Pub Date : 2023-12-04DOI: 10.1101/2023.11.28.23299152
Li Li, Irshad Hajam, Jean S McGee, Zhengkuan Tang, Ye Zhang, Nikil Badey, Esther Mintzer, Zhenrui Zhang, George Y Liu, George Church, Yu Wang
Acne vulgaris, rosacea, and hidradenitis suppurativa are enduring inflammatory skin conditions that frequently manifest with akin clinical attributes, posing a considerable challenge for their distinctive diagnosis. While these conditions do exhibit certain resemblances, they also demonstrate distinct underlying pathophysiological mechanisms and treatment modalities. Delving into both the molecular parallels and disparities among these three disorders can yield invaluable insights for refined diagnostics, effective management, and targeted therapeutic interventions. In this report, we present a comparative analysis of transcriptomic data across these three diseases, elucidating differentially expressed genes and enriched pathways specific to each ailment, as well as those shared among them. We also identified high dose dietary zinc as a potential therapeutic agent and validated its efficacy in an acne mouse model.
{"title":"Comparative Transcriptome Analysis of Acne vulgaris, Rosacea, and Hidradenitis Suppurativa Supports High Dose Dietary Zinc as a Therapeutic Agent","authors":"Li Li, Irshad Hajam, Jean S McGee, Zhengkuan Tang, Ye Zhang, Nikil Badey, Esther Mintzer, Zhenrui Zhang, George Y Liu, George Church, Yu Wang","doi":"10.1101/2023.11.28.23299152","DOIUrl":"https://doi.org/10.1101/2023.11.28.23299152","url":null,"abstract":"Acne vulgaris, rosacea, and hidradenitis suppurativa are enduring inflammatory skin conditions that frequently manifest with akin clinical attributes, posing a considerable challenge for their distinctive diagnosis. While these conditions do exhibit certain resemblances, they also demonstrate distinct underlying pathophysiological mechanisms and treatment modalities. Delving into both the molecular parallels and disparities among these three disorders can yield invaluable insights for refined diagnostics, effective management, and targeted therapeutic interventions. In this report, we present a comparative analysis of transcriptomic data across these three diseases, elucidating differentially expressed genes and enriched pathways specific to each ailment, as well as those shared among them. We also identified high dose dietary zinc as a potential therapeutic agent and validated its efficacy in an acne mouse model.","PeriodicalId":501385,"journal":{"name":"medRxiv - Dermatology","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138522819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-24DOI: 10.1101/2023.11.12.23298113
Alison Gern, Jessica Walter, Shuai Xu, Paras P. Vakharia
Adult acne vulgaris affects up to 43-51% of individuals. While there are numerous treatment options for acne including topical, oral, and energy-based approaches, benzoyl peroxide (BPO) is a popular over the counter (OTC) treatment. Although BPO monotherapy has a long history of efficacy and safety, it suffers from several disadvantages, most notably, skin irritation, particularly for treatment naïve patients. In this prospective, randomized, controlled, split-face study, we evaluated the comparative efficacy, safety, and tolerability of a novel 3-step azelaic acid, salicylic acid and graduated retinol regimen (Geologie Clear System) versus a common OTC BPO-based regimen (Proactiv Solution) over 12 weeks. A total of 37 adult subjects with selfreported mild to moderate acne vulgaris were recruited. A total of 21 subjects underwent a 2-week washout period and completed the full study with 3 dropping out due to product irritation from the BPO routine, and 13 being lost to follow-up. Detailed tolerability surveys were conducted at Week 4. Additional surveys on tolerability and product preferences were collected monthly, at Week 4, Week 8, and Week 12. A blinded board-certified dermatologist objectively scored the presence and type of acne lesions (open or closed comedones, papules, pustules, nodules, and cysts) at baseline, Week 4, Week 8, and Week 12. Patients photographed themselves and uploaded the images using personal mobile phones. Detailed Week 4 survey results showed across 25 domains of user-assessed product performance, Geologie outperformed the BPO routine in 19 (76%) which included domains in preference (e.g. “I would use this in the future), performance (“my skin improved” and “helped my acne clear up faster”). Geologie users reported less facial redness, itching, and burning, though differences did not reach statistical significance. In terms of efficacy, both products performed similarly, reducing total acne lesions by 36% (Geologie) and 40% (BPO routine) by Week 12. Overall, accounting for user preferences and tolerability Geologie was more preferred than the BPO routine in 79% of domains (22/28). Differences in objective acne lesion reduction were not statistically significant (p=0.97). In a randomized split-face study, a 3-step azelaic acid, salicylic acid, and graduated retinol regimen delivered similar acne lesion reduction, fewer user dropouts, greater user tolerability, and higher use preference compared to a 3-step BPO routine based in a cohort of participants with mild-to-moderate acne vulgaris.
