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Cost-utility of sirolimus in the treatment of vascular malformations. 西罗莫司治疗血管畸形的成本效益。
IF 2.2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-10-04 DOI: 10.1111/ajd.14369
Grace Xiaoying Li, Deshan Frank Sebaratnam

Sirolimus is being increasingly employed to manage specific vascular anomalies. We performed an exploratory cost-utility analysis to evaluate sirolimus as a treatment for vascular malformations from the Australian healthcare system perspective. Over a one-year time horizon, sirolimus treatment was associated with an increased expenditure of AU$2832.80 and a gain of 0.08 quality-adjusted life years (QALYs) when compared to supportive care, resulting in an incremental cost-effectiveness ratio of AU$35,410/QALY. By most metrics, sirolimus would be considered a cost-effective treatment for vascular malformations.

西罗莫司越来越多地被用于治疗特定的血管畸形。我们进行了一项探索性成本效用分析,从澳大利亚医疗保健系统的角度评估西罗莫司治疗血管畸形的效果。在一年的时间跨度内,与支持性治疗相比,西罗莫司治疗增加了2832.80澳元的支出,提高了0.08个质量调整生命年(QALYs),增量成本效益比为35410澳元/QALY。从大多数指标来看,西罗莫司被认为是一种治疗血管畸形的经济有效的方法。
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引用次数: 0
Advances in non-invasive imaging for dermatofibrosarcoma protuberans: A review. 原发性皮纤维肉瘤无创成像技术的进展:综述。
IF 2.2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-10-03 DOI: 10.1111/ajd.14366
Yanci A Algarin, Anika Pulumati, Jiali Tan, Nathalie C Zeitouni

Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma characterized by an asymmetric, infiltrative growth pattern and a high risk of local recurrence. This study aims to evaluate the effectiveness of various imaging modalities in the assessment and management of DFSP. Nine imaging modalities were reviewed including: Ultrasound (US), High-Frequency Doppler Ultrasound (HFUS), Computed tomography (CT), Positron emission tomography-computed tomography (PET-CT), and Magnetic Resonance Imaging (MRI), High-resolution-MRI (HR-MRI), Magnetic Resonance Spectroscopy (MRS), Optical Coherence Tomography (OCT), and Dermatoscopy. Imaging is mainly used for preoperative assessment and surgical planning, not routine diagnosis. US is effective for initial evaluations, demonstrating superior ability in detecting muscle invasion and defining tumour boundaries (sensitivity - 81.8%, specificity - 100%). MRI is valuable for preoperative evaluation, surgical planning, and monitoring DFSP recurrence. It more accurately assesses tumour depth than palpation, with a sensitivity of 67% and specificity of 100%, but was inferior when compared to US. CT is utilized in cases of suspected bone involvement or pulmonary metastasis. For advanced or recurrent DFSP, PET-CT helps manage treatment responses and imatinib therapy. Emerging technologies like MRS and OCT show potential in improving diagnostic accuracy and defining surgical margins, though more data are needed. US, MRI, and CT are the primary imaging modalities for DFSP. Emerging technologies like HR-MRI, PET-CT, MRS, and OCT hold promise for refining diagnostic and management strategies. Integrating multiple technologies could enhance management, particularly in atypical or aggressive cases. Further studies are required to refine imaging protocols and improve DFSP outcomes.

