Skin health and disease最新文献

A case of a gentleman living with chronic itch in the setting of systemic mastocytosis with cutaneous involvement.

A 50-year-old man with a background of idiopathic CD4⁺ lymphocytopenia (ICL) was successfully treated with acitretin monotherapy for recalcitrant viral warts on the hands and right cheek. Treatment duration was 35 months, with sustained effects at 15 months post-acitretin therapy. Side-effects were mild and included mild cheilitis and dryness of nasal mucosa. CD4⁺ lymphocytes play an important role in enabling host responses to human papillomavirus (HPV) and, consequently, lower CD4 counts correspond to a higher risk of chronic HPV infection, including viral warts. HPV represents the most common opportunistic infection in patients with ICL. Acitretin is an oral retinoid with affinity for retinoic acid and retinoid X receptors, and works through downregulation of signal transducer and activator of transcription (STAT)1- and STAT3-dependent signalling, with resultant increases in keratinocyte differentiation. As HPV evades the Janus kinase/STAT pathway to promote keratinocyte proliferation, acitretin may work through reversal of this mechanism. This case demonstrates effectiveness of acitretin in treating recalcitrant viral warts, specifically in a patient with ICL.

Toxic epidermal necrolysis (TEN) is a dermatological emergency with devastating morbidity and mortality rates. It is most often caused by medications. Management guidelines have focused on conservative measures, partly due to a previous lack of large randomized controlled trials evaluating systemic agents, and because experts have differing views on initiating active medical management. Tumour necrosis factor alpha (TNF-α) is a cytokine that is involved in immune defence against various infectious agents by exerting a powerful anti-inflammatory effect. Inhibition of TNF-α is well established in the management of noninfectious inflammatory (including dermatological) conditions. Patients with TEN have prominent expression of TNF-α in keratinocytes and macrophages in affected skin as well as in blister fluid. This review article aims to summarize the recent and emerging evidence for using anti-TNF-α treatment, particularly etanercept, in the management of TEN.

Background: Little is known about treatment survival in patients with plaque psoriasis who have received phototherapy.

Objectives: to analyse treatment survival in patients with plaque psoriasis who had received photother-apy, irrespective of the number of sessions and type of phototherapy, and to identify factors that influence the risk of treatment discontinuation.

Methods: Data from the Psoriasis Registry Austria and the phototherapy registry of the Centre of Phototherapy at the Department of Dermatology and Venereology, Medical University of Graz, were retrospectively analysed using Kaplan-Meier curves (logrank test) and a Cox (proportional hazards) regression analysis, irrespective of the number of phototherapy sessions or type of phototherapy.

Results: The analysis revealed an overall treatment survival rate of 70% and 66% after 1 and 3 years, respectively, with a median treatment survival of 5.5 years. However, treatment survival rates have significantly decreased compared with the rates reported in the prebiologic era [hazard ratio (HR) 1.98, P < 0.001]. While female sex did not influence overall treatment survival (HR 0.87, P = 0.28), the risk of treatment discontinuation was significantly lower in women aged ≥ 60 years (HR 0.49, P = 0.009). Moreover, patients with arthritis had an increased risk of treatment discontinuation (HR 1.69, P = 0.003). The involvement of high-impact body areas (including scalp, nail, or inverse and/or genital body areas) did not alter treatment survival; however, palmar and/or plantar involvement increased the risk of treatment discontinuation (HR 1.48, P = 0.006), especially in men (HR 2.19, P < 0.001). No significant differences in the treatment survival of phototherapy in patients were observed regarding the duration of the psoriasis.

Conclusion: Male patients with psoriasis with palmar and/or plantar involvement have the highest risk of treatment discontinuation, whereas women aged ≥ 60 years at treatment start have the lowest risk. Therefore, early treatment escalation should be considered in men with palmar and/or plantar involvement and treatment-resistance disease forms. However, the current treatment survival rates reported for patients with psoriasis treated with phototherapy (median survival 30 months) are similar to the treatment survival rates reported for patients receiving tumour necrosis factor inhibitors.

Background: Immunosuppression medication is an important risk factor for skin cancer in kidney transplant recipients (KTR). Both HIV-associated immunodeficiency and immunosuppression required for kidney transplantation increase skin cancer rates. Kidney transplant recipients living with HIV (KTRLHIV) must take steps to minimize their risk of skin cancer through prevention.

Objectives: To conduct a cross-sectional study to investigate photoprotection knowledge and practices, and skin cancer awareness in KTRLHIV compared with a matched cohort of HIV-negative KTR.

Methods: Our study, conducted at a tertiary UK HIV kidney transplantation centre, utilized a validated sun photoprotection and skin cancer awareness questionnaire either online or in person. The KTRLHIV cohort (n = 27) and HIV-negative KTR cohort (n = 25) were matched for age, sex, ethnicity and years since transplant.

