Archives of Dermatological Research

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CONSORT Diagram. Screening, enrollment, and follow-up of study patients
Undermining is thought to improve wound outcomes; however, randomized controlled data regarding its efficacy are lacking in humans. The objective of this randomized clinical trial was to determine whether undermining low to moderate tension wounds improves scar cosmesis compared to wound closure without undermining. Fifty-four patients, 18 years or older, undergoing primary linear closure of a cutaneous defect with predicted postoperative closure length of ≥ 3 cm on any anatomic site were screened. Four patients were excluded, 50 patients were enrolled, and 48 patients were seen in follow-up. Wounds were divided in half and one side was randomized to receive either no undermining or 2 cm of undermining. The other side received the unselected intervention. Three months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (POSAS). A total of 50 patients [mean (SD) age, 67.6 (11.5) years; 31 (64.6%) male; 48 (100%) white] were enrolled in the study. The mean (SD) sum of the POSAS observer component scores was 12.0 (6.05) for the undermined side and 11.1 (4.68) for the non-undermined side (P = .60). No statistically significant difference was found in the mean (SD) sum of the patient component for the POSAS score between the undermined side [15.9 (9.07)] and the non-undermined side [13.33 (6.20)] at 3 months. For wounds under low to moderate perceived tension, no statistically significant differences in scar outcome or total complications were noted between undermined wound halves and non-undermined halves. Trail Registry: Clinical Identifier NCT02289859.
Dose reduction (DR) per biologic. Results are presented as absolute number of prescribers for each biologic, and the proportion of respondents that applied DR for each specific biologic. Respondents were first asked which biologics they prescribed. Subsequently they were asked to indicate whether they applied DR for the biologics they prescribed. Respondents who indicated to prescribe a specific biologic, but did not specify if they applied DR for that biologic, were accounted as missing. DR dose reduction
Dose reduction (DR) regimen per biologic. Results are presented as absolute number of prescribers for each biologic. Respondents were asked to indicate how they applied DR per biologic they prescribed. Multiple answers were possible. *33% reduction of the original dose, **50% reduction of the original dose.QW every week, Q10D every 10 days, mg milligram, kg kilogram
Dose reduction (DR) of biologics, where possible, seems promising for more efficient use of expensive biologics. For implementation of DR strategies, it is essential to get insight in factors that influence implementation. The objective of this study was to evaluate the attitudes and behaviour regarding dose reduction of biologic therapies for psoriasis among psoriasis expert dermatologists worldwide. A 27-question e-survey was sent through the International Psoriasis Council (IPC) to its 114 dermatologist councilors worldwide. The survey assessed demographics, general and DR prescription behaviour, and motivations for and barriers against application of DR. Of 57 respondents, 53 respondents who prescribed biologics were included for analysis. Thirty-seven (69.8%) applied DR (i.e., ‘DR dermatologists’), and 16 (30.2%) did not (i.e., ‘Non-DR dermatologists’). DR strategies varied among respondents. Regarding criteria for starting DR, differences were reported in required treatment duration, and interpretation and duration of stable low disease activity. In addition, the prolongation of intervals between injections varied between respondents. For most ‘DR dermatologists’ ( n = 32/37, 86.5%), cost savings were one of the main reasons to apply DR. Fifteen out of 16 ‘Non-DR dermatologists’ (94%) did not apply DR due to lack of scientific evidence. In conclusion, DR of biologics for psoriasis is part of clinical practice in psoriasis experts globally. Barriers for applying DR included lack of evidence or guidelines, and uncertainty on DR effects and risks. Although growing evidence shows DR feasibility, future studies are needed to accumulate and broaden evidence, along with development of (inter)national guidelines on DR strategies.
The main objective is to evaluate clinical efficacy and safety of using calcipotriol–betamethasone compounding agent for psoriasis treatment through a systematic review and meta-analysis. We searched MEDLINE, Embase, The Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), and WanFang Data from inception till July 31, 2020. Efficacy was evaluated based on primary outcome indicators including skin lesion improvement and overall adverse reaction rate. Secondary outcome indicators included degree of life quality improvement, clinical effectiveness rate, and specific adverse reaction rates. RevMan5.3 was used to perform the meta-analysis. 22 studies finally met our inclusion criteria for the meta-analysis. The results indicated that for short-term treatment, a sequential therapy that uses calcipotriol betamethasone compounding agent and calcipotriol improves PASI score (MD = −0.94, 95% CI − 1.38 ~ − 0.49, P < 0.0001, I2 = 49%), comparing with using only calcipotriol. From a drug safety perspective, the difference in overall adverse reaction rate is not significant between the calcipotriol group and the sequential treatment group (RR = 0.50, 95% CI 0.22 ~ 1.14, P = 0.10, I2 = 33%). Calcipotriol betamethasone compounding agent may be more effective in plaque psoriasis treatment compared to use only calcipotriol, with no significant difference in adverse reaction rate between the two groups. Although the data were collected from 13 comparison groups, each group may not have sufficient data for a thorough and comprehensive analysis. Further research may be necessary for a more detailed evaluation of effectiveness of using calcipotriol betamethasone compounding agent for plaque psoriasis treatment.
The effect of oestrogens in androgenetic alopecia (AGA) pathophysiology has not been clearly understood. However, they are considered to have a place in the AGA pathogenesis as the androgens do. The effects of estrogen occur via the estrogen receptors alpha and beta, and the recently discovered G protein-coupled estrogen receptor 1 (GPER-1). Aim of this study is to examine serum GPER-1 levels of AGA patients and to evaluate the place of them in AGA pathogenesis for the first time through the literature. 40 AGA patients with clinical AGA stage 2–3–4 diagnoses according to the Hamilton–Norwood classification for males, and AGA stage 2 according to Ludwig system for females and with normal serum dihydroepiandrosterone sulfate, estradiol, total testosterone, progesterone, follicle stimulating hormone and luteinizing hormone were included in the study in addition to 40 healthy controls with similar characteristics by means of age and gender. We received the medical history and performed the physical examinations. We measured serum GPER-1 levels. Serum GPER-1 levels of AGA patients and the control group were 30.43 ± 3.83 ng/mL and 14.18 ± 3.61 ng/mL (mean ± SD), respectively. The levels were detected as significantly increased in AGA group compared with the control group (p = 0.007). No serum GPER-1 level differences were found among female and male patients (p = 0.101). Significantly high levels of serum GPER-1 levels in AGA patients without any relationship between gender and GPER-1 Levels compared with healthy controls reminded us that GPER-1 might have a role in AGA pathogenesis independent from the gender.
Cutaneous sarcomas are a heterogeneous group of rare mesenchymal neoplasms representing less than 1% of malignant tumors. Histology report remains the cornerstone for the diagnosis of these tumors. The most important clinicopathologic parameters related to prognosis include larger tumor size, high mitotic index, head and neck location, p53 mutations, depth of infiltration and histological grade, vascular and perineural invasion as well as the surgical margins status. Applying advanced biopsy techniques might offer more precise assessment of surgical margins, which constitutes a significant precondition for the management of these tumors. The management of cutaneous soft tissue sarcomas requires a multidisciplinary approach. Surgery remains the standard treatment, nonetheless adjuvant therapy may be required, consisting of radiotherapy, chemotherapy, and molecular targeted therapies to improve treatment outcomes. The role of molecular profiling in the treatment of uncontrolled disease is promising, but it may be offered to a relatively small proportion of patients and its use is still considered experimental in this setting. Due to the rarity of the disease, there is a need for knowledge and experience to be shared, pooled, organized and rationalized so that recent developments in medical science can have a major impact on the disease course. Multicenter clinical trials are needed to improve the care of patients with cutaneous sarcomas.
Lesion reductions in clinical trials of tea tree oil nanoemulsion containing 0.1% adapalene gel (TTO NE + ADA Gel) (n = 53) versus adapalene marketed gel (ADA Marketed Gel) (n = 47)
Percentage of patients with different acne severity grades during the study. TTO NE + ADA Gel = tea tree oil nanoemulsion loaded adapalene gel, ADA Marketed Gel = adapalene marketed gel
Reported rates of adverse events during the clinical trials in each measurment (TTO NE + ADA Gel = tea tree Oil nanoemulsion loaded adapalene, ADA Marketed Gel = adapalene marketed gel)
Adapalene is used for treatment of acne vulgaris, a common dermatological disease. Nano-based carriers have been developed to improve solubility and bioavailability of adapalene and other acne treatment drugs. In our previous report, tea tree oil nanoemulsion containing adapalene gel (TTO NE + ADA Gel) showed appropriate physical and biological properties such as stability, viscosity, pH, size, morphology and biocompatibility in an animal model. The present study was designed to assess efficacy and safety of the TTO NE + ADA Gel in comparison with 0.1% adapalene marketed gel (ADA Marketed Gel). A total of 100 patients were randomized to receive TTO NE + ADA Gel or ADA Marketed Gel, once daily at night, for 12 weeks. Analysis for efficacy was conducted by acne lesion count (total, inflammatory and non-inflammatory) and acne severity index at weeks 4, 8 and 12 using generalized estimating equation along with the safety assessments in each measurement for assessing dryness, erythema, burning sensation and irritation. Significantly better reduction in total, inflammatory, and non-inflammatory acne lesions were reported for TTO NE + ADA Gel as compared to the ADA Marketed Gel overall and on each measurement occasion (p value < 0.001 for all). Mean acne severity index also reduced with TTO NE + ADA Gel significantly in comparison with ADA Marketed Gel (p value < 0.001). Dryness was the most common adverse effect reported in both groups and it was higher in TTO NE + ADA Gel group. In conclusion, TTO NE + ADA Gel compared to ADA Marketed Gel appears more effective in the treatment of acne vulgaris, with no important change in adverse effects.