原发性皮肤纤维肉瘤(DFSP)是一种罕见的软组织肉瘤,其特点是不对称、浸润性生长模式和局部复发风险高。本研究旨在评估各种成像模式在评估和治疗 DFSP 方面的有效性。研究回顾了九种成像模式,包括超声波(US)、高频多普勒超声波(HFUS)、计算机断层扫描(CT)、正电子发射计算机断层扫描(PET-CT)、磁共振成像(MRI)、高分辨率磁共振成像(HR-MRI)、磁共振波谱成像(MRS)、光学相干断层扫描(OCT)和皮肤镜。成像主要用于术前评估和手术规划,而非例行诊断。US 对初步评估很有效,在检测肌肉侵犯和确定肿瘤边界方面表现出卓越的能力(敏感性 - 81.8%,特异性 - 100%)。核磁共振成像对于术前评估、手术规划和监测 DFSP 复发很有价值。与触诊相比,磁共振成像能更准确地评估肿瘤深度,灵敏度为 67%,特异性为 100%,但与 US 相比,磁共振成像效果较差。CT适用于疑似骨受累或肺转移的病例。对于晚期或复发性 DFSP,PET-CT 有助于管理治疗反应和伊马替尼治疗。MRS 和 OCT 等新兴技术在提高诊断准确性和确定手术边缘方面显示出潜力,但还需要更多数据。US、MRI 和 CT 是 DFSP 的主要成像方式。HR-MRI、PET-CT、MRS 和 OCT 等新兴技术有望完善诊断和管理策略。整合多种技术可加强管理,尤其是在非典型或侵袭性病例中。要完善成像方案并改善 DFSP 的预后,还需要进一步的研究。
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引用次数: 0
Pyoderma gangrenosum during infliximab in severe hidradenitis suppurativa: A paradoxical event. 重度化脓性扁桃体炎患者在使用英夫利西单抗期间出现脓皮病:一个自相矛盾的事件。
IF 2.2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-10-03 DOI: 10.1111/ajd.14367
Silvia Giordano, Federica Repetto, Sara Boskovic, Gabriele Roccuzzo, Michela Ortoncelli, Paolo Dapavo, Simone Ribero, Pietro Quaglino
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引用次数: 0
Melanoma documented arising in an involuting naevus 3 years after cessation of monitoring 停止监测 3 年后记录到内卷痣中出现黑色素瘤
IF 2.2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-09-13 DOI: 10.1111/ajd.14365
Christine Lee Bachelor Nursing, SFC (Skin Cancer Diagnostics), Sarah Coleman Grad Cert Nursing, SFC (Skin Cancer Diagnostics), Aksana Marozava MD, Blake O'Brien MBBS, FRCPA, Cliff Rosendahl MBBS, PhD
<p>A 35-year-old female, with no family history of melanoma but with a personal history of three previous melanomas, presented for a routine skin examination in 2023. She had been treated for melanoma in situ on the right forearm at age 12, with subsequent primary invasive melanomas on the scalp at ages 21 and 26. Because of her categorisation as high risk, she was having 6-monthy whole-body skin examinations as well as sequential digital dermatoscopic imaging (SDDI) of multiple randomly selected skin lesions.</p><p>As part of this process one pigmented skin lesion over the upper thoracic spine (Figure 1, black arrow) was monitored annually from 2017 and as it was observed to become smaller, then stable on sequential images (Figure 2, 2017–2020), monitoring was suspended in 2020.</p><p>In 2023 at routine examination by the treating clinician, assisted by a qualified nurse-diagnostician, with active reference to total body photography (TBP) images, an observation was made by the nurse that the lesion previously monitored (Figure 1, black arrow) was now a similar size to a previously larger lesion below it (Figure 1, white arrow). A dermatoscopic image was taken and when compared with the previous image from 2020, significant progressive change in all quadrants was identified (Figure 2, 2023). The lesion was excised and submitted for histology, accompanied by relevant clinical information and dermatoscopic images. Histological examination was consistent with early melanoma in situ, with regression, arising in a pre-existing compound naevus (Figure S1). The subject patient has provided informed consent to the publication of their information contained within this manuscript.</p><p>Sequential digital dermatoscopic imaging of randomly selected multiple naevi has been shown to have diagnostic efficacy for patients at high risk of melanoma.<span><sup>1</sup></span> As well as facilitating diagnosis of early, and even featureless melanomas,<span><sup>1</sup></span> it has been demonstrated to improve specificity, avoiding excision of biologically indolent lesions.<span><sup>2</sup></span> It has been shown that monitoring may need to be continued long-term to detect slow-growing melanomas, in one large study major changes only being evident after a mean follow-up of 33 months.