Results: Only 60% of KTRLHIV had been seen by a dermatologist, compared with 81% in the matched KTR cohort. Sun protection advice was received by 52% of KTRLHIV, significantly lower than the 80% in the matched cohort (P = 0.03), primarily sourced from nephrologists or dermatologists. KTRLHIV exhibited lower overall sunscreen use (33% vs. 60%, P = 0.05), fewer daily users (22% vs. 27%), lower utilization of sun protection factor > 25 (78% vs. 100%) and lower use on all exposed areas (67% vs. 87%). Sun protection behaviours were also suboptimal in KTRLHIV compared with the matched cohort, with regard to avoiding direct sun exposure (P = 0.003), and dressing to protect from the sun (P < 0.001).

Conclusion: Our findings reveal lower rates of skin cancer protection advice for KTRLHIV compared with matched HIV-negative KTR, likely translating into decreased sunscreen use and suboptimal sun protection behaviours. Addressing this disparity through skin cancer prevention, self-skin examination education and improved dermatology referrals is necessary.

Basal cell carcinoma (BCC), the most common skin cancer worldwide, is closely associated with sunlight exposure and generally exhibits a low metastatic potential, with a frequency ranging from 0.0028% to 0.55%. Despite its rarity, BCC with bony metastases causes important clinical complications. We collected information on published patients with a diagnosis of BCC with bony metastases, and examined patient demographics, tumour characteristics, histological features and treatment modalities to define patterns and outcomes. Our study encompassed 108 patients: 68 men and 40 women with a mean (SD) age of 66.9 (6.4) years. Histologically identified subtypes included 42 nodular, 28 infiltrative, 9 morphoeaform, 5 metatypical and 1 superficial BCC, with 23 patients having a mixed histopathology pattern. The main treatments were -surgery (n = 98), chemotherapy (n = 31), immunotherapy (n = 16) and radiotherapy (n = 34). BCC with bone metastases, although rare, requires more attention due to the complexity of management. Histological subtypes such as infiltrative, sclerosing, morphoeaform, basosquamous and micronodular are associated with aggressive behaviour and the detection of symptoms such as bone pain or hypercalcaemia in patients at high risk of metastasis is important for timely diagnosis. Because of the aggressive potential and clinical implications of some subtypes, a personalized management approach with comprehensive histological and molecular profiling is essential to optimize outcomes in patients with BCC with bone metastasis.

Background: Indoor tanning through sunbeds is linked to a heightened risk of skin cancers, particularly cutaneous squamous cell carcinoma and basal cell carcinoma, with significant increases in risk for users aged < 35 years. Despite regulations established by the Public Health (Sunbeds) Act 2014 in Ireland, sunbed use persists, primarily for cosmetic reasons.

Objectives: To analyse the characteristics, attitudes and behaviours of sunbed users attending an Irish dermatology outpatient clinic.

Methods: We undertook a prospective qualitative analysis of 104 consecutive patients attending a pigmented lesion clinic in a tertiary referral dermatology department in Ireland. This was done using a self-reported anonymous survey where respondents answered questions relating to their own demographic data, frequency of sunbed use, motivation for sunbed use and use of unregulated tan-enhancing agents (namely Melanotan I and II).

Results: The results showed that patient demographics were consistent with previous studies on sunbeds use, namely younger female patients living in urban areas. Many sunbed premises did not comply with safety regulations; over half lacked protective goggles, and nearly half received no health risk information. The reasons for sunbed use included improving appearance and confidence, with a significant number using tan-enhancing agents. Surprisingly, increased awareness of health risks did not correlate with reduced usage; many users continued tanning practices despite concerns about its adverse effects. Users of tan-enhancing agents also used sunbeds more frequently compared with nonusers.

Conclusions: This study suggests a potential psychopathological aspect of tanning behaviours similar to addictive disorders like smoking and alcohol. Patients may benefit from psychological and behavioural interventions such as cognitive behavioural therapy to address their compulsive behaviour. Furthermore, there was a concerning lack of compliance with regulations in tanning salons, highlighting a public health issue. The rising use of unregulated tanning agents, especially among younger people, poses additional risks, including blood-borne infections. This study underscores the need for targeted educational interventions among younger age groups and stricter enforcement of regulations to mitigate health risks associated with indoor tanning. Understanding the complex motivations behind sunbed use is crucial for developing effective strategies to reduce its prevalence and promote safer alternatives.

Soft tissue sarcomas (STS) are rare and heterogeneous, with cutaneous STS (CSTS) lacking recent epidemiological data. This study analyses CSTS incidence from 2000 to 2019 using SEER data, identifying 18 181 cases. CSTS was more common in men and non-Hispanic Whites, with Kaposi sarcoma (KS) and dermatofibrosarcoma protuberans (DFSP) being predominant. The overall CSTS incidence was 11.2 per 1 000 000 person-years, with KS having the highest rate. The study reveals a 1.4% annual decline in CSTS rates and highlights ethnic disparities, especially in KS incidence among Non-Hispanic Black patients.

This study evaluates sunscreen application practices among UK dermatology clinicians, revealing that only 10% meet recommended reapplication guidelines. Factors such as skin type, gender, product preferences and topical treatments significantly influence sun protection factor (SPF) use. Findings underscore the need for clearer clinical guidelines and practical solutions to enhance adherence and inform patient education.