Australasian Journal of Dermatology最新文献

Palmoplantar pustular psoriasis (PPPP), or palmoplantar pustulosis (PPP), is a type of psoriasis that affects the skin on the palms and soles. It is characterised by dermatosis and small sterile pustules and is considered a significant burden on patients' quality of life, as there is currently no gold standard treatment or cure. This network meta-analysis (NMA) compares the efficacy and safety of biologic and non-biologic medications for PPPP and PPP. Medline, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched. The efficacy and safety of all medications were assessed through a frequentist NMA using a random-effects model. Treatments were ranked using the net rank function, yielding P scores. Fourteen RCTs with 1056 participants were included. Guselkumab 100 mg was the most effective for improving PPPGA scores (p = 0.72, RR = 1.31, CI: 0.31-5.57). Guselkumab 100 mg was ranked the highest for achieving PPPASI-75 (RR = 5.4, CI: 1.26-23.2, p = 0.023). Oral cyclosporine 1 mg/kg/day was ranked the highest for PPPASI-50 (RR = 2.10, CI: 0.65-6.82). Etretinate 1 mg/kg/day had the highest rate of adverse events (RR = 1.78, CI: 0.92-3.44). Secukinumab 300 mg was associated with the highest rate of serious adverse events (RR = 1.58, CI: 0.21-12.02). Based on the P-scores from our NMA, guselkumab 100 mg was the most effective for PPPGA improvement, guselkumab 100 mg for PPPASI-75, oral cyclosporine 1 mg/kg/day for PPPASI-50, etretinate 1 mg/kg/day had the most adverse events, and secukinumab 300 mg was associated with the highest rate of serious adverse events. TRIAL REGISTRATION: PROSPERO registration number: CRD42023460842.

Moderate-to-severe hidradenitis suppurativa (HS) is a debilitating disease that often requires biological therapy. Despite the effectiveness of approved doses, some patients experience partial or loss of response over time, leading to the need for dose intensification. This retrospective multicentre study aimed to identify predictors of biological therapy intensification in HS patients. The results showed that prior use of biological treatments and biosimilar adalimumab were significant predictors of intensification, suggesting closer monitoring may be needed for certain patient profiles to optimise treatment outcomes.

The reconstruction of full-thickness scalp defects with exposed bone can be challenging. A single-stage reconstruction could be the preferred option for patients with multiple comorbidities. We propose using a dermal regeneration template (Matriderm Flex) and full-thickness skin grafts. The approach shown in this case report allows for quick healing, less donor-site discomfort in comparison with dermatome-harvested skin grafts, and very good aesthetic results, matching the surrounding skin thickness.

Introduction: Ultraviolet-based dermoscopy may support the recognition of scabies, yet neither accuracy analyses nor data on skin of colour are available. The aim of this multicentric observational retrospective was to investigate the diagnostic accuracy of polarised and ultraviolet-induced fluorescence (UVF) dermoscopic examination in both fair and dark skin, also assessing possible differences according to the skin tone.

Methods: Consecutive patients with a diagnosis of scabies were eligible. All the images were randomly evaluated by two independent experienced investigators to identify scabietic findings reported in the literature. Interobserver agreement was evaluated for both polarised and UVF dermoscopic pictures through Cohen's kappa coefficient, while Fisher's exact test with p-value set at 0.05 was used for comparative analyses between the two settings.

Results: A total of 97 lesions from 43 patients (21 with fair skin and 22 with dark skin) were included. The comparative analysis highlighted a superiority of UVF dermoscopy to detect the burrow (p = 0.003) and scabietic eggs (p = 0.012) in skin of colour, while polarised dermoscopy was more accurate to show the mite in fair skin (p = 0.042). Additionally, a general higher accuracy of both settings in light phototypes was also found, with a higher prevalence (p < 0.05) of typical scabietic findings (i.e., serpiginous white tract, 'triangle' sign and grey-brown outlines of the burrow for polarised dermoscopy and green dot for UVF dermoscopy) compared to dark skin. Kappa values were 0.87 and 0.83 for polarised and UVF-dermoscopy, respectively.

Conclusions: UVF dermoscopy improves the recognition of scabies, though it should be considered complimentary to polarised light dermoscopic examination to increase diagnostic performance.