Australasian Journal of Dermatology最新文献

Background/objectives: Cutaneous manifestations of Waldenstrom's macroglobulinaemia (WM), a rare B-cell lymphoproliferative disorder, present a diagnostic challenge. The intent of this article is to raise awareness to clinicians of a potentially overlooked condition, particularly in the context of patients with a monoclonal IgM paraproteinaemia, but also to describe the diagnostic complexity of the disease from a clinicopathological perspective.

Methods: We describe the clinical presentation and histopathological findings of two patients with cutaneous involvement of WM.

Results: Cutaneous presentations included erythematous and salmon pink plaques, which were either tender or non-tender. Histopathology analysis in both cases demonstrated direct lymphocytic infiltration by malignant lymphocytes of WM, with case 1 demonstrating aberrant CD10 expression.

Conclusion: The broad cutaneous signs of WM are sparsely described in the literature, and these can even precede formal diagnosis. Ongoing clinical suspicion is warranted from both a clinical and histopathological perspective where patients present with a monoclonal IgM paraproteinemia.

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe mucocutaneous adverse drug reactions associated with high morbidity and mortality. Current treatment regimens are largely supportive, and evidence for adjunctive systemic therapies remains limited. Recent research has implicated the Janus Kinase (JAK) signal transducer and activator of transcription (STAT) pathway in SJS/TEN pathogenesis, raising interest in JAK inhibitors as potential targeted therapies. This scoping review aimed to evaluate the existing literature on the use of JAK inhibitors in the management of SJS/TEN, summarise clinical outcomes and identify key research gaps. This scoping review was conducted in accordance with PRISMA-ScR guidelines. A systematic search of Medline, Web of Science, Embase and Scopus was conducted from inception up to 12 June 2025. Nine studies were included, comprising eight case reports and one translational research study, reporting on 15 patients (median age 45 years) treated with ruxolitinib (n = 7), tofacitinib (n = 5) or abrocitinib (n = 3). Most cases involved severe or treatment-refractory disease. Among the eight cases where time to re-epithelialisation was reported, six described 20%-30% re-epithelialisation by day 7 and one described 95% re-epithelialisation by day 16. No JAK inhibitor-related adverse events were reported. Preclinical studies supported a mechanistic role for the JAK/STAT pathway in keratinocyte apoptosis and inflammation. JAK inhibitors show promise as a novel therapeutic approach in SJS/TEN; however, current evidence is limited by small sample sizes, disease severity, concomitant therapies and potential publication bias. Well-designed prospective trials are needed to determine efficacy, safety and optimal use in this life-threatening condition.

Background: Dupilumab is a known treatment for atopic dermatitis (AD). However, there is limited data on the effectiveness and safety of its use within the paediatric population.

Objective: The objective of this study was to determine the effectiveness and safety of dupilumab in children under 16 years with moderate-to-severe AD.

Methods: 162 children aged 6 months to 16 years with moderate-to-severe AD were treated with dupilumab. Dupilumab was accessed through the Pharmaceutical Benefits Scheme (PBS) for those aged 12 and above. Those aged under 12 years accessed dupilumab with applications to the Therapeutic Goods Administration (TGA) Special Access Scheme (SAS) as a category B application. Such applications were then processed through the hospital pharmacy as an individual patient approval (IPA). Treatment was surveyed over a 3-year period from 2020 to 2023. Treatment effect was determined by overall clinical disease severity with the Eczema Area and Severity Index (EASI) score. Scores were repeated at serial appointments following dupilumab doses. All data were collected from a single Australian tertiary referral paediatric hospital and tabulated in an Excel spreadsheet.

Results: A significant improvement was observed for almost all patients, with 87% achieving at least a 75% reduction in EASI scores. Adverse effects occurred in 30% of patients, although these were mostly minor and transient. Only four patients (2.4%) ceased dupilumab due to adverse effects or failure to respond.

Limitations: Retrospective cohort design.

Conclusion: Our findings demonstrate dupilumab's long-term effectiveness and safety in treating atopic dermatitis in the paediatric population.

We reviewed the role of technologies, including artificial intelligence (AI), confocal microscopy (CM), optical coherence tomography (OCT), and Raman micro-spectroscopy (RMS) to assist in detecting keratinocyte carcinoma (KC) from Mohs micrographic surgery (MMS) fresh frozen sections (FFS). AI is potentially capable of screening MMS FFS while also improving the accuracy of the imaging modalities. Further developments and validation studies are required.

We report a case of disseminated superficial actinic porokeratosis (DSAP) in a 73-year-old woman with metastatic pancreatic cancer undergoing chemotherapy with capecitabine and nab-paclitaxel. This case suggests a possible association between DSAP and the use of these chemotherapeutic agents, emphasising the need for awareness of atypical dermatologic reactions in such patients.

Background: Referral guidelines and anecdotal evidence from public dermatology services indicate that patients referred to these services are often at high risk of developing future skin cancers or having poor skin cancer outcomes due to immunosuppression, a high skin cancer burden, or lesions that are difficult to manage. The Sunshine study aimed to capture knowledge, attitudes and behaviours related to sun exposure, sun protection and vitamin D among public hospital dermatology outpatients.

Methods: Adult patients attending the dermatology outpatient service at the University Hospital from August to December 2023 completed a survey assessing sun exposure knowledge, attitudes and behaviours. We reported these overall and within three patient groups: immunosuppressed; history of skin cancer; presenting with an inflammatory dermatology condition.

Results: We analysed data from 311 participants (immunosuppressed = 81; skin cancer = 122; inflammatory conditions = 108). Over 60% of patients were unaware of the UV index threshold for sun protection and over-estimated the time outdoors required to maintain adequate vitamin D status. Most patients did not routinely apply sunscreen, including those in the immunosuppressed and skin cancer groups, and this was particularly poor on body sites other than the face. There was also inadequate use of sun protection during outdoors exposure across all groups.

Conclusions: Knowledge and use of sun protection were poor in this high-risk population. Dermatologists are ideally placed to identify and address patients' barriers to sun protection, and this should be a priority in this high-risk setting where prevention is paramount.