Acta dermato-venereologica最新文献

Atopic dermatitis is a chronic inflammatory skin disorder influenced by genetic and environmental factors. A chromosome conformation capture study identified the cysteamine dioxygenase (ADO) gene as being associated with atopic dermatitis in differentiating keratinocytes. We aimed to evaluate the causal and pathophysiological roles of ADO in atopic dermatitis. This study utilized transcriptomic data and immunostaining techniques to analyse ADO expression. Human keratinocyte cell line (HaCat), and zebrafish models were employed to explore the functional role of ADO. RNA sequencing and immunostainings indicated higher ADO expression in lesional skin than in non-lesional skin in atopic dermatitis patients. Moreover, atopic dermatitis patients carrying the risk allele (C) exhibited increased levels of ADO in lesional skin. In vivo, zebrafish embryos with dysregulated ADO expression displayed impaired epidermal morphogenesis, particularly in their tails, along with increased neutrophil infiltration, indicating an inflammatory response. In vitro, alterations in ADO expression in HaCaT cells led to expression changes of proinflammatory cytokines and skin barrier markers. Further, both upregulation and downregulation of ADO were associated with enhanced reactive oxygen species production. These findings suggest that the ADO gene plays a critical role in maintaining skin homeostasis, and its dysregulation contributes to inflammation and compromised skin barrier function in the pathogenesis of atopic dermatitis.

Effective medical education relies on clearly defined learning objectives that foster deep and meaningful learning. This article presents a consensus-driven proposal for national learning objectives in dermatology and venereology within Sweden's new medical programme qualifying for licensure. The primary aim is to harmonize educational standards across all medical faculties and to establish a common understanding of the expected level of knowledge and competence at the point of medical licensure. Using a structured approach, existing curricula were analysed and categorized according to a modified version of Bloom's taxonomy. The initial list of objectives and core conditions was then expanded through input from invited educators at all participating medical faculties as well as practising GPs. One designated assessor from each institution independently reviewed the expanded material to determine the expected knowledge level for each condition and to assess whether any items fell outside the intended scope. This process resulted in the identification of 36 learning objectives, along with a list of 124 core diagnoses and/or medications. The learning objectives encompass knowledge, practical skills, and professional attitudes in the management of dermatological and sexually transmitted diseases. The next step is to implement them with the aim of evaluating their impact on dermatology and venereology education. In this future work, student involvement should be prioritized to ensure a learner-centred approach throughout the process.

Propranolol at 3 mg/kg/day is considered the gold standard for treating infantile haemangiomas. Nevertheless, the management of propranolol-resistant infantile haemangiomas (PRIH) remains challenging. This national multicentre retrospective observational study includes all PRIHs who received propranolol > 3 mg/kg/day. The study aims to investigate the pattern of PRIHs, assess the effects and tolerance of a higher dose, and identify predictive factors for response to this increased dosage. Fifteen PRIHs were included (prevalence 0.45%), mainly females, and most presented with a large lesion. Three distinct patterns of PRIH were identified: facial segmental lesions (47%), facial localized lesions with a subcutaneous component (40%), and body-localized mixed and ulcerated lesions (13%). Six PRIH (40%) responded to the higher dose (from 3.75 to 4 mg/kg/day). Three predictive factors were significantly associated with a good response: IGIc-IH1 at the end of 3 mg/kg/day regimen (OR = 22.9, 95% CI [1.2-1844.1]), a duration of 3.5 months or more at 3 mg/kg/day (OR = 17.5, 95% CI [1.22-250.37]), and 7 months or more at > 3 mg/kg/day (OR = 17.5, 95% CI [1.22-250.37]). Tolerance was generally good, although one patient experienced severe hypotension during dose escalation. Propranolol doses higher than 3 mg/kg/day may therefore be considered a potential treatment option for PRIHs.

Perioperative immune-checkpoint inhibition (ICI) using pembrolizumab (3 doses of pembrolizumab 200 mg every 3 weeks before surgery and 15 doses afterwards) in advanced resectable melanoma has shown substantial pathological response rates and improved event-free survival (EFS) compared to postoperative (adjuvant) ICI. Real-world evidence on efficacy and safety of perioperative ICI in melanoma remains limited. In this retrospective single-centre study, 20 patients with resectable stage IIIB–IV melanoma were treated with perioperative pembrolizumab. Radiological and pathological responses, early survival outcomes and treatment-related adverse events were analysed at a median follow-up of 13.9 months. Eighteen patients (18/20) underwent surgery. A pathological complete response was observed in 44% (8/18), while 56% (10/18) showed a pathological non-response. No patient (0/18) had a pathological partial response. One-year EFS was 66.5% (95% confidence interval (CI) 47.3-93.3), 1-year relapse-free survival 77.6% (95% CI 57.9-100) and 1-year overall survival 89.2% (95% CI 76.0-100, identical with 1-year melanoma-specific survival). Immune-related adverse events occurred in 50% of the patients (≥grade 3 in 15%). Our study confirms the feasibility of perioperative pembrolizumab in a real-world setting and shows promising efficacy and tolerability in melanoma. Pathological response may guide surgical and adjuvant strategies.