{"title":"A Randomized Controlled Double-Blinded Split-Face Prospective Clinical Study to Assess the Efficacy, Safety, and Tolerability of a Novel 3-Step Routine Compared to Benzyl Peroxide for the Treatment of Mild to Moderate Acne Vulgaris","authors":"Alison Gern, Jessica Walter, Shuai Xu, Paras P. Vakharia","doi":"10.1101/2023.11.12.23298113","DOIUrl":"https://doi.org/10.1101/2023.11.12.23298113","url":null,"abstract":"Adult acne vulgaris affects up to 43-51% of individuals. While there are numerous treatment options for acne including topical, oral, and energy-based approaches, benzoyl peroxide (BPO) is a popular over the counter (OTC) treatment. Although BPO monotherapy has a long history of efficacy and safety, it suffers from several disadvantages, most notably, skin irritation, particularly for treatment naïve patients. In this prospective, randomized, controlled, split-face study, we evaluated the comparative efficacy, safety, and tolerability of a novel 3-step azelaic acid, salicylic acid and graduated retinol regimen (Geologie Clear System) versus a common OTC BPO-based regimen (Proactiv Solution) over 12 weeks. A total of 37 adult subjects with selfreported mild to moderate acne vulgaris were recruited. A total of 21 subjects underwent a 2-week washout period and completed the full study with 3 dropping out due to product irritation from the BPO routine, and 13 being lost to follow-up. Detailed tolerability surveys were conducted at Week 4. Additional surveys on tolerability and product preferences were collected monthly, at Week 4, Week 8, and Week 12. A blinded board-certified dermatologist objectively scored the presence and type of acne lesions (open or closed comedones, papules, pustules, nodules, and cysts) at baseline, Week 4, Week 8, and Week 12. Patients photographed themselves and uploaded the images using personal mobile phones. Detailed Week 4 survey results showed across 25 domains of user-assessed product performance, Geologie outperformed the BPO routine in 19 (76%) which included domains in preference (e.g. “I would use this in the future), performance (“my skin improved” and “helped my acne clear up faster”). Geologie users reported less facial redness, itching, and burning, though differences did not reach statistical significance. In terms of efficacy, both products performed similarly, reducing total acne lesions by 36% (Geologie) and 40% (BPO routine) by Week 12. Overall, accounting for user preferences and tolerability Geologie was more preferred than the BPO routine in 79% of domains (22/28). Differences in objective acne lesion reduction were not statistically significant (p=0.97). In a randomized split-face study, a 3-step azelaic acid, salicylic acid, and graduated retinol regimen delivered similar acne lesion reduction, fewer user dropouts, greater user tolerability, and higher use preference compared to a 3-step BPO routine based in a cohort of participants with mild-to-moderate acne vulgaris.","PeriodicalId":501385,"journal":{"name":"medRxiv - Dermatology","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138522820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-20DOI: 10.1101/2023.11.20.23298649
J. Balkenhol, M. Schmidt, T. Schnauder, J. Langhorst, J. Le’Clerc Arrastia, D. Otero Baguer, G. Gilbert, L. Schmitz, T. Dirschka
Actinic Keratosis (AK) is a frequent dermatological diagnosis which contributes to a large proportion of routine dermatopathology. A current development in histopathology is in the digitization of specimens by creating whole slide images (WSI) with slide scanners. Deep Learning Models (DLM) have been introduced to radiology or pathology for image recognition but dermatopathology lacks available solutions. Building on previous work about skin pathologies, this paper proposes a DLM following the U-Net architecture to detect AK in histopathological samples. In total, 297 histopathological slides (269 with AK and 28 without AK) have been retrospectively selected. They were randomly assigned to training, validation, and testing groups. Performance was evaluated by conducting a Case Control Accuracy Study on three levels of granularity. The DLM model achieved an overall accuracy of 99.13% on the WSI level, 99.02% on the patch level and an intersection over union (IoU) of 83.88%. The proposed DLM reliably recognizes AK in histopathological images, supporting the implementation of DLMs in dermatopathology practice. Given existing technical capabilities and advancements, DLMs could have a significant influence on dermatopathology routine in the future.
