Acta dermato-venereologica最新文献

Dupilumab, the first biologic treatment approved for moderate to severe atopic dermatitis, has completely revolutionized the management of such disease allowing long-term control of its clinical signs and symptoms. Nevertheless, data regarding the safety and effectiveness profile of dupilumab in patients belonging to special populations are scarce. This observational, multicentric study analysed the effectiveness and safety profile of dupilumab over 3 years in the treatment of 70 patients with moderate to severe atopic dermatitis and associated comorbidities such as cancers, renal and liver failure, viral chronic infections, and degenerative and autoimmune neurological disorders. Patients achieved a significant improvement in both physician-assessed and patient-reported outcomes after 16 weeks of treatment, with a continuous therapeutic response maintained throughout the 156-week period. The safety profile was comparable to clinical trials and real-world data involving patients without significant comorbidities. In conclusion, the findings support the safety of dupilumab in managing severe atopic dermatitis in fragile patients.

Cutaneous basal cell carcinoma (BCC) is a primarily indolent tumour that is easily cured. However, locally advanced BCC (laBCC) and metastatic BCC can have a poor prognosis. This retrospective cohort study, conducted at a single cancer centre over a 32-year period, reports the characteristics and clinical course of 51 patients with laBCC or metastatic BCC. Thirty-five patients were men (69%), with a mean age of 72 years. Most primary BCCs were located in the head and neck (59%), and were treated with surgery (78%). Thirty-four patients had laBCC; 6 of those developed subsequent metastasis. Twenty-three metastatic BCCs were included. The median size of laBCC was 73 mm (IQR 110; range 15-400 mm), with 71% measuring 5 cm or larger. Tumour infiltration beyond the subcutaneous fat was present in 59% of laBCC and bone infiltration in 12%. Of laBCC, 44% experienced local recurrence after resection, which was seen in 35% of local tumours later developing metastasis. Median time to metastasis was 33 months. Most patients developed nodal metastases only (70%), but 26% developed distant metastases. Fifteen patients died during follow-up (29%). Three patients died of their laBCC with a 5-year disease-specific survival of 79%. Five-year disease-specific survival for metastatic BCC was 30%. Patients with laBCC in this cohort were at high risk of local recurrence and metastasis, and 12% died of their laBCC. These findings highlight the need for intensified follow-up for this relatively rare population, especially since Hedgehog inhibitors and PD1 inhibitors might be available for these patients.

Adjuvant treatment decisions in stage IIB/C melanoma require careful weighing of benefits and risks. Our aim was to investigate how dermato-oncologists in Germany prioritize efficacy, toxicity, and application mode of modern adjuvants in these stages. In a nationwide discrete choice experiment physicians evaluated hypothetical treatment scenarios that varied in recurrence risk, risk of severe adverse events, type of adverse events, and mode of administration. Two patient profiles were presented, including a 55-year-old healthy patient in stage IIB (P1) and an 83-year-old patient in stage IIC with comorbidity (P2). Physicians (n = 112) preferred adjuvant therapy to the opt-out option in 86.4% of scenarios for P1 and in 60.5% for P2. The risk of severe adverse events was considered most important for both patients and significantly more relevant for P2 (relative importance score (RIS) 53.6 vs 40.2, p < 0.001), while recurrence risk was more relevant for P1 (RIS 36.3 vs 21.8, p < 0.001). Immune-related adverse events were less acceptable than gastrointestinal symptoms or pyrexia. Infusions at longer intervals were favoured compared with oral therapies. In conclusion, dermato-oncologists prioritized safety over efficacy, particularly in the older, comorbid patient. These preferences should be reconciled with patients' preferences and treatment goals during shared decision-making.

Hydrochlorothiazide has been associated with increased cutaneous squamous cell carcinoma risk. Meanwhile, its association with basal cell carcinoma (BCC) risk is controversial. The association between commonly prescribed antihypertensive medications and BCC risk in the Swedish population was investigated. All cases with a histopathologically verified BCC in Sweden during 2007-2017 and 2 matched controls per case were included in this nationwide, registry-based, case-control study. Information on prescribed anti-hypertensive drugs, comorbidities, co-medications, and socioeconomic factors was retrieved from nationwide registries. The odds of being treated with any of the chosen treatments in relation to BCC diagnosis were estimated. In total, 133,539 cases and 257,849 controls were studied. Thiazide-containing combination treatments (OR 1.09), angiotensin II receptor blockers (OR 1.09), calcium channel blockers (OR 1.09), and beta-blockers (OR 1.07) were associated with an increased BCC risk. Use of single-agent thiazide treat-ment did not affect BCC risk. In conclusion, statistically significant associations were found between several commonly prescribed antihypertensives and an increased BCC risk. Thiazide treatment affected BCC risk only when given as combination treatment, indicating that relevant adjunctive substances should be studied further in relation to BCC risk. Presently, it is suggested that prevention efforts focus on UV protection rather than altering antihypertensive treatments.