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Pustular Erythroderma in an Infant. 婴儿脓疱性红斑。
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-10-01 DOI: 10.1001/jamadermatol.2024.2436
Mandana Fadaei Kermani, Jerome Coulombe
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引用次数: 0
Skin Cancer Care in US Veterans-Serving Those Who Served. 美国退伍军人的皮肤癌护理--为曾经服役的人服务。
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-10-01 DOI: 10.1001/jamadermatol.2024.3024
Michael S Chang, Lee Wheless, Rebecca I Hartman
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引用次数: 0
Incidence and Prevalence of Morphea. 斑秃的发病率和流行率。
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-10-01 DOI: 10.1001/jamadermatol.2024.2993
Heejo Keum, Henry W Chen, Robert W Haley, Heidi T Jacobe
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引用次数: 0
Long-Term Effectiveness and Reasons for Discontinuation of Dupilumab in Patients With Atopic Dermatitis. 杜匹单抗对特应性皮炎患者的长期疗效及停药原因
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-10-01 DOI: 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
重要性:在日常实践中,有关杜必鲁单抗治疗特应性皮炎(AD)的长期有效性和安全性的数据有限:目的:评估在日常实践中对患有特应性皮炎的儿童、成人和老年人进行长达 5 年治疗的杜必鲁单抗治疗的临床有效性和停药原因:这项前瞻性多中心队列研究通过BioDay登记处(荷兰4家学术医院和10家非学术医院)进行,以确定2017年10月至2022年12月期间接受过杜比单抗治疗的各年龄段AD患者:临床疗效通过湿疹面积和严重程度指数(EASI)、研究者全球评估(IGA)和瘙痒数字评分量表(NRS)进行评估,并按儿童进行分层(结果:共有1286名AD患者(中位数[IQR]年龄为38[26-54]岁;726[56.6%]为男性)接受了dupilumab治疗,其中包括130名儿童、1025名成人和131名老年人。随访时间的中位数(IQR)为 87.5 (32.0-157.0) 周。在长达 5 年的治疗过程中,大多数患者的 AD 均得到了控制,EASI 为 7 或更低,瘙痒 NRS 为 4 或更低的患者分别占 78.6% 至 92.3% 和 72.2% 至 88.2%,多达 70.5% 的患者延长了给药间隔,大多为每 3 或 4 周一次,每次 300 毫克。治疗 5 年后,瘙痒的 EASI 和 NRS 平均值分别为 2.7(95% CI,1.2-4.2)和 3.5(95% CI,2.7-4.3)。不同年龄组的 EASI 和 IGA 在统计学上存在显著差异,但差异很小(第 52 周:EASI,0.3-1.6;IGA,0.12-0.26)。各年龄组之间的瘙痒 NRS 差异无统计学意义。胸腺和活化相关趋化因子的中位水平在治疗 6 个月后从 1751 pg/mL(95% CI,1614-1900 pg/mL)大幅降至 390 pg/mL(95% CI,368-413 pg/mL),并保持在较低水平。嗜酸性粒细胞水平中位数在第16周前暂时上升,随后随着时间的推移出现统计学意义上的显著下降。共有 306 名患者(23.8%)在中位数(IQR)为 54.0(29.0-110.00)周后停用了杜比鲁单抗,其中 98 名患者(7.6%)报告了不良反应,85 名患者(6.6%)报告了无效,这是最常见的停药原因。41名患者(3.2%)重新开始使用杜比鲁单抗,其中大部分患者重新获得了应答:在这项随访时间长达 5 年的队列研究中,杜必鲁单抗保持了其临床疗效,而三分之二的患者将用药间隔缩短为每 3 周或 4 周一次。23.8%的患者主要因不良反应和/或疗效不佳而停止治疗。
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引用次数: 0
Smoking Cessation and Risk of Hidradenitis Suppurativa Development. 戒烟与肩周炎的发病风险
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-10-01 DOI: 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
