Skin health and disease最新文献

Langerhans cell histiocytosis (LCH) is a neoplasm originating from immature haematopoietic myeloid precursor cells. It may uncommonly present with congenital ulcers. We report a case of a neonate admitted with a fever and a purulent congenital ulcer at the base of the neck, who, in the investigations, was diagnosed with LCH. This case highlights the importance of considering LCH in persistent, treatment-resistant cutaneous lesions in neonates and the necessity for biopsy and continuous monitoring.

We report the case of a 32-year-old woman with severe psoriasis, psoriatic arthritis (PsA) and systemic lupus erythematosus (SLE), including lupus nephritis. Despite effective control of her SLE and PsA with hydroxychloroquine, mycophenolate mofetil (MMF) and belimumab, her psoriatic skin manifestations worsened over time. The differing therapeutic responses of these two autoimmune diseases are rooted in their distinct pathogenesis: SLE treatments target B cells, autoantibodies and interferon signalling, while psoriasis requires therapies inhibiting the interleukin (IL)-23/IL-17 axis or tumour necrosis factor-α to address cutaneous inflammation and keratinocyte proliferation. There is limited evidence suggesting that MMF may suppress joint inflammation in PsA, but it does not effectively control psoriatic skin manifestations. Given the negative impact on her quality of life, deucravacitinib, a selective tyrosine kinase 2 inhibitor, was initiated at the approved dose of 6 mg daily. To avoid overimmunosuppression, belimumab was halted. Within 3 months, the patient's Psoriasis Area and Severity Index (PASI) improved from 23 to 1.2, body surface area from 70% to 2% and Dermatology Life Quality Index (DLQI) from 15 to 2, with no joint pain and no SLE flare-ups. After 6 and 9 months, her skin manifestations remained in remission (PASI 1.2 and PASI 0, respectively), DLQI was 0 and joint symptoms remained fully controlled. No significant side effects or infections were observed. These findings suggest deucravacitinib may offer an effective treatment alternative for patients with overlapping autoimmune diseases, without compromising SLE control or increasing infection risk.

A 49-year-old man presented with a slowly growing, pruritic erythematous scaly plaque on his left arm. Histopathology and immunohistochemistry confirmed extraocular sebaceous carcinoma (EOSC), and the patient underwent wide local excision with clear margins. This case highlights the importance of considering EOSC in the differential diagnosis of persistent eczematous lesions.

[This corrects the article DOI: 10.1093/skinhd/vzaf051.].

Background: Epidemiological studies of atopic dermatitis lack standardization in key areas, including how the burden is collected and reported, diagnostic criteria, sociodemographic factors and measurement of disease severity. Therefore, direct cross-study comparisons, recognition of population differences and pooled analyses are challenging or not possible. Consequently, the burden of atopic dermatitis remains difficult to assess and address. The Epidemiological Study Designs for Atopic Dermatitis Research (EPISTAR) initiative aims to reach consensus on which domain items should be recommended for future population-based epidemiological studies on atopic dermatitis and how they should be assessed.

Methods: In phase 1, a steering group consisting of experts from dermatology and epidemiology as well as patient representatives will generate an initial list of items constituting key variables to measure. This list will be created by reviewing the existing literature, prioritizing evidence from systematic reviews where available. Phase 2 will include an international consensus exercise, conducted through eDelphi methodology. Phase 3 will involve an online consensus conference. In each Delphi round, international participants from diverse stakeholder groups will be invited to assess each item by rating their level of agreement with the item and methods by which it can be measured. Items that reach consensus will be removed after each round. Data analysis will follow predefined consensus criteria, with raw numbers, means and frequencies reported.

Discussion: This harmonized approach has the potential to transform the field of atopic dermatitis epidemiology by addressing gaps in data quality and comparability, facilitating meta-analyses, and ultimately informing evidence-based policy and clinical guidelines.

Background: Topical corticosteroids (TCS) are a standard treatment for many inflammatory cutaneous conditions; however, patients frequently suffer corticophobia, or fears about TCS side effects. Patients' fear of TCS can prevent them from taking the medication properly, which might have an impact on disease control, particularly for chronic conditions such as atopic dermatitis.

Objectives: To evaluate topical corticophobia among caregivers of children diagnosed with atopic dermatitis and other skin disorders treated with TCS, using the TOPICOP score. The research additionally investigated factors related to corticophobia within the study group.

Methods: A cross-sectional study was conducted at the Pediatric Department, Faculty of Medicine, Khon Kaen University, Thailand, from April 2023 to January 2024. Parents of children visiting the dermatology clinic involving TCS were asked to complete the questionnaire.

Results: The study included 320 parents of children with skin conditions. There were 251 women (78.4%) and 69 men (21.6%). The mean age was 35 years (SD 8.13). The mean age of the children in the study was 5.64 years (SD 4.69). Median Global TOPICOP score was 52.78% (interquartile range 41.69-69.44). Parents with children with atopic dermatitis had a higher median global TOPICOP score of 63.89%, whereas those with other skin disorders had a lower score of 44.44%. Men, parents over 35 years old and parents with less than a bachelor's degree showed lower corticophobia than women, younger parents and those with greater education.

