Pub Date : 2024-10-01DOI: 10.1001/jamadermatol.2024.3024
Michael S Chang, Lee Wheless, Rebecca I Hartman
{"title":"Skin Cancer Care in US Veterans-Serving Those Who Served.","authors":"Michael S Chang, Lee Wheless, Rebecca I Hartman","doi":"10.1001/jamadermatol.2024.3024","DOIUrl":"10.1001/jamadermatol.2024.3024","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"1041-1043"},"PeriodicalIF":11.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1001/jamadermatol.2024.2993
Heejo Keum, Henry W Chen, Robert W Haley, Heidi T Jacobe
{"title":"Incidence and Prevalence of Morphea.","authors":"Heejo Keum, Henry W Chen, Robert W Haley, Heidi T Jacobe","doi":"10.1001/jamadermatol.2024.2993","DOIUrl":"10.1001/jamadermatol.2024.2993","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"1128-1130"},"PeriodicalIF":11.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11391359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1001/jamadermatol.2024.2517
Celeste M Boesjes, Esmé Kamphuis, Marlies de Graaf, Lotte S Spekhorst, Inge Haeck, Lian F van der Gang, Laura Loman, Nicolaas P A Zuithoff, Coco Dekkers, Lisa P van der Rijst, Geertruida L E Romeijn, Albert J Oosting, Antoni Gostynksi, Anneke M T van Lynden-van Nes, Ron A Tupker, Anne-Moon van Tuyll van Serooskerken, Annebeth Flinterman, Klaziena Politiek, Wouter R H Touwslager, Wianda A Christoffers, Shiarra M Stewart, Marijke Kamsteeg, Marie-Louise A Schuttelaar, Marjolein S de Bruin-Weller
<p><strong>Importance: </strong>Limited data are available on the long-term effectiveness and safety of dupilumab for atopic dermatitis (AD) in daily practice.</p><p><strong>Objective: </strong>To evaluate clinical effectiveness and reasons for discontinuation of dupilumab treatment in children, adults, and older adults with AD with up to 5 years of treatment in daily practice.</p><p><strong>Design, setting, and participants: </strong>This prospective multicenter cohort study was conducted using the BioDay registry (4 academic and 10 nonacademic hospitals in the Netherlands) to identify patients with AD of all ages who were treated with dupilumab between October 2017 and December 2022.</p><p><strong>Main outcomes and measures: </strong>Clinical effectiveness was evaluated by the Eczema Area and Severity Index (EASI), Investigator Global Assessment (IGA), and numeric rating scale (NRS) for pruritus, stratified by children (<18 years), adults (18-64 years), and older adults (≥65 years). In addition, time to response, treatment responders, EASI subscores, second treatment episodes, and thymus- and activation-related chemokine and eosinophil levels were assessed. For patients who discontinued dupilumab, the reason for discontinuation was evaluated.</p><p><strong>Results: </strong>In total, 1286 patients with AD (median [IQR] age, 38 [26-54] years; 726 [56.6%] male) were treated with dupilumab, including 130 children, 1025 adults, and 131 older adults. The median (IQR) follow-up time was 87.5 (32.0-157.0) weeks. Most patients maintained controlled AD, with EASI of 7 or lower and NRS for pruritus of 4 or lower varying between 78.6% and 92.3% and 72.2% and 88.2% for up to 5 years of treatment, respectively, while up to 70.5% of all patients prolonged the dosing interval to mostly 300 mg every 3 or 4 weeks. Mean EASI and NRS for pruritus were 2.7 (95% CI, 1.2-4.2) and 3.5 (95% CI, 2.7-4.3), respectively, after 5 years of treatment. Statistically significant differences between age groups were found over time for EASI and IGA; however, differences were rather small (week 52: EASI, 0.3-1.6; IGA, 0.12-0.26). No statistically significant differences between age groups were found for NRS for pruritus. Median thymus- and activation-related chemokine levels considerably decreased from 1751 pg/mL (95% CI, 1614-1900 pg/mL) to 390 pg/mL (95% CI, 368-413 pg/mL) after 6 months of treatment and remained low. Median eosinophil levels temporarily increased up to week 16, with a subsequently statistically significant decrease over time. In total, 306 patients (23.8%) discontinued dupilumab after a median (IQR) of 54.0 (29.0-110.00) weeks, with adverse events among 98 patients (7.6%) and ineffectiveness among 85 patients (6.6%) as the most frequently reported reasons. Forty-one patients (3.2%) restarted dupilumab, and most of these patients recaptured response.</p><p><strong>Conclusions and relevance: </strong>In this cohort study with up to 5 years of follow-up, dupilum
