JEADV clinical practice最新文献

Eosinophilic dermatosis of haematologic malignancy is an infrequent skin disorder characterised by severe pruritus and skin lesions resembling arthropod bites. It primarily affects individuals with underlying haematological conditions, most commonly chronic lymphocytic leukaemia (CLL). While it does not correlate with a worse prognosis for the haematological disease itself, it significantly impacts patients' quality of life due to the distressing pruritus and recurring nature. Clinical presentation typically shows erythematous papules resembling arthropod bites, with less frequent occurrences of urticarial plaques or bullous lesions. Histologically, an intense and polymorphous inflammatory infiltrate is found both in the superficial and deep dermis, marked by an abundance of eosinophils and the absence of atypical cells. Treatment of this disease remains uncertain, with corticosteroids often being the only effective therapy. Here, we present the case of an 80-year-old patient with a history of CLL, who experienced a widespread, itchy eruption of papules and plaques over 2 months. Despite various therapeutic attempts, the lesions only responded to high-dose corticosteroids. Following the initiation of ibrutinib at a daily dose of 420 mg, both the skin lesions and pruritus resolved within 3 months. Ibrutinib, a tyrosine kinase inhibitor, is approved as a first-line treatment for CLL. However, its potential as a remedy for refractory eosinophilic dermatosis has not been reported thus far.

Janus Kinase (JAK) inhibitors are treatment options for dermatologic conditions such as atopic dermatitis, psoriasis, vitiligo, and alopecia areata. Guidance on how to counsel patients on these novel treatments is limited. The purpose of this review is to provide options providers can use to discuss JAK inhibitors with dermatology patients. The PubMed database was searched for terms including “dermatology JAK inhibitor safety” and “presenting information to patients.” Relevant literature was selected for inclusion. Black box warnings were placed on JAK inhibitors after a large, controlled trial in rheumatoid arthritis patients did not prove that tofacitinib was as safe as tumor necrosis factor inhibitors; in clinical trials for dermatologic conditions, JAK inhibitors had low risks of serious adverse events. Patient barriers to comprehending treatment information include conflicting information and limited time for discussion of risks. To address these barriers, suggested approaches have included speaking in simple phrases, providing reliable sources, and offering educational materials appropriate for different cultures. When discussing risks, physicians may use anecdotes and frame risks and side effects in ways that decrease anxiety. JAK inhibitors have uncommon severe side effects and related concerns that may be hard for patients to overcome, even when benefits exceed risks. Standard educational approaches can be complemented by anecdotes and framing to help diminish patients' anxiety.

Hidradenitis suppurativa, a chronic inflammatory skin condition, disproportionately affects individuals with skin of colour (SOC), particularly African Americans. Despite the increased prevalence in SOC, racial minorities are underrepresented in HS clinical trials, limiting our understanding of treatment efficacy. The purpose of this narrative review is to discuss the current literature regarding the clinical presentation, comorbidities, and management of HS in SOC individuals. A PubMed search was conducted using the terms Hidradenitis suppurativa, comorbidities, skin of colour, African–American, Hispanic, and quality of life with relevant studies written in English and pertaining to the demographics and clinical trials were included. African American patients with HS tend to experience more severe disease manifestations, higher rates of comorbidities like inflammatory bowel disease and anaemia, increased healthcare utilisation, and a greater likelihood of surgical interventions. While the current literature provides extensive information about African Americans regarding comorbidities and disease prevalence, there is a lack of research on Hispanic and other ethnic groups. For future research, it is important to broaden our focus to include various ethnic groups. Addressing these disparities requires focused interventions, inclusive clinical research initiatives, and healthcare policies tailored to the specific needs of patients with skin of colour.

Pyoderma gangrenosum (PG) is a complex disease with limited therapeutic options. Here we report the use of higher dose of guselkumab, a monoclonal antibody targeting interleukin (IL-) 23, in the treatment of PG in a medically complex patient. This case contributes additional evidence supporting the potential effectiveness of guselkumab in the treatment of PG and highlights the necessity for larger studies to confirm these findings.

The co-occurence of multicentric Castleman's disease (MCD) and Kaposi's sarcoma (KS) represents a rare clinical entity, mostly observed in individuals infected with the human immunodeficiency virus (HIV). Human herpesvirus 8 (HHV-8) is attributed a crucial etiological role in both conditions. This study presents the case of a 75-year-old woman who manifested an angiomatous lesion on the right thigh and erythematous firm plaques on the trunk and limbs, accompanied by asthenia, weight loss, and recurrent febrile episodes. Serological markers for HIV yielded negative results. Contrast-enhanced computed tomography (CT) and fluorine-18 fluorodeoxyglucose positron emission tomography (18 F FDG PET/CT) revealed multiple enlarged and intensely hypermetabolic lymph nodes in the supraclavicular, cervical, thoracic, and abdominopelvic regions. Subsequent excisional biopsy and immunohistochemical analysis confirmed the diagnosis of HIV-negative HHV8-positive MCD coexisting with KS.

Guselkumab, a monoclonal antibody known for its effective inhibition of T-cell-immunoactivity through specific binding to interleukin-23 (IL-23)-cytokines, may be used for off-label treatment of pyoderma gangrenosum (PG). Herein, we report two successful cases of off-label treatment for PG, using guselkumab, after unsuccessful treatments with standard regimens of corticosteroids, immunomodulating therapy and other biological agents. Case 1 involves a 39-year-old female with treatment-resistant peristomal PG post-colectomy and ileostomy. Case 2 features a 35-year-oldfemale with treatment-resistant PG, presenting with deep necrotic lower extremity ulcers. In both cases, we observed remarkable healing within months to a year. These two cases support the potential use of systemic IL-23-targetedtherapy for treatment-resistant PG.