The Journal of dermatology最新文献

As the clinical course of systemic sclerosis (SSc) varies widely, prognostic indicators have been sought to predict the outcomes of individual patients. Racial differences in SSc render it necessary to validate prognostic indicators in different patient cohorts. In this study, we aimed to assess clinical and laboratory parameters in Japanese patients with early-stage SSc with diffuse cutaneous involvement and/or interstitial lung disease, and identify predictive factors for disease progression. We performed multivariate analyses of baseline clinical information to estimate symptoms 4 years later in Japanese patients with diffuse cutaneous SSc and/or SSc with interstitial lung disease. Patients were enrolled in the study within 5 years of disease onset at 10 Japanese SSc centers. Over 12 years, 115 patients followed up for 4 years were included in this study. The modified Rodnan skin score (mRSS) at 4 years correlated with the baseline mRSS and finger-to-palm distance, defined as the average length from the distal tip of the fourth finger to the distal palmar crease. The percentage predicted vital capacity (%VC) in year 4 positively and negatively correlated with initial %VC and the presence of anti-topoisomerase I antibodies, respectively. The Health Assessment Questionnaire Disability Index (HAQ-DI) at 4 years was positively and negatively associated with baseline HAQ-DI and %VC, respectively. The occurrence of digital ulcers within 4 years was associated with the initial presence of digital ulcers, finger-to-palm distance, and the presence of digital pitting scars and anti-topoisomerase I antibodies. This study identified several factors that may predict the progression of early-stage SSc in Japanese patients. Finger-to-palm distance may be a useful tool for predicting the progression of skin thickening and the development of digital ulcers in the early stages of severe SSc, but larger, long-term prospective studies are needed to confirm our findings.

Observational studies have suggested an associations between hidradenitis suppurativa (HS) and metabolic syndrome (MetS) and its components. However, it remains unclear whether the relationship is causal or not. Our study aimed to investigate the causal association of HS with MetS and its components. We performed a bidirectional, two-sample Mendelian randomization study using summary-level data from the most comprehensive genome-wide association studies of HS (n = 362 071), MetS (n = 291 107), waist circumference (n = 462 166), hypertension (n = 463 010) fasting blood glucose (FBG, n = 200 622), triglycerides (n = 441 016), and high-density lipoprotein cholesterol (HDL-C, n = 403 943). Genetic instrumental variables were constructed by identifying single nucleotide polymorphisms associated with the corresponding factors. The random-effects inverse-variance weighted method was applied as the primary method. The results showed that genetically predicted HS was positively associated with waist circumference risk in both directions. High waist circumference increased the risk of HS (odds ratio [OR] 4.147; 95% confidence interval [CI] 2.610-6.590; p = 1.746 × 10^-9). In addition, HS was also affected by waist circumference (OR 1.009; 95% CI 1.006-1.012; p = 3.08 × 10^-7). No causal relationships were found between HS and MetS or its components other than waist circumference. The findings highlight the importance of early intervention for obesity in HS patients. Further studies are needed to determine the pathophysiology of HS associated with MetS and its components.

Plantar malignant melanoma is largely managed surgically, particularly in its early stages. However, the plantar region has a lower survival rate of skin grafts than other regions. Furthermore, complete wound healing occurs over a long period of time, postoperatively. Thus, in this study, we retrospectively analyzed the use of skin grafts to reconstruct skin defects, as postoperative complications of plantar malignant melanoma. Forty-nine patients, (23 males, 26 females; mean age 70.4-years) underwent excisional surgery for plantar malignant melanoma at our hospital, between March 2018 and December 2022. The time from initial surgery to wound healing was analyzed, using a multivariate Cox proportional hazards model, to identify related factors. We excluded cases with lesions in non-weight-bearing areas and cases with segmental layer grafts, based on multivariate analysis, to eliminate bias when comparing a one-step resection and reconstruction technique to resection followed by waiting for granulation to occur before reconstruction. Patients were categorized into three cohorts. The first and second cohorts had undergone one-step and two-step skin grafting, respectively. Patients in the third cohort underwent secondary intention healing without skin grafting. The results revealed that the factors associated with wound-healing time included a defect size of >1800 mm², in addition to two-step and split-thickness skin grafting. Therefore, Kaplan-Meier curves were constructed across the three cohorts, based on the data of 37 patients. Nine cases of non-weight-bearing areas and three cases of split-thickness skin grafts were excluded from the original total of 49 patients. The median times from the initial surgery to wound healing were 14.6, 12.0, and 21.9 weeks for the one- and two-step skin grafting and secondary intention healing cohorts, respectively. A statistically significant difference in the treatment time between the skin grafting and secondary intention healing cohorts was observed (p < 0.001) Moreover, a statistically significant difference in the treatment time between the one- and two-step skin grafting cohorts was noted (p = 0.046). Thus, two-step skin grafting after surgical treatment for plantar malignant melanoma may shorten the overall treatment duration by allowing granulation to occur.