{"title":"Long-Term Effectiveness and Reasons for Discontinuation of Dupilumab in Patients With Atopic Dermatitis.","authors":"Celeste M Boesjes, Esmé Kamphuis, Marlies de Graaf, Lotte S Spekhorst, Inge Haeck, Lian F van der Gang, Laura Loman, Nicolaas P A Zuithoff, Coco Dekkers, Lisa P van der Rijst, Geertruida L E Romeijn, Albert J Oosting, Antoni Gostynksi, Anneke M T van Lynden-van Nes, Ron A Tupker, Anne-Moon van Tuyll van Serooskerken, Annebeth Flinterman, Klaziena Politiek, Wouter R H Touwslager, Wianda A Christoffers, Shiarra M Stewart, Marijke Kamsteeg, Marie-Louise A Schuttelaar, Marjolein S de Bruin-Weller","doi":"10.1001/jamadermatol.2024.2517","DOIUrl":"10.1001/jamadermatol.2024.2517","url":null,"abstract":"<p><strong>Importance: </strong>Limited data are available on the long-term effectiveness and safety of dupilumab for atopic dermatitis (AD) in daily practice.</p><p><strong>Objective: </strong>To evaluate clinical effectiveness and reasons for discontinuation of dupilumab treatment in children, adults, and older adults with AD with up to 5 years of treatment in daily practice.</p><p><strong>Design, setting, and participants: </strong>This prospective multicenter cohort study was conducted using the BioDay registry (4 academic and 10 nonacademic hospitals in the Netherlands) to identify patients with AD of all ages who were treated with dupilumab between October 2017 and December 2022.</p><p><strong>Main outcomes and measures: </strong>Clinical effectiveness was evaluated by the Eczema Area and Severity Index (EASI), Investigator Global Assessment (IGA), and numeric rating scale (NRS) for pruritus, stratified by children (<18 years), adults (18-64 years), and older adults (≥65 years). In addition, time to response, treatment responders, EASI subscores, second treatment episodes, and thymus- and activation-related chemokine and eosinophil levels were assessed. For patients who discontinued dupilumab, the reason for discontinuation was evaluated.</p><p><strong>Results: </strong>In total, 1286 patients with AD (median [IQR] age, 38 [26-54] years; 726 [56.6%] male) were treated with dupilumab, including 130 children, 1025 adults, and 131 older adults. The median (IQR) follow-up time was 87.5 (32.0-157.0) weeks. Most patients maintained controlled AD, with EASI of 7 or lower and NRS for pruritus of 4 or lower varying between 78.6% and 92.3% and 72.2% and 88.2% for up to 5 years of treatment, respectively, while up to 70.5% of all patients prolonged the dosing interval to mostly 300 mg every 3 or 4 weeks. Mean EASI and NRS for pruritus were 2.7 (95% CI, 1.2-4.2) and 3.5 (95% CI, 2.7-4.3), respectively, after 5 years of treatment. Statistically significant differences between age groups were found over time for EASI and IGA; however, differences were rather small (week 52: EASI, 0.3-1.6; IGA, 0.12-0.26). No statistically significant differences between age groups were found for NRS for pruritus. Median thymus- and activation-related chemokine levels considerably decreased from 1751 pg/mL (95% CI, 1614-1900 pg/mL) to 390 pg/mL (95% CI, 368-413 pg/mL) after 6 months of treatment and remained low. Median eosinophil levels temporarily increased up to week 16, with a subsequently statistically significant decrease over time. In total, 306 patients (23.8%) discontinued dupilumab after a median (IQR) of 54.0 (29.0-110.00) weeks, with adverse events among 98 patients (7.6%) and ineffectiveness among 85 patients (6.6%) as the most frequently reported reasons. Forty-one patients (3.2%) restarted dupilumab, and most of these patients recaptured response.</p><p><strong>Conclusions and relevance: </strong>In this cohort study with up to 5 years of follow-up, dupilum","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"1044-1055"},"PeriodicalIF":11.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11307167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1001/jamadermatol.2024.2613
Seong Rae Kim, Young-Geun Choi, Seong Jin Jo
