with all non-beta-lactam antibiotics tested with LTT leading to negative results in AGEP. A detailed analysis of comorbidities suggested a possible association between diseases of the upper gastrointestinal tract and AGEP.

Conclusions: This study highlights the differences in causative drugs and comorbidities between AGEP and MPR, emphasizing the need for further research to enhance the understanding and management of AGEP.

Introduction: Climate change represents a devastating threat to health. Peripheral dermatology clinics have proven to be effective in enhancing patient access to healthcare. We studied the environmental health benefits of peripheral clinics in the Republic of Ireland by calculating the reduction in carbon dioxide emissions.

Methods: A national cross-sectional study of patients attending peripheral clinics and central dermatology departments over 2023 was conducted. The round-trip distances between the peripheral clinics and central dermatology departments were calculated, with results used to estimate the reduction in carbon emissions.

Results: A total of 21,786 patients attended the peripheral clinics. The average round-trip distance was 109.7 km. A total distance of 1,986,369 km was avoided by using this model, which would have otherwise resulted in additional 331 tonnes of carbon emissions.

Conclusion: With global warming accelerating at an alarming rate, healthcare professionals have a duty to adopt greener practices to reduce carbon footprints. Specialised peripheral clinics not only enhanced patient access to healthcare but also significantly reduced the carbon footprint associated with patient travel.

Introduction: Rosacea, a chronic inflammatory condition primarily affecting the skin of the face, has long been an area of interest for pharmaceutical advancements. In Switzerland, metronidazole was the only first-line topical rosacea medication (TRM), until brimonidine was licensed in 2014 and ivermectin in 2016. We aimed to evaluate the use of TRM between 2012 and 2023 in Switzerland.

Methods: We used healthcare claims data from the Swiss health insurance "Helsana Group" between 2012 and 2023 (study period). We quantified the monthly number of claims for each TRM per 10,000 insured persons, as well as the overall and annual prevalence of patients treated with TRM in Switzerland, stratified by age (≥/<50 years) and sex in 2023. Among all continuously enrolled persons (period prevalence) and persons insured during the entire calendar year (annual prevalence), we identified all persons with at least one claim of either topical metronidazole, brimonidine, or ivermectin. We additionally evaluated the proportion of patients with only one, two to five, or more than five claims for any TRM during the study period, and stratified patients by number of different TRM claimed within the same calendar year. Lastly, we evaluated the proportion of patients with comedications of interest (i.e., class 1 or 2 topical corticosteroids or oral tetracycline-antibiotics) within the same calendar year.

Results: Metronidazole was the most frequently claimed TRM in Switzerland during the study period (5.1 claims/10,000/month) but has decreased by 11% since the market introduction of ivermectin in 2016. Ivermectin continuously increased, accounting for 43% of all TRM claims in 2023 (4.0 claims/10,000/month). The overall prevalence of patients treated with TRM was 4.7%, whereas annual prevalence was lower but increased from 0.4% (2012) to 0.7% (2023); it was highest among women ≥50 years of age (1.4%). Of all patients treated with TRM, 54% had only one claim for any TRM, while 36% had between two and five claims, mostly monotherapy of metronidazole (52%) or ivermectin (36%). Throughout the study period, approximately 7% had at least one claim for any topical corticosteroid within the same calendar year. In total, 16% claimed oral tetracycline-antibiotics (80% doxycycline), which has slightly decreased since 2017.

Conclusion: The discrepancy between annual and overall prevalence suggests that many patients treated with TRM receive intermittent therapy. Despite the decline in use, metronidazole remains the most frequently used TRM in Switzerland, but the use of ivermectin increased continuously. The slight decrease in tetracycline-antibiotics among patients treated with TRM after 2017 might reflect the efficacy of ivermectin.

Introduction: Hidradenitis suppurativa (HS) is a chronic disease that causes painful skin lumps and scarring in the skin. In an important number of patients, the disease starts in adolescence. Adalimumab was the first biologic drug approved in adolescents with HS, yet approval was done on a model-based extrapolation from other diseases. Data regarding the effectiveness and safety of adalimumab in HS in this age group is lacking. Our objective was to describe the effectiveness and safety of adalimumab in adolescents with moderate-to-severe HS.

Methods: Retrospective multicenter case series. HS units across Spain were invited to participate, including all patients starting adalimumab in adolescence. Demographic, clinical, and treatment-related characteristics were retrieved. Effectiveness was measured as the proportion of patients achieving Hidradenitis Suppurativa Clinical Response (HiSCR) at 6 months. Safety was assessed by means of quantification and description of side effects over time.