{"title":"The use of a deep learning model in the histopathological diagnosis of actinic keratosis: A case control accuracy study","authors":"J. Balkenhol, M. Schmidt, T. Schnauder, J. Langhorst, J. Le’Clerc Arrastia, D. Otero Baguer, G. Gilbert, L. Schmitz, T. Dirschka","doi":"10.1101/2023.11.20.23298649","DOIUrl":"https://doi.org/10.1101/2023.11.20.23298649","url":null,"abstract":"Actinic Keratosis (AK) is a frequent dermatological diagnosis which contributes to a large proportion of routine dermatopathology. A current development in histopathology is in the digitization of specimens by creating whole slide images (WSI) with slide scanners. Deep Learning Models (DLM) have been introduced to radiology or pathology for image recognition but dermatopathology lacks available solutions. Building on previous work about skin pathologies, this paper proposes a DLM following the U-Net architecture to detect AK in histopathological samples. In total, 297 histopathological slides (269 with AK and 28 without AK) have been retrospectively selected. They were randomly assigned to training, validation, and testing groups. Performance was evaluated by conducting a Case Control Accuracy Study on three levels of granularity. The DLM model achieved an overall accuracy of 99.13% on the WSI level, 99.02% on the patch level and an intersection over union (IoU) of 83.88%. The proposed DLM reliably recognizes AK in histopathological images, supporting the implementation of DLMs in dermatopathology practice. Given existing technical capabilities and advancements, DLMs could have a significant influence on dermatopathology routine in the future.","PeriodicalId":501385,"journal":{"name":"medRxiv - Dermatology","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138522818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-16DOI: 10.1101/2023.11.16.23298508
Serges Tchatchouang, Laud A. Basing, Hugues Kouadio-Aboh, Becca L Handley, Camila G-Beiras, Ivy Amanor, Philippe Ndzomo, Mohammed Bakheit, Lisa Becherer, Sascha Knauf, Claudia Müller, Earnest Njih-Tabah, Theophilus Njmanshi, Tania Crucitti, Nadine Borst, Simone Lüert, Sieghard Frischmann, Helena Gmoser, Emelie Landmann, Aboubacar Sylla, Mireille S. Kouamé-Sina, Daniel Arhinful, Patrick Awondo, Gely Menguena, Emma-Michèle Harding-Esch, Adingra Tano, Mamadou Kaloga, Paul Koffi-Aboa, Nana Konama-Kotey, Oriol Mitjà, Sara Eyangoh, Kennedy Kwasi-Addo, Solange Ngazoa-Kakou, Michael Marks
Background: Integrated approaches to mapping skin Neglected Tropical Diseases (NTDs) may be cost-effective way to guide decisions on resource mobilization. Pilot studies have been carried out, but large-scale data covering multiple countries endemic for skin-NTDs are lacking. Within the LAMP4YAWS project, we collected integrated data on the burden of multiple skin-NTDs. Methods: From March 2021 to March 2023, integrated case searches for yaws alongside other skin conditions were performed in endemic health districts of yaws in Cameroon, Côte d’Ivoire, and Ghana. Initial screening involved a brief clinical examination of participants to determine if any skin conditions were suspected. Cases of skin-NTDs were then referred to a health facility for appropriate management. Results: Overall 61,080 individuals screened, 11,387 (18.6%) had skin lesions. The majority of individuals (>90%) examined were children aged 15 years old and under. The proportion of serologically confirmed yaws cases was 8.6% (18/210) in Cameroon, 6.8% (84/1232) in Côte d'Ivoire, and 26.8% (440/1643) in Ghana. Other skin conditions based on clinical examination included: scabies, Buruli ulcer, leprosy, lymphatic filariasis (lymphoedema and hydrocele), tungiasis, and fungal infections. The most common conditions were scabies and superficial fungal infections (scabies versus fungal infections) in Cameroon with 5.1% (214/4204) versus 88.7% (3730/4204), Côte d’Ivoire with 25.2% (1285/5095) versus 50.4% (2567/5095) and Ghana 20% (419/2090) versus 1.3% (28/2090). Other skin-NTDs were less common across all three countries. Conclusion: This study confirms that integrated screening allows simultaneous detection of multiple skin-NTDs, maximising use of scarce resources.
