JEADV clinical practice最新文献

Systemic sclerosis (SSc), a rheumatologic autoimmune disease, can present diversely, especially in patients with skin of colour (SOC). Differences in clinical manifestations among SOC individuals compared to predominantly White populations require a comprehensive examination to optimize diagnosis and treatment. This systematic review aims to explore the differences in SSc manifestations among individuals with SOC, identifying variations in disease severity, clinical features and psychosocial impacts. A systematic review of the literature was conducted following PRISMA guidelines. Databases searched included PubMed, SCOPUS, Cochrane and Web of Science, focusing on studies published within the last 10 years. Nine studies were selected and qualitatively analysed due to the heterogeneity of study types. Key findings highlight significant variations in disease severity and cutaneous clinical features among SOC cohorts compared to predominantly White populations. Raynaud's phenomenon was prevalent across all ethnicities; however, SOC groups exhibited fewer hallmark features of scleroderma, such as telangiectasias, calcinosis and digital swelling, which complicates diagnosis. SOC individuals showed a higher propensity for severe pulmonary complications and increased mortality rates. Atypical cutaneous presentations in SOC were associated with disease progression. Psychosocial impacts were more pronounced in SOC individuals, with greater awareness and dissatisfaction over cutaneous symptoms. Recognizing the atypical presentations of SSc in SOC is critical for early diagnosis and optimizing patient outcomes. The study underscores the need for further research to determine if observed differences are due to variations in prevalence, genetic factors or insufficient training in recognizing cutaneous manifestations in SOC. Enhanced awareness and targeted training for healthcare providers are essential to address these diagnostic challenges and improve care for SOC patients with SSc.

Background

Lifestyle has been associated with acne, but few studies assess how the relationship changes over time. Observational studies often overlook the effects of acne medication use and participant age in relationships with lifestyle-related factors.

Objectives

To describe relationships between lifestyle-related factors, medication use, and age in adolescent and young adult acne patients and acne-free controls.

Methods

This prospective study recruited 12- to 24-year-olds with or without acne at baseline. Surveys were electronically administered at enrolment and again 6 weeks later. Analyses were conducted on all participants who had complete baseline data (N = 190) and participants who had complete baseline and follow-up data (N = 61).

Results

Among 190 participants who completed the baseline survey, ages ranged from 12 to 24 years, but acne cases were concentrated in the middle of this range while controls had comparably more participants with ages towards the extremes. Among 61 participants who completed both baseline and follow-up surveys, no participants indicated worse acne over the 6 weeks, and most acne cases believed their acne improved (n = 25 [69.4%]). Acne cases who used medication daily (N = 24) saw improved emotion-related quality of life between the two assessments (mean ± standard deviation: 43.4 ± 24.4 to 29.1 ± 23.7; p < 0.001). Among acne cases who used medication daily, average fruit or vegetable consumption increased from 2.4 ± 2.0 to 3.0 ± 2.9 times per day over the preceding 7 days (p = 0.02). Among acne cases who believed their acne improved over the 6 weeks post-dermatology visit (N = 25), average days of skin picking over the previous 7 days declined between assessments (3.9 ± 2.4 to 2.4 ± 1.9 days; p = 0.003).

Conclusions

Medication use and age differences should be considered when designing future studies on acne and lifestyle-related factors.

Background

Dupilumab is the first human monoclonal antibody approved for the treatment of moderate–severe atopic dermatitis (AD) in children from 6 years of age. Real-world studies reviewing dupilumab-related ocular surface disorders (DROSD) in the paediatric population are needed to detail ophthalmological findings.

Objectives

This cross-sectional observational study aimed to review the incidence, features, and ophthalmological findings of DROSD in a real-world paediatric cohort, treated with dupilumab for AD.

Methods

Pharmacy and electronic medical records were used to identify all patients prescribed dupilumab for AD from April 2019 to July 2022. Data, including demographics, ocular signs and symptoms, severity and treatments, were collected and analysed.