Results: A total of 65 patients from 9 HS units were included. Mean age at adalimumab start was 15.5 years. A total of 76.9% of patients achieved HiSCR at 6 months. Side effects were observed in 7 patients, 3 of them requiring drug discontinuation, with full recovery. The adult dosage (80 mg every other week [EOW]/40 mg every week) was more frequently used. The median drug survival time for adalimumab was 5.6 years (25th percentile: 2.9 years), and the recommended adolescent dosage (40 mg EOW) was associated with a need for intensification (p < 0.001). The main limitations of the study are the lack of a comparison group and the retrospective design.

Conclusion: Adalimumab showed a similar safety profile in adolescents with moderate-to-severe HS as in adults, with better effectiveness data.

Introduction: Despite the high prevalence of acne vulgaris and its impact on affected individuals, few studies have provided a detailed characterization of acne phenotypes and their associated risk factors. This study aimed to comprehensively evaluate the prevalence, severity, scarring, and phenotypes of acne, along with their associated risk factors, in a cohort of young Chinese adults, as part of the Singapore and Malaysia Cross-Sectional Genetic Epidemiology Study (SMCGES).

Methods: Participants were randomly and consecutively recruited from universities in Singapore and Malaysia. Data on sociodemographic, familial medical histories of atopic diseases and acne, and lifestyle habits were collected using a validated investigator-administered questionnaire from 6,225 young Chinese adults (mean age = 22.8 ± 5.7 years). A subset of participants underwent clinical assessment for acne severity (n = 2,345), scarring grade (n = 2,345), and phenotypes (n = 1,191) by dermatologically trained personnel.

Results: The prevalence of acne was 56.0%. Among acne cases (n = 3,504), 38.5% had moderate-to-severe acne, 52.8% had scarring, 95.7% presented with blackhead and/or whitehead, and 55.8% had inflammatory phenotypes (e.g., papules, pustules, cysts, and nodules). A parental history of acne emerged as the strongest risk factor associated with all acne phenotypes. Pet ownership (adjusted odds ratio [AOR]: 1.403, 95% confidence interval [CI]: 1.131-1.744, p < 0.05) and occasional alcohol consumption (AOR: 1.328, 95% CI: 1.090-1.617, p < 0.05) were associated with a higher odd for blackhead and/or whitehead. Protective factors included higher parental education levels for acne scarring (AOR: 0.650, 95% CI: 0.459-0.904; p < 0.05), male gender (AOR: 0.365, 95% CI: 0.298-0.446; p < 0.05), and birthplace (AOR: 0.674, 95% CI: 0.555-0.819; p < 0.05) for non-inflammatory phenotypes.

Conclusions: This study, conducted in a well-defined cohort of young Chinese adults from the SMCGES, reinforces familial history as a key risk factor for acne onset, severity, scarring, and phenotype manifestation. The identification of modifiable and environmental factors associated with acne phenotypes offers valuable insights for targeted interventions to improve acne management and control.

Introduction: Biological treatment has been associated with changes in blood glucose levels in different populations of patients with immunological diseases, although studies report conflicting results. This study aimed to investigate changes in blood glucose levels during treatment with biologics and methotrexate as the control, through changes in hemoglobin A1c (HbA1c) levels.

Method: In this study, the HbA1c levels at baseline and after 1 year of treatment were compared using Wilcoxon's signed-rank test. The following treatments were considered: TNF-α inhibitors (TNFi) (adalimumab and infliximab), IL-17 inhibitors (IL-17i) (brodalumab, ixekizumab, and secukinumab), IL-12/23 inhibitor (IL-12/23i) (ustekinumab), IL-23 inhibitors (IL-23i) (guselkumab and risankizumab), and methotrexate.

Results: In total, 386 patients with psoriasis were included: adalimumab (n = 166), infliximab (n = 7), brodalumab (n = 19), ixekizumab (n = 35), secukinumab (n = 44), ustekinumab (n = 42), guselkumab (n = 11), risankizumab (n = 7), and methotrexate (n = 55). For all groups of biologics and methotrexate, no statistically or clinically significant changes in HbA1c levels were observed. In a sensitivity analysis including only patients in the upper quartile of baseline HbA1c (36-47 mmol/mol) treated with TNFi, IL-17i, or methotrexate, no significant change in HbA1c levels was observed after 1 year of treatment.

Conclusion: In a group of patients with psoriasis and normal baseline glucose levels, treatment with biologics or methotrexate for 1 year did not appear to affect blood glucose levels as measured by HbA1c. This could indicate that the treatments lack antidiabetic properties.