{"title":"An integrated active case search for skin-NTDs in yaws endemic health districts in Cameroon, Côte d’Ivoire and Ghana","authors":"Serges Tchatchouang, Laud A. Basing, Hugues Kouadio-Aboh, Becca L Handley, Camila G-Beiras, Ivy Amanor, Philippe Ndzomo, Mohammed Bakheit, Lisa Becherer, Sascha Knauf, Claudia Müller, Earnest Njih-Tabah, Theophilus Njmanshi, Tania Crucitti, Nadine Borst, Simone Lüert, Sieghard Frischmann, Helena Gmoser, Emelie Landmann, Aboubacar Sylla, Mireille S. Kouamé-Sina, Daniel Arhinful, Patrick Awondo, Gely Menguena, Emma-Michèle Harding-Esch, Adingra Tano, Mamadou Kaloga, Paul Koffi-Aboa, Nana Konama-Kotey, Oriol Mitjà, Sara Eyangoh, Kennedy Kwasi-Addo, Solange Ngazoa-Kakou, Michael Marks","doi":"10.1101/2023.11.16.23298508","DOIUrl":"https://doi.org/10.1101/2023.11.16.23298508","url":null,"abstract":"Background: Integrated approaches to mapping skin Neglected Tropical Diseases (NTDs) may be cost-effective way to guide decisions on resource mobilization. Pilot studies have been carried out, but large-scale data covering multiple countries endemic for skin-NTDs are lacking. Within the LAMP4YAWS project, we collected integrated data on the burden of multiple skin-NTDs.\u0000Methods: From March 2021 to March 2023, integrated case searches for yaws alongside other skin conditions were performed in endemic health districts of yaws in Cameroon, Côte d’Ivoire, and Ghana. Initial screening involved a brief clinical examination of participants to determine if any skin conditions were suspected. Cases of skin-NTDs were then referred to a health facility for appropriate management.\u0000Results: Overall 61,080 individuals screened, 11,387 (18.6%) had skin lesions. The majority of individuals (>90%) examined were children aged 15 years old and under. The proportion of serologically confirmed yaws cases was 8.6% (18/210) in Cameroon, 6.8% (84/1232) in Côte d'Ivoire, and 26.8% (440/1643) in Ghana. Other skin conditions based on clinical examination included: scabies, Buruli ulcer, leprosy, lymphatic filariasis (lymphoedema and hydrocele), tungiasis, and fungal infections. The most common conditions were scabies and superficial fungal infections (scabies versus fungal infections) in Cameroon with 5.1% (214/4204) versus 88.7% (3730/4204), Côte d’Ivoire with 25.2% (1285/5095) versus 50.4% (2567/5095) and Ghana 20% (419/2090) versus 1.3% (28/2090). Other skin-NTDs were less common across all three countries.\u0000Conclusion: This study confirms that integrated screening allows simultaneous detection of multiple skin-NTDs, maximising use of scarce resources.","PeriodicalId":501385,"journal":{"name":"medRxiv - Dermatology","volume":"265 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138522817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-08DOI: 10.1101/2022.12.07.22283119
Rachel K Rosenstein, Jeremy J Rose, Stephen R Brooks, Wanxia L Tsai, Massimo Gadina, Steven Z Pavletic, Keisuke Nagao, Edward W Cowen