Digital clinical photography of a 34-year-old female with periorbital wrinkles, of 6 years duration. Glogau scale 4. Before treatment (A, C). 2 weeks after last treatment session, (B, D). Before treatment (week 0): A Right-sided periorbital area. C Left-sided periorbital area. Two weeks after last session (week 6): B Right-sided periorbital areas, GAIS score improved, patient satisfaction rated good. D Left-sided periorbital areas, GAIS score improved, patient satisfaction rated good
Digital clinical photography of a 28-year-old female with periorbital wrinkles, of 2 years duration. Glogau scale II. Week 0: Before treatment (A, C). Week 6: two weeks after last session, (B, D). Before treatment (week 0): A Right-sided periorbital area. C Left-sided periorbital area. Two weeks after last treatment session (week 6): B Right-sided periorbital area, GAIS improved patient satisfaction rated good. D Left-sided periorbital area, GAIS much improved patient satisfaction rated excellent
Antera 3D camera photography of right periorbital area of the same patient before treatment and 2 weeks after last session. Before treatment: a Indentation index was 83.9. b Roughness index was 36.657. c Average melanin level was 0.649. Two weeks after last session. d Indentation index decreased to 67.5. e Roughness index decreased to 32.465. f Average melanin level slightly increased to 0.658
Antera 3D camera photography of left periorbital area of the same patient before treatment and 2 weeks after last treatment session. Before treatment: a Indentation index was 91.1. b Roughness index was 53.216. c Average melanin level was 0.652. 2 weeks after last session: d Indentation index decreased to 39.3. e Roughness index decreased to 39.707. f Average melanin level decreased to 0.639
Background Periorbital skin is the thinnest. That is why, it is the easiest to wrinkle and the most challenging to rejuvenate. Platelet-rich plasma (PRP) as well as plasma gel have been used for skin rejuvenation and considered relatively safe and effective. Methods This split-face study was conducted on forty female patients seeking periorbital rejuvenation where PRP was injected in the right (Rt) side and plasma gel in the left (Lt) side, two treatment sessions 4 weeks apart (week 0 and week 4). Patients were followed up 2 weeks after each treatment session (week 2 and week 6) as well as 12 weeks after the last session (week 16) using both subjective [physician assessment through Global Aesthetic Improvement score (GAIS) and patient’s satisfaction (Likert scale)] and objective [Antera 3D camera] assessment methods. Results Both modalities yielded a significant improvement of periorbital wrinkles after the 2nd session, with significantly better results on the plasma gel injected side; however, the improvement achieved through both modalities could not be maintained for the following 3 months. Besides, objective assessment could not prove any improvement in periorbital hyperpigmentation. Conclusion Two sessions of both PRP and plasma gel are effective for periorbital rejuvenation, with plasma gel showing significantly better results. However, improvement was not maintained for 3 months.
Enrollment and outcomes. From 2011 to 2015, 201 subjects were recruited with blood sample collected. Twenty-eight out of 192 subjects (15%) were tested HLA-B*58:0 positive. They were advised not to take allopurinol. 156 subjects tested HLA-B*58:01-negative took allopurinol. No SCAR was reported
Human leukocyte antigen (HLA)-B*58:01 allele is a significant risk factor for allopurinol-induced severe cutaneous adverse reactions (SCARs) which is potentially fatal. In some studies, chronic kidney disease (CKD) was also implicated to compound the risk of SCARs. We aim to investigate if pre-treatment HLA-B*58:01 screening can prevent allopurinol-induced SCARs in Chinese patients with CKD and its cost-effectiveness. We prospectively recruited Chinese CKD patients who required allopurinol during 2011–2015 and performed pre-treatment HLA testing (HLA screening group). Patients tested positive for HLA-B*58:01 were refrained from allopurinol while those tested negative were prescribed allopurinol. The incidence of SCARs in the HLA screening group was compared with the historical control in previous 5 years and the cost-effectiveness of HLA testing was analyzed. In the historical control (2006–2010), 3605 patients on allopurinol were screened, 22 out of 1027 (2.14%) CKD Chinese patients newly started on allopurinol developed SCARs, including 6 SJS/TEN. In the HLA screening group, 28 out of 192 patients (14.6%) tested HLA-B*58:01 positive were advised to avoid allopurinol; 156 out of 164 HLA-B*58:01-negative patients received allopurinol and none developed SCARs. The incidence rate of SCARs was significantly lower in the HLA screening group compared with controls (0% vs 2.14% respectively, p = 0.037*). The targeted HLA screening approach was associated with lower healthcare costs compared with no HLA screening (US$ 92,430 vs US$ 281,226). Pre-treatment HLA-B*58:01 screening is cost-effective to target on patients with CKD in Chinese to prevent allopurinol-induced SCARs.
a Investigator’s Global Assessment of improvement at each intermediate visit for those patients who had ‘excellent’ or ‘good’ improvement. b Patient’s Global Assessment of satisfaction at each intermediate visit for those patients who had ‘very’ or ‘relatively’ satisfied
a–d The photographs of a female subject with neurogenic rosacea at visits 0, 1, 2, and 3. e Histopathological examination showing the dilated blood vessels in the superficial dermal, with mild to moderate lymphocyte infiltration around the blood vessels (H and E, × 100)
a–d The photographs of a female subject with recalcitrant granulomatous rosacea at visits 0, 1, 2 and 3. e Histopathological examination showing infiltration of inflammatory cells around blood vessels and hair follicles, epithelioid tissue cells and multinucleated giant cells constitute granuloma (H and E, × 100)
Rosacea is a common chronic facial inflammatory skin disease. However, treatment for “difficult-to-treat rosacea” cases has not been established. This 48-week, prospective, observational study analyzed patients who underwent three non-insulated fractional microneedle radiofrequency (NFMRF) sessions at 2-month intervals. Therapy efficacy, epidermal barrier function, and side effects were evaluated. 34 subjects completed the trial. NFMRF resulted in CEA score reduction from 2.65 ± 0.59 to 1.56 ± 0.50 (P < 0.001) and mean DLQI reduction from 16.70 ± 3.55 to 10.48 ± 2.92 (P < 0.001). The successes of CEA (44.12 vs. 2.94%), IGA (91.67 vs. 25.00%), and flushing (58.82 vs. 26.47%) were observed. Among 34 patients, 22 reported “excellent” or “good” improvement and 30 were “very” or “relatively” satisfied. Skin barrier results revealed that hemoglobin content significantly decreased from 376.47 ± 71.29 at visit 0 to 161.32 ± 52.86 at visit 3. 2 of 30 patients followed-up at 6 months had a relapse at 18 and 20 weeks, respectively. No serious side effects were observed. NFMRF alone results in visible improvement and has great efficacy for difficult-to-treat rosacea without compromising patient safety or damaging the skin barrier.
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram
Risk of bias of included cohort studies. A green dot denotes low risk of bias, yellow for unclear risk of bias, and red for high risk of bias
Forest plot on the risk for incident completed suicide, suicide attempt, suicidal behavior, and suicide ideation
Forest plot for subgroup analysis according to age groups on risk for suicide ideation
Previous meta-analyses have produced conflicting conclusions about suicidality risk among psoriasis patients. We aimed to update the evidence on the risk for the whole continuum of incident suicidality in psoriasis patients. We performed an update systematic review and meta-analysis and searched CENTRAL, PubMed, and Embase from January 1, 2017 to August 14, 2021 for relevant new cohort studies and incorporated new studies into our previous systematic review. Random-effects model meta-analysis was used to obtain pooled hazard ratio (HR) with 95% confidence interval (CI). Subgroup analysis was conducted according to age and disease severity. A total of 12 studies were included in this meta-analysis. We detected no significant differences in the risk for incident completed suicide (HR 1.33, 95% CI 0.91–1.95), suicide attempt (HR 1.22, 95% CI 0.96–1.56), suicidal behavior (HR 1.08, 95% CI 0.98–1.19), and suicide ideation (HR 1.74, 95% CI 0.99–3.06) between psoriasis patients and non-psoriatic controls. In the subgroup analysis based on age, an increased risk for incident suicide ideation was observed in pediatric subgroup (HR 1.50, 95% CI 1.12–2.03). The updated evidence suggests no increased risk for whole continuum of incident suicidality spectrum in psoriasis patients but an increased risk for incident suicide ideation among pediatric psoriasis patients. Involving mental health professionals may be crucial in psoriasis management especially in young patients.
Vitiligo is the most common depigmenting disease characterized by achromic macules due to selective loss of melanocytes. The pathogenesis remains poorly elucidated, and multiple hypotheses exist regarding its pathogenesis. Evidence suggests that stress on melanocytes can result in activation of the immune system, and involvement of both activated cluster of differentiation (CD8+) cytotoxic and CD4+ T cells in the dysfunction, depigmentation, and apoptosis of melanocytes. Recent studies show that the interleukin 17 (IL-17) axis plays a central role in the pathogenesis of the disease. IL-17 is an important regulatory effector cytokine in this pathway. The aim of this study was to evaluate the association of IL-17A rs4711998 (−832A/G), IL-17A rs2275913 (−197G/A), and IL-17F rs763780 (7488A/G) with vitiligo in a Northeastern Mexican population. This was a case–control study and included 116 patients with vitiligo and 116 control subjects. Genotype characterization of IL-17A rs4711998 (−832A/G), IL-17A rs2275913 (−197G/A), and IL-17F rs763780 (7488A/G) was performed using polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) method. A p ≤ 0.05 was considered significant. It was observed that the combination of the genotypes GG/GA for IL-17F rs763780 (7488A/G) was associated with an increased risk for the development of vitiligo (OR 2.0943, 95% Cl 1.2375–3.5445, p = 0.0056). Regarding IL-17A rs4711998 (−832A/G) and IL-17A rs2275913 (−197G/A) genotyping, no association with vitiligo development was found. In conclusion, the SNP rs763780 in the IL-17F gene appears to be a risk factor for vitiligo development in this Mexican population and it may be useful in future studies, especially for the development of new therapies.
Basal cell carcinomas (BCC) are the most common form of cancer globally. Linear BCCs are an unusual variant which are generally defined by having a length three times longer than the width and exhibiting relatively straight edges. In this report, we describe the largest global cohort (n = 31) with this rare subtype. Within this cohort, 22 were in the periocular region, 27 underwent Mohs micrographic surgery and 12 involved oculoplastic reconstruction. These results suggest that, whilst this subtype is relatively rare, it may be more prevalent than previously thought. Dermatologists and other specialities managing skin cancer, particularly ophthalmologists, should, therefore, be aware of this subtype, as it is often more aggressive than other BCC subtypes, often requiring multi-disciplinary management.