<p><strong>Importance: </strong>Although tobacco smoking is established as a risk factor for hidradenitis suppurativa (HS), studies on the effects of smoking cessation on HS are limited, and evidence is lacking.</p><p><strong>Objective: </strong>To examine the association between changes in smoking status and the development of HS.</p><p><strong>Design, setting, and participants: </strong>This population-based cohort study enrolled participants from the Korean National Health Insurance Service database who had undergone 2 consecutive biennial health examinations (2004-2005 and 2006-2007) as the primary cohort. Within the primary cohort, the secondary cohort comprised individuals who underwent all biennial health examinations throughout the follow-up period and maintained the same smoking status from 2006 to 2007 to the end of the follow-up period. Data were analyzed from July to December 2023.</p><p><strong>Exposures: </strong>Changes in smoking habit status.</p><p><strong>Main outcomes and measures: </strong>Risk of HS development. The HS risk according to change in smoking status between the 2 consecutive health examinations was estimated using a Cox proportional hazards model.</p><p><strong>Results: </strong>Of the 6 230 189 participants enrolled, the mean (SD) age was 47.2 (13.5) years, and 55.6% were male. During 84 457 025 person-years of follow-up, 3761 HS events occurred. In the primary cohort, compared to those who consistently reported active smoking at both checkups (ie, sustained smokers), lower HS risk was seen among those who were confirmed to smoke initially but quit by the second checkup (ie, smoking quitters) (adjusted hazard ratio [AHR], 0.68; 95% CI, 0.56-0.83), those who maintained cessation status throughout (AHR, 0.67; 95% CI, 0.57-0.77), and those who reported never smoking at either checkup (ie, never smokers) (AHR, 0.57; 95% CI, 0.52-0.63). Those who initially quit smoking but resumed by the second checkup and those who had no previous smoking history but started at the second checkup (ie, new smokers) exhibited similar HS risk as sustained smokers. The secondary cohort results aligned with those of the primary cohort, showing a more pronounced risk reduction with smoking cessation (AHR, 0.57; 95% CI, 0.39-0.83). Considering time-smoking interaction, the cumulative incidence and the risk of HS in smoking quitters were similar to those in sustained smokers in the early stages of observation. However, 3 to 4 years after smoking cessation, the rate decelerated, resembling that of never smokers, and there was a statistically significant decrease in the risk that persisted (between 3 and 6 years from the index date: AHR, 0.58; 95% CI, 0.36-0.92; and ≥12 years from the index date: AHR, 0.70; 95% CI, 0.50-0.97). New smokers initially paralleled never smokers but accelerated after 2 to 3 years, reaching sustained smokers' levels.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, quitting smoking and sustaini
{"title":"Smoking Cessation and Risk of Hidradenitis Suppurativa Development.","authors":"Seong Rae Kim, Young-Geun Choi, Seong Jin Jo","doi":"10.1001/jamadermatol.2024.2613","DOIUrl":"10.1001/jamadermatol.2024.2613","url":null,"abstract":"<p><strong>Importance: </strong>Although tobacco smoking is established as a risk factor for hidradenitis suppurativa (HS), studies on the effects of smoking cessation on HS are limited, and evidence is lacking.</p><p><strong>Objective: </strong>To examine the association between changes in smoking status and the development of HS.</p><p><strong>Design, setting, and participants: </strong>This population-based cohort study enrolled participants from the Korean National Health Insurance Service database who had undergone 2 consecutive biennial health examinations (2004-2005 and 2006-2007) as the primary cohort. Within the primary cohort, the secondary cohort comprised individuals who underwent all biennial health examinations throughout the follow-up period and maintained the same smoking status from 2006 to 2007 to the end of the follow-up period. Data were analyzed from July to December 2023.</p><p><strong>Exposures: </strong>Changes in smoking habit status.</p><p><strong>Main outcomes and measures: </strong>Risk of HS development. The HS risk according to change in smoking status between the 2 consecutive health examinations was estimated using a Cox proportional hazards model.