Acta dermato-venereologica最新文献

Topical steroid withdrawal (TSW) is described as an adverse reaction to topical glucocorticoids (TGCs). A pathophysiological mechanism has not been identified. There are no diagnostic criteria. The aim was to describe patient-reported characteristics of TSW in atopic dermatitis (AD). An observational cross-sectional study was performed by posting a questionnaire for participants, aged ≥18 years, reporting both AD and TSW, in a Swedish TSW-themed Facebook group during 4 weeks in 2023. The questionnaire was accessed by 98 participants, with 82 completing it. Most were female (95%), 18-39 years old (74%), self-diagnosed with TSW (84%), and reported current symptoms of AD and TSW. They defined TSW as dependency on TGCs and adverse reactions to their use. Erythema, desquamation, dryness, and oozing affecting the face, neck, and upper extremities were the most reported signs. Pruritus, sleep disturbance, and signs of anxiety and depression were the most reported symptoms. Recurring episodes of manifestations attributed to TSW were reported by 60%. The personal trigger factor was believed to be TGCs by 93%, and 33% also identified oral glucocorticoids. TGCs were currently used by 21%. Self-reported manifestations of TSW are similar to those of AD but appeared to be distinguishable for the participants and caused considerable morbidity.

Recent cohort studies suggest a potential association between atopic dermatitis and dementia, though the evidence remains conflicting. This study aims to elucidate the association between atopic dermatitis and dementia employing systematic review, meta-analysis, and Mendelian randomization (MR). A comprehensive search was performed to select eligible cohort studies using Medline, Embase, Scopus, ScienceDirect, and the Web of Science database. In MR analysis, genomic data from the Genome Wide Association Study (GWAS) (864,982 European individuals) for atopic dermatitis cases and dementia cases were obtained from the MRBase. Statistical analyses included the inverse-variance weighted (IVW) method, sensitivity tests, and MR-PRESSO for outliers. The adjustment accounted for various factors, including sex, age, smoking status, and other medical comorbidities, along with several additional variables. In the systematic review and meta-analysis, 5 longitudinal cohort studies (12,576,235 participants) indicated a significant association between atopic dermatitis and all-cause dementia (adjusted hazard ratio: 1.15, 95% CI: 1.07-1.23). Subgroup analyses revealed an adjusted hazard ratio of 1.18 (95% CI: 1.08-1.27) for Alzheimer's disease in patients with atopic dermatitis, and an adjusted hazard ratio of 1.37 (95% CI: 1.21-1.55) for all-cause dementia in patients with moderate-to-severe atopic dermatitis. However, MR analysis showed no significant causal link between atopic dermatitis and dementia, Alzheimer's disease, vascular dementia, or cognitive performance. While the meta-analysis revealed a significant association, MR analysis did not substantiate a significant causal link. Future research should consider demographic variables and medication influences in unravelling the intricate atopic dermatitis-dementia interplay.

This study investigates serum cell-free DNA fluctuations in patients with herpes zoster or post-herpetic neuralgia, offering insight into the tissue damage and inflammatory dynamics associated with these conditions. A single-centre combined cross-sectional and longitudinal study was conducted with 59 patients to assess cell-free DNA levels in herpes zoster and post-herpetic neuralgia. Cell-free DNA was extracted from blood samples of patients with herpes zoster or post-herpetic neuralgia and compared with healthy controls. The findings demonstrated elevated cell-free DNA levels in patients with herpes zoster, which remained elevated for 3 months or longer following treat-ment. These results suggest the presence of a subacute inflammatory state after herpes zoster infection. Furthermore, patients who developed post-herpetic neuralgia did not show elevated cell-free DNA levels, while those who did not develop post-herpetic neuralgia exhibited increased levels. This indicates that post-herpetic neuralgia is likely a localized response to prior nerve damage rather than a systemic inflammatory process with acute tissue damage.