Autoimmune bullous disease autoantibodies, particularly including bullous pemphigoid (BP)-related anti-BP180-NC16A IgG, have been reported in a small subset of healthy individuals, but information about associated factors is lacking. We hypothesized that an abnormal status of immunomodulatory vitamin D could play a role in anti-BP180-NC16A autoantibody reactivity in healthy persons. In addition, we aimed to evaluate the cytokine profile associated with these autoantibodies. Plasma samples from 34 anti-BP180-NC16A IgG-reactive and 85 anti-BP180-NC16A IgG-negative healthy blood donors were tested for levels of 25-hydroxyvitamin D [25(OH)D] and a wide range of cytokines (IL-2, IL-4, IL-5, IL-6, IL-9, IL-10, IL-13, IL-17A, IL-17F, IL-21, IL-22, IFN-γ, and TNF-α). We observed that anti-BP180-NC16A IgG-reactive healthy subjects had significantly lower plasma 25(OH)D levels and about a twofold higher rate of vitamin D deficiency (< 20 ng/ ml) compared to anti-BP180-NC16A IgG-negative healthy persons. In addition, anti-BP180-NC16A IgG-positive samples were characterized by significantly higher levels of IL-2, IL-5, IL-9, IL-10, and IL-13 which were, however, not significantly associated with the vitamin D levels. Our results indicate that healthy individuals with BP autoantibody reactivity share similarities with BP patients regarding the vitamin D status and cytokine profile (i.e., marked hypovitaminosis D and Th2 predominance), which may have pathophysiologic implications.
Flow diagram of study exclusion and inclusion at each phase of article screening
An overview of published repair methods for defects on the ears following Mohs micrographic surgery or excision. The x axis represents repair methods, and the y axis represents the number of reported cases
Repair of auricular defects following tumor removal can be challenging. Many techniques have been described, but the literature lacks a comprehensive review of these methods. To perform a systematic review to compile and describe methods of reconstruction for post-surgical defects on the ears, eight databases were searched using terms related to ear anatomy, Mohs and excisions, and repair methods. Articles were eligible for inclusion if they contained repair data for ear defects following Mohs or excision for at least 4 subjects and were published in English between 2004 and 2019. Two reviewers screened all abstracts, and then evaluated the remaining full text articles to determine eligibility. The authors’ specialties, study design, subject information, tumor and defect characteristics, procedure, repair methods, outcomes, and complications were then extracted. Most articles were written by dermatologic surgeons (66.7%). Repair methods included wedge excisions (19 cases), second intention healing (376), linear closures (294), purse strings (4), locoregional flaps (221), and grafts (2003). Most studies were small observational case series or cohort studies that lacked clear outcome measures. The available evidence on this topic is low quality. Further research utilizing improved study designs and standardized outcome measures is needed.
Graph illustrating the correlation between (A) Irisin and IFN levels and (B) Irisin and IL-3 levels
Chronic spontaneous urticaria (CSU) is an important dermatological disease involving severe itchy urticaria lesions and/or angioedema. Urticaria and angioedema occur in the community at a rate of 25–30%. Many factors, such as inflammation, have been implicated in the etiology of CSU. Irisin is a newly identified adipocytokine shown by research to exhibit anti-inflammatory properties in addition to its many other effects. The aim of the study was to investigate, for the first time in the literature, the significance of serum irisin levels in patients with CSU. Seventy-eight individuals were evaluated. The study group included 44 patients diagnosed with CSU, and the control group consisted of 34 healthy individuals. Serum samples were collected, and serum irisin, Interleukin-2 (IL-2), Interleukin-3 (IL-3), Tumor Necrosis Factor-alpha (TNF-α), and Interferon-ɣ (IF-ɣ) levels were determined using the enzyme-linked immunosorbent assay (ELISA) method. Irisin was studied for the first time in patients with CSU and exhibited a significantly higher level in the control group than in the patient group (p = 0.020). IL-2, IL-3, and IF-ɣ levels were higher in the CSU group than in the control group, although the results were not statistically significant. Only TNF-α results increased significantly. Correlation analysis was applied to determine the relationships between irisin and IF-ɣ and IL-3 levels. This revealed that the irisin parameter was significantly and positively correlated with IF-ɣ and IL-3 in patients with CSU (r = 0.518, p = 0.016 and r = 0.536, p = 0.022, respectively). This is the first report to evaluate irisin as an inflammatory biomarker in CSU. Irisin levels in patients with CSU were low, suggesting that irisin may pay a role in the pathogenesis of CSU and may be a marker showing the severity of the disease.
Multiple high-risk factors have been associated with poor outcomes in cutaneous squamous cell carcinoma, including immunosuppression, poor differentiation, depth, diameter, and perineural invasion. While many of these are included in major staging systems, their measurement and reporting vary considerably in clinical practice. We performed a survey study of fellowship-trained Mohs surgeons to explore their attitudes and practices related to recording squamous cell carcinoma high-risk factors and staging information at the time of Mohs. An anonymous Qualtrics survey of 25 questions was distributed to the American College of Mohs Surgery membership listserv. There were 107 complete surveys (response rate 7.1%), with over 95% of subjects from the United States. Fifty-five percent had been practicing 10 years or less, 28% between 11 and 20 years, and the remainder greater than 20 years. Fifty-seven percent were in private or group practices, and 43% were in academia. Nearly all respondents consistently report tumor recurrence (100%), location (100%), immunosuppression (94%), and diameter (93%). Only 70% grade differentiation for every squamous cell carcinoma case. Sixty-six percent of participants consistently record anatomic depth, while only 2% always or almost always record Breslow depth. Although 96% of respondents almost always or always record perineural invasion, only 34% consistently record nerve diameter. Forty-three percent reported that they never or rarely stage cutaneous squamous cell carcinomas, whereas 43% often, almost always, or always stage. In conclusion, certain high-risk factors, such as differentiation, Breslow depth, and stage, are recorded inconsistently by Mohs surgeons. Several participants commented that they prefer to send a central debulk to dermatopathology to assess staging parameters in all tumors with high-risk features. While this strategy may be useful in some practice settings, Mohs surgeons possess the skills necessary to perform a central debulk analysis themselves at the time of Mohs. Whether performed at the time of Mohs or by dermatopathology, assessing high-risk features and accurately staging cutaneous squamous cell carcinoma is paramount to detecting tumors at higher risk of poor outcomes.
PRISMA flowchart illustrating the process of data screening
Calcinosis cutis is a deposition of calcium in the skin and subcutaneous tissue, often accompanied by pain, reduced mobility, and chronic infections. Limited evidence is available about the feasibility and efficacy of therapies alternative to systemic treatment and surgical excision, both of which often lead to unsatisfactory results or complications. We conducted a systematic review to evaluate the efficacy and safety of topical and intralesional sodium thiosulfate, extracorporeal shock-wave lithotripsy (ESWL), and laser for calcinosis cutis. PubMed, Embase, and Web of Science were searched. Reports of calciphylaxis and treatment combined with systemic medications were excluded. A total of 40 studies including 136 patients were analysed. Partial or complete remission after monotherapy was observed in 64% to 81% of cases. Self-applied topical sodium thiosulfate required patient’s adherence (mean treatment duration, 4.9 months; range 2–24). Laser therapy enabled complete remission of microcalcifications after a single procedure (57%; 12/21). ESWL and intralesional sodium thiosulfate injections decreased calcinosis-associated pain (median reduction in VAS score, 3; range 0–9 and 1; range 0–5, respectively). The most common adverse event was scarring and hyperkeratosis, observed after CO 2 laser (56%; 10/18). Intralesional sodium thiosulfate injections caused transient pain in over 11% of patients. Recurrences within the follow-up were rare (2%; 3/136). This study provides an overview of minimally invasive and local therapies that in selected cases might transcend conventional treatment. The limitation of this study is the poor level of evidence, which emerges mainly from non-randomized studies at high risk of bias.
Kaplan–Meier survival curves of adenoid cystic carcinoma (ACC) and ceruminous adenocarcinoma (CA)
Kaplan–Meier survival curves of adenoid cystic carcinoma (ACC) with/without radiation
Kaplan–Meier survival curves of ceruminous adenocarcinoma (CA) with/without radiation
Ceruminous carcinomas of the external auditory canal (EAC), encompassing adenoid cystic carcinoma (ACC), ceruminous adenocarcinoma (CA), and mucoepidermoid carcinoma (MEC), are extremely rare with little known regarding the influence of demographics, tumor characteristics, and treatment on survival. This study aimed to summarize existent data and describe prognostic factors affecting survival in ceruminous carcinoma. Cases of ceruminous carcinoma of the EAC in the Surveillance, Epidemiology, and End Results (SEER) database were analyzed to provide demographic, cancer-related, and treatment data and assess their influence on disease-specific and overall survival. A literature review was also performed. No significant difference in overall survival (OS) existed for localized versus regional disease, tumor type, or use of radiation therapy. In those with ACC, distant disease had a lower OS compared to regional disease. On review of the literature, local recurrence was a common finding with a low risk for nodal metastasis in ACC and CA. In conclusion, local recurrence was common despite aggressive surgical intervention (± radiation therapy); overall survival was unaffected by radiation therapy, tumor type, or local versus regional disease; and more cases of MEC are needed for analysis.
PRISMA describing inclusion and exclusion methodology
of included article findings: clinical improvement of ustekinumab use in off-label dermatological conditions
Ustekinumab is approved for the treatment of psoriasis and Crohn’s disease. Because many dermatological conditions are due to immune-mediated development, ustekinumab may be effective in other conditions. A systematic review of the off-label uses of ustekinumab, as well as on-label adverse effect, was performed, reporting on clinical improvement. MEDLINE, Embase, Web of Science, and Cochrane databases were searched for studies regarding ustekinumab treatment of rativa (HS), lichen planus (LP), pyoderma gangrenosum (PG), pityriasis rubra pilaris (PRP), cutalopecia areata (AA), atopic dermatitis (AD), Bechet’s disease, bullous pemphigoid (BP), hidradenitis suppuaneous sarcoidosis, cutaneous systemic lupus erythematosus (SLE), and vitiligo. Descriptive statistics were performed. 74 articles of 4596 screened were included, and reported on 212 patients receiving ustekinumab treatment. Across all studies, ustekinumab showed promise in treating patients: AA (10/12 patients; 83.3% improvement), AD (28/74 patients; 37.8% improvement), HS (42/52 patients; 80.8% improvement), and PRP (25/27 patients; 92.6% improvement), among others. Adverse events were noted with the use of ustekinumab, including development of AA (four patients), AD (three patients), and BP (four patients), among others. Ustekinumab can be a promising option for patients with dermatological conditions refractory to traditional therapies. Adverse events must be monitored in certain patients.