<span><sup>3</sup></span> The use of TBP and SDDI, known as the ‘two-step method of digital follow-up’ has been suggested as an ideal surveillance strategy for high-risk melanoma patients.<span><sup>2</sup></span> It is also known that the provision of relevant clinical information has been shown to improve pathologists' confidence in, and accuracy of histological diagnosis.<span><sup>4</sup></span></p><p>A meta-analysis of naevus-associated melanomas in 2017 reported that most cutaneous melanomas arose de novo, 29.1% arising in association with a naevus. In contrast to a commonly held misconception, melanoma-associated naevi were most frequently non-dysplastic, the bland dermal nae
一名 35 岁的女性于 2023 年接受常规皮肤检查,她没有黑色素瘤家族史,但曾患过三次黑色素瘤。她在 12 岁时曾因右前臂原位黑色素瘤接受过治疗,随后在 21 岁和 26 岁时又患上了头皮原发性浸润性黑色素瘤。作为这一过程的一部分,从 2017 年起,每年对胸椎上部的一个色素性皮肤病变(图 1,黑色箭头)进行监测,由于观察到该病变变小,然后在连续图像上趋于稳定(图 2,2017-2020 年),因此在 2020 年暂停监测。2023 年,主治临床医生在一名合格诊断护士的协助下进行常规检查,并积极参考全身摄影(TBP)图像,护士观察到之前监测到的病灶(图 1,黑色箭头)现在与下方之前较大的病灶(图 1,白色箭头)大小相似。护士拍摄了一张皮肤镜图像,与 2020 年的图像相比,发现所有象限都发生了明显的渐进性变化(图 2,2023)。病变被切除并提交组织学检查,同时附上了相关的临床信息和皮肤镜图像。组织学检查结果与早期原位黑色素瘤一致,并伴有退行性病变,产生于原有的复合痣(图 S1)。随机选取多发痣进行顺序数字皮肤镜成像已被证明对黑色素瘤高危患者有诊断效果1。1 它不仅有助于诊断早期甚至无特征的黑色素瘤,1 还能提高特异性,避免切除生物学上不活跃的病变。2 有研究表明,要发现生长缓慢的黑色素瘤,可能需要长期持续监测,在一项大型研究中,平均随访 33 个月后才会发现重大变化。4 2017 年一项关于痣相关黑色素瘤的荟萃分析报告显示,大多数皮肤黑色素瘤是新发的,29.1% 与痣相关。5 本病例说明了 "数字随访两步法 "的偶然结果,大学培训的护士诊断人员在联合检查过程中的参与也为这一结果提供了便利。Cliff Rosendahl 构思并撰写了手稿,Christine Lee、Sarah Coleman 和 Aksana Marozava 直接参与了摄影技术的应用和病变检测,Blake O'Brien 是报告的皮肤病理学家,他还提供了组织学图像。所有作者都严格审阅并批准了手稿。作者声明没有利益冲突。
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引用次数: 0
Tuberculosis reactivation following apremilast therapy for psoriasis: Time to consider routine TB screening? 阿普司匹灵治疗银屑病后肺结核再活化:是时候考虑进行常规结核病筛查了吗?
IF 2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-09-11 DOI: 10.1111/ajd.14364
Lucinda Adams, Emma L. Smith, Dev Tilakaratne, Vicki Krause
Apremilast is a relatively new oral treatment for psoriasis, which reduces expression of pro‐inflammatory factors, including tumour necrosis factor‐α (TNFα), critical to the immune control of Mycobacterium tuberculosis infection. In randomised controlled trials (RCTs) for apremilast no new cases of active tuberculosis (TB) were identified, thus, screening for latent TB infection (LTBI) is not currently recommended prior to apremilast initiation. We describe a case of M.tuberculosis reactivation shortly after commencement of apremilast for psoriasis. We are recommending clinicians perform LTBI risk assessment in all patients, and appropriate LTBI screening in select populations prior to apremilast initiation.
阿普司特是一种相对较新的治疗银屑病的口服药物,它能减少促炎因子的表达,包括肿瘤坏死因子-α(TNFα),这对结核分枝杆菌感染的免疫控制至关重要。在阿普瑞司特的随机对照试验(RCT)中,没有发现新的活动性结核病(TB)病例,因此目前不建议在开始使用阿普瑞司特前进行潜伏性结核感染(LTBI)筛查。我们描述了一例在开始使用阿普司特治疗银屑病后不久再次激活结核杆菌的病例。我们建议临床医生对所有患者进行LTBI风险评估,并在使用阿普司特前对特定人群进行适当的LTBI筛查。
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引用次数: 0
The use of oral benzodiazepines for patient anxiety associated with Mohs micrographic surgery: An Australian survey 使用口服苯并二氮杂卓治疗与莫氏显微摄影手术相关的患者焦虑症:澳大利亚调查
IF 2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-09-10 DOI: 10.1111/ajd.14361
Adam G. Harris, Simon Lee
A survey of Mohs surgery specialists in Australia showed diazepam was the preferred agent and felt to be the safest oral benzodiazepine for perioperative anxiolysis.
对澳大利亚莫氏手术专家的调查显示,地西泮是首选药物,也是围手术期最安全的口服苯二氮卓类药物。
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引用次数: 0
Skin health of Aboriginal children living in urban communities. 生活在城市社区的原住民儿童的皮肤健康。
IF 2.2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-08-28 DOI: 10.1111/ajd.14363
Bernadette M Ricciardo, Heather-Lynn Kessaris, Noel Nannup, Dale Tilbrook, Nadia Rind, Richelle Douglas, Jodie Ingrey, Jacinta Walton, Carol Michie, Brad Farrant, Eloise Delaney, S Prasad Kumarasinghe, Jonathan R Carapetis, Asha C Bowen

