Dermatology最新文献

Introduction: Inherited ichthyosis comprises a group of rare keratinization disorders caused by abnormal epidermal barrier function. Ichthyosis is yet incurable and current treatments mainly focus on alleviating symptoms such as scaling, erythema and pruritus. Recent developments show promising results for interventions based on the immune-phenotype like biologicals or pathogenesis-based therapies such as gene therapy. However, the lack of uniform reporting and variety of treatment outcomes may complicate performing and comparing efficacy studies. The core outcome set for inherited ichthyosis (COSII) aims to develop a core outcome set (COS), i.e., the minimum of outcomes that should be measured and reported in observational and interventional studies, including a minimum set of baseline characteristics. Methods: The COSII project will follow the guidelines from the Core Outcome Measures in Effectiveness Trials (COMET) initiative, including the Core Outcome Set-Standards for Development (COS-STAD) recommendations and the Core Outcome Set Standardised Protocol (COS-STAP) checklist. The COS development methodology, including this protocol, follows the guidance of the CHORD COUSIN Collaboration 'C3'. The first stage of this project involves identifying a possible list of outcomes through performing a scoping literature review and conducting interviews with patient(s) (representatives). This list will be presented to five different stakeholder groups: healthcare professionals, researchers, patient(s) (representatives), industry representatives, and regulators. All stakeholders will rate the importance of each outcome in a three-round eDelphi survey. Ultimately, a virtual consensus meeting will be convened to finalize the COS. Ethical approval was obtained prior to the start of this project from the Medical Ethics Committee Board at Maastricht University Medical Centre (METC 2022-3192). Informed consent will be asked prior to enrolment in the eDelphi. This study is registered with the COMET. The results will be distributed via a peer-reviewed journal, communicated to all relevant parties and showcased at national and international conferences. Conclusion: This will be the first COS for inherited ichthyosis research in accordance with the Core Outcome Measures in Effectiveness Trials initiative. The development of a COS aims to improve the consistency of reporting and the heterogeneity of outcomes in ichthyosis research.

Introduction: The aim of this study was to identify whether high-frequency ultrasound (HFUS) could correct the misdiagnosis, confirm equivocal skin lesions, and improve the management after clinical examination.

Methods: In this study, a total of 574 skin lesions from 552 patients were prospectively enrolled. The specific diagnosis and management decisions (treatment/excision, observation) determined by HFUS after clinical examination were recorded during the clinical practice. The area under the receiver operating characteristic curve, accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and the number needed to excise (NNE) before and after HFUS were also evaluated. The pathological results were conducted as golden standards to compare the performance.

Results: Among the 574 skin lesions, 290 (50.5%) were malignancies and 284 (49.5%) were benign. The diagnostic accuracy was improved from 77.5% to 90.8% after the HFUS examination. There were 44 lesions wrongfully diagnosed by the initial clinical diagnosis, whereas 28 of 44 (63.6%) lesions were correctly identified by HFUS examination. Of 85 lesions categorized as equivocal skin lesions by clinical examination, 65 (76.5%) were diagnosed correctly after HFUS. Lesion management changed in 72 of 574 (12.5%) after HFUS. Among these lesions, HFUS saved 22 unnecessary excisions and prompted the treatment of 30 malignancies that would be observed based on clinical examination alone. Additionally, the NNE was reduced by 15.4% (NNE, 0.828) after HFUS and 4.6% (NNE, 0.933) before HFUS.

Conclusions: HFUS could be a valuable tool in diagnosing equivocal skin lesions, identifying skin cancers missed by clinical examination, and reducing unnecessary excision of benign lesions while improving NNE.

Background: Therapeutic management of skin cancer (SC) in the "H-area" of the face is challenging due to the demands of function, cosmesis, and efficacy.

Objective: To evaluate the efficacy and safety of superficial radiotherapy (RT) for SC in the "H-area" of the face and to identify predictors of recurrence.

