Skin health and disease最新文献

Background: Bullous pemphigoid (BP) is a chronic, autoimmune, blistering disorder that predominantly affects older adults and is associated with significant morbidity and treatment challenges. The British Association of Dermatologists (BAD) clinical guideline for managing people with BP was published in 2012; a national clinical audit was undertaken in 2018. This 2024 reaudit evaluates changes in clinical practice, including diagnostic methods, treatment strategies and documentation standards.

Objectives: To reassess compliance with BAD audit standards, compare findings with the 2018 audit and identify trends in BP management.

Methods: Over 9 weeks in 2024, BAD members submitted data for 450 cases of BP from 77 centres across the UK. Audit standards included documentation of comorbidities, osteoporosis risk management, patient satisfaction and systemic treatment monitoring.

Results: The reaudit identified a shift in diagnostic practices, an increased proportion of severe baseline disease and continued gaps in -osteoporosis risk documentation. The use of doxycycline as a primary treatment has increased significantly since 2018.

Conclusions: The findings highlight both progress and persistent challenges in BP management. Improved documentation and greater adherence to osteoporosis management guidelines remain priorities for future practice.

Background: Chronic idiopathic urticaria (CIU) is a debilitating condition characterized by recurrent hives, itching and angioedema lasting for more than 6 weeks without an identifiable cause. It significantly impacts quality of life, causing physical discomfort and emotional distress. CIU's complex pathophysiology involves immune interactions, mast cells and histamine release, with aeroallergens potentially exacerbating symptoms in sensitized patients. Current treatments primarily involve antihistamines, but many patients experience inadequate relief, prompting the exploration of alternative therapies. Intranasal corticosteroids, typically used for allergic rhinitis, may offer potential benefits for CIU, although evidence of their efficacy is limited.

Objectives: To investigate the effect of intranasal corticosteroids in adults with CIU who had a positive skin prick test for aeroallergens.

Methods: In this double-blind placebo-controlled trial, 69 adults with CIU sensitized to aeroallergens received budesonide 32 µg per actuation, 2 sprays per nostril twice daily or identical placebo for 6 months while maintained on a stable single-agent nonsedating H1 antihistamine. Participants were randomly assigned to receive either budesonide or placebo. Outcomes included changes in urticaria symptoms and Urticaria Severity Score and quality of life. The study was registered with the Iranian Registry of Clinical Trials (IRCT 20231229060563N1).

Results: At baseline, both groups were comparable. Post-treatment, participants in the corticosteroid group showed a greater reduction in Urticaria Activity Score (mean difference = 4.25, P = 0.02). No significant difference was found in chronic urticaria quality of life questionnaire scores (mean difference = 4.74, P = 0.35).

Conclusions: Intranasal corticosteroids were effective in reducing urticaria symptoms but did not offer significant benefits over placebo with regard to overall quality of life. The results highlight the complexity of CIU management and suggest a potential placebo effect.

Background: Acne is a common inflammatory dermatological condition that can have detrimental psychological consequences due to its visible lesions and scarring. Recent studies suggest a potential role of gut microbiota in acne development; however, the evidence remains inconclusive and might be subject to various confounders.

Objectives: To investigate the causal relationship between gut microbiota and acne.

Methods: This study investigated the causal relationship between gut microbiota and acne using a two-sample Mendelian randomization (MR) approach with large-scale genome-wide association study summary statistics. To ascertain the direction of causality and the independent effect of gut microbiota, reverse MR and multivariable MR accounting for dietary phenotypes were performed.

Results: Higher abundances of the Actinobacteria phylum and class, Bifidobacteriales order, Bifidobacteriaceae family and Bifidobacterium -genus were associated with a reduced risk of acne [odds ratios (ORs) ranging from 0.54 to 0.63]. In contrast, higher levels of the Gastranaerophilales order, Streptococcaceae family and Streptococcus genus were positively associated with an increased risk of acne (OR 1.12-1.36). Notably, associations for Bifidobacterium and its upstream taxa remained robust even after accounting for dietary factors.

Conclusions: These findings provide further evidence of a causal relationship between gut microbial composition and acne, highlighting the role of gut microbiota in developing more targeted and possibly less harmful alternatives to current acne management strategies.

Background: A wide variation of phenotypes is displayed by individuals with alopecia areata (AA), especially in the paediatric population.

Objectives: To systematically search published studies to identify paediatric syndromes with AA and their clinical features, and to summarize the current state of their genetic elucidation.

Methods: In accordance with the PRISMA guidelines, a systematic search of MEDLINE, Embase, CENTRAL and PubMed databases was performed. All original case reports, case series and observational studies describing AA in children (aged <18 years) with monogenic or chromosomal syndromes were included. Further searches in OMIM and Orphanet, and reviews, clinical guidelines and basic science studies were used to retrieve additional comprehensive information on each syndrome.

Results: After title and abstract screening of 1426 studies, and full-text review of 224 studies, 64 met the inclusion criteria and are summarized in this review. Overall, the search identified 33 genetic syndromes with paediatric AA. Prevalence estimates were available for 79% (n = 26/33) of syndromes, with 45% (n = 15/33) of syndromes presenting in fewer than 1/1 000 000 individuals. Sixty-seven per cent (n = 22/33) of syndromes were fully genetically elucidated; 12% (n = 4/33) were partially elucidated; 9% (n = 3/33) were not genetically elucidated; and 12% (n = 4/33) were syndromes with chromosomal abnormalities. Seventy-nine per cent (n = 26/33) of syndromes were described by only one report, while 21% (n = 7/33) were described in multiple independent reports.