Comparison of composite patient satisfaction score, by disease
Patient satisfaction is associated with improved patient retention and clinical outcomes. Previous studies investigated the impact of disease severity and mental health conditions on patient satisfaction among psoriasis patients. However, associations with healthcare utilization were not studied. Moreover, socio-demographic differences in patient satisfaction among adults with psoriasis are not well-delineated. The objectives of this study were to determine the impact of psoriasis disease on patient satisfaction among US adults and examine associations of satisfaction with healthcare utilization and socio-demographic characteristics. We analyzed the 2000–2016 Medical Expenditure Panel Surveys, representative surveys of US population health status and perceptions. Patient satisfaction was evaluated by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Adults with psoriasis were compared to a control group of all adults without current diagnosis of psoriasis. Multivariable linear and logistic regression models were constructed to examine associations of satisfaction among those with psoriasis. Overall, data were analyzed from 1419 adults with psoriasis who completed the entire CAHPS survey. Adults with psoriasis had similar patient satisfaction compared to healthy controls (LS-means: 86.0 vs 85.6, adjusted β [CI 95]: 0.38 [− 0.45, 1.22]). Based on sensitivity analysis, adults with vs without psoriasis had similar rates of high satisfaction in each CAHPS domain: time spent, clear explanations, listening, and respect demonstrated. Among those with psoriasis, high satisfaction was associated with ≥ 1 office visit (adjusted OR [CI 95]: 2.50 [1.63, 3.84]), and consultation with a specialist was associated with increased satisfaction (adjusted β [CI 95]: 1.36 [0.95, 1.77]). Overall satisfaction score among psoriasis adults was associated with increased age and black race, and inversely associated with lower income, public or no insurance, other race or multiracial, and multimorbidity. In conclusion, psoriasis diagnosis was not associated with difference in satisfaction. However, lower-income adults with public or no insurance and multimorbidity had lower satisfaction. Moreover, specialist consultation was associated with higher satisfaction. Multidisciplinary and increased healthcare access are needed to optimize patient satisfaction.
Images are showing changes in lentigo maligna/lentigo maligna melanoma on reflectance confocal microscopy (RCM). a A standard honeycomb image of the epidermis. b Multiple dendritic cells in the interfollicular epithelium. c Sheet of dendritic cells (yellow arrows) and atypical round cell (white arrow). d Dissemination of round epidermal nucleated cells. e Dendritic cell infiltrating follicular epithelium. f Medusa head. 300 µm images
a Clinical image of the brownish macula in the right malar region. b, c Dermoscopy images (10 × magnification): asymmetrically pigmented follicular opening, rhomboidal structures, and an annular-granular pattern area. d, e Individual images of RCM (≅ 200 × 200 μm) at the epidermis level: the presence of dendritic cells and perifollicular dendrites (yellow arrows). f Individual image of RCM (≅ 200 × 200μm) at the DEJ level: nucleated dendritic cells, perifollicular dendrites, and round cells (yellow and red arrows, respectively). g, h Image of the anatomopathological examination on H&E (increases of 100 × and 200 ×, respectively): the presence of atypical melanocytes in the epidermis in a lentiginous pattern. i Melan-A immunohistochemistry (200 × magnification): labeling of cytoplasmic melanin on melanocytes and keratinocytes. j Immunohistochemistry CD1A (200 × magnification): the presence of Langerhans dendritic cells in the epidermis. k, l MITF immunohistochemistry—p63 (200 × magnification): marking of keratinocytes in red and the nucleus of melanocytes in brown. Diagnosis: malignant lentigo. Score by nomogram: 75%
Facial melanoma presents itself as a brownish macula, being difficult to differentiate it from benign pigmented lesions of the face on clinical examination. Reflectance confocal microscopy (RCM) assists in diagnosing facial lesions in which dermoscopy has limitations, allowing to increase the diagnostic accuracy. The study aimed to analyze the RCM features of pigmented isolated lesions of the face for diagnosing melanoma. Also, we sought to establish the chance of a pigmented lesion on the face being a melanoma using RCM criteria. In this retrospective and prospective study, 105 clinical pigmented lesions on the face underwent RCM, and cytoarchitectural features in the epidermis, the dermo-epidermal junction (DEJ), and dermis were described. For statistical analysis, the exact chi-square test was applied to the RCM criteria. The odds ratio was estimated using univariate logistic regression. Finally, we used the multiple logistic regression method for creating a nomogram to predict the chance of a lesion being a melanoma. After univariate and multivariate logistic regression, atypical round nucleated cells within the epidermis, pagetoid spread, and follicular dendritic cells presented as statistically significant features. Then, a complex nomogram was created to give the chance of a pigmented lesion on the face being a melanoma. The presence of these three features resulted in a 98% probability for melanoma. This study allowed to estimate the diagnosis of melanoma on the face, using RCM, practicable and feasible in the daily routine, through the presence of some RCM nomogram criteria.
Numbers of blackheads (A), whiteheads (B) and papules (C), before, 4 and 8 weeks following the treatment using NLC-TRE and TRE cream (n = 16, *significant vs the baseline). Significant decrease in percentage of blackheads and whiteheads but not papules after 8 weeks treatment with NLC-TRE compared to TRE cream (D)
Visiopore camera pictures for one of the patients, showing the size and intensity of porphyrin production on the skin, before and 8 weeks after treatment with NLC-TRE and TRE cream
Here, we assessed the efficacy and safety of Nano lipid carrier (NLC) drug delivery system containing tretinoin (NLC-TRE) in comparison with the conventional 0.05% tretinoin cream (TRE cream) in mild to moderate acne vulgaris. A stable and appropriate NLC-TRE formulation was prepared using a high-pressure homogenizer and particle characterization and physicochemical properties were evaluated under accelerated conditions. Efficacy assessment was performed via a split-face clinical study, by comparing the number of acne lesions, porphyrin production and skin biophysical parameters in both sides of the face randomly treated with NLC-TRE and TRE cream. Plasma concentration of tretinoin after topical application of NLC-TRE was measured for primary safety evaluation. We acquired a stable, spherical nanoparticles with particle size of 118.5 nm, PI equal to 0.485 and ZP of − 44.7 mV. The rate of decrease of acne lesions was significantly higher in NLC- TRE side (p value < 0.001). The size and intensity of porphyrin production in pilosebaceous follicles were significantly reduced only on NLC-TRE side (p value < 0.01). The plasma concentration of the tretinoin, after 8 weeks’ application remained lower than the toxic levels. The NLC-TRE formula provides better efficiency and good loading capacity of TRE in the drug delivery system.
Bioinformatic analysis of the differentially expressed circRNAs obtained from GSE74758 dataset. A Volcano plot of the differentially expressed circRNAs. Red dots represent up-regulated circRNAs; Green dots represent down-regulated circRNAs. B Clustered heatmap of 26 significantly differentially expressed circRNAs in cSCC tissues and normal control tissues. Red represents up-regulation and green represents down-regulation. C The schematic presentation of hsa_circ_0002891, hsa_circ_0008234 and hsa_circ_0001402
The identification of hsa_circ_0008234 in cSCC. A The expression of circ_0002891, circ_0008234 and circ_0001402 in ten paired cSCC tissues and non-lesional skin tissues detected by qRT-PCR. B FISH assay showed that circ_0008234 preferentially localized in the cytoplasm of A431 cell. C The existence of circ_0008234 was validated in A431 cell and one case of cancer tissue by RT-PCR. Divergent primers were used to amplify circular RNA transcript circ_0008234, and convergent primers were used to amplify the related linear RNA transcript. GAPDH was used as an internal reference. D Sanger sequencing result of the RT-PCR product proved the junction site of circ_0008234. E The expression level of circ_0008234 and the linear FOXP1 were detected by qRT-PCR in A431cell with RNase R treatment. F The expression level of circ_0008234 and FOXP1 mRNA was detected by qRT-PCR in A431 cell with Actinomycin D treatment. *P < 0.05, NS:P > 0.05
circ_0008234 siRNA inhibits the proliferation and colony formation ability of A431 and primary cSCC cells. A The knocking down efficiency of circ_0008234 siRNA in A431 cells was detected by qRT-PCR. B The proliferation viability of A431 cells transfected with circ_0008234 siRNA were evaluated by CCK-8 assay. C The colony formation ability of A431 cells transfected with circ_0008234 siRNA was evaluated by colony formation assay. D The knocking down the efficiency of circ_0008234 siRNA in primary cSCC cells was detected by qRT-PCR. E The proliferation viability of primary cSCC cells transfected with circ_0008234 siRNA was evaluated by CCK-8 assay. F The colony formation ability of primary cSCC cells transfected with circ_0008234 siRNA were evaluated by colony formation assay. *P < 0.05
circ_0008234 acts as a miR-127-5p sponge in cSCC cells. A The CircInteractome online database was performed to predict the binding sites between circ_0008234 and miR-127-5p. B Immunoprecipitation of Myc-tagged AGO2 from A431 cells transfected with either Myc-AGO2 or Myc-vector plus miR-127-5p mimics. The enrichment of circ_0008234 was detected by qRT-PCR. C, D CCK-8 and colony formation assay showed that circ_0008234 siRNA decreased the proliferation viability of A431 cells, but such suppressive effect was reversed when miR-127-5p inhibitor added simultaneously. E, F CCK-8 and colony formation assay showed that circ_0008234 siRNA decreased the proliferation viability of primary cSCC cells, but such suppressive effect was reversed when miR-127-5p inhibitor added simultaneously. *P < 0.05
miR-127-5p mediated targeting repression of ADCY7 in cSCC cells. A Targetscan and miRDB database were applied for the prediction of the potential target genes of miR-127-5p. Venn diagram was presented to show the intersection of the above two databases. B KEGG pathway analysis of the downstream signaling pathway of miR-127-5p. C Targetscan database was performed to predict the binding sites between miR-127-5p and the 3’UTR of ADCY7. D Luciferase reporter assay was performed to detect the luciferase activity of wild type ADCY7 3’UTR vector or mutant ADCY7 3’UTR vector in A431 cells co-transfected with miR-127-5p mimics or NC mimics. E ADCY7 mRNA expression in A431 and primary cells transfected with miR-127-5p mimics or NC mimics was detected by qRT-PCR. F ADCY7 protein expression in A431 and primary cells transfected with miR-127-5p mimics or NC mimics was detected by western blot. G The expression correlation between hsa_circ_0008234 and ADCY7 in 10 cases of cSCC tissues detected by qRT-PCR. *P < 0.05
Cutaneous squamous cell carcinoma (cSCC) is the second most common skin malignant tumor with 25–50% of 5-year survival. There exist urgent needs for the identification of novel biomarkers for the diagnostic and therapeutic strategies of cSCC. The differentially expressed circRNAs in cSCC tissues and non-lesional skin tissues were obtained through analyzing the circular RNAs (circRNAs) microarray dataset GSE74758. The expression pattern of the indicated circRNAs in cSCC tissues was confirmed by qRT-PCR. FISH analysis was used to detect the location of hsa_circ_0008234 in cells. RIP experiment was used to detect the interaction between hsa_circ_0008234 and miR-127-5p. CCK-8 analysis and colony formation assay were used to detect the proliferation of cSCC cells. qRT-PCR and western blot were adopted to detect the expression of ACDY7. Three differential expressed circRNAs were obtained from the microarray data (GSE74758), and hsa_circ_0008234 was confirmed to be highly expressed in cSCC tissues by qRT-PCR. Hsa_circ_0008234 was mainly located in cytoplasm and stable in cSCC cells. RIP experiment revealed that hsa_circ_0008234 directly interacts with miR-127-5p in cSCC cells. Hsa_circ_0008234 increased the cell viability and colony formation of cSCC cells through acting as the sponge of miR-127-5p. MiR-127-5p inhibited the expression of ADCY7 in cSCC cells through binding the 3’UTR of ADCY7. Hsa_circ_0008234 was positively associated with ADCY7 expression in cSCC tissues. Hsa_circ_0008234 facilitates the proliferation of cSCC through targeting miR-127-5p to regulate ADCY7 expression and has the potential to be a novel therapeutic target for cSCC.