Methods: Retrospective analysis of patients with SC in the "H-area" of the face treated with superficial RT at the University Hospital of Zurich, Switzerland, between 2010 and 2021. The study included cases of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), in situ SCC (isSCC), lentigo maligna melanoma (LMM), lentigo maligna (LM), and primary cutaneous T/B-cell lymphoma.

Results: We identified 546 lesions in 382 patients. Estimated relapse rates at 5 years were lowest for SCC (3.2%), isSCC (1.9%), and BCC (9.7%), while LMM and LM showed estimated relapse rates of 28.9% and 35.0%, respectively. Significant predictive factors for overall recurrence were increased Common Terminology Criteria for Adverse Events (CTCAE) grades with a hazard ratio (HR) of 1.9 (1.1-3.4) and the treatment of secondary lesions with an HR of 2.6 (1.4-5.1).

Conclusion: RT is a valuable treatment option for malignant skin tumors, especially non-melanoma SC, in high-risk areas, including the facial "H-area," providing favorable results with minimal side effects.

Introduction: Lebrikizumab significantly reduced itch and itch interference on sleep in patients with moderate-to-severe atopic dermatitis (AD) at week 16 in two phase 3 trials. We investigated itch reduction and the efficacy of improving itch interference on sleep in lebrikizumab-treated patients over 52 weeks.

Methods: At week 16 in ADvocate1 and ADvocate2, patients who met protocol-defined response criteria to lebrikizumab 250 mg every 2 weeks (Q2W) were re-randomized 2:2:1 to lebrikizumab Q2W, lebrikizumab 250 mg every 4 weeks (Q4W), or placebo Q2W to week 52; patients who did not achieve protocol-defined response continued open-label lebrikizumab Q2W. The Pruritus Numeric Rating Scale (NRS) evaluated the worst itch intensity over the previous 24 h in daily electronic diaries; the Sleep-Loss Scale measured the interference of itch on sleep over the last night. For week 16 responders, data after systemic rescue medication or discontinuation due to lack of efficacy were imputed with non-responder imputation; data after topical corticosteroid usage and discontinuation due to other reasons were set as missing; all missing data were imputed with multiple imputation. Descriptive statistics using observed data are reported for week 16 by non-responders.

Results: At week 52 among patients who met week-16 protocol-defined response criteria, 73.4% and 71.8% receiving lebrikizumab Q4W and Q2W, respectively, reported ≥3-point improvement in the Pruritus NRS. Mean percent improvement from baseline to week 52 in the Pruritus NRS was 59.9% and 59.6% with lebrikizumab Q4W and Q2W, respectively. For patients who did not achieve a week-16 protocol-defined response, 73.3% achieved ≥3-point improvement on the Pruritus NRS at week 52, with mean percent improvement from baseline to week 52 of 59.2%. At week 52 in responders, ≥1-point improvement in the Sleep-Loss Scale was achieved by 77.9% and 78.9% of patients receiving lebrikizumab Q4W and Q2W, respectively, with a mean percent improvement from baseline to week 52 of 64.4% and 65.9%. For week-16 non-responders, 86.1% of patients achieved ≥1-point improvement in the Sleep-Loss Scale at week 52, with a mean percent improvement of 74.9%.

Conclusion: These findings indicate that lebrikizumab is an effective AD treatment to reduce itch and improve sleep loss due to itch over the long term for both patients who did and did not meet protocol-defined response criteria at week 16.

Introduction: Given the increasing incidence of Bowen's disease, treatment leads to a substantial economic burden for healthcare services. There are several treatment options for Bowen's disease, of which surgical excision, 5-fluorouracil (5-FU) and methyl aminolevulinate photodynamic therapy (MAL-PDT) are the most commonly used. Recently, results from a randomized controlled non-inferiority trial showed that 5-FU was non-inferior to excision and was associated with a better cosmetic outcome. MAL-PDT was not shown to be non-inferior to excision. Although 5-FU and MAL-PDT were expected to be cheaper than excision, it remains to be determined whether the potential cost savings compensate for the loss of effectiveness. The aim of this study was to determine the most cost-effective treatment for Bowen's disease when comparing surgical excision, MAL-PDT, and 5% 5-FU cream from a healthcare perspective.