Cutaneous sclerotic chronic graft-versus-host disease (cGVHD) is a common and highly morbid complication of allogeneic hematopoietic stem cell transplantation (HSCT). We identified genes that are significantly upregulated in the skin of sclerotic cGVHD patients (n = 17) compared to HSCT patients without sclerotic cGVHD (n = 9) by bulk RNA sequencing. This revealed two transcriptomic groups of affected patients: those with fibrotic and inflammatory/Th1 gene expression, the fibroinflammatory group, and those with predominantly fibrotic/TGFb-associated expression, the fibrotic group. This transcriptomic heterogeneity was also associated with histopathologic heterogeneity, with the fibroinflammatory sub-cluster showing more histopathologic features of epidermal cGVHD and inflammation. Further study will help elucidate if these gene expression and histopathologic findings can be used to tailor treatment decisions. Multiple proteins encoded by highly-induced genes in the skin (SFRP4, SERPINE2, COMP) were also highly induced in the plasma of sclerotic cGVHD patients (n = 16) compared to control HSCT patients without sclerotic cGVHD (n = 17), suggesting these TGFb and Wnt pathway mediators as candidate blood biomarkers of disease.
{"title":"Identification of fibroinflammatory and fibrotic transcriptomic subsets of human sclerotic cutaneous chronic graft-versus-host disease","authors":"Rachel K Rosenstein, Jeremy J Rose, Stephen R Brooks, Wanxia L Tsai, Massimo Gadina, Steven Z Pavletic, Keisuke Nagao, Edward W Cowen","doi":"10.1101/2022.12.07.22283119","DOIUrl":"https://doi.org/10.1101/2022.12.07.22283119","url":null,"abstract":"Cutaneous sclerotic chronic graft-versus-host disease (cGVHD) is a common and highly morbid complication of allogeneic hematopoietic stem cell transplantation (HSCT). We identified genes that are significantly upregulated in the skin of sclerotic cGVHD patients (n = 17) compared to HSCT patients without sclerotic cGVHD (n = 9) by bulk RNA sequencing. This revealed two transcriptomic groups of affected patients: those with fibrotic and inflammatory/Th1 gene expression, the fibroinflammatory group, and those with predominantly fibrotic/TGFb-associated expression, the fibrotic group. This transcriptomic heterogeneity was also associated with histopathologic heterogeneity, with the fibroinflammatory sub-cluster showing more histopathologic features of epidermal cGVHD and inflammation. Further study will help elucidate if these gene expression and histopathologic findings can be used to tailor treatment decisions. Multiple proteins encoded by highly-induced genes in the skin (SFRP4, SERPINE2, COMP) were also highly induced in the plasma of sclerotic cGVHD patients (n = 16) compared to control HSCT patients without sclerotic cGVHD (n = 17), suggesting these TGFb and Wnt pathway mediators as candidate blood biomarkers of disease.","PeriodicalId":501385,"journal":{"name":"medRxiv - Dermatology","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138522736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-07DOI: 10.1101/2022.11.05.22281951
Rahman Attar, Guillem Hurault, Zihao Wang, Ricardo Mokhtari, Kevin Pan, Bayanne Olabi, Eleanor Earp, Lloyd Steele, Hywel C. Williams, Reiko J. Tanaka
Assessing the severity of eczema in clinical research requires face-to-face skin examination by trained staff. Such approaches are resource-intensive for participants and staff, challenging during pandemics, and prone to inter- and intra-observer variation. Computer vision algorithms have been proposed to automate the assessment of eczema severity using digital camera images. However, they often require human intervention to detect eczema lesions and cannot automatically assess eczema severity from real-world images in an end-to-end pipeline.