Pemphigus vulgaris is a chronic autoimmune blistering disease with significant morbidity. Rituximab, approved as its first-line treatment, effectively induces remission. However, few studies have analysed the prognostic factors for improved rituximab outcomes. Therefore, this study aimed to identify such factors in a cohort of pemphigus vulgaris patients. A total of 142 pemphigus vulgaris patients treated with rituximab at Sheba Medical Center, with data encompassing demographics, comorbidities, disease characteristics, and treatment outcomes, were retrospectively examined. Results showed that 61.9% of patients previously treated with mycophenolate mofetil achieved partial remission, whereas only 34.7% achieved complete remission. Patients with diabetes mellitus exhibited a significantly shorter median time to relapse compared with those without. Patients with a disease duration ≤ 16 months before rituximab therapy exhibited a shorter median time to relapse. Moreover, previous dapsone treatment extended time to relapse. Notably, sex, age at symptom onset and rituximab therapy, ethnicity, comorbidities, skin involvement, weight, rituximab dosing protocol, and other variables were not statistically significant between the complete remission and partial remission groups. These findings highlight the influence of specific patient characteristics and treatment histories on response to rituximab and time to relapse in pemphigus vulgaris patients. Understanding these factors can aid clinicians in predicting treatment outcomes and selecting the appropriate patient population for rituximab therapy.

Pregnancy-associated changes in melanocytic nevi (MN), apart from size increase on the trunk, remain a topic of debate. We conducted the first prospective study to investigate dermoscopic changes in MN comparing pregnant with non-pregnant women on all body parts using a market-approved convolutional neural network (CNN). We included 25 pregnant and 25 non-pregnant women from Basel, Switzerland, who underwent standard skin cancer screenings and whose MN > 2 mm were digitally recorded and analysed by a CNN. Pregnant women were examined three times: in the first and third trimester and 8-12 weeks postpartum; non-pregnant women twice in an interval of 17-21 weeks. We analysed 2,799 MN. In pregnant women, diameter[p < 0.001], area[p < 0.001], number of colours [p = 0.009], shape asymmetry[p = 0.005] and border sharpness[p = 0.006] (inversely proportional value) increased while ellipseness [p < 0.001] decreased from first trimester to postpartum. Changes occurred mainly during the third trimester to postpartum. Compared to non-pregnant women (only first to third trimester) MN on the upper extremities of pregnant women increased in area[p = 0.011] and diameter[p = 0.025] and decreased in ellipseness[p = 0.037]. MN on the lower extremities increased in area[p = 0.044] and MN on the back increased in colour asymmetry[p = 0.022].

The comorbidity cycle between psoriasis and addictions remains unclear. The study aimed to investigate the cumulative incidence of addictions in psoriasis patients and controls in the Stockholm Psoriasis Cohort (SPC). The SPC is an observational cohort study that enrolled psoriasis patients between 2001 and 2005 and matched controls using the Swedish Total Population Register. Data were complemented by medical records from 1987-2013, focusing on 11 addiction diagnoses and the date of their assignment. Overall, 4,545 individuals (56.4% female; median age: 40) were included: 722 psoriasis patients and 3,823 controls. Patients showed 1.4 times (95% confidence interval: 0.98-1.98) higher odds of addiction diagnosis than controls. Alcohol dependency was the most common addiction diagnosis (78.2%), which was more frequent in patients than in controls (94.3% vs 73.6%, p = 0.009). Furthermore, patients showed 4.3 times (1.85-11.56) higher odds of receiving an addiction diagnosis after their initial psoriasis diagnosis than before. Results showed a tendency towards a higher risk of addiction in psoriasis patients, suggesting potential psoriasis-triggered addictive behaviour. Nevertheless, both substance abuse triggering psoriasis and chronic psoriasis inflammation triggering addictions have to be considered. In both cases, addictive behaviour needs to be addressed in psoriasis healthcare as a driver for poor disease outcome and comorbidities.

Cutaneous immune-related adverse events (cirAEs) may be associated with tumoral response and survival in patients using immune checkpoint inhibitors, but this relationship remains unclear because previous reports on the topic have various limitations. The purpose of this study was to examine the association of cirAEs with overall survival and progression-free survival in patients starting immune checkpoint inhibitors. A prospective observational study was conducted in a Spanish tertiary care hospital, including participants between March 2020 and May 2022. The statistical analysis involved the Kaplan-Meier method, log-rank test, and multivariable Cox proportional hazards regression models. At total of 189 patients were included, of whom 82 (43.4%) presented cirAEs. Most participants (56.6%) were diagnosed with non-small cell lung cancer (NSCLC). Mortality and progression rates were lower in patients with vs without cirAEs (p < 0.0001). Cox models showed that cirAEs were a protective factor for overall survival (adjusted HR 0.50; p < 0.0001) and progression-free survival (adjusted HR 0.54; p = 0.001) independently of cancer type, tumour stage or immune checkpoint inhibitor category. There were similar results for extracutaneous irAEs. A limitation was the single-centre design. CirAE occurrence is positively associated with longer survival and less cancer progression among immune checkpoint inhibitor recipients independently of other factors.