Methods: Data were collected alongside a randomized controlled trial with 250 patients in the Netherlands. Valuation of treatment costs was based on documented resource use and Dutch cost prices. A cost-effectiveness analysis was performed from a healthcare perspective. The primary outcome was the decremental cost-effectiveness ratio (DCER), expressed as the cost-savings per additional recurrence or residual Bowen's disease. Bootstrap analysis and sensitivity analysis were performed to address uncertainty. This trial is registered with ClinicalTrials.gov number, NCT03909646.

Results: At 12 months after treatment, the costs for 5-FU cream were significantly lower (EUR 311 [CI: -240 to -378]) and the costs for MAL-PDT were higher (EUR 3 [CI: -74 to 65]) compared to excision. 5-FU cream offers cost savings compared to excision, but is less effective although within the non-inferiority margin of 22%. Our results showed that 5-FU has the highest probability of being cost-effective at willingness to accept threshold values of EUR 2,500 and lower compared to MAL-PDT and surgical excision.

Conclusion: 5-FU cream is a cost-effective treatment at a threshold value of EUR 2,500 and lower when compared to surgical excision and MAL-PDT. Therefore, from a cost-effectiveness point of view, 5-FU is considered the first-choice treatment option for Bowen's disease.

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition. The prevalence of HS is underreported worldwide; moreover, the epidemiological studies about HS in Saudi Arabia are scarce. Therefore, this study was performed to explore the prevalence in Saudi Arabia.

Methods: This study was a part of the Global Hidradenitis Suppurativa Atlas (GHiSA) initiative. This study was a single-center study in tertiary care center in Riyadh, Saudi Arabia. All relevant data were collected after obtaining a written informed consent, and data were analyzed accordingly. The study was conducted between March and May 2023. The participants were healthy adults accompanying a child or adult in internal medicine or pediatrics outpatient clinics. The diagnosis was done clinically by an expert physician.

Results: In total, 688 individuals were included; the estimated prevalence of HS is a minimum of 4.07% within the sample. The utilized questionnaire has a sensitivity of 100% and a specificity of 15%.

Conclusion: The high prevalence of HS in Saudi population necessitates more education to the community and health care providers for early diagnosis and management.

Background: Hidradenitis suppurativa (HS), a chronic inflammatory skin disease affecting intertriginous areas, presents a recurring and debilitating challenge. Even though recent efforts have been made to estimate the overall HS prevalence, variations in screening modalities and missing data from the Global South warrant further investigation. Understanding the HS prevalence is crucial for treatment approaches and pathogenesis. Thus, we aimed to estimate a global HS prevalence based on studies using homogeneous validated questions.

Methods: This systematic review was prospectively registered on PROSPERO and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Searches in PubMed, Embase, and CINAHL were performed on August 9, 2023. Original reports assessing the HS prevalence in adults using the following two questions were included: "Do you have recurrent boils of the skin?" and "Have you for the past 6 months had 2 or more boils/abscesses in any of the below locations: in the axilla, in the groin, around your genitals, on the buttocks, several locations i.e., first the buttocks then the axilla, etc.?" A pooled prevalence with 95% confidence interval (CI) was calculated with a random-effects model.

Results: Eight studies qualified for inclusion, of which the prevalence estimate ranged from 0.7% to 6.4%. The meta-analysis encompassing 49,971 participants revealed a global HS prevalence of 2.5% (95% CI, 1.8-3.5%).

Conclusion: This meta-analysis suggests a global HS prevalence of 2.5% using a validated questionnaire. Due to heterogeneity and sparse data from the Global South, this estimate should be interpreted with caution.