{"title":"Reliable detection of eczema areas for fully automated assessment of eczema severity from digital camera images","authors":"Rahman Attar, Guillem Hurault, Zihao Wang, Ricardo Mokhtari, Kevin Pan, Bayanne Olabi, Eleanor Earp, Lloyd Steele, Hywel C. Williams, Reiko J. Tanaka","doi":"10.1101/2022.11.05.22281951","DOIUrl":"https://doi.org/10.1101/2022.11.05.22281951","url":null,"abstract":"Assessing the severity of eczema in clinical research requires face-to-face skin examination by trained staff. Such approaches are resource-intensive for participants and staff, challenging during pandemics, and prone to inter- and intra-observer variation. Computer vision algorithms have been proposed to automate the assessment of eczema severity using digital camera images. However, they often require human intervention to detect eczema lesions and cannot automatically assess eczema severity from real-world images in an end-to-end pipeline.","PeriodicalId":501385,"journal":{"name":"medRxiv - Dermatology","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138522461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Interest in image-guidance superficial radiation therapy (IGSRT) for the treatment of early-stage Non-Melanoma Skin Cancer (NMSC) has resurfaced given its low complication rates, superior cosmesis and local control and cure rates. Additionally, it has been recommended by the American Academy of Dermatology (AAD) for early-stage NMSC in patients who are considered poor surgical candidates. Methods: 1899 NMSC lesions were treated with energies ranging from 50 to 100 kilovoltage (kV), for a mean of 20.2 fractions, and treatment dose of 5364.4 centigray (cGy). Lesions were treated for a mean of 7.5 weeks and followed for 65.5 weeks. The Radiation Treatment Oncology Group (RTOG) toxicity scoring system was used to grade acute toxicities. Patients were followed after treatment completion until No Evidence of Disease (NED) was achieved or failure/recurrence. SAS studio was used to conduct Kaplan-Meier analysis to calculate local control rates and account for differences in follow-up intervals. A log-rank test was used to calculate statistical differences between histologies. Results: 95% of lesions received a RTOG grade of 1 or 2. Absolute lesion control was achieved in 99.7% of the patients after an average of 7.5 weeks of treatment, with a stable control rate of 99.6% when the follow-up duration was over 12 months. Conclusion: IGSRT has a high safety profile, can achieve superior cosmesis and should be considered first-line for treating early-stage NMSC tumors as cure rates have been shown to be effective in all NMSC on early follow-up.
{"title":"Analysis of Image-Guided Superficial Radiation Therapy (IGSRT) on the Treatment of Early Stage Non-Melanoma Skin Cancer (NMSC) in the Outpatient Dermatology Setting","authors":"Alison Tran, Mairead Moloney, Peter Kaczmarski, Songzhu Zheng, Alpesh Desai, Tejas Desai, Lio Yu","doi":"10.1101/2022.09.14.22279951","DOIUrl":"https://doi.org/10.1101/2022.09.14.22279951","url":null,"abstract":"Interest in image-guidance superficial radiation therapy (IGSRT) for the treatment of early-stage Non-Melanoma Skin Cancer (NMSC) has resurfaced given its low complication rates, superior cosmesis and local control and cure rates. Additionally, it has been recommended by the American Academy of Dermatology (AAD) for early-stage NMSC in patients who are considered poor surgical candidates.\u0000Methods: 1899 NMSC lesions were treated with energies ranging from 50 to 100 kilovoltage (kV), for a mean of 20.2 fractions, and treatment dose of 5364.4 centigray (cGy). Lesions were treated for a mean of 7.5 weeks and followed for 65.5 weeks. The Radiation Treatment Oncology Group (RTOG) toxicity scoring system was used to grade acute toxicities. Patients were followed after treatment completion until No Evidence of Disease (NED) was achieved or failure/recurrence. SAS studio was used to conduct Kaplan-Meier analysis to calculate local control rates and account for differences in follow-up intervals. A log-rank test was used to calculate statistical differences between histologies.\u0000Results: 95% of lesions received a RTOG grade of 1 or 2. Absolute lesion control was achieved in 99.7% of the patients after an average of 7.5 weeks of treatment, with a stable control rate of 99.6% when the follow-up duration was over 12 months. Conclusion: IGSRT has a high safety profile, can achieve superior cosmesis and should be considered first-line for treating early-stage NMSC tumors as cure rates have been shown to be effective in all NMSC on early follow-up.","PeriodicalId":501385,"journal":{"name":"medRxiv - Dermatology","volume":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138522734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-26DOI: 10.1101/2022.05.05.22274498
