Stephanie Bowe conceived and designed the analysis, collected the data, contributed data or analysis tools, performed the analysis, wrote the paper. Claire Quigley collected data at pigmented lesion clinics via paper forms. Liana Victory collected data at pigmented lesion clinics via paper forms. Eoin Storan supervised the project and edited the final paper.
The authors declare no conflict of interest.
All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the MMUH and Mater Private Hospital Dublin Institutional Review Board at a meeting in October 2022, with the project reference number: 1/378/2322.
Iododerma is a rare halogenoderma resulting from exposure to iodinated compounds. We present a case involving a 51-year-old Caucasian female with advanced renal disease who developed a hemorrhagic and papulonodular eruption following oral contrast exposure. Cryptococcoid bodies were noted on histopathological evaluation and raised suspicion for the diagnosis of iododerma, which was ultimately confirmed through serum and urine iodine studies. This case highlights a severe presentation of iododerma with important dermatopathology findings.
Psoriasis is a chronic skin disorder characterized by the accelerated proliferation of keratinocytes, which leads to the formation of scaly plaques and a chronic inflammatory response. Vitamin D is an inhibitor of dendritic cells acting as an immune modulator; therefore, vitamin D deficiency could explain the increased incidence of psoriasis for the reduction of anti-inflammatory activity.
To compare serum 25-hydroxy vitamin D levels in patients with psoriasis and healthy individuals.
A systematic review of the literature and meta-analysis was performed by searching PubMed, Embase, Cochrane, Lilacs, Ovid and ProQuest databases to find the best available evidence from 2013 to 2024. We also conducted a snowballing literature search to expand the included studies. The methodological quality and risk of bias were assessed through the Newcastle–Ottawa scale. A random effect meta-analysis model was applied.
A total of 27 articles were included in the systematic review of these three cross-sectional studies included in the first meta-analysis, the synthesized standardized mean difference (SMD) in serum vitamin D between psoriatic arthritis and psoriasis was −0.13 (95% CI [−0.46, 0.20], p = 0.45). The second meta-analysis included two case controls, the synthesized SMD in serum vitamin D between psoriasis and controls was −0.71 (95% CI [−0.85, −0.57], p = 0.00).
No difference in vitamin D levels between psoriasis and psoriatic arthritis was found. Psoriasis patients have lower vitamin D levels than the general population. However, further studies are essential to understand how vitamin D levels contribute to the pathogenesis of psoriasis or vice versa and its role in severity.
Despite significant advances in computer-aided diagnostics, onychomycosis, a widespread fungal nail infection, lacks an automated approach for objective analysis and classification.
Our study aimed to develop and validate automated machine learning models to accurately detect and classify onychomycosis-affected areas in toenails.
The images in this study were captured using the Scarletred® Vision mobile App and SkinPatch, a CE certified medical device system working seamlessly together to deliver auto-color calibrated, high-resolution clinical images. Considering a total of 1687 images from 440 subjects, the research explores various degrees of onychomycosis and evaluates the infection extent in the toenails detected. We developed an advanced machine learning algorithm for precise segmentation and classification of onychomycosis-affected toenails, utilizing expert annotations and advanced post-processing techniques. Additionally, an analysis of nail growth was performed, and a comparison graph with the percentage of infection was estimated.
Using advanced machine learning algorithms, we successfully detected toenails, enabling detailed analysis of intricate structures within the images. We achieved a final validation loss of 0.0236 and an F1 score of 0.8566 for accurate toenail detection, while the Random Forest algorithm demonstrated 81% accuracy in classifying and distinguishing between infected and healthy toenail areas. Our applied superpixel method furthermore improved the algorithm's precision in identifying the infected regions.
Our AI-powered image analysis method, initially focused on the big toe's toenail, shows great promise for broader validation on comprehensive datasets, enabling more detailed assessments of onychomycosis severity and disease dynamics. The potential impact of limited patient diversity, particularly with darker skin tones, needs further assessment. Proven to measure nail growth and assess treatment effectiveness over time, our developed AI is the first of its kind to demonstrate this capability, representing a significant advancement as a novel decision support tool for clinical research and routine medical practice.
