Australasian Journal of Dermatology最新文献

Cutaneous leiomyomas can cause severe pain that may be spontaneous or stimulus-evoked, and is commonly exacerbated by cold exposure, mechanical pressure/touch, or stress. We report a patient with genetically confirmed hereditary leiomyomatosis and renal cell cancer (HLRCC) in whom topical diltiazem 2% was associated with reduced pain, assessed using a controlled cold-provocation test and validated pain scores. This brief report suggests that topical diltiazem may be a useful symptomatic option and supports further evaluation.

Background: Although adalimumab has shown strong efficacy and safety in clinical trials, real-world evidence in Australian patients with moderate-to-severe chronic plaque psoriasis is limited. This study assessed adalimumab efficacy and drug survival in routine clinical practice, comparing outcomes with the Phase 3 REVEAL trial and its open-label extension.

Methods: Data were extracted from the Australasian Psoriasis Registry for adults meeting Pharmaceutical Benefits Scheme criteria to be prescribed adalimumab for chronic plaque psoriasis. Baseline demographics, Psoriasis Area and Severity Index (PASI) scores and treatment history between June 2006 and March 2022 were analysed. Drug survival was evaluated using Kaplan-Meier and Cox regression.

Results: A total of 306 patients were included; 59.8% had prior biologic exposure compared to 12.8% in REVEAL. The mean baseline PASI was 24.1 and at 3 months, 63.5% achieved PASI75 while 33.6% achieved PASI90. PASI90 responses remained stable through 3 years and exceeded REVEAL extension rates beyond 18 months. Median drug survival was 27.9 months; survival was 97.7%, 78.6%, 63.7% and 51.0% at 3, 9, 15 and 27 months, respectively. Male sex and achieving PASI ≤ 2 predicted longer drug survival.

Conclusions: In Australian real-world practice, adalimumab demonstrated sustained effectiveness and drug survival in patients with chronic plaque psoriasis comparable to RCTs, despite higher baseline disease severity and greater prior biologic exposure.

Background/objectives: Vulval lichen sclerosus (LS) is a chronic inflammatory dermatosis with recognised associations with autoimmune disease, including thyroid disease, vitiligo, and psoriasis. Current expert consensus guidelines recommend investigating for autoimmune disease when clinically indicated by symptoms or signs. More recently, focused screening for thyroid disease and pernicious anaemia in women with LS has been proposed. This study aimed to assess the prevalence of autoimmune disease in a tertiary multidisciplinary vulval clinic and to determine whether findings from this cohort provide support for these proposed screening recommendations.

Methods: A retrospective review of electronic medical records was conducted for patients attending a tertiary women's hospital vulval dermatology service between August 2020 and June 2025 with a diagnosis of LS. Data extracted included autoimmune history, serological testing for autoimmune disease (including thyroid function and pernicious anaemia), and family history. Descriptive statistics were used for analysis.

Results: Eight hundred fifty-one patients met inclusion criteria. Autoimmune disease was recorded in 31.7%, with autoimmune thyroid disease (12.5%), lichen planus (8.23%), and psoriasis (5.05%) being most common. Inflammatory arthritis was present in 4.8% and autoimmune dermatological conditions in 18.4%. Serological screening was performed infrequently; thyroid stimulating hormone was performed in 18.4% of patients without known thyroid disease and 6.5% of these were abnormal. Vitamin B12 screening was performed in 8.9% and 10.5% were abnormal. Pernicious anaemia antibodies were performed in 0.35% and all were negative.

Conclusions: This single-centre cohort study demonstrated a high prevalence of autoimmune disease in women with LS, particularly thyroid disease, providing support for consideration of thyroid stimulating hormone screening. Serological testing for autoimmune disease was infrequently documented in this cohort, and the limited data on pernicious anaemia were insufficient to evaluate the proposed recommendation. The findings also highlight a high burden of autoimmune arthritis and other dermatological conditions, suggesting a role for clinical assessment in these domains. Prospective multicentre studies are required to inform and refine screening recommendations.

