International Journal of Dermatology最新文献

Introduction: Psoriasis is a chronic autoimmune skin disorder affecting roughly 2% of the population worldwide. This condition manifests variably due to individual phenotypes. As the number of therapies has increased, Belgium established its own registry. However, these treatments are often inaccessible due to reimbursement criteria. This study suggests that some groups of psoriasis patients (particularly younger patients) may selectively benefit from early treatment approaches with biological therapies.

Material and methods: Patients diagnosed with psoriasis included in the Belgian Psoriasis Registry were included in the study. Collected data included socio-demographic changes, lifestyle changes, psoriasis-related characteristics, treatment specifics and treatment changes, and associated diseases.

Results: Two hundred and five patients were included. Patients were classified as responders if their Psoriasis Area Severity Index (PASI) score decreased by more than 75% between the initial visit and follow-up (PASI75). 47% of patients achieved PASI75. In the short-term, 50% of patients treated with biologic therapy, 30.5% on systemic conventional therapies, and 32.25% on topicals/phototherapy responded with PASI75. At long-term follow-up, an increase in response was observed in patients receiving biologic therapy, as well as in patients undergoing systemic conventional therapy (55.5%). Patients receiving treatment shortly after their first lesions' onset had better responses (p value < 0.0001).

Conclusion: Intervening earlier with effective treatments improves outcomes, particularly in younger patients. Treatment algorithms should use a step-down approach rather than a step-up approach. This would enhance the number of responders and potentially reduce costs.

Primary anogenital squamous cell carcinoma (SCC) is a locally aggressive malignancy that requires careful consideration of surgical margins. Anogenital SCC impacts the quality of life due to tissue removal, scarring, and sexual dysfunction. Mohs micrographic surgery (MMS) offers a compelling alternative to wide local excision (WLE) due to its complete margin control and potential tissue-sparing properties. This analysis systematically reviews surgical modalities used for the management of anogenital SCC. Articles meeting eligibility criteria were identified using MEDLINE (via PubMed), Embase, Cochrane, and Scopus databases. All studies investigating surgical management of anogenital SCC with WLE (including vulvectomy) or MMS were considered. A total of 70 studies met inclusion criteria: 46 examined WLE patients, 8 utilized vulvectomy, and 24 examined MMS patients. MMS patients experienced lower local recurrence rates; regional and distant recurrence rates did not differ. The local, regional, and distant recurrence rates for WLE were 17.7%, 5.1%, and 6.0%, respectively, and 5.0%, 3.8%, and 4.3% for MMS. Local recurrence was more likely in patients treated with WLE (p < 0.0001). No differences were noted in regional recurrence (p = 0.444) and distant recurrence (p = 0.420). Study limitations include differences in tumor characteristics and follow-up durations between the groups. The WLE group had larger tumors at presentation. Overall, MMS had superior outcomes for local recurrence compared to WLE and vulvectomy, making it a reasonable option for managing anogenital SCC.