Skin health and disease最新文献

Photodermatoses represent a varied collection of skin disorders characterized by cutaneous reactions provoked by exposure to ultraviolet radiation. The disease mechanism is based on an immune-mediated delayed hypersensitivity reaction. Clinical presentation of patients with photodermatosis includes pigmentary changes, erythema and/or lichenification, with interindividual differences in lesion morphology and distribution. Most patients report associated symptoms of burning sensation and itchiness as their chief complaint, severely affecting their quality of life. Management of photodermatoses involves both preventive measures and medical management applying topical steroids and calcineurin inhibitors, or systemic immunosuppressives, with variable degree of success and adverse events. Here, we report three cases of chronic photodermatitis treated with upadacitinib, a selective Janus kinase 1 inhibitor, as monotherapy, which resulted in fast, significant and sustainable improvement of signs and symptoms, with a favourable safety and tolerability profile.

Background: Rhinophyma, a progressive nasal deformity resulting from advanced rosacea, presents significant cosmetic and functional challenges. Fully ablative CO₂ laser therapy is a recognized treatment modality, but data on its long-term efficacy and safety, and recurrence rates remain limited.

Objectives: To assess the long-term outcomes, safety and patient satisfaction associated with fully ablative CO₂ laser therapy for rhinophyma and to identify predictors of treatment success using an artificial intelligence (AI)-assisted model.

Methods: A retrospective study was conducted on 152 patients with rhinophyma (grades I-III) treated with CO₂ laser therapy at an outpatient clinic affiliated with McGill University. Patients were evaluated for aesthetic improvement using the Global Aesthetic Improvement Scale (GAIS), satisfaction surveys and follow-up assessments at 1, 3, 6 and 12 months post-treatment. Demographic and clinical data were analysed using descriptive statistics, logistic regression and a deep learning model to determine predictors of hypopigmentation, recurrence and patient outcomes.

Results: Significant aesthetic improvement (GAIS ≥ 3) was observed in 84% of p atients, with an average satisfaction score of 2.51/3. Recurrence was rare (4%), occurring primarily in older men with grade III rhinophyma. Side effects included mild hypopigmentation (9%) and textural changes (2%). A deep learning model identified rhinophyma grade, age and Fitzpatrick phototype as key predictors of treatment outcomes. Logistic regression confirmed that advanced rhinophyma grades significantly reduced hypopigmentation risk [adjusted odds ratio (aOR) 0.43, 95% confidence interval (CI) 0.18-0.97; P = 0.041], while age significantly increased it (aOR 1.08, 95% CI 1.00-1.17, P = 0.026). Higher rhinophyma grades were also strongly associated with increased patient satisfaction (aOR 4.97, 95% CI 2.79-9.48; P < 0.001) and showed a trend toward higher recurrence risk (aOR = 6.11, 95% CI: 0.92-690.69, P = 0.064). Fitzpatrick phototype was significantly associated with patient satisfaction; decreasing Fitzpatrick phototype was associated with reduced odds of patient-reported satisfaction (aOR 0.48, 95% CI 0.25-0.87; P = 0.015).

Conclusions: Fully ablative CO₂ laser therapy is highly effective and safe for rhinophyma, with most patients achieving significant improvements after a single session. AI-assisted analysis provides valuable insights into predictors of success, enabling personalized treatment plans. Older patients had an 8% increased risk of hypopigmentation per year of age, while patients with severe rhinophyma were at lower risk of hypopigmentation but at higher risk of recurrence. These findings reinforce the role of CO₂ laser therapy as a cornerstone treatment f

This case report presents a rare occurrence of pigmented demodicosis in a 59-year-old woman with Fitzpatrick skin type IV, who presented with pruritic and progressively pigmented plaques over her cheeks and eyelids. Dermoscopic examination and skin biopsy confirmed the presence of Demodex mites in the hair follicles. Treatment with topical ivermectin led to marked improvement, highlighting the importance of considering this condition in cases of facial hyperpigmentation and the efficacy of antidemodectic therapies.

Background: Keloids are among the leading benign skin conditions globally, affecting up to 16% of the African population. They are characterized by aggressive behaviour, high recurrence rates and poor treatment outcomes, particularly in African populations. Despite this, most information on keloids in sub-Saharan Africa remains anecdotal, with limited comprehensive studies describing their clinical and pathological characteristics.

Objectives: To analyse the clinical and histopathological features of keloids in a sub-Saharan African population.

Methods: Following ethical approval, 231 participants were enrolled in a cross-sectional study conducted at the 2 national referral plastic surgical centres in Uganda. Data on demographics, clinical presentations and histopathological features of keloids were collected and analysed.

Results: Sixty-four per cent of participants (n = 148/231) were women, 63.3% (n = 133/210) resided in central Uganda and 82.3% (n = 190/231) belonged to the Bantu ethnic group, with those belonging to the Baganda tribe predominating (n = 97/231; 42.0%). Keloids were broadly classified into sessile (n = 116/231; 50.2%) and nodular types. The most frequently affected anatomical sites were the head and neck (n = 106/231; 45.9%) and the trunk (n = 52/231; 22.5%). Additionally, 58.0% (n = 134/231) of participants had multiple keloids. Histopathological analysis of 35 excised specimens revealed that keloids are primarily a dermal disease, characterized by excessive collagen deposition, particularly hyalinized collagen.

Conclusions: Keloids in African populations exhibit a slight female predominance, a tendency toward multiplicity and larger lesion volumes. Histopathological findings highlight excessive collagen deposition as a hallmark, emphasizing the need for tailored approaches to improve treatment outcomes.

