Australasian Journal of Dermatology最新文献_第9页

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

Australasian Journal of Dermatology

Pub Date : 2024-08-28 DOI: 10.1111/ajd.14363

Bernadette M. Ricciardo MBBS, DCH, FACD, Heather-Lynn Kessaris BSc, MD, Noel Nannup OAM, Dale Tilbrook GradDipBus, Nadia Rind, Richelle Douglas MBBS, FRACGP, Jodie Ingrey BSc, RN, Jacinta Walton, Carol Michie, Brad Farrant BSc, PhD, Eloise Delaney BBiomedSc, S. Prasad Kumarasinghe MBBS, MD, FACD, Jonathan R. Carapetis MBBS, FRACP, PhD, Asha C. Bowen MBBS, DCH, FRACP, PhD

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。

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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

Australasian Journal of Dermatology

Pub Date : 2024-08-13 DOI: 10.1111/ajd.14359

Anna Lyakhovitsky MD, Boaz Amichai, Eran Galili MD, 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. 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

Australasian Journal of Dermatology

Pub Date : 2024-08-08 DOI: 10.1111/ajd.14360

Roy Kingsley Wong MBBS, Jenny Harrington PhD, Annabel Irene Stevenson MBBS, MMed, FACD

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

Australasian Journal of 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

Biologic treatment outcomes in generalized pustular psoriasis of pregnancy: A systematic review 妊娠期泛发性脓疱型银屑病的生物治疗效果：系统综述。

IF 2.2 4区医学 Q2 DERMATOLOGY

Australasian Journal of Dermatology

Pub Date : 2024-08-01 DOI: 10.1111/ajd.14357

YuFei Wang BM, ChaoJing Zhou BM, YiYun Hou BM, YaMei Gao MM, JiLiang Lu MM, ZhiQiang Yin MD, PhD

引用次数: 0

A narrative review of the literature: The role of biologics and JAK inhibitors in vitiligo 文献综述：生物制剂和JAK抑制剂在白癜风中的作用。

IF 2.2 4区医学 Q2 DERMATOLOGY

Australasian Journal of Dermatology

Pub Date : 2024-08-01 DOI: 10.1111/ajd.14353

Rhiannon Russell MD, Benjamin S. Daniel MBBS

Vitiligo is a chronic depigmenting disorder that significantly impacts the quality of life of patients. Though there have been significant advancements in targeted therapies in skin diseases such as psoriasis or eczema, the progress in the treatment of vitiligo has been slow, with minimal studies assessing the effect of biologics, though there has been recent evidence of the effectiveness of JAK inhibition. This paper reviews the published case reports and studies for the use of systemic targeted therapies including biologics and JAK inhibitors in vitiligo.

白癜风是一种慢性脱色性疾病，严重影响患者的生活质量。虽然银屑病或湿疹等皮肤病的靶向治疗取得了重大进展，但白癜风的治疗进展缓慢，评估生物制剂疗效的研究极少，不过最近有证据表明JAK抑制剂具有疗效。本文回顾了已发表的病例报告和关于系统性靶向疗法（包括生物制剂和JAK抑制剂）在白癜风中应用的研究。

引用次数: 0

The cardiovascular risk in bullous pemphigoid: Insights from a population-based study 大疱性类天疱疮的心血管风险：一项人群研究的启示。

IF 2.2 4区医学 Q2 DERMATOLOGY

Australasian Journal of Dermatology

Pub Date : 2024-08-01 DOI: 10.1111/ajd.14355

Khalaf Kridin PhD, Rina Goychberg BSc, Mouhammad Kridin MD, Niv Kafri BSc, Masad Barhoum MHA, Arnon D. Cohen PhD

Background

The risk of life-threatening major cardiovascular outcomes among patients with bullous pemphigoid (BP) is inconsistent in the current literature.

Objective

To evaluate the risk and prognostic outcomes of myocardial infarction (MI), cerebrovascular accident (CVA), peripheral vascular disease (PVD) and pulmonary embolism (PE) in patients with BP. We additionally aimed to explore the influence of different therapeutic approaches on the risk of these outcomes.

Methods

A population-based retrospective cohort study was conducted to compare BP patients (n = 3924) with age-, gender- and ethnicity-matched control subjects (n = 19,280) with regard to incident cases of MI, CVA, PVD and PE. Adjusted hazard ratio (HR) and 95% confidence intervals (CI) were estimated by multivariate Cox regression analysis. Data were retrieved from Clalit Health Services' computerized database.