Background: Skin concerns are frequent among urban-living Aboriginal children, yet specialist dermatology consultations are limited with studies highlighting the need for improved cultural security. Through newly established paediatric dermatology clinics at two urban Aboriginal Community Controlled Health Organisations (ACCHOs), we aimed to describe clinic and patient data, including disease frequencies and associations, to inform dermatology service provision and advocacy.

Methods: A prospective cohort study of Aboriginal children and young people (CYP, 0-18 years) attending Aboriginal Health Practitioner (AHP) co-ordinated paediatric dermatology clinics at two urban ACCHOs.

Results: Data were collected from 32 clinics over 19 months, with 335 episodes of care and a mean attendance rate of 74%. From 78 new patients, 72 (92%) were recruited into the study, only one of whom had previously received dermatologist assessment. Eczema, tinea or acne accounted for 47% (34/72) of referrals, and 60% of patients received their first appointment within 4 weeks of referral. In 47/72 (65%) consultations, the GP referral and dermatologist diagnosis concurred. The most frequent diagnoses (primary or secondary) at first consultation were atopic dermatitis (26%, 19/72), dermatophyte infections (25%, 18/72), acne (21%, 15/72), bacterial skin infections (18%, 13/72) and post-inflammatory dyspigmentation (18%, 13/72). Three categories of the 2022 Australasian College of Dermatologists curriculum (infections, eczema/dermatitis, pigmentary disorders) accounted for 59% of all diagnoses.

Conclusions: This study highlights the specialist dermatology needs of urban-living Aboriginal CYP. ACCHO-embedded dermatology clinics co-ordinated by AHPs demonstrated benefits for Aboriginal CYP in accessing care. Opportunities to embed dermatology practice within ACCHOs should be prioritised.