</p><p><strong>Results: </strong>Of the 6 230 189 participants enrolled, the mean (SD) age was 47.2 (13.5) years, and 55.6% were male. During 84 457 025 person-years of follow-up, 3761 HS events occurred. In the primary cohort, compared to those who consistently reported active smoking at both checkups (ie, sustained smokers), lower HS risk was seen among those who were confirmed to smoke initially but quit by the second checkup (ie, smoking quitters) (adjusted hazard ratio [AHR], 0.68; 95% CI, 0.56-0.83), those who maintained cessation status throughout (AHR, 0.67; 95% CI, 0.57-0.77), and those who reported never smoking at either checkup (ie, never smokers) (AHR, 0.57; 95% CI, 0.52-0.63). Those who initially quit smoking but resumed by the second checkup and those who had no previous smoking history but started at the second checkup (ie, new smokers) exhibited similar HS risk as sustained smokers. The secondary cohort results aligned with those of the primary cohort, showing a more pronounced risk reduction with smoking cessation (AHR, 0.57; 95% CI, 0.39-0.83). Considering time-smoking interaction, the cumulative incidence and the risk of HS in smoking quitters were similar to those in sustained smokers in the early stages of observation. However, 3 to 4 years after smoking cessation, the rate decelerated, resembling that of never smokers, and there was a statistically significant decrease in the risk that persisted (between 3 and 6 years from the index date: AHR, 0.58; 95% CI, 0.36-0.92; and ≥12 years from the index date: AHR, 0.70; 95% CI, 0.50-0.97). New smokers initially paralleled never smokers but accelerated after 2 to 3 years, reaching sustained smokers' levels.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, quitting smoking and sustaini","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"1056-1065"},"PeriodicalIF":11.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11339703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1001/jamadermatol.2024.2701
April W Armstrong, Melinda Gooderham, Charles Lynde, Catherine Maari, Seth Forman, Lawrence Green, Vivian Laquer, Xinyan Zhang, Nathalie Franchimont, Esha A Gangolli, Jessamyn Blau, Yiwei Zhao, Wenwen Zhang, Bhaskar Srivastava, Graham Heap, Kim Papp
Importance: New, effective, and well-tolerated oral therapies are needed for treating psoriasis. Zasocitinib, a highly selective allosteric tyrosine kinase 2 (TYK2) inhibitor, is a potential new oral treatment for this disease.
Objective: To assess the efficacy, safety, and tolerability of zasocitinib in patients with moderate to severe plaque psoriasis.
Design, setting, and participants: This phase 2b, randomized, double-blind, placebo-controlled, multiple-dose randomized clinical trial was conducted from August 11, 2021, to September 12, 2022, at 47 centers in the US and 8 in Canada. The study included a 12-week treatment period and a 4-week follow-up period. Key eligibility criteria for participants included age 18 to 70 years; a Psoriasis Area and Severity Index (PASI) score of 12 or greater; a Physician's Global Assessment score of 3 or greater; and a body surface area covered by plaque psoriasis of 10% or greater. Of 287 patients randomized, 259 (90.2%) received at least 1 dose of study treatment.
Intervention: Patients were randomly assigned (1:1:1:1:1) to receive zasocitinib at 2, 5, 15, or 30 mg or placebo orally, once daily, for 12 weeks.
Main outcomes and measures: The primary efficacy end point was the proportion of patients achieving 75% or greater improvement in PASI score (PASI 75) at week 12. Secondary efficacy end points included PASI 90 and 100 responses. Safety was also assessed.
Results: In total, 259 patients were randomized and received treatment (mean [SD] age, 47 [13] years; 82 women [32%]). At week 12, PASI 75 was achieved for 9 (18%), 23 (44%), 36 (68%), and 35 (67%) patients receiving zasocitinib at 2, 5, 15, and 30 mg, respectively, and 3 patients (6%) receiving placebo. PASI 90 responses were consistent with PASI 75. PASI 100 demonstrated a dose response at all doses, with 17 patients (33%) achieving PASI 100 with zasocitinib, 30 mg. Treatment-emergent adverse events occurred for 23 patients (44%) receiving placebo and 28 (53%) to 31 (62%) patients receiving the 4 different doses of zasocitinib, with no dose dependency and no clinically meaningful longitudinal differences in laboratory parameters.
Conclusions and relevance: This randomized clinical trial found that potent and selective inhibition of TYK2 with zasocitinib at oral doses of 5 mg or more once daily resulted in greater skin clearance than placebo over 12 weeks.