Results

Relative to their matched controls, patients with BP were at an elevated risk of MI (fully-adjusted HR: 1.44; 95% CI: 1.14–1.81; p = 0.002), CVA (fully-adjusted HR: 1.24; 95% CI: 1.06–1.45; p = 0.007), PVD (fully-adjusted HR: 1.60; 95% CI: 1.27–2.03; p = 0.003) and PE (fully-adjusted HR: 1.72; 95% CI: 1.28–2.32; p < 0.008). Patients with BP experienced heightened risk of all-cause mortality in the presence of comorbid MI (fully-adjusted HR: 1.61; 95% CI: 1.44–1.81; p < 0.001), CVA (fully-adjusted HR: 1.70; 95% CI: 1.52–1.89; p < 0.001), PVD (fully-adjusted HR: 1.38; 95% CI: 1.20–1.58; p < 0.001) and PE (fully-adjusted HR: 1.44; 95% CI: 1.10–1.88; p = 0.007). The therapeutic approach utilized to manage BP did not significantly influence the risk of cardiovascular outcomes.

Conclusions

BP is associated with an elevated risk of MI, CVA, PVD, PE and cardiovascular mortality. Primary, secondary and tertiary cardiovascular prevention measures should be implemented among patients with BP.

背景：关于大疱性类天疱疮（BP）患者危及生命的主要心血管后果的风险，目前的文献并不一致：关于大疱性类天疱疮（BP）患者发生危及生命的主要心血管疾病的风险，目前的文献报道并不一致：目的：评估大疱性类天疱疮患者发生心肌梗死（MI）、脑血管意外（CVA）、外周血管疾病（PVD）和肺栓塞（PE）的风险和预后结果。此外，我们还旨在探讨不同治疗方法对这些后果风险的影响：我们进行了一项基于人群的回顾性队列研究，比较了血压患者（n = 3924）与年龄、性别和种族匹配的对照组（n = 19280）在心肌梗死、脑梗死、心血管疾病和肺栓塞方面的发病情况。通过多变量考克斯回归分析估算了调整后的危险比（HR）和 95% 的置信区间（CI）。数据取自 Clalit Health Services 的计算机数据库：与匹配的对照组相比，血压患者发生心肌梗死（完全调整后 HR：1.44；95% CI：1.14-1.81；P = 0.002）、脑梗死（完全调整后 HR：1.24；95% CI：1.06-1.45；p = 0.007）、PVD（完全调整 HR：1.60；95% CI：1.27-2.03；p = 0.003）和 PE（完全调整 HR：1.72；95% CI：1.28-2.32；p 结论：血压与 MI、CVA、PVD、PE 和心血管死亡风险升高有关。应对血压患者采取一级、二级和三级心血管预防措施。

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引用次数: 0

Bullous pemphigoid in infancy 婴儿大疱性类天疱疮

IF 2.2 4区医学 Q2 DERMATOLOGY

Australasian Journal of Dermatology

Pub Date : 2024-08-01 DOI: 10.1111/ajd.14354

Lois Zhang BMed, MMed, Gloria Fong BMLSc, MBBS, PhD, FACD, Andrew Ming BSC(MED), MBBS(HONS), DCH, FRACP, FACD, Melanie Wong MBBS(Hons), PhD, FRACP, FRCPA

<p>Bullous pemphigoid (BP) is an autoimmune, subepidermal blistering disease typically affecting the elderly and remains rare in children and infants. Paediatric BP often presents with mucosal involvement, and in infants, commonly affects the hands and feet. The pathogenesis is thought to be similar to that of adult BP with autoantibodies to BP180 (type VII collagen) having been described in the literature. Here, we present a case of BP occurring in a 2-month-old, investigating the potential role of vertical transmission of autoantibodies.</p><p>A 2-month-old female infant presented with blistering eruptions initially localised to the hands and feet, which rapidly extended to the groin, neck, arms, and chest. The antenatal and birth history were unremarkable, and there was no family history of autoimmune diseases. The infant was systemically well. Physical examination revealed tense and flaccid bullae on the hands and feet, deep-seated vesicles on an erythematous base on the torso, and some erosions (Figure 1). Mucosal surfaces were unaffected. Viral and bacterial swabs were negative. Histopathology of skin biopsies showed eosinophilic spongiosis and subepidermal bulla formation, with indirect immunofluorescence demonstrating linear C3 and IgG deposition at the dermal-epidermal junction. Serum indirect immunofluorescence was positive for BP180 antibodies, confirming the diagnosis of BP. The infant was treated with high-potency topical corticosteroids (0.05% betamethasone dipropionate) and a short course of oral antibiotics. Significant improvement and complete resolution of the lesions were observed by 6 months of age, with no relapse. The mother had no history of BP or pemphigoid gestationis and no peripartum skin lesions. However, serum indirect immunofluorescence testing of the mother revealed the presence of BP230 antibodies. Six months later, repeat testing showed the absence of antibodies in both mother and child.</p><p>The exact cause of BP remains unclear, although certain triggers have been identified such as drug-induced BP and infections.<span><sup>1</sup></span> A potential trigger in neonates and infants may include the transplacental transfer of antibodies, a known mechanism that forms the foundation for maternal immunisation strategies where antibodies may be present up to 6–12 months from birth.<span><sup>2, 3</sup></span> Transfer of pathogenic antibodies has been seen to cause transient disease in infants from asymptomatic mothers such as in neonatal lupus and thyroid disease. In neonatal BP, BP180 antibodies are recognised as the pathogenic cause of the neonatal onset of disease.<span><sup>4, 5</sup></span></p><p>We postulate that our patient's mother developed low levels of BP180 as well as BP230 antibodies, during pregnancy, with active transplacental transfer of BP180 antibodies, leading to levels capable of inducing clinical disease in her baby. Due to the half-life of IgG antibodies (21 days), by the time of testing, mater