背景:在城市生活的原住民儿童中,皮肤问题很常见,但专科皮肤病咨询却很有限,研究强调需要改善文化安全。通过在两个城市原住民社区控制健康组织(ACCHOs)新设立的儿科皮肤病诊所,我们旨在描述诊所和患者数据,包括疾病频率和关联,为皮肤病服务的提供和宣传提供信息:一项前瞻性队列研究,研究对象是在两个城市 ACCHOs 的原住民保健医生(AHP)协调下的儿科皮肤病诊所就诊的原住民儿童和青少年(CYP,0-18 岁):在 19 个月的时间里,我们从 32 个诊所收集了数据,共进行了 335 次治疗,平均就诊率为 74%。在78名新患者中,有72人(92%)被纳入研究,其中只有一人曾接受过皮肤科医生的评估。湿疹、癣或痤疮占转诊患者的 47%(34/72),60% 的患者在转诊后 4 周内接受了首次预约。在 47/72 次(65%)会诊中,全科医生的转诊和皮肤科医生的诊断是一致的。首次就诊时最常见的诊断(一级或二级)是特应性皮炎(26%,19/72)、皮癣菌感染(25%,18/72)、痤疮(21%,15/72)、细菌性皮肤感染(18%,13/72)和炎症后色素沉着(18%,13/72)。2022 年澳大利亚皮肤科医师学院课程中的三个类别(感染、湿疹/皮炎、色素性疾病)占所有诊断的 59%:这项研究凸显了生活在城市中的原住民青少 年对专科皮肤病的需求。由AHPs协调的ACCHO嵌入式皮肤科诊所显示了原住民儿童青少年在获得护理方面的益处。应优先考虑将皮肤病学实践纳入 ACCHO 的机会。
{"title":"Skin health of Aboriginal children living in urban communities.","authors":"Bernadette M Ricciardo, Heather-Lynn Kessaris, Noel Nannup, Dale Tilbrook, Nadia Rind, Richelle Douglas, Jodie Ingrey, Jacinta Walton, Carol Michie, Brad Farrant, Eloise Delaney, S Prasad Kumarasinghe, Jonathan R Carapetis, Asha C Bowen","doi":"10.1111/ajd.14363","DOIUrl":"https://doi.org/10.1111/ajd.14363","url":null,"abstract":"<p><strong>Background: </strong>Skin concerns are frequent among urban-living Aboriginal children, yet specialist dermatology consultations are limited with studies highlighting the need for improved cultural security. Through newly established paediatric dermatology clinics at two urban Aboriginal Community Controlled Health Organisations (ACCHOs), we aimed to describe clinic and patient data, including disease frequencies and associations, to inform dermatology service provision and advocacy.</p><p><strong>Methods: </strong>A prospective cohort study of Aboriginal children and young people (CYP, 0-18 years) attending Aboriginal Health Practitioner (AHP) co-ordinated paediatric dermatology clinics at two urban ACCHOs.</p><p><strong>Results: </strong>Data were collected from 32 clinics over 19 months, with 335 episodes of care and a mean attendance rate of 74%. From 78 new patients, 72 (92%) were recruited into the study, only one of whom had previously received dermatologist assessment. Eczema, tinea or acne accounted for 47% (34/72) of referrals, and 60% of patients received their first appointment within 4 weeks of referral. In 47/72 (65%) consultations, the GP referral and dermatologist diagnosis concurred. The most frequent diagnoses (primary or secondary) at first consultation were atopic dermatitis (26%, 19/72), dermatophyte infections (25%, 18/72), acne (21%, 15/72), bacterial skin infections (18%, 13/72) and post-inflammatory dyspigmentation (18%, 13/72). Three categories of the 2022 Australasian College of Dermatologists curriculum (infections, eczema/dermatitis, pigmentary disorders) accounted for 59% of all diagnoses.</p><p><strong>Conclusions: </strong>This study highlights the specialist dermatology needs of urban-living Aboriginal CYP. ACCHO-embedded dermatology clinics co-ordinated by AHPs demonstrated benefits for Aboriginal CYP in accessing care. Opportunities to embed dermatology practice within ACCHOs should be prioritised.</p>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The risk of psychiatric disorders in finasteride users with benign prostatic hyperplasia and androgenetic alopecia: A population-based case-control study. 患有良性前列腺增生症和雄激素性脱发的非那雄胺使用者患精神疾病的风险:一项基于人群的病例对照研究。
IF 2.2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-08-13 DOI: 10.1111/ajd.14359
Anna Lyakhovitsky, Boaz Amichai, Eran Galili, Arnon Cohen, Khalaf Kridin, Zvi Segal, Doron Netzer

Background: There is a long-standing debate if finasteride, a medication used to treat benign prostatic hyperplasia (BPH) and androgenetic alopecia (AGA), can cause psychiatric side effects.

Objective: The goal of this large-scale population-based study was to determine whether finasteride therapy for BPH and AGA is associated with the emergence of mental health conditions.

Methods: This observational case-control study compared the data from patients with BPH who received finasteride 5 mg daily and patients with AGA who received finasteride 1 mg daily with age- and gender-matched controls. The incidence of psychological health outcomes such as depression, anxiety, neuroses, bipolar disorder, schizophrenia, psychoses and alcohol abuse within 2 years of the initiation of finasteride therapy has been evaluated and compared between the finasteride groups and controls.