Conclusions: Despite the limited knowledge of these syndromes, this review provides insights into the range of genetic syndromes with paediatric AA and their clinical features, facilitating early prediction, diagnosis and personalized treatments.

A 25-year-old breastfeeding woman from rural India presented with a 2-month history of intense scalp pruritus, formication and fever. Examination revealed a severe Pediculus humanus capitis infestation involving her scalp, face and religious headscarf, with extensive live lice, nits, pustules, excoriations, crusted papules and dermatopathic lymphadenopathy. Treatment with permethrin 1% lotion and weekly oral ivermectin for 4 weeks, in conjunction with broad-spectrum antibiotics and supportive care, resulted in near-complete eradication. This case represents one of the most severe presentations of pediculosis capitis documented, demonstrating how cultural practices can impede early detection and complicate management.

Woolly hair is an uncommon disorder of the hair shaft, characterized by tightly coiled scalp hair often accompanied by varying grades of hypotrichosis. Woolly hair involving the entire scalp can be syndromic when associated with various anomalies involving the heart, nervous system, liver, gastrointestinal organs and so on, and is designated as nonsyndromic when it occurs in isolation without any systemic involvement. Nonsyndromic woolly hair can be autosomal dominant or autosomal recessive. We hereby present a series of eight cases of autosomal recessive woolly hair (ARWH) seen in an Indian population in the last 12 years. Their clinical presentation, hair characteristics and response to treatment is described.

Histoid leprosy (HL) is a very rare and highly infectious variant of lepromatous leprosy, presenting as skin-coloured, succulent nodules and plaques on apparently healthy skin. It is histologically characterized by a dense bundle of histiocytes arranged in storiform manner. Usually, it occurs in patients with leprosy who relapse after dapsone monotherapy or inadequate antileprotic treatment; it can even arise de novo. We present a case of umbilicated presentation in a patient with a case of relapse HL, even after adequate treatment with multibacillary multidrug therapy for 12 months. Although rare, the higher load of lepra bacilli in these cases makes it a matter of concern, and challenging for leprologists to make early diagnosis and treatment.

The British Association of Dermatology (BAD) has gone to notable efforts to ensure adequate representation of darker skin tones within its journal. The Association has frequently highlighted the lack of awareness of presentations of hair, skin and nail pathologies in minority groups, and the contents of its journals - British Journal of Dermatology, Clinical and Experimental Dermatology and Skin Health and Disease - are representative of the significant work it has done to enhance physician awareness of darker skin tone pathologies. We explored the role of a front page of a medical journal. Our qualitative analysis of journal covers suggests front cover representation to be an ample opportunity for the BAD to continue to promote darker skin tone pathology awareness.

Social media platforms, particularly TikTok, are increasingly used by adolescents for skincare advice. However, much of the content lacks medical accuracy and may delay appropriate treatment. We report two adolescent boys with severe nodulocystic acne who postponed dermatology care while following influencer-promoted routines. In both cases, the disease progressed to a highly inflammatory state, prompting the use of systemic corticosteroids before starting isotretinoin. The first patient, aged 16 years, presented with painful nodules after months of self-treatment; a short course of oral prednisone and antibiotics was followed by isotretinoin, with a good response. The second patient, aged 15 years, experienced similar progression and was also pretreated with oral steroids before isotretinoin initiation. Both achieved clinical improvement. These cases highlight the therapeutic consequences of digital misinformation and the role of corticosteroids as effective bridging therapy. They underscore the importance of early dermatology intervention and the need for evidence-based communication in online health spaces.

Background: Generalized pustular psoriasis (GPP) is a chronic and potentially life-threatening inflammatory disease characterized by recurrent, sudden flares often accompanied by systemic symptoms. With the introduction of new, targeted therapies for GPP there is an increased need to better understand patient characteristics to improve disease management.

Objectives: To assess the epidemiology of GPP, and compare clinical characteristics, treatments and overall survival between GPP and population-based controls and control participants with psoriasis vulgaris. Furthermore, flare occurrence and risk factors for flares were also assessed.

Methods: All Finnish patients with ≥1 GPP diagnosis (International Classification of Diseases, Tenth Revision: L40.1) in secondary healthcare between 1996 and 2021 and age- and sex-matched control groups were identified. Data on diagnoses, medications and deaths were collected from national registers. Incidence and prevalence were assessed using different case criteria. The primary analysis group included patients with ≥2 GPP diagnoses at a dermatology clinic in specialty care.

Results: GPP period prevalence decreased from 9.9 to 4.7 and the incidence rate from 4.2 to 2.1 per 100 000 when using stricter case criteria. Psoriasis (73%) and hypertension (49%) were the most common comorbidities among patients with GPP, and topical corticosteroids were the most used medication (92%; P < 0.05 vs. control groups). Overall survival was lower in GPP compared with both control groups (P < 0.001). In total, 43% of the patients experienced a flare during follow-up, of which one-third (33%) had a flare at the time of first GPP diagnosis. Systemic corticosteroid use [hazard ratio (HR) 1.41; 95% confidence interval (CI) 1.10-1.81; P = 0.007] was associated with a higher risk of GPP flares and flares were associated with an increased risk of death (HR 1.7; 95% CI 1.08-2.60; P < 0.05).

Conclusions: The epidemiology of GPP in Finland was found to be comparable to previously published estimates and associated with a high disease burden and shorter overall survival. Flares occurred frequently during follow-up and are associated with an increased risk of death. Standardized guidelines are crucial to improve the timely diagnosis and management of the disease.