Sameer Gupta, Alexandra J Poret, David Hashemi, Amarachi Eseonu, Sherry H Yu, Jonathon D'Gama, Victor A Neel, Tami D Lieberman
Infections are relatively rare following cutaneous surgical procedures, despite the potential for wound exposure to pathogens both during surgery and throughout the healing process. Although gut commensals are believed to reduce the risk of intestinal infections, an analogous role for skin commensals has not been described. In fact, the microbiome of normally healing surgical skin wounds has not yet been profiled using culture-independent techniques. We characterized the wound microbiome in 53 patients who underwent skin cancer surgery and healed without signs or symptoms of infection. A week after surgery, several bacterial species displayed significant differences in relative abundance when compared to control, non-operated skin from the same patient. The most common bacteria found on intact skin, Cutibacterium acnes, was depleted in wounds 5-fold. Staphylococcus aureus, a frequent cause of postoperative skin infections, was enriched 6.4-fold in clinically non-infected wounds, suggesting active suppression of pathogenicity. Finally, members of the Corynebacterium genus were the dominant organism in postoperative wounds, making up 37% of the average wound microbiome. The enrichment of these bacteria in normally healing wounds suggests they might be capable of providing colonization resistance. Future studies focused on the biological and clinical significance of the wound microbiome may shed light on normal wound healing and potential therapeutic opportunities to mitigate infection risk.
{"title":"Cutaneous surgical wounds have distinct microbiomes from intact skin","authors":"Sameer Gupta, Alexandra J Poret, David Hashemi, Amarachi Eseonu, Sherry H Yu, Jonathon D'Gama, Victor A Neel, Tami D Lieberman","doi":"10.1101/2022.05.05.22274498","DOIUrl":"https://doi.org/10.1101/2022.05.05.22274498","url":null,"abstract":"Infections are relatively rare following cutaneous surgical procedures, despite the potential for wound exposure to pathogens both during surgery and throughout the healing process. Although gut commensals are believed to reduce the risk of intestinal infections, an analogous role for skin commensals has not been described. In fact, the microbiome of normally healing surgical skin wounds has not yet been profiled using culture-independent techniques. We characterized the wound microbiome in 53 patients who underwent skin cancer surgery and healed without signs or symptoms of infection. A week after surgery, several bacterial species displayed significant differences in relative abundance when compared to control, non-operated skin from the same patient. The most common bacteria found on intact skin, Cutibacterium acnes, was depleted in wounds 5-fold. Staphylococcus aureus, a frequent cause of postoperative skin infections, was enriched 6.4-fold in clinically non-infected wounds, suggesting active suppression of pathogenicity. Finally, members of the Corynebacterium genus were the dominant organism in postoperative wounds, making up 37% of the average wound microbiome. The enrichment of these bacteria in normally healing wounds suggests they might be capable of providing colonization resistance. Future studies focused on the biological and clinical significance of the wound microbiome may shed light on normal wound healing and potential therapeutic opportunities to mitigate infection risk.","PeriodicalId":501385,"journal":{"name":"medRxiv - Dermatology","volume":"92 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138522462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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