{"title":"Tyrosine Kinase 2 Inhibition With Zasocitinib (TAK-279) in Psoriasis: A Randomized Clinical Trial.","authors":"April W Armstrong, Melinda Gooderham, Charles Lynde, Catherine Maari, Seth Forman, Lawrence Green, Vivian Laquer, Xinyan Zhang, Nathalie Franchimont, Esha A Gangolli, Jessamyn Blau, Yiwei Zhao, Wenwen Zhang, Bhaskar Srivastava, Graham Heap, Kim Papp","doi":"10.1001/jamadermatol.2024.2701","DOIUrl":"10.1001/jamadermatol.2024.2701","url":null,"abstract":"<p><strong>Importance: </strong>New, effective, and well-tolerated oral therapies are needed for treating psoriasis. Zasocitinib, a highly selective allosteric tyrosine kinase 2 (TYK2) inhibitor, is a potential new oral treatment for this disease.</p><p><strong>Objective: </strong>To assess the efficacy, safety, and tolerability of zasocitinib in patients with moderate to severe plaque psoriasis.</p><p><strong>Design, setting, and participants: </strong>This phase 2b, randomized, double-blind, placebo-controlled, multiple-dose randomized clinical trial was conducted from August 11, 2021, to September 12, 2022, at 47 centers in the US and 8 in Canada. The study included a 12-week treatment period and a 4-week follow-up period. Key eligibility criteria for participants included age 18 to 70 years; a Psoriasis Area and Severity Index (PASI) score of 12 or greater; a Physician's Global Assessment score of 3 or greater; and a body surface area covered by plaque psoriasis of 10% or greater. Of 287 patients randomized, 259 (90.2%) received at least 1 dose of study treatment.</p><p><strong>Intervention: </strong>Patients were randomly assigned (1:1:1:1:1) to receive zasocitinib at 2, 5, 15, or 30 mg or placebo orally, once daily, for 12 weeks.</p><p><strong>Main outcomes and measures: </strong>The primary efficacy end point was the proportion of patients achieving 75% or greater improvement in PASI score (PASI 75) at week 12. Secondary efficacy end points included PASI 90 and 100 responses. Safety was also assessed.</p><p><strong>Results: </strong>In total, 259 patients were randomized and received treatment (mean [SD] age, 47 [13] years; 82 women [32%]). At week 12, PASI 75 was achieved for 9 (18%), 23 (44%), 36 (68%), and 35 (67%) patients receiving zasocitinib at 2, 5, 15, and 30 mg, respectively, and 3 patients (6%) receiving placebo. PASI 90 responses were consistent with PASI 75. PASI 100 demonstrated a dose response at all doses, with 17 patients (33%) achieving PASI 100 with zasocitinib, 30 mg. Treatment-emergent adverse events occurred for 23 patients (44%) receiving placebo and 28 (53%) to 31 (62%) patients receiving the 4 different doses of zasocitinib, with no dose dependency and no clinically meaningful longitudinal differences in laboratory parameters.</p><p><strong>Conclusions and relevance: </strong>This randomized clinical trial found that potent and selective inhibition of TYK2 with zasocitinib at oral doses of 5 mg or more once daily resulted in greater skin clearance than placebo over 12 weeks.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT04999839.</p>","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"1066-1074"},"PeriodicalIF":11.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11339701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1001/jamadermatol.2024.3043
Shawheen J Rezaei, Jiyeong Kim, Sonia Onyeka, Susan M Swetter, Martin A Weinstock, Steven M Asch, Eleni Linos
Importance: US veterans may be at an increased risk of developing various dermatologic conditions compared with nonveterans.
Objectives: To compare the prevalence and the odds of dermatologic conditions (eg, skin cancers, dermatitis/eczema/rash, psoriasis) between veterans and nonveterans.
Design, setting, and participants: This population-based cross-sectional study leveraged nationally representative data from the National Health and Nutrition Examination Survey (NHANES). Three questionnaires (demographics, medical conditions, and dermatology) were merged from 1999-2018 for analysis. Participants were nonveterans and veterans from NHANES data. Data were analyzed from August 2023 to April 2024.
Main outcomes and measures: The prevalence and odds ratios (ORs) comparing veterans and nonveterans were examined for various dermatologic conditions, including self-reported skin cancer history (any skin cancer, melanoma, nonmelanoma and unknown subtypes), dermatitis/eczema/inflamed rash, and psoriasis.