Preferred reporting items for systematic reviews and meta-analyses flowchart of study selection. From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement. PLoS Med 6(7):e1000097.
Meta-analysis odds ratio and risk difference estimate of hemorrhage for antithrombotic therapy vs control. Hemorrhage is of any severity. M–H Mantel–Haenszel
Meta-analysis odds ratio estimate of hemorrhage for antithrombotic therapy continued vs antithrombotic therapy stopped. Hemorrhage is of any severity. M–H Mantel–Haenszel
Meta-analysis odds ratio and risk difference estimate of thromboembolic events for antithrombotic therapy vs control. Events are for any antithrombotic therapy. M–H Mantel–Haenszel
Cutaneous operations are generally safe procedures with minimal major risks. Excessive bleeding occasionally occurs, especially for patients taking antithrombotic medications. Conversely, stopping these medications before cutaneous surgery may increase the risk of a thromboembolic event. We aimed to synthesize the evidence regarding the risk of hemorrhage and thromboembolic events for patients undergoing cutaneous surgery while taking antithrombotic therapy. We performed a comprehensive search to identify randomized controlled trials and cohort studies that compared rates of hemorrhage and/or thromboembolic events between patients receiving antithrombotic therapy at cutaneous surgery and patients not receiving it. Odds ratio (OR) and risk difference for complications were calculated with random-effects models. Of 9214 patients taking anticoagulant or antiplatelet medications, 323 (3.5%) had hemorrhagic complications; of 21,696 control patients, 265 (1.2%) had hemorrhagic complications. Patients taking antithrombotic therapy had increased bleeding risk relative to control patients (OR 2.63 [95% CI 1.90–3.63]; P < 0.001) and an increased but less clinically important risk difference (OR 0.02 [95% CI 0.01–0.03]; P < 0.001) with high heterogeneity. No difference was observed in hemorrhage rates among patients whose antithrombotic therapy was stopped vs continued (OR 1.16 [95% CI 0.73–1.83]; P = 0.54). No difference was seen in rates of thromboembolic events among patients taking antithrombotic therapy vs control patients. However, two serious thromboembolic events were noted in a cohort of 59 patients whose antithrombotic therapy was stopped. Because of potentially devastating effects of thromboembolic events, the current accepted practice is indicated for continuation of antithrombotic therapy for patients undergoing cutaneous surgery.
Representative photographs of refractory alopecia areata patients before and after combination therapy and comparison of SALT scores between baseline of study and last visit. Patient 1: A at first visit, B before ASC-CM with fractional laser, C after 20 sessions. Patient 2: D at first visit, E before ASC-CM with microneedling, F after 15 sessions. Patient 3: G at first visit, H before ASC-CM with fractional laser, I after 20 sessions. Remarkable hair growth was observed in the patients. J Statistically significant difference of SALT scores from baseline of study to last visit (p < 0.01). The Mann–Whitney U test was used for group comparisons
Time-dependent effects of ASC-CM/fractional CO2 laser or microneedling combination therapy; Responders (Patients 1–9) and non-responders (Patients 10–14)
Mean baseline SALT scores (A) and numbers of alopecic patches at baseline (B) in the responder group and non-responder group. The Mann–Whitney U test was used for group comparisons. *Statistically significant, p < 0.05
Management of alopecia areata (AA) is often challenging especially when patients have AA lesion refractory to conventional treatments such as corticosteroids, contact immunotherapy, and systemic therapy. Reports indicate adipocyte-derived stem cell conditioned media (ASC-CM) can activate hair growth and micro-injury using fractional laser or microneedling can also induce wound healing and hair regeneration, which suggests ASC-CM combined with fractional laser or microneedling might provide alternative therapeutic option for a refractory patch of AA. This study aimed to evaluate the clinical efficacy and safety of ASC-CM combined with 10,600 nm carbon dioxide fractional laser or microneedling for the treatment of refractory patch of AA. This retrospective study was based on evaluations of 14 patients with a refractory patch of AA treated with ASC-CM, combined with a 10,600 nm carbon dioxide fractional laser, or microneedling from March 2017 to August 2020. The efficacy of treatment was assessed by extents of hair regrowth percentages of involved areas. Of the 14 enrolled patients, 9 (64.3%) showed > 50% hair regrowth and 6 patients (42.9%) showed complete recovery. In the responder group (n = 9), mean period to achieve > 50% hair regrowth was 11.3 weeks (range 8–16 weeks). In the non-responder group (n = 5), 4 patients (28.6%) showed < 25% of hair regrowth and 1 patient show slight hair regrowth (7.1%) after 3 months of treatment. This study showed ASC-CM combined with 10,600 nm carbon dioxide fractional laser or microneedling may offer effective and safe treatment options for a refractory patch of AA.
Factors associated to adult AD severity
Adult atopic dermatitis (adult AD) is a systemic inflammatory disorder, whose relationship with immune-allergic and metabolic comorbidities is not well established yet. Moreover, treatment of mild-to-moderate and severe atopic dermatitis needs standardization among clinicians. The aim of this study was to evaluate the distribution of comorbidities, including metabolic abnormalities, rhinitis, conjunctivitis, asthma, alopecia and sleep disturbance, according to severity of adult AD, and describe treatments most commonly used by Italian dermatologists. Retrospective, observational, nationwide study of adult patients over a 2-year period was performed. Clinical and laboratory data were obtained through review of medical records of patients aged ≥ 18 years, followed in 23 Italian National reference centres for atopic dermatitis between September 2016 and September 2018. The main measurements evaluated were disease severity, atopic and metabolic comorbidities, treatment type and duration. Six-hundred and eighty-four adult patients with AD were included into the study. Atopic, but not metabolic conditions, except for hypertension, were significantly associated with having moderate-to-severe AD in young adult patients. Disease duration was significantly associated with disease severity. Oral corticosteroids and cyclosporine were the most widely used immunosuppressant. Our study seems confirm the close relationship between adult AD and other atopic conditions, further long-term cohort studies on patients affected by adult AD need to be performed to evaluate the complex relationship between adult AD disease severity and metabolic comorbidities.
Kaplan–Meier curves demonstrating the cumulative incidence of MI (a), CVA (b), and PVD (c) among patients with HS and controls
Previous studies have identified an association between myocardial infarction (MI), cerebrovascular accident (CVA), and peripheral vascular disease (PVD) in patients with hidradenitis suppurativa (HS). To evaluate the risk and prognostic outcomes of MI, CVA, and PVD in patients with HS. A population-based retrospective cohort study using the computerized database of Clalit Health Services (CHS), the largest managed care organization in Israel, was conducted to compare the incidence of MI, CVA, and PVD among patients with HS (N = 6779) with age-, sex- and ethnicity-matched control subjects (N = 33,260). Adjusted hazard ratios (HRs) were estimated by multivariate Cox regression analysis. The overall incidence rates of MI, CVA, and PVD were estimated at 2.9 (2.3–3.4), 1.3 (0.9–1.7), and 0.8 (0.6–1.1) per 1000 person-year, respectively. Patients with HS were at an increased risk of developing MI (fully-adjusted HR 1.33; 95% CI 1.04–1.68; P = 0.021), but the risk of CVA (fully-adjusted HR 0.82; 95% CI 0.59–1.14; P = 0.245) and PVD (fully-adjusted HR 1.22; 95% CI 0.80–1.87; P = 0.355) was comparable relative to controls. Compared to other patients with HS, increased risk of all-cause mortality was observed among patients with HS and comorbid MI (HR 12.56; 95% CI 7.59–20.80; P < 0.001), CVA (HR 13.33; 95% CI 7.29–24.37; P < 0.001), and PVD (HR 7.11; 95% CI 2.61–19.32; P < 0.001). Patients with HS are at an increased risk of MI, but not CVA and PVD. Awareness of these epidemiological findings is of importance for clinicians managing patients with HS.