大疱性类天疱疮（BP）是一种自身免疫性表皮下大疱性疾病，通常累及老年人，在儿童和婴儿中仍然罕见。小儿大疱性类天疱疮常伴有粘膜受累，婴儿常累及手足。其发病机制被认为与成人 BP 相似，文献中描述了 BP180（Ⅶ型胶原）的自身抗体。在此，我们介绍了一例发生在 2 个月大婴儿身上的 BP 病例，研究了自身抗体垂直传播的潜在作用。一名 2 个月大的女婴出现水疱性荨麻疹，最初发生在手脚，随后迅速扩展到腹股沟、颈部、手臂和胸部。婴儿的产前和出生史均无异常，也无自身免疫性疾病家族史。婴儿全身状况良好。体格检查发现，婴儿的手和脚上有紧张和松弛的水泡，躯干上有深在红斑基础上的水泡和一些糜烂（图1）。粘膜表面未受影响。病毒和细菌拭子均呈阴性。皮肤活检组织病理学显示嗜酸性粒细胞海绵状增生和表皮下小泡形成，间接免疫荧光显示真皮-表皮交界处有线性C3和IgG沉积。血清间接免疫荧光显示 BP180 抗体阳性，确诊为 BP。婴儿接受了强效局部皮质类固醇激素（0.05% 倍他米松二丙酸酯）和短期口服抗生素治疗。到婴儿 6 个月大时，皮损明显好转并完全消退，而且没有复发。母亲没有 BP 或妊娠丘疹性荨麻疹病史，也没有围产期皮损。然而，对母亲进行的血清间接免疫荧光检测发现了 BP230 抗体。6 个月后，重复检测显示母婴体内均未发现抗体。BP 的确切病因仍不清楚，但已发现某些诱因，如药物诱发的 BP 和感染。新生儿和婴儿的潜在诱因可能包括抗体经胎盘转移，这是一种已知的机制，是母体免疫策略的基础，抗体可能在出生后 6-12 个月内存在。在新生儿BP中，BP180抗体被认为是新生儿发病的致病原因。4, 5 我们推测，患者母亲在怀孕期间产生了低水平的BP180和BP230抗体，BP180抗体经胎盘转移活跃，导致其水平能够诱发婴儿临床疾病。由于 IgG 抗体的半衰期（21 天），在检测时，母体的抗 BP180 水平已降至可检测限以下，而抗 BP230 仍可检测到。该病例强调了在婴儿大疱性荨麻疹的鉴别诊断中考虑 BP 的重要性，并提示经胎盘转移的抗体可在婴儿和新生儿中引发这种疾病，母体自身抗体可持续长达 12 个月。这可能会对母亲今后的妊娠产生影响。本文没有得到任何资助。作者声明没有利益冲突。发表文章已征得患者父母的同意。

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引用次数: 0

Diversifying dermatology: Improving skin of colour representation 皮肤病学多样化：改善有色人种皮肤的代表性。

IF 2.2 4区医学 Q2 DERMATOLOGY

Australasian Journal of Dermatology

Pub Date : 2024-07-24 DOI: 10.1111/ajd.14356

Alyssa Susanto PhD, Vaishnavi Nathan PhD, Monika Janda PhD, Kiarash Khosrotehrani MD, PhD, Erin McMeniman MD, PhD, H. Peter Soyer MD, PhD, Brigid Betz-Stablein PhD

