Australasian Journal of Dermatology最新文献

Background: Psoriasis is a risk factor for cardiovascular disease (CVD). This risk is independent and incremental to traditional cardiovascular (CV) risk factors, but clinician and patient perspectives on this risk are unclear. This study aims to assess the knowledge, perceptions, and practice of clinicians and patients with respect to psoriasis and CVD.

Methods: This cross-sectional study consisted of a self-administered questionnaire capturing demographic characteristics, knowledge of the association between psoriasis and CVD, and perspectives on CV screening and management. This was distributed to members of relevant Australasian Speciality Medical Colleges, speciality societies, and psoriasis patients in public and private clinic settings. Survey data were assessed using descriptive statistics. Logistic regression was used to investigate the relationship between categorical variables and the outcome variable, for example, to determine factors predictive of clinician knowledge and perceptions. For all analyses, a p-value of less than 0.05 was considered statistically significant.

Results: A total of 298 clinicians (dermatologists (86), rheumatologists (56), cardiologists (53), general practitioners (103)) and 102 patients with psoriasis were surveyed. Regarding clinician knowledge of the association between psoriasis and CVD, dermatologists and rheumatologists indicated knowledge of this association (98.8%) (85/96) and 91.1% (51/56) respectively, while only 54.7% (29/53) of cardiologists and 29.1% (30/103) of GPs indicated knowledge of this association. Only 23.5% (24/102) of patients surveyed indicated knowledge of this association. Clinicians with a higher proportion of their caseload including psoriasis patients were significantly more likely to be aware of the association between psoriasis and CVD (OR 3.05 [1.64, 5.68]; p < 0.001). Most clinicians nominated GPs as best placed to facilitate CV risk factor screening and management (dermatologists 80.2% (69/86); rheumatologists 83.9% (47/56); cardiologists 75.5% (40/53); GPs 88.3% (91/103)). Patients preferred specialist input and multidisciplinary care for CVD risk management; 34.3% (35/102) nominated a cardiologist as the preferred clinician, and 23.5% (24/102) indicated preference for a multidisciplinary team.

Limitations: The possibility of sampling and response bias, inherent in the study design, is acknowledged; however, responses are likely representative of clinician and patient sentiments on this issue and in keeping with similar study findings.

Conclusion: Clinician and patient knowledge of the relationship between psoriasis and CVD needs to be improved. The establishment of a national consensus approach to address this gap in clinical care is needed.

There is a high prevalence of musculoskeletal pain among dermatological surgeons, particularly in the neck, upper and lower back, and shoulders. We performed an international survey which revealed a lack of ergonomic education and use of ergonomic tools in dermatological surgery. Most respondents were aware of bad posture during surgery, but few regularly checked their posture. Behavioural interventions, such as alternating between standing and sitting, and taking frequent breaks, are recommended to reduce pain. Ergonomic workstation adaptations, including the use of surgical loupes, good lighting and adjustable stools, are crucial for reducing strain.

Background/objectives: Post-inflammatory hyperpigmentation (PIH) impacts all skin tones with a heightened predilection for Fitzpatrick skin types (FST) III-VI. Preventative measures include pre- and post-intervention approaches, such as sunscreen and corticosteroids. This systematic review aims to summarise the preventative measure outcomes for skin of colour individuals.

Methods: A literature search was conducted using MEDLINE (from 1946) and Embase (from 1974) in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

Results: Of 14 studies, 369 cases were included. The mean age was 38 years (n = 293) and 72% were female (n = 265). All patients were of Asian ethnicity, and 42% were of FST III, 54% FST IV, and 4% FST V. Nearly all cases were precipitated by laser therapy (> 95%), and the face was the most reported location (85%). The most successful preventative measure was sunscreen alone or combined with other ingredients. Less successful outcomes were seen with topical corticosteroids and systemic tranexamic acid, while cooling air devices exacerbated the development of PIH.

