Australasian Journal of Dermatology最新文献

Background: Smoking is a modifiable risk factor that increases the likelihood of developing psoriasis and the severity of the disease. In recent years, biological therapies have transformed the management of psoriasis. There is conflicting evidence about whether smoking affects the efficacy of biologics. The aim of this study was to assess drug survival and the efficacy of the first biologic for psoriasis in smokers compared with non-smokers.

Methods: This was a retrospective cohort study using data from the Australasian Psoriasis Registry. Participants with psoriasis who met Pharmaceutical Benefits Scheme eligibility criteria for a biologic (n = 395) were included. Associations between smoking and drug survival or Psoriasis Area and Severity Index (PASI) response were assessed using univariable and multivariable Cox Proportional Hazards regression, controlling for confounders including sex, obesity, psoriatic arthritis, biologic class and baseline PASI.

Results: The prevalence of current smoking was 24.6% and former smoking was 18.5%. On univariable analysis, smokers were 34% more likely to discontinue treatment compared with non-smokers (p = 0.039), were 27% less likely to attain PASI90 (p = 0.037) and 33% less likely to attain PASI100 (p = 0.038). On multivariable analysis, the association between smoking and reduced drug survival was no longer statistically significant. Multiple factors, including obesity, female sex, psoriatic arthritis and higher PASI scores, were risk factors for drug discontinuation.

Conclusions: This analysis illustrated that multiple factors are involved in drug survival, and smoking was not an independent risk factor for drug discontinuation. This study provides a rationale for future studies examining the effect of lifestyle modification on the efficacy of biological therapies in psoriasis.

Acne vulgaris is a globally prevalent dermatological disease, with its severity ranging from mild to severe. While moderate to severe acne often requires topical or systemic pharmaceutical therapy, mild to moderate acne may be managed with dermocosmetics, which are over-the-counter skincare agents with active ingredients that target acne pathophysiology. Dermocosmetics can also be effective as adjunct therapy for the management of more severe acne. For example, they can be used to complement the mode of action of pharmaceuticals or to mitigate side effects and improve treatment compliance. This review discusses the roles of commonly available dermocosmetics in the context of both mild and severe acne management protocols.

Interstitial Lung, Nephrotic Syndrome and Epidermolysis Bullosa (ILNEB) is a rare autosomal recessive genetic syndrome caused by mutations in ITGA3. This gene encodes the three subunit of integrin 3β1, which plays an important role in the structure and function of keratinocytes. We analysed compound heterozygous mutations in a patient, observing clinical features that mirrored some but not all previously reported ILNEB cases. These findings suggested that the mutations in this patient shared a common loss-of-function mechanism. This case expands the current understanding of the genotype-phenotype correlations in ILNEB.

A 33-year-old woman with a segmental non-involuting congenital vascular anomaly of the left neck developed pain and ulceration in pregnancy and left-sided Horner's syndrome after delivery. Mutational analysis of affected tissue showed a missense mutation in GNA11 (Glu209) and a second mutation in PIK3CA. Sirolimus therapy resulted in healing of the ulceration and resolution of the Horner's syndrome.

Aim: TikTok has accrued over 3 million posts and 129 billion views under #acne, establishing itself as a popular platform amongst adolescents to access health information. We conducted an in-depth thematic analysis of acne videos on TikTok to determine how adolescents engage with acne content.

Methods: The top 150 consecutive videos under #acne on TikTok were subjected to rigorous qualitative analysis by experienced researchers (Laxmi Iyengar, Susan Saldanha) until data saturation was reached, guided by SRQR (Standards for Reporting Qualitative Research) guidelines. Five themes were identified:(1) Pimple popping, (2) Acne education, (3) 'Acne transformation' depicting treatment success stories, (4) Acne positivity, normalising acne and (5) Acne reality, capturing the lived experience of acne.

Results: Overall, the top 150 videos under #acne accumulated almost 2 billion views and 102 million followers. The majority of acne content was uploaded by females (125/150; 84%). Medically trained clinicians represented only 11% of the content (17/150). Pimple-popping videos attracted the most significant viewership (804 million views; 44%; 17% of content) despite having a lower proportion of content than acne education videos, uploaded by patients and clinicians (324 million views; 34% of content). These videos included dietary hacks, miracle cures and narratives that antagonised the medical treatments. Acne reality videos demonstrating the mental health burden of acne were the least popular amongst TikTok viewers (79 million views; 4% of content).

Conclusion: Thematic qualitative research of acne on TikTok bridges the gap between clinical expertise and the lived experiences of those navigating acne in the digital age. Based on the results of the study, strategies are proposed for dermatologists to engage in the TikTok platform on the topic of acne, including medicolegal precautions. Given the lack of content credibility on social media, this research urges dermatologists to redefine healthy skin care practices based on evidence-based principles.

Benign adnexal tumours are characterised by slow growth; however, they can cause significant patient morbidity due to their predilection for the face and potential for disfigurement. We present a series of cases treated with Mohs micrographic surgery to reinforce the existing data that these tumours can be sub-clinically extensive and draw attention to their ability to invade both widely and deeply.

We describe the case of an 87-year-old woman who developed Sweet's syndrome with atypical mucosal involvement following a post-operative wound infection. The disease manifestations included two large, ulcerated plaques on both sides of the tongue as well as cutaneous lesions. Her lesions resolved promptly with oral prednisolone.

Paediatric hypotrichosis is the clinical feature of paucity of hair arising congenitally or in early life with the presentation being that of the child whose hair is growing insufficiently. It is a hallmark finding of a diverse group of genodermatoses and sporadic disorders, presenting as either an isolated symptom or in association with syndromic features. Hypotrichoses are rare, with numerous possible differentials requiring a thorough clinical assessment, additional investigations for hair shaft abnormalities and occasionally genetic counselling to reach a diagnosis. We propose a clinical algorithm for the investigation and diagnosis of paediatric hypotrichosis, designed to aid the clinician by utilising key clinical findings in conjunction with the forced hair pull test and trichoscopy to differentiate groups of hair shaft and hair loss disorders. We also discuss in further detail the pathogenesis, phenotypical features and microscopy findings of various types of hypotrichosis.