Results

We identified 46 patients, with a median age of treatment initiation of 12 years (range 9–14 years). Twelve patients (26.1%) developed DROSD. Mean time to development of DROSD was 4.1 months (±2.4 months, 95% confidence interval). Two patients (16.7%) with DROSD had severe eye findings including peripheral corneal opacification, one of which had reported only asymptomatic red eyes. Ocular signs included 91.7% (11/12) bulbar conjunctival injection, 41.7% (5/12) follicle involvement (limbal or forniceal), 25% (3/12) diffuse tarsal-conjunctival thickening, 16.7% (2/12) featureless thickening, 16.7% (2/12) peripheral corneal opacification, 8.3% (1/12) cicatrisation and 8.3% (1/12) periorbital skin changes. No patients ceased treatment due to DROSD.

Conclusions

This study had a higher incidence of DROSD, compared to other real-world paediatric studies but had a similar incidence to real-world adult studies. Patient-reported eye symptoms did not always correlate to severity of DROSD. Larger paediatric studies looking at the incidence and long-term outcome of DROSD are needed.

Background

Various skin diseases exist; some require specialist treatment. Consequently, patients with these conditions are often referred from primary dermatological clinics to other medical institutions for further secondary or tertiary care. However, it has yet to be fully evaluated at primary dermatological clinics which skin conditions necessitate such referrals.

Objectives

This study aims to identify skin conditions that often require further care when treated at a primary dermatological clinic.

Methods

This study enroled 14,306 patients who had visited the Ueo Dermatology Clinic (a primary dermatological clinic in Saiki City, Oita prefecture, Japan) from 1 January 2020 to 31 December 2022. The following clinical information was examined: the primary disease, age, sex, whether referrals (general or emergency) were made after the clinic visit or not, and the reasons for the referrals.

Results

'Eczema and dermatitis' was the most frequent category in the clinic, although the referral rates for this category were not exceptionally high compared to other categories. A large number of emergency referrals was observed for 'Viral infections (herpes zoster),' 'Drug-induced skin reactions,' and 'Bacterial infections (cellulitis)'; a large number of general referrals was observed for 'Malignant skin tumours and melanomas' and 'Benign skin tumours.' Although low numbers, the rates for general and emergency referrals were high in the categories of 'Blistering Diseases,' 'Connective Tissue Diseases,' and 'Vasculitis, Purpura, and Other Vascular Diseases.' In an analysis of the reasons for the referrals, the following reasons ranked highest: requirement for high-level medical treatment, surgical operation, or hospitalisation, and consultation with doctors in departments other than dermatology.

Conclusions

This study identified several skin conditions often requiring additional care when treated at a primary dermatological clinic. Based on these findings, seamless cooperation between primary clinics and specialised medical institutions is anticipated.

Background

Chronic venous insufficiency is a commonly underdiagnosed, highly prevalent disease that causes significant patient morbidity.

Objectives

The aim of this study is to assess the utility of virtual reality (VR) during outpatient endovenous laser ablation procedures with the goal of reducing patient-reported anxiety or pain. The authors also sought to examine the effects on patient-reported overall satisfaction.

Methods

Patients completed a two-part survey interrupted by an immersive VR experience. Differences in the pre- and post-VR surveys were compared using a chi-square test. The pain scores were compared using a t-test.

Results

The pre-VR mean Beck Anxiety Inventory score was 1.41, decreasing post-VR to 1.33 (a reduction of 0.08; p < 0.001). There were statistically significant differences for 3 questions including 'Are you currently feeling fear of the worst happening' (p = 0.04), 'Are you currently feeling nervous' (p < 0.001), and 'Are you currently feeling scared' (p = 0.04).

Conclusions

Overall, our study demonstrates that a VR experience during endovenous laser ablations significantly improved measures of anxiety and patient satisfaction.