Results: The BPH group included 307 men with a mean age of 61.5 (±17.4) years and 1218 controls. Mental health outcomes recorded in 2.3% of the patients, with no significant increase in rate when compared to controls. The AGA group consisted of 23,227 men with a mean age of 31.4 (±10.3) years and 39,444 controls. Only One percent of AGA patients developed psychiatric disorders. In comparison to controls, patients with AGA had higher rates of anxiety and depression (0.6% vs. 0.4%, p = 0.04, and 0.5% vs. 0.4%, p = 0.007, respectively). In multivariate regression models, finasteride was found as one of the risk factors for anxiety (OR 1.449, p = 0.002) and depression (OR 1.439, p = 0.003) when stratified to age, sector, socioeconomic status and comorbidities.

Conclusions: According to our research, finasteride users had a very low rate of adverse mental health effects, with no increase in psychological sequelae in BPH patients and a slight increase in anxiety and depression in AGA patients.

背景:非那雄胺是一种用于治疗良性前列腺增生症(BPH)和雄激素性脱发症(AGA)的药物,关于非那雄胺是否会导致精神疾病副作用的争论由来已久:这项大规模人群研究的目的是确定非那雄胺治疗良性前列腺增生症和雄激素性脱发症是否与精神健康状况的出现有关:这项观察性病例对照研究比较了每天服用5毫克非那雄胺的良性前列腺增生患者和每天服用1毫克非那雄胺的AGA患者与年龄和性别匹配的对照组的数据。研究还评估了非那雄胺治疗开始后 2 年内抑郁、焦虑、神经官能症、躁郁症、精神分裂症、精神病和酗酒等心理健康后果的发生率,并将非那雄胺治疗组与对照组进行了比较:良性前列腺增生症组包括 307 名男性,平均年龄为 61.5 (±17.4) 岁,对照组包括 1218 名男性。2.3%的患者出现了心理健康问题,与对照组相比,比例没有显著增加。AGA组包括23227名男性(平均年龄为31.4(±10.3)岁)和39444名对照组。只有1%的AGA患者出现精神障碍。与对照组相比,AGA 患者患焦虑症和抑郁症的比例更高(分别为 0.6% 对 0.4%,p = 0.04;0.5% 对 0.4%,p = 0.007)。在多变量回归模型中,发现非那雄胺是导致焦虑症(OR 1.449,p = 0.002)和抑郁症(OR 1.439,p = 0.003)的危险因素之一,并与年龄、部门、社会经济地位和合并症进行了分层:根据我们的研究,非那雄胺使用者的心理健康不良反应率非常低,良性前列腺增生患者的心理后遗症没有增加,而AGA患者的焦虑和抑郁略有增加。
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引用次数: 0
Dermatological care of gender-diverse patients in Australia. 澳大利亚对不同性别患者的皮肤病护理。
IF 2.2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-08-08 DOI: 10.1111/ajd.14360
Roy Kingsley Wong, Jenny Harrington, Annabel Irene Stevenson

In recent years, there has been an increasing recognition of the unique healthcare needs of gender-diverse patients in Australia. With the continuous growth of referrals to gender health services, there is an increased demand for specialised dermatological care. There is still a significant knowledge gap and a lack of guidelines specifically tailored to this patient group. In this article, we will provide a brief overview of the journey of Transgender and Gender Diverse (TGD) individuals as they embark on psychological and pharmacologic treatment for gender dysphoria in Australia. We endeavour to contribute to the existing body of knowledge by examining the evidence surrounding the treatment of skin, hair and nail issues for TGD patients. This article will outline how dermatologists can assist in the care of the gender-diverse patient. Although puberty blockade (stage 1 treatments) has minimal dermatological impact, gender-affirming pharmacotherapy (stage 2 treatments) can lead to many dermatological issues including acne, patterned hair loss (PHL) and dermatitis. The dermatologist may also play a role in stage 3 treatments which include surgical or procedural interventions for gender affirmation.