Results: In a total of 61 307 participants (54 554 nonveterans and 6753 veterans), there was a higher prevalence of any skin cancer history among US veterans compared with nonveterans (9.0% vs 2.9%; P < .001) as well as a higher prevalence of melanoma history (2.2% vs 0.6%; P < .001). Adjusted for demographic factors, veterans had higher odds of any skin cancer history (OR, 1.72; 95% CI, 1.23-2.40) and higher odds of a melanoma history (OR, 2.27; 95% CI, 1.17-4.39) compared with nonveterans. Veterans had a higher prevalence of a psoriasis diagnosis compared with nonveterans (4.5% vs 2.9%; P = .002) and a 61% higher odds of a psoriasis diagnosis (OR, 1.61; 95% CI, 1.05-2.46) compared with nonveterans.
Conclusions and relevance: This cross-sectional study found that veterans have higher prevalence and odds of various dermatologic conditions compared with nonveterans. Efforts aimed at improving health care quality among veterans must investigate the underlying causes of worsened skin health in this population.
{"title":"Skin Cancer and Other Dermatologic Conditions Among US Veterans.","authors":"Shawheen J Rezaei, Jiyeong Kim, Sonia Onyeka, Susan M Swetter, Martin A Weinstock, Steven M Asch, Eleni Linos","doi":"10.1001/jamadermatol.2024.3043","DOIUrl":"10.1001/jamadermatol.2024.3043","url":null,"abstract":"<p><strong>Importance: </strong>US veterans may be at an increased risk of developing various dermatologic conditions compared with nonveterans.</p><p><strong>Objectives: </strong>To compare the prevalence and the odds of dermatologic conditions (eg, skin cancers, dermatitis/eczema/rash, psoriasis) between veterans and nonveterans.</p><p><strong>Design, setting, and participants: </strong>This population-based cross-sectional study leveraged nationally representative data from the National Health and Nutrition Examination Survey (NHANES). Three questionnaires (demographics, medical conditions, and dermatology) were merged from 1999-2018 for analysis. Participants were nonveterans and veterans from NHANES data. Data were analyzed from August 2023 to April 2024.</p><p><strong>Main outcomes and measures: </strong>The prevalence and odds ratios (ORs) comparing veterans and nonveterans were examined for various dermatologic conditions, including self-reported skin cancer history (any skin cancer, melanoma, nonmelanoma and unknown subtypes), dermatitis/eczema/inflamed rash, and psoriasis.</p><p><strong>Results: </strong>In a total of 61 307 participants (54 554 nonveterans and 6753 veterans), there was a higher prevalence of any skin cancer history among US veterans compared with nonveterans (9.0% vs 2.9%; P < .001) as well as a higher prevalence of melanoma history (2.2% vs 0.6%; P < .001). Adjusted for demographic factors, veterans had higher odds of any skin cancer history (OR, 1.72; 95% CI, 1.23-2.40) and higher odds of a melanoma history (OR, 2.27; 95% CI, 1.17-4.39) compared with nonveterans. Veterans had a higher prevalence of a psoriasis diagnosis compared with nonveterans (4.5% vs 2.9%; P = .002) and a 61% higher odds of a psoriasis diagnosis (OR, 1.61; 95% CI, 1.05-2.46) compared with nonveterans.</p><p><strong>Conclusions and relevance: </strong>This cross-sectional study found that veterans have higher prevalence and odds of various dermatologic conditions compared with nonveterans. Efforts aimed at improving health care quality among veterans must investigate the underlying causes of worsened skin health in this population.</p>","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"1107-1111"},"PeriodicalIF":11.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1001/jamadermatol.2024.2912
Michelle Jade Lin, Hanqi Yao, Katya Vera, Ekshika Patel, Mandi Johnson, Peter Caroline, Jeanie Ramos, Jasmine Mehta, Xing Hu, Jaishri O Blakeley, Carlos G Romo, Kavita Y Sarin
Importance: There is a burgeoning interest in therapeutic development for cutaneous neurofibromas (cNFs), a major cause of morbidity in persons with neurofibromatosis type 1 (NF1). To determine meaningful clinical trial outcomes, deeper understanding is needed regarding how cNFs are associated with quality of life (QoL). However, this understanding has been hampered by challenges in recruiting participants with this rare genetic disease.
Objective: To develop a large, crowdsourced validated registry of persons with NF1 and determine the association of specific cNF features with QoL, pain, and itch.
