Australasian Journal of Dermatology最新文献

Background/objectives: Congenital melanocytic naevi (CMN) are a risk factor for melanoma. Melanoma risk is dependent on the congenital phenotype. Our primary aims were to assess the clinical characteristics of CMN that indicate a high risk of neurocutaneous melanosis (NCM) and melanoma in an Australian paediatric population group; to identify patient characteristics and clinical features of CMN that trigger further investigations; and to determine the rate of malignancy and other complications for CMN.

Methods: We retrospectively reviewed the electronic medical records of all patients under 18 years who were diagnosed with CMN at the Queensland Children's Hospital between 2014 and 2021.

Results: Eighty-eight patients (38 males and 50 females) were included in the analysis. Eighteen patients (20%) had a biopsy to rule out malignancy. Central nervous system magnetic resonance imaging (MRI) was performed in 16 patients (18%). Five patients (5.7%) experienced complications, of which three had NCM and two had transient neurological symptoms with normal MRI. No cases of melanoma, non-melanoma tumours or deaths were recorded.

Conclusions: CMN size, location over the posterior midline axis and multiple numbers of CMN were found to be significantly associated with the development of complications. CMN size, CMN site, presence of satellite naevi and location over the posterior midline axis were all significantly associated with the likelihood of an MRI or biopsy being performed. Large-scale studies, such as a population-based registry, are recommended to accurately assess the true lifetime risk of complications and associated risk factors.

There is paucity of research available regarding the epidemiological characteristics of patients attending dermatology outpatient services in rural Australia. We performed a retrospective cohort study of patients attending a public dermatology clinic established at Dubbo Base Hospital in rural New South Wales. The broad range of dermatological presentations encountered, coupled with the brisk uptake of services by remote patients, highlights the ongoing need for specialist dermatology services in underserved rural communities.

Objectives: This study aimed to evaluate the prevalence of lichen sclerosus (LS) in male patients undergoing circumcision for phimosis, emphasising the significance of a multidisciplinary approach in the early diagnosis and management of this condition.

Methods: A retrospective analysis was performed on 841 male patients who underwent circumcision at a high-volume medical centre between 2001 and 2023. Data were collected on clinical diagnoses made by both dermatologists and urologists, along with the corresponding histological findings. Logistic regression models were utilised to assess diagnostic accuracy and the relationship between clinical suspicion and histological confirmation.

Results: Histological confirmation of LS was identified in 30.6% of the cases. Dermatologists demonstrated a diagnostic accuracy of 81.8%, whereas urologists showed an accuracy of 46.1%. The evaluations conducted by dermatologists exhibited a significant correlation with histological confirmation of LS (odds ratio 4.81; 95% confidence interval: 1.96-11.80; p = 0.001).

Conclusions: This study elucidates the differences in diagnostic accuracy between dermatologists and urologists in identifying LS in patients undergoing circumcision for phimosis, highlighting the necessity of a multidisciplinary approach to improve the diagnostic process. Furthermore, the epidemiological data obtained from this research offer valuable insights into the prevalence of LS and the associated diagnostic challenges within a substantial patient cohort.

Background: Recent Australian trends indicate that shave biopsies for diagnosing lesions suspicious of melanoma are increasing, yet reasons for this remain relatively unknown. We sought to understand which factors influence Australian clinicians' use of shave biopsy for managing thin lesions suspicious of melanoma in sites of low cosmetic sensitivity.

Methods: We used a convergent, exploratory mixed-methods design, with a cross-sectional online survey (n = 59) and semi-structured qualitative interviews (n = 15). We recruited clinicians working in skin cancer medicine across Australia, mostly general practitioners (> 80%) with some dermatologists (n = 7 survey and n = 1 interview participant). Survey participants indicated how frequently they used shave biopsies and rated the importance of factors when considering the use of a shave biopsy. Interview participants elaborated on the motivating factors for using different biopsy techniques. Qualitative data were professionally transcribed and analysed with content analysis.

Results: Most survey participants (95%) reported that identifying fewer signs of locally advanced melanoma was 'very important' for using shave biopsy. Fifty per cent of survey participants also reported that faster procedure speed and greater convenience were 'very important' reasons for using shave biopsy. Procedure speed was particularly important for using shave biopsy among clinicians self-identifying as time-poor. Interview participants noted (a) the risk of transecting the lesion base or (b) incomplete lesion removal from shave biopsies as reasons against their use.

Conclusions: The relative speed and convenience of shave biopsies in clinical practice are strong motivators for their use. Further evidence on patient outcomes with widespread use of shave biopsy is required to inform clinical guidelines.

Palmoplantar pustular psoriasis (PPPP), or palmoplantar pustulosis (PPP), is a type of psoriasis that affects the skin on the palms and soles. It is characterised by dermatosis and small sterile pustules and is considered a significant burden on patients' quality of life, as there is currently no gold standard treatment or cure. This network meta-analysis (NMA) compares the efficacy and safety of biologic and non-biologic medications for PPPP and PPP. Medline, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched. The efficacy and safety of all medications were assessed through a frequentist NMA using a random-effects model. Treatments were ranked using the net rank function, yielding P scores. Fourteen RCTs with 1056 participants were included. Guselkumab 100 mg was the most effective for improving PPPGA scores (p = 0.72, RR = 1.31, CI: 0.31-5.57). Guselkumab 100 mg was ranked the highest for achieving PPPASI-75 (RR = 5.4, CI: 1.26-23.2, p = 0.023). Oral cyclosporine 1 mg/kg/day was ranked the highest for PPPASI-50 (RR = 2.10, CI: 0.65-6.82). Etretinate 1 mg/kg/day had the highest rate of adverse events (RR = 1.78, CI: 0.92-3.44). Secukinumab 300 mg was associated with the highest rate of serious adverse events (RR = 1.58, CI: 0.21-12.02). Based on the P-scores from our NMA, guselkumab 100 mg was the most effective for PPPGA improvement, guselkumab 100 mg for PPPASI-75, oral cyclosporine 1 mg/kg/day for PPPASI-50, etretinate 1 mg/kg/day had the most adverse events, and secukinumab 300 mg was associated with the highest rate of serious adverse events. TRIAL REGISTRATION: PROSPERO registration number: CRD42023460842.

Moderate-to-severe hidradenitis suppurativa (HS) is a debilitating disease that often requires biological therapy. Despite the effectiveness of approved doses, some patients experience partial or loss of response over time, leading to the need for dose intensification. This retrospective multicentre study aimed to identify predictors of biological therapy intensification in HS patients. The results showed that prior use of biological treatments and biosimilar adalimumab were significant predictors of intensification, suggesting closer monitoring may be needed for certain patient profiles to optimise treatment outcomes.