<p>Current recruitment strategies in dermatology research have segregated those with skin of colour (SOC).<span><sup>1</sup></span> In Australia, SOC describes a heterogenous group with non-European or mixed ancestry, in addition to First Nations Australians.<span><sup>2</sup></span> As darker skin differs substantially in biology, structure and function compared with lighter skin,<span><sup>2</sup></span> a diverse participant pool is crucial for understanding human variation and disease pathology. However, dermatology data sets are historically homogenous and tend to be biased towards those with European ancestry.<span><sup>1</sup></span> Factors contributing to this phenomenon include physician, investigator, industry and patient-related barriers.<span><sup>1</sup></span> An example of a physician-related barrier is the light skin model recognised in medical education,<span><sup>3</sup></span> which evokes clinical uncertainty when conditions present differently in darker skin, despite the addition of SOC to the Australian dermatology training curriculum in 2017.<span><sup>4</sup></span></p><p>Australia has the highest incidence of melanoma per capita worldwide, with 36.6 cases per 100,000 age standardised rate (ASR).<span><sup>5</sup></span> This includes 14.1 cases per 100,000 ASR for Aboriginal and Torres Strait Islanders, and 30.4 cases per 100,000 ASR for non-Indigenous Australians.<span><sup>6</sup></span> It is concerning that these data are not stratified further by ethnicity, as melanoma tends to present at more advanced stages in SOC with poorer prognosis.<span><sup>7</sup></span> Acral lentiginous melanoma is the most common subtype in SOC, yet its atypical presentation in non-sun-exposed areas may contribute to oversight or misdiagnosis.<span><sup>7</sup></span> Without conscious effort to incorporate all skin types in research studies, the unique manifestations, risk factors and treatment for melanoma in SOC will remain unknown, whilst mortality rates in these minority populations continue to rise.<span><sup>6, 7</sup></span></p><p>The ongoing Australian Centre of Excellence in Melanoma Imaging and Diagnosis (ACEMID) cohort study<span><sup>8</sup></span> aims to create a large repository of three-dimensional total body photography to aid the development of artificial intelligence (AI) for early melanoma detection. Participants were recruited across 15 metropolitan and regional Australian sites through referrals, social media, traditional media and previous skin cancer research studies,<span><sup>8</sup></span> without actively targeting those with SOC.</p><p>In our subanalysis of two ACEMID sites with completed recruitment in Brisbane, Australia, we identified 4% of participants (Table 1) with SOC (i.e. self-reported non-European ancestry). This proportion differs substantially from the Australian population, since census data report that 30% have non-European ancestry.<span><sup>9</sup></span> However, the most prevalent non-Euro

通过丰富对深色皮肤黑色素瘤的了解和识别，增强医生、研究人员和患者等利益相关者（SOC）的能力，将改善死亡率结果和数据质量，促进开发对所有皮肤类型都具有诊断准确性的人工智能模型。这项研究得到了澳大利亚癌症研究基金会（ACRF）、NHMRC临床试验和队列研究补助金（APP2001517）以及澳大利亚皮肤科医师学院2021年科学研究基金补助金的支持。HPS是新西兰MoleMap有限公司和e-derm consult GmbH的股东，并定期为这两家公司提供远程皮肤病学报告。HPS是Canfield Scientific Inc.公司的医学顾问和First Derm公司的医学顾问。KK 是《澳大拉西亚皮肤病学杂志》的编辑委员会成员，也是本文的合著者之一。为了最大限度地减少偏倚，他们被排除在与接受本文发表相关的所有编辑决策之外。ACEMID队列研究获得了Metro South Health人类研究伦理委员会（HREC/2019/QMS/57206）& 昆士兰大学人类研究伦理委员会（2019003077）的批准。

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引用次数: 0

Histological diversity in hyperkeratotic flexural erythema—Beyond granular parakeratosis? 角化过度挠曲性红斑的组织学多样性--颗粒状副角化病之外？

IF 2.2 4区医学 Q2 DERMATOLOGY

Australasian Journal of Dermatology

Pub Date : 2024-07-24 DOI: 10.1111/ajd.14349

Anna Luo MBChB, Fergus Oliver MBChB FRACP FNZDSI, Harriet Kennedy BHB MBChB MPhil FRACP

The term ‘hyperkeratotic flexural erythema’ (HFE) has been used synonymously with granular parakeratosis (GP), to describe a scaly, typically intertriginous rash associated with contact factors such as benzalkonium chloride. However, clinical HFE can occur without the classical GP histological pattern. We reviewed skin biopsies from 10 patients with clinically diagnosed HFE. A progression of histopathological features is suggested. The absence of histological GP should not exclude the clinical diagnosis of HFE when there is a high index of suspicion.

角化过度性挠曲红斑"（HFE）与 "粒状角化病"（GP）同义，用于描述与苯扎氯铵等接触性因素有关的鳞状典型皮疹。然而，临床上的 HFE 也可能没有典型的 GP 组织学模式。我们对 10 名临床诊断为 HFE 的患者的皮肤活检进行了复查。我们提出了组织病理学特征的发展过程。在高度怀疑的情况下，不存在组织学 GP 不应排除 HFE 的临床诊断。

引用次数: 0