近年来,人们越来越认识到澳大利亚不同性别患者独特的医疗保健需求。随着转诊到性别健康服务机构的人数持续增长,对皮肤病专科护理的需求也在不断增加。目前,针对这一患者群体的知识缺口仍然很大,也缺乏专门针对这一患者群体的指南。在本文中,我们将简要介绍澳大利亚变性人和性别多元化(TGD)人士在接受心理和药物治疗以治疗性别障碍时的历程。我们将通过研究 TGD 患者皮肤、头发和指甲问题治疗的相关证据,努力为现有知识体系做出贡献。本文将概述皮肤科医生如何协助护理性别多元化患者。虽然青春期阻断(第一阶段治疗)对皮肤病的影响很小,但性别确认药物治疗(第二阶段治疗)可导致许多皮肤病问题,包括痤疮、模式化脱发(PHL)和皮炎。皮肤科医生还可能在第三阶段治疗中发挥作用,第三阶段治疗包括通过手术或程序干预来确认性别。
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引用次数: 0
Safety and efficacy of biologic drugs in children or adolescents with atopic dermatitis: A systematic review and meta-analysis of randomized controlled trials 生物制剂药物对儿童或青少年特应性皮炎患者的安全性和疗效:随机对照试验的系统回顾和荟萃分析。
IF 2.2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-08-05 DOI: 10.1111/ajd.14358
Ana Clara Felix de Farias Santos, Fernanda Valeriano Zamora MD, Lorhayne Kerly Capuchinho Scalioni Galvao MD, Nicole dos Santos Pimenta, João Pedro Costa Esteves Almuinha Salles, Kélen Klein Heffel MD

Children and adolescents suffering from moderate-to-severe atopic dermatitis (AD) face a significant disease burden that greatly impacts their quality of life. Treatment options for AD are currently limited. To assess the safety and efficacy of biologic drugs, dupilumab, lebrikizumab, or tralokinumab, in improving outcomes in patients with moderate to severe inadequately controlled AD. We searched PubMed, Embase and Cochrane databases for randomized controlled trials (RCTs) comparing dupilumab, lebrikizumab or tralokinumab to placebo in patients with AD. We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs), random effects model was used and a p-value <0.05 was considered as statistically significant. We analysed data into Review Manager 5.4. A total of five RCTs and 973 patients were included, of whom 592 were prescribed a biologic drug. Compared with placebo, patients receiving a biologic drug had a greater improvement, achieved an Investigator Global Assessment (IGA) score of 0 or 1 (OR 5.05; 95% CI 3.08–8.29), Eczema Area and Severity Index (EASI) 75 (OR 6.87; 95% CI 4.71–10.02), EASI 50 (OR 8.89; 95% CI 6.18–12.78) and EASI 90 (8.30; 95% CI 4.81–14.31). The proportion of patients with 3 points or more (OR 6.56; 95% CI 4.34–9.90) or 4 points or more (OR 8.09; 95% CI 5.19–12.59) improvement from baseline in peak pruritus NRS was significantly higher with biologic drugs than placebo. There were no significant differences between groups regarding adverse events (OR 0.79; 95% CI 0.58–1.07), and conjunctivitis (OR 2.08; 95% CI 1.00–4.33). In this meta-analysis, dupilumab, lebrikizumab, and tralokinumab have shown significant improvements in signs, symptoms and quality of life in children or adolescents with moderate to severe AD. Larger studies may be needed to continue evaluating the safety and efficacy of these biologic drugs in this patient population.

患有中度至重度特应性皮炎(AD)的儿童和青少年面临着巨大的疾病负担,极大地影响了他们的生活质量。目前,特应性皮炎的治疗方案十分有限。为了评估生物药物杜匹单抗、来布利珠单抗或曲妥珠单抗在改善中度至重度未得到充分控制的特应性皮炎患者预后方面的安全性和有效性。我们在 PubMed、Embase 和 Cochrane 数据库中检索了在 AD 患者中比较 dupilumab、lebrikizumab 或 tralokinumab 与安慰剂的随机对照试验 (RCT)。我们计算了二元终点的几率比(OR)及95%置信区间(CI),采用随机效应模型,P值为
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引用次数: 0
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Australasian Journal of Dermatology
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