This case vignette describes a 74-year-old patient with cutaneous metastases to the scalp from renal cell carcinoma. It highlights the histological and immunohistochemical findings in cutaneous metastatic renal cell carcinoma and the good response of the scalp metastasis to chemotherapy.

Background: Consensus amongst dermatologists regarding the phenomenon of topical steroid withdrawal (TSW) is elusive. This may be contrasted with a growing online patient movement, including social media communities.

Objectives: This study aimed to investigate dermatologist perspectives regarding TSW and to assess attitudes towards self-diagnosis.

Methods: A two-part online questionnaire was disseminated to UK-based Dermatology Consultants, Registrars and Fellows. Section one presented a clinical scenario and randomized respondents into two groups: one mentioning TSW self-diagnosis, and an otherwise identical control without the self-diagnosis. Questions about the clinical scenario were directed to dermatologists and focused on attitudes regarding patient-predicted behaviours. Section two asked about TSW perceptions and experiences, and thematic analysis of open text responses was undertaken.

Results: One hundred and three responses were received, including 51 Consultants, 38 Trainee Dermatologists, 10 Dermatology Fellows, 3 Specialty And Specialist (SAS) Dermatology doctors and 1 Post-CCT (Certificate of Completion of Training) Fellow. Thirty-four percent (n = 35/103) of respondents considered TSW to be a distinct clinical entity, 17.5% (n = 18/103) did not and 48.5% (n = 50/103) were unsure. Respondents felt that self-diagnosing TSW patients were less likely to comply with treatment, and more likely to take up time and pose management problems compared with controls. Themes of uncertainty regarding diagnostic veracity and social media misinformation were identified.

Conclusions: Uncertainty regarding the veracity of a TSW diagnosis and its management is common amongst dermatology healthcare professionals (HCPs). Dermatology HCPs in this study considered that patients who self-diagnosed TSW were more difficult to engage with skin disease management. Dermatologists desire further understanding of and research into the nature and management of TSW.

Immune-related adverse events (irAE) are common in checkpoint blockade-treated patients and limit its clinical application. Corticosteroids are the first-line therapy for treatment of irAE, but animal models clearly demonstrate that steroids diminish anti-programmed cell death protein 1 (PD-1)-induced tumour immunity. Better strategies to manage irAE while preserving anti-tumour immunity are needed. Extracorporeal photopheresis (ECP) was recently introduced as second-line treatment for steroid-refractory immune checkpoint inhibitor (ICI)-related colitis and hepatitis. Here, we extend the application of ECP to immune-related maculopapular rash after adjuvant anti-PD-1 therapy in a single melanoma patient. The patient's dermatitis markedly improved after off-label ECP, with a substantial reduction in skin lesions and pruritus scores, and stabilization of immune markers. The patient remained well after ECP with no recurrent or metastatic disease at 14 months after starting ECP treatment. Hence, in this case, ECP led to successful resolution of pembrolizumab-induced dermatitis and a favourable oncological outcome.

Endometriosis is defined as the presence of endometrial tissue (glands and stroma) outside the uterine cavity. Various organs can be affected, including the skin. Umbilical endometriosis is the most common clinical form of extrapelvic endometriosis and the most frequent type of cutaneous endometriosis, classified into primary and secondary forms. The primary or spontaneous form is rare, occurring without any prior surgical intervention, with a predilection for the umbilical area.

Background: Despite a high frequency of presentations of skin disease in primary care, research has demonstrated a paucity of dermatology teaching in the medical school curriculum and a variable level of postgraduate dermatology teaching in general practice training. While it is clear that general practitioner (GP) trainees feel they would benefit from additional dermatology teaching, there is a gap in the literature regarding the factors that influence their learning.

Objectives: The aim of this study was to identify and examine factors that influence the dermatology learning of GP trainees.

Methods: A qualitative study of GP trainees in their third and fourth year of their training scheme practising in Ireland was undertaken. Full ethical approval was obtained prior to commencement. Semi-structured interviews were conducted with participants via Microsoft Teams. Participants were sampled using a combination of purposive, convenience and snowball sampling. Interviews were audio-recorded and transcribed verbatim. Data were analysed inductively by employing thematic analysis.

Results: Fourteen GP trainees from five GP training schemes in Ireland participated in the study. Emergent themes identified factors that influence the dermatology learning of GP trainees in Ireland. These factors include experiential learning, competing demands, the clinical learning environment and mixed emotions towards dermatology. These influences mainly had a positive effect on the dermatology learning of trainees but certain competing demands such as time and incongruent teaching were felt to hinder their learning.

Conclusion: This study broadens our understanding of factors that influence the dermatology learning of GP trainees. Findings generated from this study may be utilized to improve the clinical learning environment and inform the dermatology curriculum of GP trainees.

Actinomycetoma is a chronic, progressive bacterial infection characterized by granuloma formation, with Nocardia vulneris being a rare causative agent. A 32-year-old healthy man from El Salvador presented with painless nodules, scars and discharging sinus tracts on his back. Examination of the exudate revealed small white grains, and Nocardia species were isolated through culture. Molecular identification of N. vulneris was confirmed via 16S rDNA gene amplification and sequencing. The patient was treated with trimethoprim-sulfamethoxazole and dapsone, resulting in significant clinical improvement after 6 months. He continues on this treatment regimen. This case highlights the rarity of N. vulneris mycetoma at an unusual anatomical site and demonstrates the effectiveness of combined trimethoprim-sulfamethoxazole and dapsone therapy.