Although it is established that individuals with albinism have increased risks for nonmelanoma skin cancers, melanomas occurring in the setting of albinism are rare. PubMed and Google Scholar were searched for individual case reports describing melanoma in individuals with oculocutaneous albinism (OCA). All published cases characterizing individuals with albinism and melanoma in the medical literature were gathered to evaluate any epidemiologic or histologic differences from melanomas arising in the general population. Frequencies of melanoma characteristics between the OCA literature cohort and general population were compared using Clopper-Pearson confidence intervals. From 1952 to 2018, at least 64 cases of melanoma in 56 individuals with albinism were reported in the global medical literature. The median age of diagnosis for melanoma in individuals with albinism was 41 years, and the median Breslow depth at diagnosis was 2.0 mm. The subtypes of melanoma were nodular in 33% and superficial spreading in 46% of these cases, respectively. Amelanotic melanomas comprised 65% of the cases in our OCA cohort; however, histologic subtypes were only available for fourteen of the amelanotic cases. Finally, 17% of melanomas in patients with albinism arose from preexisting lesions. Despite their rarity, melanomas arising in oculocutaneous albinism have distinct characteristics from melanomas arising in the general population. Clinicians should consider a differential diagnosis of melanoma for any potential skin malignancies in individuals with albinism.
Flow diagram of study patient selection
Although bullous pemphigoid (BP) and atopic dermatitis (AD) share pathogenic mechanisms, their relationship remains controversial. Therefore, we conducted a population-based case-control study to investigate the association between BP and AD in Taiwan. Based on the Taiwan National Health Insurance Research Database, 9344 patients with BP and 18,688 age- and sex-matched controls were enrolled between 2000 and 2013. Furthermore, the study included 7,196 BP patients and 14,392 controls, matched for age, sex, and propensity score of comorbidities, with a case to controls ratio of 1:2. Logistic regression analysis was performed to examine the association between AD and BP. In the age- and sex-matched cohorts, AD (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.50-1.95) was independently associated with BP. In the age, sex, and comorbidities-matched cohorts, AD (OR 1.76, 95% CI 1.55-2.00) remained a significant risk factor for BP. Other significant risk factors included psoriasis, hypertension, diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, neuropsychiatric diseases, and autoimmune connective tissue disease. Limitations of this study include the lack of information on disease severity and phenotypes of BP and misclassification of diseases as potential sources of bias. In conclusion, AD increased the risk of developing BP by 76%, and this association was independent of many BP comorbidities. Further studies are warranted to investigate the clinical and pathophysiological relevance of factors contributing to BP and AD.
Within organized dermatology, it is imperative that leaders embody a diverse group of individuals, reflective of the dermatologists they represent and the greater U.S. population. Despite women constituting more than half of the dermatologic workforce, they represent a leadership minority in dermatology society higher level positions. This gap is evident by fewer women holding presidency positions within prominent dermatological societies; however, a comprehensive comparison across multiple societies has yet to be made. Our study analyzes and compares demographic as well as academic metrics of presidents from 16 prominent dermatology societies spanning 22 years, 2000–2021. Data were collected using organization websites, which demonstrated 247 unique presidents over 22 years. Of these presidents, 175 (70.9%) were male and 72 (29.1%) were female. Surgically focused societies had 63 (87.5%) male presidents and nine (12.5%) female presidents, while clinically focused societies had 112 (64.0%) male presidents and 63 (36.0%) female presidents (P < 0.0002). The publication h-index, academic rank, chairmanship, and number of advanced degrees, and total number of years in practice prior to election did not significantly differ between male and female leaders. There was no statistically significant difference in the proportion of female presidents across all societies between 2000 and 2021 by Cochran Armitage Trend Test. However, between 2016 and 2021, 35% of presidents were female and a general trend toward more gender balance may be noticed. This equality goal should continue to be emphasized in organized medicine.
Boxplot representing median values, 25–75% range (box) and minimum–maximum range (bars) of the ages with respect to each group
Positive immunostaining of the inflammatory infiltrate with NLRP3 in a PLC case. The approximate staining percentage is seventy and pale positive staining of the keratinocytes is evident (a) (NLRP3, × 200). Positive staining of stratum granulosum and inner layer of the hair follicle (b) (NLRP1, × 40). Positive immunostaining of the dermal infiltrate with a percentage of 50% in a stage 1 MF case (c) (NLRP1, × 200). Positive immunostaining of the dermal infiltrate with a percentage of 10% in a control (d) (NLRP1, × 200)
Positive immunostaining of the inflammatory infiltrate with a percentage of 70% in an stage 2 MF case along with diffuse-intense staining of keratinocytes (a) (IL-1β, × 200) and sebaceous glands (b) (IL-1β, × 200). Intense positive immunostaining of the inflammatory infiltrate with a percentage of 90% in a PLC case (c) (caspase 1, × 200). Pale immunostaining with a percentage of 20% in a control (d) (caspase 1, × 200). Intense positive immunostaining of the inflammatory infiltrate with a percentage of 90% in a stage 2 MF patient (e) (IL-18, × 200)
Boxplot representing median values, 25–75% range (box) and minimum–maximum range (bars) of the percentage of NLRP-1 (a), IL-1β (b), caspase 1 (c) and IL-18 (d) staining with respect to groups
Negative correlation between NLRP3 and NLRP1 in control group (a) and in stage 1 MF group (b). Positive correlation between IL-1β and caspase 1 in stage 1 MF group (c)
Mycosis fungoides (MF) is the most common subtype of primary cutaneous T cell lymphomas, whereas pityriasis lichenoides chronica (PLC) is a chronic inflammatory skin disorder. The inflammasome is a part of the natural immune system which has a multimeric structure consisting of the receptor, adaptor and effector protein that show specificity for various ligands or activators. After the activation of the inflammasome complex, caspase 1 becomes activated which subsequently triggers interleukin-18 (IL-18) and interleukin-1β (IL-1β) production. In our study we aimed to examine the roles of nucleotide-binding oligomerization domain-like receptor containing pyrin domain 1 (NLRP1) and nucleotide-binding oligomerization domain-like receptor containing pyrin domain (NLRP3) inflammasomes in the etiopathogeneses of PLC and MF. NLRP1, NLRP3, caspase 1, IL-18 and IL-1β levels were examined and compared immunohistochemically in the skin biopsies belonging to 16 control patients; 16 PLC cases, 12 cases with stage 1 MF and 12 cases with other stages of MF (stage 2–4). In the paired comparisons of NLRP1, stage 2–4 MF group and PLC group were shown to have increased levels of NLRP1 expression compared to the control group. IL-1β was also expressed at statistically significantly higher levels in each of the stage 1 MF, stage 2–4 MF and PLC groups compared to the control group. In the paired comparisons of caspase 1 and IL-18, it was found that stage 1 MF, stage 2–4 MF and PLC groups had increased levels of expression compared to the control group. Our findings suggest that the NLRP1 inflammasome pathway might play a role in the etiopathogenesis and progression of PLC and MF.
Epidermal keratinocytes transcribe alpha-melanocyte stimulating hormone (αMSH), which binds to the melanocortin receptor-1 (MC1R) on melanocytes inducing a signaling cascade that leads to pre-melanosome transcription, tyrosinase activity, eumelanin assembly, melanosome secretion, and eventual melanosome degradation within neighboring keratinocytes. This process simultaneously darkens the skin and causes upregulation of protease activated receptor-2 (PAR-2) and downstream transient receptor vanilloid subtype-1 (TRPV1), itch receptors located on epidermal and dermal unmyelinated C fibers, making them more vulnerable to stimulation by histamine and proteases, such as trypsin, released from dermal mast cells
Prurigo nodularis (PN) with underlying atopic eczema is characterized by intensely pruritic and excoriated papules and nodules, sometimes to the point of ulceration, involving the extensor surface of the upper and lower extremities. Molecularly, nerve growth factor (NGF) is released by keratinocytes and binds to tropomyosin receptor kinase-A (TrkA) channels, causing release of Substance P (SP). SP travels down the axon to the dorsal root ganglia and also binds to Neurokinin 1 (NK1) receptors on dermal mast cells causing release of Tryptase and Prostaglandin E2 (PGE2). Activated Th2 T cells release IL-31, which directly induces pruritus by binding to IL-31 Receptor A and Oncostatin M Receptor (OMR). Th2 T Cells also release IL-4 and IL-13, which cause nearby macrophages to release Periostin, which binds to Integrin Receptors, causing positive feedback for further Th2 activation and release of pruritic cytokines
Central centrifugal cicatricial alopecia predominantly affects the vertex and crown of the scalp. Molecularly, it is driven by premature desquamation of the inner root sheath (IRS) below the follicular isthmus which causes an inflammatory reaction between the IRS and outer root sheath (ORS). Protease activated receptor-2 (PAR-2), located at the level of the IRS, transmits a non-histamine pruritus and sensitizes nearby transient receptor vanilloid subtype-1 (TRPV1) receptors, located at the level of the ORS, causing sustained hyperalgesia
a Following acute cutaneous injury, including burn injury, thymic stromal lymphoprotein (TSLP), IL-4, IL-13, TGFβ, and periostin are key molecules that cause aberrant activation of fibroblasts, leading to excessive proliferation, collagen deposition, and keloid formation with associated pruritus. b Dermal nerve impingement and decreased epidermal nerve fiber density cause dermal mast cells to release nerve growth factor (NGF), which attempts to reverse the small fiber neuropathy yet simultaneously causes histamine release from neighboring mast cells leading to stimulation of transient receptor vanilloid subtype-1 (TRPV1) channels and resultant pruritus most commonly found at the periphery of keloids.
Chronic pruritus carries a significant burden of disease and is associated with a negative impact on quality of life. African Americans are disproportionately burdened by chronic pruritic disorders, including but not limited to atopic dermatitis, prurigo nodularis, inflammatory scalp dermatoses, pathologic scarring, and HIV-related dermatoses. Racial differences in skin structure and function may contribute to the pathogenesis of itch in African Americans. Itch perception and response to treatment in African Americans remain understudied and not well understood. As such, there is a large unmet need with regard to the knowledge and management of pruritus in African Americans. This review highlights notable differences in the epidemiology, pathophysiology, genetic predisposition, clinical presentation, and response to treatment for select pruritic skin conditions. By addressing itch as an unmet need in African Americans, we hope to improve patient outcomes and lessen disparities in dermatologic care.