Conclusion: Overall, only sunscreen consistently prevented the incidence of PIH; however, the severity of the ensuing PIH may be diminished with other measures. There is considerable room for improved preventative strategies for at-risk populations.

Background: The aetiology of vulvar lichen sclerosus (VLS) remains unknown. However, there is evidence that in addition to a genetic predisposition, autoimmunity contributes to the pathogenesis.

Objectives: The objective of this study was to determine the prevalence of autoimmune disease and positive autoantibody serology in patients with VLS.

Methods: A VLS database in Sydney, Australia, was retrospectively reviewed. A diagnosis of VLS was required for inclusion in the study. Data collected included demographics, comorbidities including any personal history of autoimmune disease, family history of autoimmune disease, and the results from autoantibody testing. A total of 2243 females with VLS were included in this study.

Results: Autoimmune disease was found in 24.5% and 34.6% of children and adults with VLS, respectively. The most prevalent autoimmune conditions were psoriasis, Hashimoto's thyroiditis, lichen planus, and vitiligo. Antinuclear antibodies were common and found in 31.0% of patients. Thyroid peroxidase and thyroglobulin antibodies were present in 16.1% and 18.9% of cases, respectively. Thyroid function, determined by thyroid stimulating hormone, was abnormal in 8.2% of patients. 5.3% of patients had positive parietal cell antibodies, and 5.9% had low vitamin B12 levels.

Conclusions: This work provides support that VLS is of an autoimmune aetiology, and that there is an association between VLS and autoimmune diseases. The high proportion of patients with an abnormal thyroid test, positive thyroid antibodies, and intrinsic factor and gastric parietal cell antibodies with low vitamin B12 levels, warrants screening for thyroid disease and pernicious anaemia in patients with VLS. Initial autoimmune screening in VLS can be rationalised to TSH, vitamin B12 levels, intrinsic factor and parietal cell antibodies. Thyroid antibodiy testing shouls be performed in hypothyroid patients.

Acne vulgaris is a common inflammatory condition that is often treated by dermatologists with isotretinoin. Isotretinoin has a number of effects on inflammatory pathways, with clear efficacy in managing acne vulgaris. There are also well-documented side effects of isotretinoin, including hyperlipidemia; however, the overall cardiovascular risk is unclear. This systematic review revealed low evidence for major adverse cardiovascular events associated with the use of isotretinoin in acne patients. Despite this low evidence, rare events may be associated and should still be considered when using isotretinoin in acne patients.

This systematic review and meta-analysis aimed to assess the efficacy and safety of spironolactone for moderate to severe acne in adult women by synthesising data from randomised controlled trials (RCTs). The meta-analysis demonstrated that spironolactone significantly increased the odds of treatment success, with a pooled odds ratio (OR) of 2.51 compared to placebo or doxycycline. This analysis supports spironolactone as a highly effective treatment for moderate to severe acne in adult women, particularly in hormonally driven cases. Its efficacy, combined with its role as an alternative to long-term antibiotic therapy, makes it a valuable option for acne management in women population.

Australia experiences some of the highest ultraviolet radiation (UVR) levels globally, known for causing sunburn, skin cancers, photoageing and immunosuppression. While effects of UVA and UVB are well-studied, visible light (VL; 400-700 nm) is the driving force behind pigmentary disorders, especially in skin of colour (SOC) patients. Nearly 50% of Australians are affected, with significant impacts on appearance and psychological well-being. Tinted sunscreens containing iron oxides and pigmentary-grade titanium dioxide are the only effective options for blocking VL. However, Australia's stringent Therapeutic Goods Administration (TGA) regulations limit the availability of colour-matched tinted sunscreens, significantly impacting SOC patients. SOC patients may also underestimate their need for photoprotection, believing their skin provides sufficient natural protection. In dermatological practice, tailored sunscreen recommendations for darker skin tones may sometimes be overlooked. This review explores the barriers to effective treatment and the cost implications for SOC individuals suffering from pigmentary disorders in Australia. The goal is to guide both patients and dermatologists in making informed decisions on VL protection and skin tone matching.