Design, setting, and participants: From May 2021 to December 2023, a decentralized platform was developed and recruited persons 40 years or older with NF1 and at least 1 cNF from 49 states and 12 countries, who provided clinical survey data, detailed photographs, and genetic sequencing data. Photographs from 583 participants were scored on 12 features of cNFs, including general severity, number, size, facial severity, color, and subtypes.
Exposure: cNF features derived from participant-supplied photographs.
Main outcomes and measures: Total Skindex scores and subdomain scores (symptoms, emotion, function, pain, and itch).
Results: Of 583 participants, 384 (65.9%) were female, and the mean (range) age was 51.7 (40.0-83.0) years. Female sex, general severity, number, size, and facial severity of cNFs were negatively associated with QoL, as demonstrated by increased total Skindex scores. QoL had the largest association with the number of cNFs and presence of facial cNFs. Increasing number of cNFs was associated with worse QoL, and even individuals with a low cNF burden (<10 total cNFs) experienced a decrease in QoL.
Conclusions and relevance: The results of this study suggest that reducing cNF number, particularly on the face, may be associated with improved QoL in individuals with NF1. In addition, early intervention before the development of numerous tumors may lead to the highest benefit in QoL. These data potentially provide insight into which individuals and cNF tumors may benefit most from therapy and highlights the utility of a completely decentralized, photograph-validated and age-controlled study for rare genetic disease. This cohort will allow analysis of disease and tumor heterogeneity after full phenotypic expression is achieved in NF1 and potentially serves as an example in its design for other rare diseases that struggle from poor recruitment.
{"title":"Cutaneous Neurofibromas and Quality of Life in Adults With Neurofibromatosis Type 1.","authors":"Michelle Jade Lin, Hanqi Yao, Katya Vera, Ekshika Patel, Mandi Johnson, Peter Caroline, Jeanie Ramos, Jasmine Mehta, Xing Hu, Jaishri O Blakeley, Carlos G Romo, Kavita Y Sarin","doi":"10.1001/jamadermatol.2024.2912","DOIUrl":"10.1001/jamadermatol.2024.2912","url":null,"abstract":"<p><strong>Importance: </strong>There is a burgeoning interest in therapeutic development for cutaneous neurofibromas (cNFs), a major cause of morbidity in persons with neurofibromatosis type 1 (NF1). To determine meaningful clinical trial outcomes, deeper understanding is needed regarding how cNFs are associated with quality of life (QoL). However, this understanding has been hampered by challenges in recruiting participants with this rare genetic disease.</p><p><strong>Objective: </strong>To develop a large, crowdsourced validated registry of persons with NF1 and determine the association of specific cNF features with QoL, pain, and itch.</p><p><strong>Design, setting, and participants: </strong>From May 2021 to December 2023, a decentralized platform was developed and recruited persons 40 years or older with NF1 and at least 1 cNF from 49 states and 12 countries, who provided clinical survey data, detailed photographs, and genetic sequencing data. Photographs from 583 participants were scored on 12 features of cNFs, including general severity, number, size, facial severity, color, and subtypes.</p><p><strong>Exposure: </strong>cNF features derived from participant-supplied photographs.</p><p><strong>Main outcomes and measures: </strong>Total Skindex scores and subdomain scores (symptoms, emotion, function, pain, and itch).</p><p><strong>Results: </strong>Of 583 participants, 384 (65.9%) were female, and the mean (range) age was 51.7 (40.0-83.0) years. Female sex, general severity, number, size, and facial severity of cNFs were negatively associated with QoL, as demonstrated by increased total Skindex scores. QoL had the largest association with the number of cNFs and presence of facial cNFs. Increasing number of cNFs was associated with worse QoL, and even individuals with a low cNF burden (<10 total cNFs) experienced a decrease in QoL.</p><p><strong>Conclusions and relevance: </strong>The results of this study suggest that reducing cNF number, particularly on the face, may be associated with improved QoL in individuals with NF1. In addition, early intervention before the development of numerous tumors may lead to the highest benefit in QoL. These data potentially provide insight into which individuals and cNF tumors may benefit most from therapy and highlights the utility of a completely decentralized, photograph-validated and age-controlled study for rare genetic disease. This cohort will allow analysis of disease and tumor heterogeneity after full phenotypic expression is achieved in NF1 and potentially serves as an example in its design for other rare diseases that struggle from poor recruitment.</p>","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"1091-1098"},"PeriodicalIF":11.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11359107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}