Conclusions: The present study indicated that long-term diseases such atopic dermatitis caused more anxiety regarding TCS use than other skin problems. The face and periorbital were more vulnerable to TCS. Parents with higher education reported increased concern regarding TCS usage in Thai settings; thus, parents and caregivers, especially those with children with atopic dermatitis, should get appropriate TCS advice.

A 29-year-old woman presented with 3 weeks of fever, arthralgia and pruritic rashes on her trunk and limbs. She had no significant medical history and denied occurrence of muscle weakness, dysphagia, mouth ulcers, alopecia and sicca symptoms. Physical examination revealed erythematous, oedematous papules and plaques on the anterior sternum, upper to mid-back, arms, flanks and lateral aspect of the proximal thighs. Antinuclear antibody and anti-double-stranded DNA were negative. Complements, creatine kinase and myositis panel were normal. Her erythrocyte sediment rate and ferritin levels were elevated at 48 mm h^-1 and 580 µg L^-1, respectively. Histological examination of the plaque on her upper back revealed epidermal dyskeratosis, with a mixed perivascular infiltrate of neutrophils, lymphocytes and histiocytes within the superficial dermis. There was prominent nuclear dust, red cell extravasation and increased dermal mucin. Direct immunofluorescence was negative. She was eventually diagnosed with persistent pruritic eruption (PPE) of adult-onset Still disease (AOSD) and was treated with oral etoricoxib with resolution of her fever and symptoms. The entity of PPE in AOSD is associated with the striking histological feature of dyskeratotic keratinocytes in the upper one-third of the epidermis. This is in contrast to other conditions such as cutaneous lupus or dermatomyositis, where the dyskeratotic keratinocytes are found in the lower epidermis instead. This case highlights the importance of clinicopathological correlation and recognition of PPEs in AOSD in view of the associated poorer prognosis due to associated conditions such as secondary macrophage activation syndrome.

Background: Lanadelumab is administered subcutaneously at 2- to 4-week intervals for long-term prophylaxis in hereditary angioedema (HAE). The effect of longer treatment intervals on disease control or disease-related quality of life (QoL) remains elusive.

Objectives: To assess whether the reduction of the burden of treatment improves QoL.

Methods: The treatment outcome of 56 patients with HAE treated with lanadelumab was assessed. The last documented treatment interval was extracted from patient records; individual disease control and QoL were assessed routinely with the Angioedema Control Test (AECT) and Angioedema Quality of Life Questionnaire (AE-QoL). The evaluation was based on the duration of the injection interval, i.e. equal to or less than 28 days (L ≤ 28) or more than 28 days (L > 28).

Results: In total, 56 patients were included, 23 patients with L ≤ 28 and 33 with L > 28. In the L ≤ 28 group, the mean AECT was 14 points and the AE-QoL was 24 points. In the L > 28 group, the mean AECT was 15.5 points and the AE-QoL was 11.6 points.

Conclusions: We conclude that lanadelumab injection intervals can be generously individualized in many patients with HAE while fully maintaining disease control and QoL.

Androgenetic alopecia (AGA) is a very common cause of noncicatricial alopecia, which negatively affects a person's wellbeing. Although Food and Drug Administration (FDA)-approved drugs such as topical minoxidil result in an apparent improvement in this hair condition in a period of 4-6 months and have been used commonly as the first-line treatment of choice, another treatment modality that has gained popularity over the years is platelet-rich plasma (PRP) therapy. PRP is minimally invasive but much more cost-effective than restoration surgery. The FDA has not approved PRP as a treatment modality for AGA. We systematically reviewed the existing literature from Embase, Web of Science, CENTRAL and PubMed from inception to 2024, and included six clinical trials that compared these two commonly practised dermatological therapies for the treatment of AGA. Most studies used global photographic assessment of hair changes based on the investigator's examination, which demonstrated statistically significant changes in hair density, terminal hair count and hair pull test. A few studies used subjective quantitative measures of hair parameters, such as patient satisfaction scores and improvement in hair quality. Topical minoxidil showed more improvement in terminal hair count and proportion of anagen hair. PRP showed more improvement in hair density and a negative hair pull test. All of the selected studies suggested that the efficacy of PRP is nearly comparable to that of topical minoxidil, with minimal adverse effects on long-term follow-up. Thus, PRP is a valuable treatment option either adjuvant to topical minoxidil or as a second-line treatment option for AGA.

Childhood granulomatous periorificial dermatitis (CGPD) is a well-known, self-limiting condition that primarily affects prepubertal children of African heritage. Although thought to be a variant of perioral dermatitis, its precise aetiology remains unknown. The condition is characterized by monomorphic, yellow-brown papular eruptions localized to the perioral, perinasal and periocular regions, with a granulomatous pattern observed upon histopathological examination. We report the case of a 10-year-old Omani boy with a 7-month history of facial and ear papular eruptions diagnosed as CGPD and requiring a multidrug regimen to achieve remission with minor pitted scarring.