重要性:尽管吸烟是化脓性扁桃体炎(HS)的一个危险因素,但有关戒烟对HS影响的研究却很有限,而且缺乏证据:目的:研究吸烟状况的变化与 HS 发病之间的关系:这项以人群为基础的队列研究从韩国国民健康保险服务数据库中选取了连续两年(2004-2005年和2006-2007年)接受健康检查的人群作为主要队列。在主要队列中,次要队列包括在整个随访期间接受了所有两年一次的健康检查,并在 2006 至 2007 年间至随访期结束时保持相同吸烟状态的个人。数据分析时间为 2023 年 7 月至 12 月:主要结果和测量指标:HS发病风险。根据两次连续健康检查之间吸烟状况的变化,采用 Cox 比例危险模型估算 HS 风险:在 6 230 189 名参与者中,平均年龄为 47.2 (13.5)岁,55.6% 为男性。在 84 457 025 人年的随访期间,共发生了 3761 起 HS 事件。在主要队列中,与在两次体检中均持续报告主动吸烟的人群(即持续吸烟者)相比,最初确认吸烟但在第二次体检时戒烟的人群(即戒烟者)的 HS 风险较低(调整后危险比 [AHR],0.68;95% CI,0.56-0.83)、始终保持戒烟状态者(AHR,0.67;95% CI,0.57-0.77)以及在两次体检中均报告从未吸烟者(即从未吸烟者)(AHR,0.57;95% CI,0.52-0.63)。最初戒烟但在第二次体检时恢复吸烟的人和以前没有吸烟史但在第二次体检时开始吸烟的人(即新吸烟者)表现出与持续吸烟者相似的 HS 风险。二级队列的结果与一级队列的结果一致,显示戒烟后风险降低更明显(AHR,0.57;95% CI,0.39-0.83)。考虑到时间与吸烟的交互作用,在观察的早期阶段,戒烟者的累积发病率和 HS 风险与持续吸烟者相似。然而,在戒烟3至4年后,发病率有所下降,与从不吸烟者的发病率相似,而且风险持续显著下降(从指数日期算起3至6年之间:AHR,0.58;95% CI,0.36-0.92;从指数日期算起≥12年:AHR,0.70;95% CI,0.50-0.97)。新吸烟者最初与从不吸烟者的情况相似,但在 2 至 3 年后加速,达到持续吸烟者的水平:在这项队列研究中,与持续吸烟相比,戒烟和保持无烟状态可降低 HS 的发病风险。相比之下,恢复吸烟或开始吸烟与持续吸烟一样,都会对HS的发展产生不利影响。
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引用次数: 0
Tyrosine Kinase 2 Inhibition With Zasocitinib (TAK-279) in Psoriasis: A Randomized Clinical Trial. 用扎索西替尼 (TAK-279) 抑制酪氨酸激酶 2 治疗银屑病:随机临床试验
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-10-01 DOI: 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.

Trial registration: ClinicalTrials.gov Identifier: NCT04999839.

重要性:治疗银屑病需要新的、有效且耐受性良好的口服疗法。扎索西替尼是一种高选择性异位酪氨酸激酶2(TYK2)抑制剂,是治疗这种疾病的一种潜在口服新疗法:评估扎索西替尼对中重度斑块状银屑病患者的疗效、安全性和耐受性:这项2b期随机、双盲、安慰剂对照、多剂量随机临床试验于2021年8月11日至2022年9月12日在美国的47个中心和加拿大的8个中心进行。研究包括为期 12 周的治疗和为期 4 周的随访。参与者的主要资格标准包括:年龄在18至70岁之间;银屑病面积和严重程度指数(PASI)达到或超过12分;医生总体评估得分达到或超过3分;斑块状银屑病覆盖体表面积达到或超过10%。在随机分配的 287 名患者中,259 人(90.2%)至少接受了 1 次治疗:患者被随机分配(1:1:1:1:1:1)接受扎索西替尼治疗,剂量为2、5、15或30毫克,或口服安慰剂,每日一次,为期12周:主要疗效终点是第12周时PASI评分(PASI 75)改善75%或以上的患者比例。次要疗效终点包括 PASI 90 和 100 反应。此外,还对安全性进行了评估:共有 259 名患者接受了随机治疗(平均 [SD] 年龄为 47 [13] 岁;82 名女性 [32%])。第 12 周时,接受 2、5、15 和 30 毫克扎索西替尼治疗的患者中分别有 9 人(18%)、23 人(44%)、36 人(68%)和 35 人(67%)的 PASI 达到 75,接受安慰剂治疗的患者中分别有 3 人(6%)的 PASI 达到 75。PASI 90 反应与 PASI 75 一致。所有剂量的 PASI 100 均显示出剂量反应,其中 17 名患者(33%)在服用 30 毫克的扎索西替尼后 PASI 达到 100。23名接受安慰剂治疗的患者(44%)和28名(53%)至31名(62%)接受4种不同剂量扎索西替尼治疗的患者发生了治疗突发不良事件,但没有剂量依赖性,实验室参数也没有临床意义的纵向差异:这项随机临床试验发现,扎索西替尼口服剂量为5毫克或以上,每天一次,对TYK2具有强效选择性抑制作用,12周内皮肤清除率高于安慰剂:试验注册:ClinicalTrials.gov Identifier:NCT04999839。
{"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}
引用次数: 0
Genetic Aspects of Necrobiotic Xanthogranuloma. 坏死性黄疽瘤的遗传学方面。
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-10-01 DOI: 10.1001/jamadermatol.2024.2921
Peng-Yu Chen, Zhuang-Li Tang, Yuan-Yu Hong, I-Jung Hsieh, Zi-Yun Li, Jiong Zhou, Sui-Qing Cai
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引用次数: 0
Skin Cancer and Other Dermatologic Conditions Among US Veterans. 美国退伍军人中的皮肤癌和其他皮肤病。
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-10-01 DOI: 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.

