The Journal of dermatology最新文献

We investigated nailfold videocapillaroscopy (NVC) findings in antisynthetase syndrome (ASyS) and compared patterns among six anti-aminoacyl-tRNA synthetase (anti-ARS) antibody (Ab) subtypes. In this retrospective study of 66 Japanese patients positive for anti-Jo-1, EJ, PL-7, PL-12, KS, or OJ Abs, seven NVC abnormalities were assessed: enlarged capillaries, reduced capillaries, hemorrhages, capillary ramifications, disorganization of the vascular array, loss of capillaries, and giant capillaries. Enlarged capillaries, reduced capillaries, and hemorrhages were common overall; in contrast, patients with anti-KS Abs exhibited significantly fewer abnormalities, particularly hemorrhages (25% vs. 75%-100% in other groups; p < 0.05). Capillary ramifications, disorganization, and capillary loss were rare across all subtypes. Although ASyS patients may present with similar clinical manifestations, NVC findings vary among anti-ARS Ab subtypes; anti-KS Ab identifies a subset with milder microvascular involvement. Recognizing anti-ARS Ab specificity may help interpretation of vascular heterogeneity in ASyS.

An octogenarian man developed a recurrent cheek lesion 8 years after surgical resection. Although the histopathological features resembled those of endocrine mucin-producing sweat gland carcinoma (EMPSGC), small tumor nests lacking mucinous carcinoma components infiltrated the surrounding adipose tissue and striated muscle. This infiltrative morphology is inconsistent with the pushing invasion described by the WHO classification. To our knowledge, this is the first report of EMPSGC demonstrating this distinct growth pattern, the clinical significance of which remains unclear.

Drug-induced severe cutaneous adverse reactions (SCARs) are rare but potentially life-threatening drug-induced hypersensitivity reactions. Current understanding of the drug risks associated with SCARs is limited, emphasizing the need for more research to identify and understand medications that may trigger these reactions. This study aimed to identify risk factors and suspect drugs associated with SCARs. Disproportionality analysis was conducted through the case-control design using the FDA Adverse Event Reporting System (FAERS) database of drug-induced SCARs. The reporting odds ratios (ROR) were used to analyze reports of drug-induced SCARs from January 1, 2004, to March 31, 2025. Least absolute shrinkage and selection operator (LASSO), and multivariable regression analyses were conducted to identify risk factors associated with SCARs. Bonferroni correction was applied to adjust for multiple comparisons. A total of 103 337 drug-induced SCARs cases were identified. The median patient age was 57.00 years (IQR 37.00-70.00), with a nearly equal sex distribution (49.26% female, 40.57% male). Disproportionality analysis identified 415 drugs with positive signals for drug-induced SCARs. Logistic regression identified older age, male sex, and 114 drugs as independent risk factors for drug-induced SCARs, including amlodipine (adjusted ROR = 2.89), bisoprolol (adjusted ROR = 3.52), and losartan (adjusted ROR = 2.77). In the non-Asian population, the strongest signals were observed for allopurinol (adjusted ROR = 98.52), cefotaxime (adjusted ROR = 68.52), and lamotrigine (adjusted ROR = 38.59), whereas apalutamide (adjusted ROR = 14.57), ipilimumab (adjusted ROR = 3.24), and acetylsalicylic acid (adjusted ROR = 2.85) were detected only in Asians. The median time to onset (TTO) of drug-induced SCARs was 14 days (IQR 4-47). The Asian population had a significantly shorter TTO compared to the non-Asian population (p < 0.001). This study uses FAERS data to analyze risk factors for drug-induced SCARs, emphasizing early identification and discontinuation of suspected drugs to enhance patient safety.

Vitiligo is a disorder characterized by depigmentation of the skin and is known to impact patients' health-related quality of life (HRQoL). In Japan, HRQoL studies on vitiligo remain limited in size and scope, and factors contributing to impaired HRQoL, as well as the psychological burden, have not been adequately evaluated. This study aimed to assess HRQoL and symptoms of anxiety and depression in patients with vitiligo in Japan. A web-based survey was completed by 271 patients with vitiligo aged 18 to 79 years. The survey included the 12-item Short Form Health Survey version 2 (SF-12v2) and the Dermatology Life Quality Index (DLQI) to assess HRQoL, as well as the Hospital Anxiety and Depression Scale (HADS). The role/social component summary score (mean ± standard deviation) of the SF-12v2 in vitiligo patients was 45.8 ± 14.5, which was lower than the Japanese population norm (national standard values for Japanese). Based on the DLQI, which is specific to dermatologic diseases, 62.7% of patients reported at least a small effect on their daily lives. HADS anxiety and depression scores showed that 38.0% and 40.3% of patients, respectively, were classified as doubtful or definite cases. Subgroup analyses revealed that higher DLQI and HADS scores were associated with sex, age, disease duration, affected body surface area (BSA), and history of relapse. Notably, nonlinear associations in these measures were observed for disease duration and affected BSA, with the highest scores seen in patients with an intermediate range of disease duration and affected BSA. These findings underscore the need for timely and sustained treatment strategies to control symptoms, reduce psychological distress, and prevent relapse, which may help not only improve clinical outcomes but also maintain long-term HRQoL in individuals with vitiligo.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe and life-threatening mucocutaneous disorders, primarily triggered by medications. Despite the frequent need for antipyretic and analgesic therapy, the impact of nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen on clinical outcomes in patients with SJS/TEN remains unclear. This study aimed to compare the effects of NSAIDs and acetaminophen use on in-hospital mortality, infection-related events, and renal outcomes, with particular attention to the presence or absence of chronic kidney disease (CKD). We conducted a retrospective analysis using a nationwide administrative database of over 1200 acute care hospitals in Japan between July 2010 and March 2022. Adult patients diagnosed with SJS or TEN who received either NSAIDs or acetaminophen within the first 5 days of hospitalization were included. Patients who received both drugs or neither were excluded. Among 8301 eligible patients, 2484 met inclusion criteria. Overall mortality did not differ significantly between groups (4.1% vs. 4.6%; risk difference [RD], -0.6%; 95% confidence interval [CI], -2.5% to 1.4%). In patients without CKD, NSAID use was associated with lower mortality (2.6% vs. 4.3%; RD, -1.7%; 95% CI, -3.4% to 0.0%). Conversely, in patients with CKD, acetaminophen use was associated with lower mortality (12.0% vs. 38.2%; RD, 26.2%; 95% CI, 5.0% to 47.4%). In conclusion, NSAID use may be associated with relatively improved survival compared with acetaminophen in patients without CKD, while acetaminophen appears safer in those with CKD, suggesting that renal function may inform the selection of antipyretic or analgesic therapy when such treatment is unavoidable. As both drugs are known causative agents of SJS/TEN, these results should be interpreted with caution. Further studies are warranted to validate these observational findings.