Patients with psoriasis often suffer from obesity. However, only limited data are available on the efficacy of brodalumab 210 mg, a fully human monoclonal immunoglobulin IgG2 antibody binding to the human interleukin 17 receptor subunit A, in obese patients in daily practice, to date.
A subgroup analysis from the LIBERO study was conducted to compare the effectiveness of brodalumab in patients weighing ≤100 and >100 kg after ~12 weeks (W) and ~52 W.
LIBERO is a large prospective, multicenter, non-interventional, real-world-evidence study including adult patients with plaque psoriasis treated with brodalumab 210 mg.
Four hundred and sixty-one patients with a body weight up to 100 kg (nonobese) and 161 patients with >100 kg body weight (obese) were included in this subgroup analysis. At baseline, the majority of patients in both groups had very severe (12.6%; 15.7%) or severe (49.4%; 55.0%) psoriasis, as assessed by Physician Global Assessment (PGA). As of W2, a significant reduction of the mean PASI could be achieved in both groups. In patients weighing ≤100 kg mean PASI decreased from 16.9 to 9.0 and further improved to 2.6 at ~W12 (p < 0.001). In the patient group >100 kg, the PASI decreased from 17.9 to 10.2 at ~W2 (p < 0.001) and improved further to 3.9 at ~W12 (p < 0.001). However, at ~W12 absolute PASI0-3 rates were lower in patients >100 kg than in patients ≤100 kg (68.4% vs. 80.5%, p = 0.006); there was no statistically significant difference between the groups at ~W52/last visit any more in any of the effectiveness parameters with, for example, a PGA0/1 response of 82.3% versus 86.5% (p = 0.6089), respectively.
This subgroup analysis of LIBERO confirmed, that in daily practice brodalumab can be equally beneficial patients with >100 and ≤100 kg in the long-term management of psoriasis.
The integration of wearable technology in real-time skin health monitoring represents a significant advancement in personalised healthcare. This review synthesises existing research on wearable devices tailored for skin condition monitoring, encompassing aspects such as ultraviolet exposure tracking, hydration level assessment, and early detection of potential dermatological diseases. Current literature underscores the efficacy of wearable sensors in providing timely insights into skin health parameters, enabling proactive skin care interventions and disease management. Moreover, the seamless integration of sensor data with smartphone applications facilitates user-friendly monitoring and personalised alerts, enhancing user engagement and adherence to skincare regimens. Moving forward, future research should prioritise the refinement of sensor accuracy and reliability, the development of standardised metrics for skin health assessment, and the exploration of novel applications such as artificial intelligence-driven predictive analytics for early disease detection. Additionally, interdisciplinary collaborations between engineers, dermatologists, and data scientists hold promise for unlocking the full potential of wearable technology in revolutionising skin health management. Incorporating wearable technology in real-time skin health monitoring not only revolutionises preventive skincare practices but also holds immense potential for transforming the management of chronic skin conditions, paving the way for personalised, proactive, and patient-centric dermatological care.
Epidermolysis bullosa acquisita (EBA) is a rare autoimmune blistering disease associated with IgG autoantibodies directed against type VII collagen. Different clinical forms have been described, including the classical mechanobullous variant resembling epidermolysis bullosa dystrophica, which is typically treatment-resistant. We here describe a 67-year-old patient with a mechanobullous EBA characterized by trauma-induced blisters on her hands and feet for 9 months. Despite treatments with oral prednisolone, topical steroids or calcineurin inhibitors, doxycycline, ciclosporin, and baracitinib, no improvement was observed. The patient went into complete remission only after administration of rituximab with no lesions off therapy at the 10-month follow up. Our observation suggests that inflammatory cytokines are not primarily responsible for skin blistering and fragility in mechanobullous EBA. The effectiveness of rituximab provides some insights into the major direct role of autoantibodies in mediating dermo-epidermal separation in this variant of EBA.
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