JAMA dermatology最新文献

Importance: The long-term effectiveness of biologic therapies in psoriasis may decline over time. Gut microbiota alterations induced by antibiotics have been proposed as a potential mechanism impairing biologic persistence.

Objective: To evaluate the association between antibiotic exposure and the persistence of biologic therapies in patients with psoriasis.

Design, setting, and participants: This retrospective cohort study used data from the French National Health Insurance database between June 2011 and December 2022. Adults initiating a biologic therapy for psoriasis were included, excluding those with preexisting inflammatory bowel disease at baseline. Data were analyzed from January to September 2024.

Exposures: At baseline, antibiotics exposure was classified as none, 1, or 2 or more dispensations in the 6 months preceding the index date. During follow-up, time-dependent antibiotics exposure was defined as none, 1, or 2 or more antibiotics dispensations in the 6 months prior to each time of follow-up.

Main outcomes and measures: The primary outcome was discontinuation or switch of the initial biologic therapy. Exposure to antibiotics was assessed within 6 months prior to biologic initiation and during follow-up. A weighted Cox marginal structural model was used to estimate adjusted hazard ratios.

Results: Of 36 129 included patients, 11 228 (42.0%) were female, 20 192 (55.9%) were male, and the mean (SD) age was 48.4 (15.1) years. A total of 9366 (25.9%) were exposed to antibiotics at baseline and 21 900 (60.6%) during follow-up. The most commonly prescribed antibiotic classes were β-lactams, macrolides, and fluoroquinolones. Antibiotic exposure was associated with a higher risk of biologic discontinuation (weighted hazard ratio, 1.12; 95% CI, 1.08-1.16), with a stronger effect observed for multiple dispensations (weighted hazard ratio, 1.29; 95% CI, 1.24-1.35), suggesting a dose-response relationship.

Conclusions and relevance: In this cohort study, antibiotic exposure was significantly associated with an increased risk of discontinuation of biologic therapies in psoriasis. These findings support the hypothesis that antibiotics, potentially through gut dysbiosis, may reduce biologic persistence. However, unmeasured confounders limit causal interpretation. Further studies are necessary to validate these findings.

Importance: Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) survivors experience substantial long-term sequelae. Research on physical symptoms experienced during acute hospitalization is well documented, but limited studies have been completed on the long-term biopsychosocial effects of SJS/TEN, particularly from the patient's perspective.

Objective: To increase the understanding of the long-term complications of SJS/TEN.

Design, setting, and participants: This qualitative investigation was completed from within a community-based study, the SJS Survivors Study, using a semistructured, in-depth interview guide to query participants about their SJS/TEN experience postdischarge from the hospital. Interviews took place by phone from July 2021 through August 2023. This study included adults who experienced SJS/TEN within the United States.

Main outcome and measures: A biopsychosocial theory-based framework and hierarchical coding system were utilized to understand the long-term life impacts of survivors of SJS/TEN.

Results: The 29 participants, aged 26 to 76 years, were 66% female and 69% White and had experienced SJS/TEN from a wide range of drugs. Patients experienced support while in the hospital, but once discharged, felt isolated and without support to understand the potential sustained impacts of SJS/TEN in their lives and the lives of their family members. Patients experienced ongoing biological symptoms, such as skin issues, debilitating visual impairment, blindness, and lack of functional autonomy. Psychological impacts included symptoms of anxiety, obsessive thinking, flashbacks, and depression. Socially, some survivors expressed a sense of abandonment and described negative impacts on their careers. Survivors also expressed frustration and isolation with having to navigate posthospital care alone. There was a lack of preemptive discharge education and SJS/TEN-specific planning. Lack of physician knowledge about SJS/TEN was particularly noted and survivors turned to the internet for guidance instead of receiving direction from their physicians. Medical distrust among survivors was frequently noted.

Conclusions and relevance: The findings highlight the need for postdischarge care coordination among patients and their primary physicians, including mental health support. This care coordination should be arranged prior to discharge to ensure the availability of adequate support and optimal health outcomes. It is essential that clinicians and researchers prioritize the understanding of long-term sequelae of SJS/TEN and improve current discharge education and protocols for patients and their families.

Importance: The epithelial barrier theory (EBT) proposes that epithelial barrier disruption is implicated in the development of skin, respiratory, gastrointestinal, and ocular diseases (epithelial barrier diseases, or EBDs). There is a need to better understand the relationship between seborrheic dermatitis and EBDs, and we hypothesize that seborrheic dermatitis, characterized by epithelial barrier dysfunction, is associated with increased frequency of other EBDs.

Objective: To explore the association between seborrheic dermatitis and EBDs.

Design, setting, and participants: This retrospective cohort study used a large US administrative claims database, which included data collected from multiple health care centers and patient care settings across the US from January 1, 2016, through June 30, 2022. This study consisted of patients aged 18 years and older at enrollment, with at least 1 year of continuous enrollment, and with a minimum of 2 visits on unique days to a medical professional. The mean (SD) patient follow-up time was 3.46 (1.80) years with a total follow-up of more than 70 million person-years. Individuals with missing data for demographic covariates, including age, sex, and division (ie, billing region), were excluded. Data were analyzed from January to September 2025.

Exposures: Diagnosis of seborrheic dermatitis at any point during the observation period.

Main outcomes and measures: Diagnosis of an EBD at any point during the observation period.

Results: Of 20 274 189 patients, 733 776 (3.62%) had seborrheic dermatitis (median [IQR] age, 62.63 [41.53-70.55] years; 54.7% female). Using adjusted models, seborrheic dermatitis was positively associated with atopic dermatitis (odds ratio [OR], 3.21; 95% CI, 3.18-3.24), alopecia areata (OR, 4.02; 95% CI, 3.93-4.11), contact dermatitis (OR, 2.25; 95% CI, 2.23-2.26), psoriasis (OR, 3.26; 95% CI, 3.23-3.29), rosacea (OR, 4.52; 95% CI, 4.49-4.56), hidradenitis suppurativa (OR, 1.63; 95% CI, 1.58-1.68), chronic spontaneous urticaria (OR, 1.35; 95% CI, 1.33-1.37), pemphigus vulgaris (OR, 1.48; 95% CI, 1.31-1.69), bullous pemphigoid (OR, 1.60; 95% CI, 1.51-1.70), rhinosinusitis (OR, 1.24; 95% CI, 1.24-1.25), celiac disease (OR, 1.36; 95% CI, 1.32-1.39), irritable bowel syndrome (OR, 1.32; 95% CI, 1.31-1.33), ocular allergy (OR, 1.39; 95% CI, 1.37-1.41), and dry eye (OR, 1.48; 95% CI, 1.48-1.49) and was negatively associated with chronic obstructive pulmonary disease (OR, 0.72; 95% CI, 0.71-0.72) and pulmonary hypertension (OR, 0.70; 95% CI, 0.69-0.71).

Conclusions and relevance: These findings support the EBT as a shared driver in the pathogenesis of seborrheic dermatitis and other diverse EBDs and encourage further investigation into the underlying mechanisms of disease pathogenesis.