Journal of the American Academy of Dermatology最新文献

Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disorder, primarily presenting with tense bullae and severe pruritus. Diagnosing and treating BP can be challenging due to its variable clinical presentations. We will briefly discuss these phenotypes, highlight diagnostic basics, and briefly summarize recent laboratory advancements that have improved diagnostic sensitivity and accuracy. The treatment landscape for BP has evolved significantly. Newer therapies, including biologics such as rituximab, omalizumab, dupilumab and Janus kinase inhibitors target the immunopathogenesis of BP and can reduce the adverse effects associated with cumulative corticosteroid exposure and conventional immunosuppressants. This article provides a comprehensive overview of BP's clinical features, diagnostic approaches, and emerging therapeutic options, emphasizing personalized medicine and improved patient outcomes.

Background: Hidradenitis suppurativa (HS) is a disabling inflammatory skin disease.

Objective: To investigate the efficacy and safety of upadacitinib, a selective Janus kinase inhibitor.

Methods: In this phase 2, randomized, placebo-controlled, double-blind clinical trial (NCT04430855), adults with moderate-to-severe HS were randomized 2:1 to once-daily upadacitinib 30 mg or placebo. At 12 weeks, placebo patients switched to blinded upadacitinib 15 mg, and patients receiving upadacitinib 30 mg continued assigned treatment through week 48. The primary endpoint was ≥50% reduction in total abscess and inflammatory nodule count with no increase in abscess or draining fistula count relative to baseline (Hidradenitis Suppurativa Clinical Response [HiSCR50]) at week 12.

Results: Forty-seven patients received upadacitinib; 21 patients received placebo. At week 12, a significantly greater proportion of patients receiving upadacitinib achieved HiSCR50 vs a prespecified historical placebo rate (38.3% vs 25.0%, 1-sided P=.018). Comparison with the in-trial placebo group showed an adjusted difference of 14.7% (nominal P=.087). HiSCR50 achievement with upadacitinib was consistent across baseline Hurley stage and prior tumor necrosis factor inhibitor exposure and maintained through week 40. Upadacitinib's safety profile was consistent with previous reports on dermatological conditions.

Limitations: Sample size was small.

Conclusion: Findings support further investigation of upadacitinib for moderate-to-severe HS.

Major health organizations recognize various pathogens as potential bioweapons. Category A bioweapons (anthrax, plague, smallpox, tularemia, and viral hemorrhagic fevers) are the highest priority due to their ease of spread and high mortality rates. As these conditions have cutaneous manifestations, dermatologists may have an important role as front-line responders to indolent or bioterrorism threats. Few dermatologists are adequately prepared to approach the diagnosis and management of these conditions if encountered. Furthermore, despite improvements made in identifying, diagnosing, and treating these conditions over the past ten years, there persists an absence of a synthesized distribution of these updates customized to adequately equip dermatologists. In this paper, we review the epidemiology, transmission, and dermatologic signs and symptoms of the Category A bioweapons listed above. We also offer an overview of the evidence-based strategies for diagnosis and management and provide access to each states' guidelines for reporting these conditions.

Background: HPV is a prevalent sexually transmitted infection (STI) associated with malignancies and condyloma acuminata (CA), with significant healthcare costs. Despite vaccine availability, vaccination rates remain low, highlighting the need for effective interventions to increase uptake.

Objective: To improve HPV vaccination rates among eligible individuals at a safety-net dermatology STI clinic.

Methods: A multiphase quality improvement program aimed to improve HPV education and vaccination rates was implemented in a dermatology STI clinic. The cohort included 175 patients with CA between August 2019 and December 2022. HPV vaccine education and immunization rates were measured.

Results: While counseling/education rates were high, vaccination initiation rates remained low before the onset of in-office HPV vaccine. In-office HPV vaccine administration demonstrated a 175% increase in vaccine initiation (p < 0.01).

Limitations: This study had a relatively small sample size and was conducted in an urban, safety-net hospital; results may not be generalizable to smaller or rural practices.

Conclusion: This quality improvement initiative successfully increased HPV vaccination rates at a safety-net dermatology STI clinic, demonstrating that in-office, same day vaccination for HPV was critical for the success. Our study highlights an effective approach toward improving vaccination rates for HPV and is a model for vaccine delivery.