British Journal of Dermatology最新文献

Background: Hidradenitis suppurativa (HS) is a long-term skin condition where evidence for management after first-line treatment fails is limited and practice varies across the UK. Medical and surgical treatment options are potential avenues of treatment. Furthermore, patient perspectives on HS treatments have received little attention in research to date.

Objectives: To explore patients' views and experiences of treatment for HS to inform clinical care.

Methods: We conducted a nested qualitative study within a prospective cohort study. Interviews with 35 participants were completed by telephone. Purposive sampling was undertaken. Framework analysis was used to develop themes.

Results: Past experiences and knowledge informed patient beliefs and whether an individual felt a treatment option was appropriate or a good 'fit' for them at a specific moment in time. Healthcare professional recommendations can influence a patient's views and which treatment option they ultimately receive. Positive experiences were reported across all treatment types covered in the study. Negative experiences included mediation side-effects, lack of efficacy, delays to procedures and burden of wound care. However, even when personal experiences were not wholly positive for an individual, participants often believed the same treatment may potentially help others with HS, owing to the importance placed on personalization of treatment.

Conclusions: This paper has implications for how healthcare professionals discuss treatment options with people with HS. A 'one-size-fits-all' approach is inappropriate, and shared decision-making that elicits patients' beliefs and preferences is crucial.

Background: The biologic therapy nemolizumab has been shown to improve the signs and symptoms of prurigo nodularis (PN) to a significantly greater extent than placebo over 16 weeks of treatment. We now report efficacy and safety data over 68 weeks.

Objectives: To evaluate the long-term impact of nemolizumab on pruritus, disease severity, quality of life (QoL) and topical corticosteroid (TCS) usage in patients with PN in Japan, and to confirm the safety profile.

Methods: Asian patients aged ≥ 13 years were randomly assigned (1 : 1 : 1) to receive nemolizumab 30 mg, 60 mg or placebo, with concomitant medium-potency TCS, every 4 weeks for 16 weeks. For the subsequent 52 weeks, nemolizumab treatment was continued, while placebo-treated patients were reallocated to either the 30-mg or 60-mg nemolizumab groups. Efficacy outcome measures included the Peak Pruritus Numerical Rating Scale (PP-NRS), 5-level itch scale, Investigator's Global Assessment (IGA), the number of prurigo nodules, Insomnia Severity Index, Dermatology Life Quality Index and use of TCS. Safety measures included the frequency of treatment-emergent adverse events (TEAEs). The trial was registered with the Japan Registry of Clinical Trials (jRCT2011200017).

Results: In the modified intention-to-treat population (n = 226), nemolizumab provided sustained and continuing improvements in efficacy between weeks 16 and 68. In patients who received nemolizumab 30 mg, PP-NRS had decreased by 60.5% at week 16 and by 78.6% at week 68; respective decreases in the 60-mg group were 55.1% and 76.5%. Across all treatment groups, a large proportion of patients experienced improvements indicating a reduction from moderate-to-severe to mild pruritus, improvements in IGA indicating a reduction in PN severity, a decrease in the number of nodules, and rapid and durable improvements in sleep and daily life activities. Nemolizumab-treated patients were also able to reduce the daily quantity of medium-potency and higher TCS used by at least half. There was no indication of relapse in pruritus, PN severity or QoL scores following treatment cessation. Most TEAEs were mild and similar to those reported in prior studies.

Conclusions: Nemolizumab elicited continuous and durable improvements across multiple measures of pruritus, PN severity and QoL over 68 weeks of treatment, with no new safety concerns.

Background: British Association of Dermatologists (BAD) guidelines for managing basal (BCC) and squamous (SCC) cell skin carcinomas are distinct; however, there is a paucity of evidence relating to the histopathological behaviour of SCC and BCC over time, and the implications this has for management guidelines.

Objectives: To investigate the effect of lesion duration on keratinocyte skin cancer (KSC) growth, the development of high risk factors and excision margin adequacy; further aims included investigating the impact of the presence of high or very high risk histological parameters on excision rates and clearance margins.

Methods: A cohort study was undertaken with a random sample of patients referred to our Plastic Surgery Skin Cancer Centre with BCC and SCC from January to June 2019 inclusive. Data collected included patient demographics, referral source, lesion duration (first appearance to treatment), histological data, excision margins and skin cancer risk, as defined by BAD guidelines.

Results: In total, 728 patients were included [397 men, 331 women; median age 77 years (interquartile range 72-85)] who underwent 872 excisions (BCC, n = 454; SCC, n = 418). Longer lesion duration was associated with increased BCC (P < 0.001 and P = 0.001, respectively) and SCC (P < 0.001 and P < 0.001, respectively) surface area and thickness on multivariable regression. The likelihood of developing very high risk histological parameters increased with SCC lesion time, including diameter > 40 mm (P < 0.001), thickness > 6 mm (P < 0.001) and total number of very high risk factors (P < 0.001). SCCs with lesion durations > 3 months had greater median surface areas (706.9 mm2 vs. 295.3 mm2; P < 0.001) and thicknesses (3.5 mm vs. 3 mm; P < 0.001) than those of ≤ 3 months' duration; the same was found for median BCC surface area (263.9 mm2 vs. 131.9 mm2; P < 0.001). A general decline in the adequate excision of BCCs and SCCs was found with an increasing number of high- or very high risk parameters.

Conclusions: Longer lesion duration resulted in increased KSC thickness and surface area, and the increased presence of high risk factors as set out by the BAD. This was more common SCCs than for BCCs, and had a negative impact on surgical excision margins. Crucially, lesion duration was significantly associated with increased SCC (but not BCC) thickness at 3 months. Our results support BAD guidance on the management of KSC, identifying the highest risk lesions and informing the practice of skin cancer units.