JAMA dermatology最新文献

Importance: Patient and caregiver values and preferences should inform clinical management. An update to the American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma and Immunology's Joint Task Force on Practice Parameters guidelines on chronic urticaria (CU) plans to incorporate them; however, a systematic review of evidence on the values and preferences of patients with CU and their caregivers has not been previously available.

Objective: To synthesize patient and caregiver values and preferences regarding CU treatment options.

Evidence review: A systematic search was conducted of MEDLINE, Embase, PsycINFO, and CINAHL databases, from inception to May 15, 2025, for studies addressing patient and/or caregiver values and preferences for CU management. Paired reviewers independently screened studies, extracted data, and assessed risk of bias. Thematic and inductive content analysis was used to qualitatively synthesize findings and certainty of evidence was rated per the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research approach.

Findings: The search resulted in 18 studies addressing the values and preferences among 28 497 participants. Moderate certainty evidence showed that patients were likely to place a high value on rapid improvement (eg, 2 days to 2 weeks) of disease signs and symptoms, long-term effectiveness, and treatments that were easy to prepare, use, and self-manage-oral or topical treatments were favored over injections, with the least favored being infusions. Low certainty evidence suggested that patients accepted minor feasibility burdens for rapid and sustained symptom relief but prioritized safety and tolerability as the risk or severity of adverse effects (eg, kidney injury, vomiting) increased.

Conclusions and relevance: This systematic review suggests that patients with CU place high value on immediate and sustained hive, itch, and swelling relief, particularly long-term symptom-free periods, but may shift to prioritizing avoiding harms and burdens as the risk and severity of adverse effects increases. These findings may serve as a resource to improve the trustworthiness of recommendations and inform future CU management and research.

Importance: Dermatomyositis (DM) is associated with increased rates of hospitalization and mortality. However, characteristics present at the time of admission that are associated with in-hospital mortality remain poorly defined in the US.

Objective: To evaluate whether features of DM present at admission, including active rash and muscle disease, interstitial lung disease (ILD), elevated neutrophil to lymphocyte ratio (NLR), myositis-specific autoantibody status, and baseline treatment regimens, are associated with in-hospital mortality among patients admitted with DM.

Design, setting, and participants: This cohort study included adults with pre-existing DM (confirmed by documentation by a dermatologist or rheumatologist) who were admitted for any cause at a single tertiary referral center from January 2013 to May 2024. Data were analyzed from August 2024 to August 2025.

Exposures: Clinical, serologic, and laboratory features of DM at the time of admission as well as baseline treatment prior to hospitalization.

Main outcomes and measures: The primary outcome was in-hospital mortality. Statistical analyses included descriptive statistics and multivariable logistic regression with the Firth correction, adjusting for demographics and DM subtype. Bonferroni correction was applied to control for multiple comparisons.

Results: Among 153 patients with DM (113 females [73.9%]; mean [SD] age, 56.5 [14.3] years), 16 (10.5%) died during hospitalization. Deceased patients were more likely than survivors to have active rash (13 of 16 [81.3%] vs 47 of 137 [34.3%]), ILD (14 of 16 [87.5%] vs 57 of 137 [41.6%]), and elevated NLR (mean [SD], 12.5 [7.43] vs 4.90 [3.82]). Myositis prevalence did not differ significantly between deceased patients and survivors. In multivariable analysis, active rash (odds ratio [OR], 12.13; 95% CI, 3.18-46.28; P = .003), ILD (OR, 6.43; 95% CI, 1.78-23.13; P = .04), and NLR (OR per 1-unit increase, 1.29 [95% CI, 1.16-1.44]; P < .001) were independently associated with mortality. No association with baseline intravenous immunoglobulin use was observed among patients who died after Bonferroni correction.

Conclusions and relevance: In this study, active rash, ILD, and elevated NLR were independently associated with in-hospital mortality in patients with DM, regardless of disease subtype or myositis-specific autoantibody status. Recognizing these high-risk features may guide inpatient management and support future risk stratification strategies.

Importance: Treatment of facial flushing and erythema for patients with erythematotelangiectatic rosacea (ETR) is challenging. Transcutaneous auricular vagus nerve stimulation (taVNS) therapy may be beneficial for treating ETR; however, it has not been rigorously evaluated in a randomized clinical trial.

Objective: To evaluate the efficacy of taVNS for ETR compared with sham stimulation (SS).

Design, setting, and participants: Enrollment for this single-center, randomized, double-blind, sham-controlled device clinical trial was initiated in February 2024 and ended in August 2024. The follow-up period ended in February 2025, and data were analyzed in March 2025. Patients with ETR that was accompanied by a Clinician's Erythema Assessment (CEA) score of at least 2 were selected from the Department of Dermatology of Southwest Hospital in China.

Interventions: Patients were allocated to the taVNS group (stimulation pulses at a frequency of 30 Hz and a pulse width of 200 μs for 30 minutes per day) or the SS group at a 1:1 ratio. Both groups received 3 weeks of treatment and 24 weeks of follow-up.

Main outcomes and measures: The primary outcome was CEA score after 3 weeks of treatment. The secondary outcomes included improvements in erythema and facial flushing, sleep disorders, migraine, anxiety, fatigue, and depression, as measured via clinical tools.

Results: Seventy-two participants (67 female individuals [93.1%]; median [IQR] age: 29.5 [24.0-36.0] years) with ETR were randomized into either the taVNS (36 [50.0%]) or SS groups (36 [50.0%]). At 3 weeks, the mean (SD) CEA score was lower in the taVNS group than the SS group (1.56 [0.84] vs 2.47 [0.81]; mean difference, -0.92; 95% CI, -1.3 to -0.53; P < .001). Moreover, taVNS also reduced the severity of anxiety (mean difference, -5.42; 95% CI, -8.11 to -2.73; P < .001) and depression (mean difference, -6.22; 95% CI, -9.69 to -2.75; P < .001). This relief persisted until the follow-up period. The effects on sleep disorders, migraine, and fatigue were consistent with the previously described indicators. Adverse events were not common for taVNS (2 of 36 [5.6%]) and SS (3 of 36 [8.3%]).

Conclusions and relevance: This randomized clinical trial demonstrated that treating ETR with taVNS concurrently ameliorated cutaneous symptoms and systemic comorbidities, and the results suggest that taVNS is a novel therapeutic option for ETR management.

Trial registration: Chinese Clinical Trial Register Identifier: ChiCTR2400080637.