Blood vessel depth measurement. 6 × 6 mm en-face images of D-OCT scan and the method of blood vessel depth measurement. a 70 µm depth showing no blood vessels. b 90 µm depth showing visible blood vessels (arrow). c 110 µm depth showing the blood vessel from (b) to be connected to deeper blood vessels
Epidermal thickness measurement. Cross sectional and en-face OCT-image of the upper arm showing epidermal thickness measurement. a 2 × 6 mm cross-sectional image showing a surface fitted line at the dermo epidermal junction. b 6 × 6 mm en-face image from the surface fitted line in (a) showing both dermis (bright streaks) and epidermis (less bright streaks) indicating the line’s presence at the dermo epidermal junction
Season and epidermal thickness. Scatter plot of ‘days since midsummer’ and epidermal thickness with fitted tendency lines for each location, showing the steepest slope at the medial part of the upper arm
IntroductionPhoto aging predominantly occurs in the face, neck and hands due to UVA and UVB irradiation. It is associated with skin cancer and histological studies indicate thinning of the epidermis and elastosis occurs. Dynamic Optical coherence tomography (D-OCT) is a non-invasive imaging tool able to visualize the epidermis and upper dermis and its blood vessels as well as to evaluate epidermal thickness (ET) and blood flow.Objective To investigate ET and blood vessel depth using D-OCT in human subjects correlated to UV exposure.Methods We evaluated data from 249 healthy adults, that had D-OCT-scans conducted at four different regions (forehead, neck, arm and hand) and correlated ET and blood vessel depth with occupational UV exposure (total standard erythema dose, Total SED), season and demographic data.ResultsRegional differences in ET and blood vessel depth were found (p values < 0.001). Multiple linear regressions showed a seasonal effect on both ET (− 0.113 to − 0.288 µm/day, p values < 0.001) and blood vessel depth (0.168–0.347 µm/day, p values < 0.001–0.007) during August–December. Significant age-related decrease of ET was seen in forehead, arm and hand (0.207–0.328 µm/year, p values = 0.002–0.18) and blood vessel depth in forehead (0.064–0.553 µm/year, p values = 0.01–0.61). Males had thicker epidermis (3.92–10.93 µm, p values = 0.002–0.15).Conclusion Changing seasons are a major predictor of both ET and blood vessel depth, showing strongest effect in non-exposed areas, suggesting a systemic effect, possibly due to seasonal vitamin D fluctuation. Sex, age and occupational UV exposure affect ET. This study demonstrated the feasibility of D-OCT to evaluate epidermal thickness and blood vessel depth.
Although Alopecia areata (AA) has been found to be associated with psychological distress, the scope and nature of this association has not been fully delineated. The current study sought to examine the association of AA with anxiety, depression, schizophrenia, and bipolar disorder, utilizing a large-scale matched controlled cohort design. Patients suffering from AA (n = 41,055) were matched to control cases (n = 41,055) by age, sex, and socioeconomic status (SES). The prevalence of the four major mental disorders was assessed while stratifying the sample by age and sex, and after adjusting for marital status, smoking, BMI, hypertension, and diabetes. Data were accessed via the Clalit Health Services (CHS) database, a comprehensive health registry utilized by the largest managed healthcare company in Israel. Anxiety was independently and positively associated with AA (OR 1.22, 95% CI 1.13–1.31, p < 0.001), across all age groups above 30, with similar rates in males and females. Depression was also independently and positively associated with AA (OR 1.09, 95% CI 1.01–1.17, p < 0.005), particularly in the 30–49 age group, with a higher association among females. A negative association was found between AA and schizophrenia (OR 0. 71, 95% CI 0.61–0.83, p < 0.001). No association was found between AA and bipolar disease. Patients with AA are at risk for anxiety and depression, with female patients, and patients in the 30–49 age group being particularly vulnerable to develop a co-occurring mental disorder. Medical treatment should therefore include psychiatric evaluation and appropriate care.
Wound quality of life survey given to our patients
Patient satisfaction is an important consideration when determining the optimal treatment for non-melanoma skin cancer (NMSC). One critical aspect of patient satisfaction is post-procedural wound care quality of life (QOL), especially as the elderly population grows. This study aimed to evaluate post-procedural wound care QOL in elderly patients undergoing electrodessication and curettage (ED&C) for NMSC in difficult-to-reach areas, namely the posterior shoulder and back. To do so, patient demographics, functionality, co-morbidities, and post-procedural wound care QOL were assessed in twenty elderly patients (age > 65) who underwent ED&C for NMSC at a single academic dermatologic surgery clinic. Independent t-tests were used to evaluate how QOL related to patient age, gender, living situation, relationship status, co-morbidities, and functionality. Patients who lived alone had better-wound care QOL compared to patients who did not live alone (p = 0.04). Patients reported concerns about knocking the wound and did not feel they could care for the wound independently. Patients who were married, female, or had a lower comorbidity score reported poorer QOL, although this finding was not statistically significant. This study indicates that patients’ QOL can be negatively affected by post-procedural wounds located in difficult-to-reach areas. As dermatologists strive to improve patient satisfaction, wound care quality of life should be considered when choosing treatment for NMSC.
PRISMA flow diagram
Inclusion/exclusion criteria
Data extraction table of included studies, study and sample characteristics, and conclusions
Atopic dermatitis (AD) is a common chronic inflammatory skin condition which impacts psychological wellbeing and social relationships. There have been studies of AD’s impact on quality of life (QoL) in Western countries, but these findings cannot be directly extrapolated to Asian populations with genetic, environmental and cultural differences. Therefore, we aimed to systematically review the literature pertaining to QoL impairment in AD in East and Southeast Asia to characterize the impact of AD on patients and their families, and to identify the factors affecting the degree of QoL impairment. A search of English language papers was conducted on MEDLINE, EMBASE, PSYCInfo, Global Health and Web of Science. Observational studies measuring QoL using single or multi-item instruments in people with self-reported or physician diagnosed atopic dermatitis were included. 27 studies from 29 articles were included and synthesized. There is data documenting QoL impairment in AD sufferers and their families, across a wide range of Asian countries, healthcare settings and ages. Aspects of QoL impacted to a greater extent included symptoms of itch, feelings of embarrassment, and sleep disturbance. Severity of disease affects the degree of impairment of QoL, but there is no apparent link between QoL impairment and patient demographic factors, or other medical factors such as age at diagnosis or duration of illness. Our findings also highlighted the need for clinicians to actively explore the impact of patient’s symptoms, especially in an Asian context where healthcare communications are traditionally doctor-centric.
Atopic Dermatitis (AD) is a chronic, inflammatory skin condition that imposes an enormous personal and economic burden in the United States. Due to the ubiquity of the use of electronic medical records (EMR) in the United States, utilizing such data is critically important to studying common dermatologic diseases, such as AD. Our goal was to create a simple-to-use algorithm applied to EMR data to accurately identify AD patients thereby making it possible to efficiently use EMR data to ascertain and then study individuals with AD. Our results suggest that the algorithm that is most likely to accurately identify AD patients from the EMR based on PPV utilizes ICD-10 code for L20.89, L20.9, or L20.84 in conjunction with a diagnosis code for asthma or allergic rhinitis, treatment code, and dermatology consult code. This approach yields a PPV of 95.00% in our training cohort and 100.00% in our validation cohort. Therefore, future studies can use this algorithm to better assure that a subject has AD for studies of the pathogenesis and/or potential treatment targets of AD.
Number of individual hospitalizations of patients aged equal to and over 65 years between 2009 and 2017 Subgrouping according to age. Total n = 10,009
Subgroup analysis clustering primarily patients with operative diagnoses (NMSC/MCC/melanoma), non-operative diagnoses (psoriasis/matureT/NK-cell lymphoma/ (autoimmune) bullous dermatoses with lupus erythematosus/erysipelas/zoster/dermatitis/eczema/venous disease with/without ulceration), and all other remaining diagnoses of all individual hospitalizations of patients aged equal to and over 65 years between 2009 and 2017. Subgrouping according to age. Total n = 10,009. NMSC nonmelanoma skin cancer, MCC Merkel cell carcinoma
Subgroup analysis of specific diagnoses performed for different age cohorts between 2009 and 2017. Total n = 10,009. ICD-10 codes: nonmelanoma skin cancer/Merkel cell carcinoma (C44/D04), melanoma (C43/D03), mature T/NK-cell lymphoma (C84); (autoimmune) bullous dermatoses (L10-L14) including lupus erythematosus (L93), venous disease with/without ulceration (I83), psoriasis (L40), dermatitis/eczema (L20-L30), zoster (B02), erysipelas (A46)
Enlistment of minor diagnoses grouped according to ICD-10 categories for individual main diagnoses of all individual hospitalizations of patients aged equal to and over 65 years between 2009 and 2017. ICD-10 of minor diagnoses: infectious /parasitic diseases (A/B), neoplasms (C/D00-D48), diseases of blood/immune system (D50-D90), endocrine/nutritional/metabolic diseases (E), psychiatric diseases/diseases of nervous system (ICD-10 F/G/R40-R49), diseases of circulatory/pulmonary system (I and J); diseases of skin (L), diseases of musculoskelettal system/connective tissue (M); diseases of genitourinary system (N/R25-R29), factors influencing health status/contact with health services (Z), other diagnoses (H, K, O, P, Q, R, S, T, V). NMSC nonmelanoma skin cancer, MCC Merkel cell carcinoma
Numbers of most frequent encoded procedures 2009, 2017 and between 2009 and 2017. OPS-codes: “Moh’s surgery of diseased dermis and hypodermis”(5-895), “dressing of extensive and severe skin diseases” (8-191), “phototherapy” (8-560), “multimodal dermatological complex whole body treatment” (8-971), “regional skin flap” (5-903), “extensive debridement” (5-896), “paraffin gauze dressing with antiseptic ointments without debridement or bath” (8-191.20), “psoralen and ultraviolet A (PUVA) treatment)” (8-560.1), “paraffin gauze dressing with antiseptic solution without debridement or bath” (8-191.20) (8-191.10), “extensive local tissue expansion skin flap on the head” (5-903.54), “Moh’s surgery on the nasal skin” (5-212.1), “biopsy on the facial skin and the scalp” (1-415), “extensive debridement on the lower leg” (5-896.1f)
The demographic trend of an ageing society is mirrored in the rising number of hospitalized geriatric patients in Germany. However, there is still a wide gap of knowledge regarding the dermatological diseases, comorbidities and performed procedures within this growingly important group of patients. The study was conducted as a retrospective monocentric data analysis of all patients 65 years or older from the Department of Dermatology, Medical Center—University of Freiburg, Germany. In total, 10,009 individual hospitalisations were included from 2009 to 2017, and there was a notable increase of geriatric patients in the study period. This study illustrates the following: leading major diagnoses included malignant neoplasm of the head and neck, ulcerated and non-ulcerated inflammatory spectrum of chronic venous insufficiency, whereas angina pectoris, type 2 diabetes and cardiac diseases were noted most frequently as secondary diagnoses. Patients with venous diseases had considerably more often cardiopulmonary minor diagnoses, whereas endocrine diagnoses peaked in the cohort of patients with psoriasis and psychiatric and muscululoskeletal disorders in patients with bullous dieseases. Moh’s surgery, dressings and multimodal dermatological treatments were the most often encoded procedures.
