Indian Journal of Dermatology Venereology & Leprology最新文献

Background Granulomatous skin lesions pose a diagnostic challenge due to overlapping clinical and histopathological features. Objectives To describe the clinical and histopathological features of facial granulomatous lesions and their clinical mimics, and evaluate the utility of clinico-pathological correlation in making the final diagnosis. Methods This was a cross-sectional study including 77 patients with clinically suspected granulomatous skin lesions on the face. Diagnosis was based on clinico-pathological features, and where required, ancillary investigations and/or therapeutic trial. Clinico-pathological correlation was classified as concordant, discordant, or non-contributory. Results A definitive diagnosis could be made in 70 (91%) cases - 58 (75%) based on clinico-pathological correlation and 12 (16%) on additional ancillary investigations and/or therapeutic trial, while 7 (9%) cases remained undiagnosed. The 70 diagnosed cases included 60 (86%) granulomatous and 10 (14%) non-granulomatous dermatoses. Orofacial granulomatosis (n=25), leprosy (n=15), and sarcoidosis (n=10) accounted for >80% of granulomatous lesions, while pseudolymphoma and lupus erythematosus (4 cases each) were the most common non-granulomatous diseases. Histopathology was concordant with clinical diagnosis in 57 (74%) cases, discordant in 8 (10%) cases, and non-contributory in 12 (16%) cases. In cases with two or more clinical differential diagnoses (n=35), histopathology aided the diagnostic decision process in 20 (57%) cases. Clinically, swellings and lip involvement favoured granulomatous lesions, while follicular plugging and nose involvement were more common in non-granulomatous lesions. Among granulomatous lesions, macules, plaques, and large (>5 cm) plaques, scaling, and forehead and nose/peri-nasal area involvement were more common in the infectious group, while swelling and lip involvement were more common in the non-infectious group (p<0.05). Limitations A relatively small number of non-granulomatous and some granulomatous dermatoses Conclusion Granulomatous skin lesions on the face can be a diagnostic dilemma with varied clinical morphologies and histological patterns. A small subset remains undiagnosed despite comprehensive evaluation. Though not definitive in all cases, histopathology remains a valuable diagnostic tool, particularly in clinically challenging cases. Diagnostic yield can be increased by integrating ancillary investigations and therapeutic trial.

Background The spectrum of cutaneous immune-related adverse events (cirAEs) has been described, and the occurrence of cirAEs may be associated with improved survival. However, the accuracy of these findings is limited by inconsistent classification. Aim This study was designed to determine the type, incidence, and timing of cirAEs and their impacts on survival in cancer patients treated with atezolizumab by using the Medical Dictionary for Regulatory Activities (MedDRA) classification. Methods The Vivli platform was used to search for randomised controlled trials (RCTs) on atezolizumab. Patients with individual patient data (IPD) were enrolled in the study. Both 1-stage pooled analysis and 2-stage meta-analysis were used to estimate the survival outcomes of the occurrence of cirAEs during atezolizumab therapy, as well as their types, incidences, and timing. Results Fifteen RCTs having IPDs of 5870 patients were enrolled in this study. The incidence was 27.5% in this study, with rash/eruption/exanthem (83.9%) being the most frequent cirAEs. The earliest types to occur were alopecia. The occurrence of cirAE was an independent protective factor for both overall survival (OS, hazard ratio [HR]=0.40-0.72) and progression-free survival (PFS, HR=0.52-0.84). However, with respect to specific types, urticaria, erythema, alopecia, etc. were found to be independent protective factors for OS, whereas dry skin, purpura, dermatitis/eczema, etc. were found to be independent protective factors for PFS. Regarding the impact of management and outcomes, cirAE following medical treatment was an independent protective factor for both OS (HR=0.731, 0.622-0.859, P<0.001) and PFS (HR=0.785, 0.699-0.881, P<0.001). Limitations No patients treated with Programmed Death-1 (PD-1) or Cytotoxic T-Lymphocyte associated Antigen 4 (CTLA-4) agonists were enrolled. Conclusions Atezolizumab-induced cirAEs cover almost all types of dermatological diseases, with varied timing and severity. CirAEs, in general, are linked to improved treatment responses, but different types have different prognostic significance. The treatment of cirAE could influence cancer survival, suggesting the necessity of active management of cirAEs during atezolizumab therapy.