重要性:与非退伍军人相比,美国退伍军人患各种皮肤病的风险可能更高:比较退伍军人和非退伍军人患皮肤病(如皮肤癌、皮炎/湿疹/皮疹、银屑病)的患病率和几率:这项基于人群的横断面研究利用了美国国家健康与营养调查(NHANES)中具有全国代表性的数据。研究合并了 1999-2018 年的三份问卷(人口统计学、医疗条件和皮肤病学)进行分析。参与者包括非退伍军人和来自 NHANES 数据的退伍军人。数据分析时间为 2023 年 8 月至 2024 年 4 月:研究了退伍军人和非退伍军人各种皮肤病的患病率和几率比(ORs),包括自我报告的皮肤癌病史(任何皮肤癌、黑色素瘤、非黑色素瘤和未知亚型)、皮炎/湿疹/炎性皮疹和银屑病:在总共 61 307 名参与者(54 554 名非退伍军人和 6 753 名退伍军人)中,与非退伍军人相比,美国退伍军人患任何皮肤癌的比例更高(9.0% 对 2.9%;P 结论和意义:这项横断面研究发现,与非退伍军人相比,退伍军人患各种皮肤病的患病率和几率更高。要提高退伍军人的医疗保健质量,就必须调查造成这一人群皮肤健康状况恶化的根本原因。
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引用次数: 0
Orofacial Manifestations of Kindler Epidermolysis Bullosa-Reply. 金德勒大疱性表皮松解症的口面部表现--回复。
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-10-01 DOI: 10.1001/jamadermatol.2024.2830
Susanne Krämer, Agnes Bloch-Zupan, Cristina Has
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引用次数: 0
Cutaneous Neurofibromas and Quality of Life in Adults With Neurofibromatosis Type 1. 皮肤神经纤维瘤与 1 型神经纤维瘤成人患者的生活质量。
IF 11.5 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-10-01 DOI: 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.

重要性:皮肤神经纤维瘤(cNFs)是导致 1 型神经纤维瘤病(NF1)患者发病的一个主要原因,目前人们对皮肤神经纤维瘤的治疗开发兴趣日渐浓厚。为了确定有意义的临床试验结果,需要深入了解 cNFs 与生活质量 (QoL) 的关系。然而,由于招募患有这种罕见遗传病的参与者存在困难,这种理解受到了阻碍:目的:建立一个大型的、经多方验证的 NF1 患者登记册,并确定 cNF 的特定特征与 QoL、疼痛和瘙痒的关联:从 2021 年 5 月到 2023 年 12 月,我们开发了一个分散式平台,并从 49 个州和 12 个国家招募了 40 岁或以上的 NF1 患者和至少 1 名 cNF 患者,他们提供了临床调查数据、详细照片和基因测序数据。对 583 名参与者的照片进行了 12 项 cNF 特征评分,包括一般严重程度、数量、大小、面部严重程度、颜色和亚型:主要结果和测量:Skindex 总分和子域得分(症状、情绪、功能、疼痛和痒):在 583 名参与者中,384 人(65.9%)为女性,平均年龄为 51.7(40.0-83.0)岁。女性性别、cNFs 的总体严重程度、数量、大小和面部严重程度与 QoL 呈负相关,Skindex 总分的增加证明了这一点。QoL 与 cNFs 的数量和面部 cNFs 的存在关系最大。cNFs 数量的增加与 QoL 的恶化有关,即使是 cNF 负担较低的个体也是如此(结论和相关性:本研究结果表明,减少 cNF 数量,尤其是面部 cNF 数量,可能与改善 NF1 患者的 QoL 有关。此外,在出现大量肿瘤之前进行早期干预,可能会使 QoL 受益最大。这些数据有可能让我们深入了解哪些患者和 cNF 肿瘤可能从治疗中获益最多,并凸显了针对罕见遗传病进行完全分散、照片验证和年龄控制研究的实用性。在 NF1 实现完全表型表达后,该队列将允许对疾病和肿瘤异质性进行分析,并有可能成为其他罕见疾病的设计范例,因为这些疾病的患者招募困难。
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JAMA dermatology
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