Journal of the American Academy of Dermatology最新文献

Background: Most epidemiological studies of hidradenitis suppurativa (HS) have described homogeneous patient populations.

Objective: To characterize demographics, modifiable health behaviors, and comorbidities of HS patients within a diverse cohort.

Methods: A retrospective cross-sectional study of 13,130 HS patients within a healthcare system was conducted.

Results: A female sex bias of ∼3:1 in all racial/ethnic subgroups was observed. Black/African American (AA) patients had a lower age at HS diagnosis than White patients (37.1 years vs 39.4 years, P<0.001). A higher proportion of Black/AA females than White females with HS had BMI in the obese range (69.9% vs 56.5%; P=0.03). In contrast, fewer Black/African American males with HS had a BMI in the obese range compared to White males (51.4% vs. 61.0%; P<0.001). More Black/AA patients than White patients with HS had congestive heart failure (OR=2.10, CI=1.19-3.78; P<0.05), chronic pulmonary disease (OR=1.34; CI=1.02-1.78; P<0.05), diabetes with chronic complication (OR=1.73; CI=1.16-2.60; P<0.05), renal disease (OR=2.66; CI=1.67-4.34; P<0.05), and Charlson Comorbidity Index score ≥4 (OR=1.67; CI=1.09-2.58; P<0.05). Furthermore, male patients were more likely than female patients to have renal disease (OR=2.62; CI 1.66-4.14; P<0.05).

Limitations: A single-center study.

Conclusion: Subgroups of HS patients had significant differences in demographics, risk factors, and comorbid conditions.

Background: Differentiating melanoma (MM) from seborrheic keratosis (SK) containing a blue-white veil (BWV) remains challenging.

Objective: Identify dermoscopic features that can improve upon the differentiation between MMs and SKs exhibiting BWV.

Methods: Images from 110 MMs and 121 SKs containing BWV were aggregated, and 91 MMs and 62 SKs from this dataset had complete agreement on the presence of BWV according to 3 expert dermoscopists. Independent readers recorded the presence or absence of dermoscopic structures using a web-based data collection instrument. Odds ratios were used to evaluate the association between features and diagnosis, and Fisher's exact test was used to determine significance of associations.

Results: The combination of milia-like cysts and/or comedo-like openings (MCCO) within the BWV and BWV encompassing the entire lesion occurred in 56% of SKs and 0% of MM. All MMs had at least one MM-specific structure other than BWV or lacked MCCO.

Limitations: Agreement on dermoscopic feature prevalence was variable. The subset of lesions with complete agreement on the presence of BWV may not be representative of lesions encountered in an individual clinician's practice.

Conclusion: Lesions exhibiting BWV with MCCO and no additional MM-specific features suggests a benign diagnosis, as was not seen in any cases of MM.

Background: OnabotulinumtoxinA is used to treat masseter muscle prominence (MMP).

Objective: To assess the safety and efficacy of onabotulinumtoxinA for MMP in a randomized study.

Methods: This 12-month, multicenter, double-blind, placebo-controlled, phase 2 study randomized adults (18-50 years of age) with marked/very marked bilateral MMP (≥4 on the Masseter Muscle Prominence Scale [MMPS]) to onabotulinumtoxinA (24, 48, 72, or 96 U) or placebo; retreatment occurred at day 180 if MMPS ≥4. Lower facial volume at day 90 was measured using Vectra 3-dimensional photography. Safety assessments included computed tomography and dental exams. Evaluations occurred monthly through day 360.

Results: Among 187 randomized subjects, significant lower facial volume reductions and percentage of responders (MMPS grade ≤3) were greater with onabotulinumtoxinA versus placebo at day 90 (P < .001 and ≤ .008, respectively). Similar efficacy was observed with retreatment. No dose-related safety trends or clinically relevant changes in the mandible or teeth occurred. Localized impact on smile was reported with 96 U onabotulinumtoxinA (n=4).

Limitations: Limited sample size per individual treatment group.

Conclusion: OnabotulinumtoxinA administered in 1 or 2 treatments over 1 year was associated with significant reductions in masseter muscle volume and MMP severity, with an acceptable safety profile.