Acta dermato-venereologica最新文献

Due to the risk of scarring and the psychological impact on affected patients, folliculitis decalvans (FD) requires prompt and focused care to control inflammation and prevent disease progression. This study aimed to provide a comprehensive long-term evaluation of treatment outcomes in difficult-to-treat cases of FD by analysing the effectiveness of various therapies and identifying reasons for treatment switches or discontinuation. The single-centre, retrospective cohort study collected information on patient characteristics and management strategies, focusing on different treatment groups and reasons for discontinuation or switching. Eighteen patients with biopsy-confirmed FD were included in the study because of their recalcitrant course (38.9% females, median age 33.0 years), with a median follow-up period of 1.5 years. During the study period, all patients received at least one pre-scription for topical therapies, primarily non-antibiotic disinfectants, topical corticosteroids, topical antibiotics, and topical dapsone. Systemic antibiotics were prescribed for 88.9% of patients, predominantly tetra-cyclines and a combination of rifampicin and clindamycin. Non-biological systemic therapies, excluding steroids, were used in 61.1% of patients, with isotretinoin being the most common (27.8%). Among immunomodulatory drugs, apremilast was prescribed to 11.1% of patients. Overall, the highest treatment discontinuation rates were observed with systemic antibiotics (risk ratio: 1.63; 95% confidence interval: 1.46-1.82), followed by systemic steroids. The treatment of patients with severe FD requires a personalized, multifaceted approach, typically involving a combination of local and systemic therapies. Antibiotics are often used as a first-line treatment, but they are associated with a high rate of discontinuation. This highlights the urgent need for effective immunomodulatory treatments, either as alternatives or as adjuncts to current options.

Chronic pruritus is a burdensome condition that frequently affects older adults, yet its epidemiology and impact on quality of life in the ageing population remain underexplored. This cross-sectional study examined the prevalence of chronic pruritus, its associated factors, and pruritus-specific quality of life in 4,474 participants (median age: 72 years; range: 48-99, 58.8% female) from the population-based Rotterdam Study. Questionnaires assessed current, 12-month, and lifetime chronic pruritus, along with the ItchyQoL. Multivariable logistic regression identified factors associated with chronic pruritus, and linear regression assessed factors linked to pruritus-specific quality of life. Principal component analysis explored the ItchyQoL's dimensional structure in this older population. Chronic pruritus prevalence was 8.6% (current), 10.5% (12-month), and 18.6% (lifetime). Female sex, older age, smoking, atopic dermatitis, psoriasis, self-reported dry skin, asthma, steatotic liver disease, polyneuropathy, depressive symptoms, anxiety, and poor sleep were associated with higher odds of chronic pruritus. Among those with current chronic pruritus, pruritus-specific quality of life was moderately impaired, with the greatest impairment associated with atopic dermatitis and psychological symptoms. Principal component analysis identified 4 ItchyQoL dimensions, extending beyond the original 3 domains. Given the cross-sectional design, directionality cannot be inferred. These findings highlight chronic pruritus as a prevalent, multifactorial condition in older adults, with significant psychological impact and implications for multidisciplinary management.

Increasing life expectancy will lead to more elderly people with atopic dermatitis; however, analyses of the impact of atopic dermatitis therapy on the elderly are lacking. This prospective, multicentre observational study assessed the effect of treatment choice on the efficacy of atopic dermatitis therapies in patients with atopic dermatitis aged ≥ 65 years vs < 65 years in France. Clinical endpoints assessed included changes in Eczema Area and Severity Index scores, atopic dermatitis-related hospitalizations, and quality of life. Between December 2020 and October 2024, 679 patients were included in the study (≥65 years: n = 83; < 65 years: n = 596). At baseline, most patients had moderate/severe atopic dermatitis. Biological therapy was the most common treatment initiated at the enrollment visit (≥ 65 years: 72.3%; < 65 years: 54.0%). At 12 months, the mean Eczema Area and Severity Index score decreased similarly in both groups (p = 0.845), from 17.6 ±9.6 to 3.7 ± 5.2 for patients aged ≥ 65 years and from 18.4 ±12.3 to 4.3 ± 5.5 for those aged < 65 years. The reduction in number of atopic dermatitis-related hospitalizations was significant and similar in both groups, and quality of life improved across all areas. Overall, results suggest that therapeutic choices made by dermatologists have a positive impact on elderly patients with atopic dermatitis.

Teledermatology has become increasingly relevant for skin cancer diagnosis, particularly following the COVID-19 pandemic. This retrospective study assessed whether teledermatology enables earlier diagnosis of cutaneous squamous cell carcinoma (cSCC) compared with conventional face-to-face consultation. Clinical and histopathological data from 224 patients (101 in 2019; 123 in 2022) were analysed. Referral delays decreased from 55 to 3 days and surgical wait times from 28.7 to 12.3 days. Tumours diagnosed via teledermatology had significantly smaller minor diameters (0.56 ± 0.3 cm vs 1.09 ± 0.5 cm; p < 0.001). Al-though maximum diameter and tumour depth did not differ significantly, the smaller tumour surface area in the teledermatology group suggests diagnosis at an earlier clinical stage. In multivariate analysis, minor diameter was the strongest independent predictor of teledermatology-based diagnosis (OR = 0.01, 95% CI: 0.001-0.02). These findings suggest that teledermatology facilitates earlier diagnosis of cSCC, allowing timely treatment and potentially reducing the need for extensive surgical procedures. Teledermatology should be considered a valuable triage tool for skin cancer detection, particularly in health systems with limited access to dermatological care.