There have only been a limited number of case reports that have described vulval lichen sclerosus in patients receiving immune checkpoint inhibitor (ICI) therapy. We describe 11 cases of vulval lichen sclerosus in patients with melanoma treated with ICIs, and in nine of these cases, the lichen sclerosus symptoms began after ICI commencement. This represents the largest reported series to date and highlights the need for clinician awareness of this potential immune-related adverse effect.

Background: Skin cancer rates are high in Australians, outdoor workers and physically active people. Australia is currently preparing a roadmap to better assess high risk groups for consideration of more targeted skin screening.

Methods: The membership of the Australian Cricketers Association (ACA), both current and retired cricketers, was invited to participate in a questionnaire survey to assess self-reported rates of skin cancer (and associated risk factors).

Results: Response rate was 451 subjects (29% of 1530 invited participants), of which 39% were female. Cohort self-reported melanoma rates were 1% for < 30 year olds, 8% for 51-60 year olds and 20% for those over 70 years old. BCC (basal cell carcinoma) rates for < 30 year olds were 1%, 33% for 51-60 year olds and 55% for those over 70 years old. SCC (squamous cell carcinoma) rates for < 30 year olds were 0%, 23% for 51-60 year olds and 38% for those over 70 years old. Very fair- or fair-skinned players (compared to medium- or dark-skinned players) and those who lived in lower latitudes (sunnier regions) as an adult experienced higher rates of all skin cancers. Females were less likely to have reported BCCs compared to males. The most common body area for skin cancer in cricketers (slightly over half of all cases) was the head/face/neck region.

Conclusion: The rates of BCC, SCC and melanoma in cricketers were high for almost all age groups. This is likely to represent a combination of true increase (due to a combination of sporting and leisure-time exposure) and bias due to methodological limitations. Fair-skinned cricketers can reasonably be considered a high-risk population in Australia who should exercise lifetime vigilance.

Through a multidisciplinary quality improvement initiative, the Pre-Immunosuppression (Pre-IS) Clinic was created at a tertiary referral institution to ensure appropriate vaccination and infectious disease screening for patients on immunosuppressive medications. Consensus guidelines on immunisation and infectious disease screening for immunosuppressed patients were created through a multidisciplinary committee. The guidelines included three sections: (1) screening recommendations for chronic/latent infections prior to immunosuppression, (2) immunisation recommendations for immunosuppressed patients and (3) recommendations for household contacts of immunosuppressed patients. The workflow to the Pre-IS Clinic was optimised. We present the vaccination guidelines and workflow as an effective example of a multidisciplinary qualitive improvement initiative.

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous tumour with a locally infiltrative growth pattern that has high rates of recurrence. Mohs micrographic surgery is recommended as the gold-standard treatment over wide local excision (WLE) due to tissue-sparing and reduced recurrence rates. No previous data on surgical outcomes following Mohs Micrographic Surgery (MMS) for DFSP have been reported in Australia to date. This study aims to review the outcomes of DFSP treated with frozen-section MMS across three centres in New South Wales (NSW), Australia, and compare these outcomes with those in the current literature.

Methods: A retrospective review of patients who underwent MMS for DFSP between 2010 and 2023 was performed. Patient demographics, histological findings, surgical treatment and follow-up data were collected. Recurrence was assessed through electronic medical records, clinical assessments by a dermatologist or general practitioner, and patient self-report.

Results: In all, 38 cases of DFSP were included (27 female, 11 male; median age 39 years, range 16-64). The trunk was the most common site. Clinical margins and Mohs stages were recorded in 37 of 38 cases, with 73% of cases cleared with clinical margins of ≤ 20 mm. Clinical or self-reported follow-up was available for 28 of 38 patients (73.6%) over a mean of 51 months (range, 5-132 months). No local recurrences were identified during this period.

Conclusion: This is the first Australian case series on MMS for DFSP. Our findings demonstrate no recurrences with follow-up and demonstrate that MMS may achieve clearance with smaller clinical margins than WLE. These results support international guidelines recommending MMS as the gold-standard treatment and highlight the need to improve access to MMS in Australia.