Australasian Journal of Dermatology最新文献

This case series outlines a proposed simplified and cost-effective alternative to expensive laboratory-based autologous non-cultured epidermal suspension (NCES). In all five adult participants, 75%-100% repigmentation was observed at 6 months, with one participant experiencing unsatisfactory colour mismatch and one participant experiencing hypertrophic scarring. Larger, randomised controlled trials with extended follow-up are needed to determine the long-term efficacy and safety profile of our clinical NCES protocol.

Atypical fibroxanthoma (AFX) is a rare spindle cell neoplasm that arises within the dermis of chronically sun-exposed skin. Although wide local excision is standard practice, patients are regularly elderly and highly comorbid and therefore, curettage may offer a suitable alternative as a same day treatment with minimal aftercare. A retrospective case series was conducted analysing the files of all patients diagnosed with histopathological AFX at a single dermatology practice in Fremantle, Western Australia between the years 2016 and 2025. Kaplan-Meier analyses estimated recurrence rate with subgroup analyses comparing recurrence with gender, lesion location and lesion size. The study analysed 77 cases of AFX tumours treated with curettage and cautery. Patients had a mean age of 78.3 years with male predominance in the sample population. A total of nine tumours had documented recurrence, within a median time of 6.41 months, reflecting a crude recurrence rate of 11.69% and a Kaplan-Meier estimated 5-year recurrence rate of 16.99%. There were no disease-specific deaths, and no cases developed metastases. Given the high efficacy of curettage and cautery reflected in the study, and the lacking risk of disease-specific deaths and metastasis, a valuable treatment option is proposed. Employing curettage and cautery for AFX may reduce the personal and economic burden of cumbersome interventions, mitigating hospital admission and extensive wound care. Curettage and cautery may be of particular benefit in the nursing home population.

Background/objectives: Studies on factors that predict the number of stages in Mohs micrographic surgery (MMS) have been published previously. To date, no studies have analysed the predictors for the number of sections during MMS.

Methods: A retrospective case-control study of patients treated for keratinocyte cancer (KC) between 2013 and 2017 was conducted to identify predictive factors for 13 or more MMS sections. Patient, tumour, management and practitioner-related factors were analysed with univariate logistic regression and a multivariate predictive model. Surface area for tumours and defects was studied in cases and controls as a secondary outcome.

Results: Out of 10,132 tumours, a total of 195 cases representing 1.9% of all MMS procedures for the study period required more than 13 MMS sections. A control group with 213 tumours was also randomly selected. Largest preoperative tumour diameter, mixed histology, tumour recurrence and age were significant predictors for 13 or more MMS sections in a multivariate model (AUC 88.4%, sensitivity 77.2% and specificity 87.0%). Significantly larger defects were also found in our cases compared to the control group (median tumour to defect ratio 3.94 vs. 2.43; p < 0.0001).

Conclusion: Identifying factors that predict 13 or more sections prior to surgery could assist the Mohs practitioner in informing patients and allocating time and resources accordingly.

Bullous pemphigoid (BP) is a common autoimmune blistering disease associated with medications, particularly dipeptidyl peptidase-4 inhibitors such as vildagliptin, funded in New Zealand since 2018. We conducted a retrospective single-centre study of histologically confirmed BP cases between 2018 and 2023. Of 49 patients identified, 15 (30.6%) had vildagliptin-induced BP. Māori patients were over-represented in this subgroup. The mean time to BP onset after vildagliptin initiation was 388 days. Non-vildagliptin BP was more likely to require systemic immunosuppression. Vildagliptin-induced BP represents a common and under-recognised clinical entity in New Zealand.

Total Body Photography has undergone substantial technological advancement, now embracing high-resolution digital imaging, 3D reconstruction and the potential applications of artificial intelligence (AI), and mobile interoperability. However, its broader implementation is tempered by logistical hurdles as well as concerns regarding cost-effectiveness. This article traces its historical trajectory, evaluates its current clinical utility, and explores future applications.

Actinic prurigo (AP) is a rare, idiopathic, acquired photodermatosis predominantly affecting indigenous populations in North, Central and South America. It is characterised by intensely pruritic papules and nodules on sun-exposed skin, with potential involvement of the lips and conjunctivae. Treatment options are limited and often ineffective or associated with an unacceptable safety profile. This systematic review evaluates the existing evidence on the use of dupilumab and Janus kinase (JAK) inhibitors for AP management. A literature search was performed in MEDLINE, Google Scholar, ScienceDirect and Embase, for English-language publications mentioning the use of dupilumab or JAK inhibitors for AP. Eligible studies included case reports, case series, observational studies, clinical trials, consensus statements and guidelines. Two independent reviewers assessed the manuscripts. The search yielded 125 results, with seven publications meeting eligibility criteria, comprising six case reports and one case series. Four publications described three patients successfully treated with dupilumab, demonstrating significant improvement within weeks of initiation. Three reports detailed the successful use of the JAK inhibitors tofacitinib and baricitinib in three patients, leading to rapid symptom resolution. Emerging evidence suggests that dupilumab and JAK inhibitors may be effective in AP treatment. Evidence is limited to case reports with short follow-up durations. Further studies are necessary to establish the efficacy, safety and long-term outcomes of these novel therapies.