Dermatology最新文献

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: Alopecia areata (AA) is an autoimmune disorder with a higher prevalence in pediatric patients than adults, but treatment options remain limited. Baricitinib, a Janus kinase (JAK)-1/2 inhibitor, has shown efficacy in adults with severe AA, yet data on its use in pediatric patients are limited.

Methods: This study included pediatric patients (ages 2-18) with severe AA (Severity of Alopecia Tool [SALT] ≥50) treated with baricitinib for at least 3 months between January 2023 and October 2024. Demographics, SALT scores before and after treatment, and adverse events were collected.

Results: Thirty-three patients were included, with a mean age of 9.93 years and average disease duration of 23.44 months. Sixteen patients received 2 mg and 17 received 4 mg of baricitinib. At baseline, 54.5% had a SALT score above 90. After treatment, 45.5% of patients had a 50% reduction in their SALT score. The average treatment duration was 6.5 months. Adverse events included elevated ALT (n = 1), acne (n = 1), and upper respiratory infection (n = 1), with no serious adverse events.

Conclusion: Baricitinib demonstrated clinical efficacy and good tolerance in pediatric patients with severe AA.

Introduction: Hidradenitis suppurativa (HS) is a painful, chronic, recurring, debilitating, inflammatory skin disease affecting the areas rich in apocrine glands, with typical lesions (abscesses, nodules, discharging sinuses, and scars) and distribution (intertriginous areas). The prevalence of HS varies across geographical locality with lower rates reported in Asia.

Methods: A cross-sectional, descriptive study, involving 500 consecutive healthy adults in Hospital Kuala Lumpur (HKL), was done from December 2022 to April 2023, to estimate the prevalence of HS in HKL, via a validated questionnaire. We included healthy hospital staff and those accompanying patients in the Department of Medicine. Consented participants would answer the screening questionnaire for HS, as well as the socio-demographic data questionnaire. The screened-positive participants were evaluated by a dermatologist to confirm the diagnosis of HS and to take clinical photos.

Results: Ten participants were screened-positive for HS, but only 7 were confirmed cases. The prevalence of this study was 7/500 (1.4%). Majority had mild diseases (71% Hurley stage 1, 29% Hurley stage 2). HS was more prevalent among males (n = 4), lower education level (n = 4), and Chinese ethnicity (n = 3). There was no significant difference among the HS participants when compared to non-HS participants based on their age, gender, education level, income status, BMI, or smoking status (p > 0.05).

Conclusion: HS is a complex disease with multifactorial elements to consider in its pathogenesis. The availability for early detection of mild HS disease, via a validated screening questionnaire, may change the paradigm of management of HS in the future.

Introduction: The exact prevalence of hidradenitis suppurativa (HS) remains elusive, in France as elsewhere. The Global Hidradenitis Suppurativa Atlas (GHiSA) project is a unique opportunity not only to determine the exact prevalence in each participating center but also to help estimate the global prevalence and provide a basis for comparing centers with each other and obtaining potential pathophysiological indications.

Methods: A French version of the questionnaire developed for the GHiSA initiative was proposed to healthy adults accompanying a patient to the outpatient clinic.

Results: The prevalence of HS in the 525 participants was 3.43% (95% confidence interval: 2.2%-5.4%). The HS patients were 10 females and 8 males and were significantly younger than non-HS controls and more frequently smokers. The screening questionnaire showed a 100% sensitivity and negative predictive value.

Conclusion: The estimated prevalence here is more than three times higher than the 1% prevalence usually recognized in Western countries. It remains to be determined whether this increase is apparent (freedom of speech; methodological differences compared with previous studies, which contribute to the usual figure of 1%) or real. In the latter case (gross increase in the prevalence of the disease), the underlying mechanisms need to be explored, and comparison with the results observed in other GHiSA centers will be decisive.

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.