Prisma flowchart of the selected studies, with criteria and numbers of studies. WHO ICTRP = World Health Organization International Clinical Trials Registry Platform
Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) summary of published studies
Background Stromal vascular fraction (SVF), derived enzymatically or mechanically from adipose tissue, contains a heterogenous population of cells and stroma, including multipotent stem cells. The regenerative capacity of SVF may potentially be adapted for a broad range of clinical applications, including the healing of acute cutaneous wounds.Objective To evaluate the available literature on the efficacy and safety of autologous adipose-derived stromal vascular fraction (SVF) for the treatment of acute cutaneous wounds in humans.MethodsA systematic review of the literature utilizing MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was performed to identify published clinical trials of autologous adipose-derived SVF or similar ADSC-containing derivatives for patients with acute cutaneous wounds. This was supplemented by searches for ongoing clinical trials through and the WHO International Clinical Trials Registry Platform.Results872 records were initially retrieved. Application of inclusion and exclusion criteria yielded 10 relevant studies: two completed non-randomized controlled trials and eight ongoing clinical trials. Both completed studies reported a statistically significant benefit in percentage re-epithelialization and time to healing for the SVF treatment arms. Safety information for SVF was not provided. Ongoing clinical trials were assessing outcomes such as safety, patient and observer reported scar appearance, wound healing rate, and wound epithelization.Conclusion In the context of substantial limitations in the quantity and quality of available evidence, the existing literature suggests that SVF may be a useful treatment for acute cutaneous wounds in humans. More clinical trials with improved outcome measures and safety assessment are needed.
Trichoblastic carcinoma is a rare neoplasm thought to arise from malignant degeneration of benign follicular tumors. Its clinical features, optimal treatment, and outcomes remain largely unknown. We performed a comprehensive review of the existing trichoblastic carcinoma literature. PubMed and Google Scholar were searched for keywords related to trichoblastic carcinoma, and additional articles were found in reference lists. Cases with a histopathologic diagnosis of trichoblastic carcinoma were summarized. A total of 93 cases have been described, all in case reports or case series. The average age was 65, with 66.7% of cases in males. A minority of patients had familial tumor syndromes or a history of radiation at the site, and only one was reported to be immunosuppressed. The most common site was the face (48.4%), and the majority developed de novo (87.1%). The clinical presentation was highly variable. Although most cases (82.8%) were successfully treated with surgery alone, a subset of patients had more aggressive disease including local progression or recurrence in five cases, nodal metastases in five cases, and distant metastases in three cases. Trichoblastic carcinoma is a rare malignancy with the potential for aggressive behavior. Further research is needed to better characterize this neoplasm.
Episodes of patients with primary axillary hyperhidrosis assessed by physicians (reported by physicians)
Episodes experienced when sweat began to trouble the respondent (reported by individuals with primary axillary hyperhidrosis)
Information provided by patients/provided to physicians at presentation (reported by physicians/diagnosed respondents who have sought medical care)
Drugs/treatments that have been given and that are currently given (reported by diagnosed respondents who have sought medical care, n = 77)
What diagnosed respondents who have sought medical care expect for future treatment and what will motivate respondents who have never sought medical care to visit a health care facility
To obtain current epidemiological information on primary focal hyperhidrosis in Japan, a large epidemiological survey was conducted using a web-based questionnaire. The prevalence of primary focal hyperhidrosis was 10.0% and the site-specific prevalence was highest for primary axillary hyperhidrosis (5.9%). The proportion of respondents with primary focal hyperhidrosis who had consulted a physician was 4.6%, which was similar to the low prevalence reported previously in 2013 in Japan. A questionnaire survey for physicians and individuals with primary axillary hyperhidrosis on the current medical management of primary axillary hyperhidrosis showed that physicians recognized the existence of patients who were very worried about hyperhidrosis, but failed to provide active treatment. Regarding the information provided by patients to physicians at presentation, it was found that patients failed to provide sufficient information to the physicians about their worries in daily life. Among individuals who had sought medical care with primary axillary hyperhidrosis, 62.3% reported that they were not currently receiving treatment, highlighting a challenge to be addressed regarding continued treatment. Frequently chosen options leading to willingness to receive treatment were less expensive treatment and highly effective treatment as well as feeling free to consult a physician, suggesting a desire for an improved medical environment.
Disparities in racial diversity in the field of dermatology continue to persist given that dermatology has the second lowest percentage of underrepresented minorities (URM), only second to orthopedic surgery. This study aims to investigate any trends in racial representation of dermatology residency applicants over a 5-year period from 2016 to 2020. Dermatology residency applicant race data were extracted from the Electronic Residency Application Service (ERAS) of the Association of American Medical Colleges (AAMC) for application seasons 2016-2020 for a retrospective review study. There was an overall increase in the number of dermatology residency applicants during the 5-year study period. Prior to 2018 (midpoint of the study), 14.1% of applicants identified as URM compared to 16.2% after 2018, although this difference was not statistically significant (p = 0.25). Our findings suggest that in the study period analyzed, racial representation remained relatively similar, with a non-statistically significant increase in URM applicants. Outlining the current trends in dermatology residency applicants may be helpful in identifying factors affecting the disparity in racial representation within the field. There is hope that dermatology residency applicants are becoming more racially diverse with improved representation of URMs.
Disparities in racial diversity in the field of dermatology continue to persist given that dermatology has the second lowest percentage of underrepresented minorities (URM), only second to orthopedic surgery. This study aims to investigate any trends in racial representation of Mohs Micrographic Surgery (MMS) fellowship applicants over a five-year period from 2016 to 2020. Dermatology residency applicant race data were extracted from the San Francisco Match for application seasons 2016-2020 for a retrospective review study. There was an overall increase in the number of MMS fellowship applicants during the five-year study period. Prior to 2018 (midpoint of study), 6.6% of matched applicants and 10.9% of unmatched applicants identified as URMs, compared to 8.1% of matched applicants and 10.1% of unmatched applicants after 2018, but this increase was not statistically significant (p = 0.62). There is hope that Mohs Micrographic Surgery fellowship applicants are becoming more racially diverse with improved representation of underrepresented minorities.
The bilobed flap (BLF) is a workhorse for nasal repair. Alterations to the length and orientation of the BLF's standing cutaneous deformity (SCD) have been suggested as a means of preventing Z-plasty-induced flap lengthening and consequent ipsilateral alar depression. To investigate the effect of design variations of the SCD on bilobed flap mechanics. Geometric analysis of the BLF was performed using commercially available graphing software. BLFs were designed with a SCD equal to one radius (rBLF) and one diameter (dBLF) of the primary defect as well as with a more superiorly-oriented one diameter SCD (soBLF). Lengths from the pivot point to the distal edges of the primary defect and primary lobe were measured and compared. Elongation or a more superior orientation of the SCD without changes to the rest of the flap design forms a primary lobe along a shorter arc resulting in insufficient flap length to resurface the primary defect. The insufficient length requires secondary motion to complete the repair and possible unintended alar displacement. Modification of the size and orientation of the SCD alters the location of the pivot point, which is a key determinant of BLF mechanics. Therefore, changes to the SCD require alterations to the remainder of the flap design to ensure aesthetic and functional success.
Dupilumab has emerged as an effective treatment option for those suffering from moderate-to-severe atopic dermatitis (AD). Since its approval in 2017 by the United States Food and Drug Administration, dupilumab demonstrated efficacy in a wide range of “off-label” dermatologic conditions. With its increasing use, dermatologists must navigate prescribing dupilumab in complex patient populations. To that end, we performed a single-institution, retrospective, case-series study to assess efficacy, tolerability, and safety of dupilumab in elderly, patients on concomitant immunosuppressive/immunomodulating therapies, and those with pre-existing co-morbidities (e.g., malignancies, chronic renal and/or liver diseases, organ transplantation, hematologic malignancies, and infection). We conducted chart reviews of 248 patients who were prescribed dupilumab between January 1, 2017 and August 31, 2021, and identified 64 patients who met the criteria of being in the complex patient group as described above. Our results showed that 87.5% (56/64) of complex patients demonstrated improvement and/or disease clearance on dupilumab. 20.3% (13/64) of them experienced one or more side effects reported as conjunctivitis, seborrheic dermatitis, psoriasiform eruption, xerosis, facial burning sensation, anaphylactic reaction/angioedema, and worsening of AD. 9.4% (6/64) of them discontinued dupilumab due to the side effects. These findings demonstrated that dupilumab can be safely considered in certain complex patient populations such as elderly and those with significant pre-existing co-morbidities and can be safely combined with immunosuppressive medications and/or other biologic therapies. In the future, more studies with long-term follow-up are needed to validate the efficacy and safety of dupilumab in these challenging patients with complex medical histories.
Top-cited authors
Alexander Nast
  • Charité Universitätsmedizin Berlin
Matthias Augustin
  • University of Hamburg
Chris E Griffiths
  • The University of Manchester
Thomas Rosenbach
  • Universität Osnabrück
Lajos Kemény