The latest medical research on Dermatology

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about dermatology gathered by our medical AI research bot.

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Incidence and Risk Factors of Keratinocyte Carcinoma After First Solid Organ Transplant in Ontario, Canada.

JAMA Dermatology

Keratinocyte carcinoma (KC), also known as nonmelanoma skin cancer, is the most common malignancy after solid organ transplant. Epidemiologic data on posttransplant KC in North America are limited by a lack of KC capture in cancer and transplant registries.

To estimate the incidence and identify risk factors for posttransplant KC.

This population-based inception cohort study in Ontario, Canada, used linked administrative databases and a health insurance claims-based algorithm. Participants were adult recipients of a first kidney, liver, heart, or lung transplant from January 1, 1994, to December 31, 2012. The cohort (n = 10 198) was followed up to December 31, 2013. Data were analyzed from May 31, 2016, to April 21, 2017.

Solid organ transplant with functioning graft.

Age- and sex-adjusted standardized incidence ratio for KC in the transplant cohort was compared with that in the general population. Cumulative incidence of posttransplant KC was estimated using cumulative incidence functions, accounting for the competing risks of death or kidney graft loss. The association between KC and patient-, transplant-, and health services-related factors was evaluated with a multivariable cause-specific hazards model.

A total of 10 198 transplant recipients were included in the study. The median (interquartile range [IQR]) age at transplant was 51 (41-59) years, with most recipients being male (6608 [64.8%]) and white (5964 [58.5%]). Posttransplant KC was diagnosed in 1690 patients (16.6%) after a median (IQR) of 3.96 (1.94-7.09) years, with an incidence rate of 2.63 per 100 patient-years (95% CI, 2.51-2.76). The rate of KC was significantly higher after transplant compared with the general population (standardized incidence ratio, 6.61; 95% CI, 6.31-6.93). The highest 10-year cumulative incidence was in the subsets of patients with a history of pretransplant skin cancer (66.5%), older than 50 years at transplant (27.5% for 51-65 years; 40.5% for >65 years), and of the white race (24.1%). The strongest independent risk factors for KC included older age at transplant (adjusted hazard ratio [aHR], 9.27; 95% CI, 7.08-12.14 for >65 years vs 18-35 years), white vs black race (aHR, 8.50; 95% CI, 4.03-17.91), pretransplant invasive skin cancer (aHR, 4.30; 95% CI, 3.72-4.98), and posttransplant precancerous skin lesions (aHR, 4.32; 95% CI, 3.77-4.95).

The incidence of KC appeared to be substantially increased after transplant, particularly in patients who were older at transplant, were white, and had a history of cancerous or precancerous skin tumors; intensified skin cancer screening, education, and early use of chemopreventive interventions may be warranted for these high-risk patient subsets.

Localization, Morphologic Features, and Chemical Composition of Calciphylaxis-Related Skin Deposits in Patients With Calcific Uremic Arteriolopathy.

JAMA Dermatology

Calcific uremic arteriolopathy (CUA), a rare, potentially fatal, disease with calcium deposits in skin, mostly affects patients with end-stage renal disease who are receiving dialysis. Chemical composition and structure of CUA calcifications have been poorly described.

To describe the localization and morphologic features and determine the precise chemical composition of CUA-related calcium deposits in skin, and identify any mortality-associated factors.

A retrospective, multicenter cohort study was conducted at 7 French hospitals including consecutive adults diagnosed with CUA between January 1, 2006, and January 1, 2017, confirmed according to Hayashi clinical and histologic criteria. Patients with normal renal function were excluded. For comparison, 5 skin samples from patients with arteriolosclerosis and 5 others from the negative margins of skin-carcinoma resection specimens were also analyzed.

Localization and morphologic features of the CUA-related cutaneous calcium deposits were assessed with optical microscopy and field-emission-scanning electron microscopy, and the chemical compositions of those deposits were evaluated with μ Fourier transform infrared spectroscopy, Raman spectroscopy, and energy dispersive radiographs.

Thirty-six patients (median [range] age, 64 [33-89] years; 26 [72%] female) were included, and 29 cutaneous biopsies were analyzed. Calcific uremic arteriolopathy and arteriolosclerosis skin calcifications were composed of pure calcium-phosphate apatite. Calcific uremic arteriolopathy vascular calcifications were always circumferential, found in small to medium-sized vessels, with interstitial deposits in 22 (76%) of the samples. A thrombosis, most often in noncalcified capillary lumens in the superficial dermis, was seen in 5 samples from patients with CUA. Except for calcium deposits, the vessel structure of patients with CUA appeared normal, unlike thickened arteriolosclerotic vessel walls. Twelve (33%) patients died of CUA.

Calcific uremic arteriolopathy-related skin calcifications were exclusively composed of pure calcium-phosphate apatite, localized circumferentially in small to medium-sized vessels and often associated with interstitial deposits, suggesting its pathogenesis differs from that of arteriolosclerosis. Although the chemical compositions of CUA and arteriolosclerosis calcifications were similar, the vessels' appearances and deposit localizations differed, suggesting different pathogenetic mechanisms.

A 44-Week Open-Label Study Evaluating Safety and Efficacy of Topical Glycopyrronium Tosylate in Patients with Primary Axillary Hyperhidrosis.

American Journal of Clinical Dermatology

Clinicaltrials.gov NCT02553798.

This 44-week open-label extension study assessed glycopyrronium tosylate safety and descriptive efficacy in patients completing one of two, phase III, double-blind, vehicle-controlled, 4-week trials (NCT02530281; NCT02530294).

Patients aged ≥ 9 years with primary axillary hyperhidrosis were randomized 2:1 (glycopyrronium tosylate: vehicle, once daily) in the double-blind trials. Completers could receive open-label glycopyrronium tosylate for up to an additional 44 weeks. Treatment-emergent adverse events and local skin reactions were assessed. Descriptive efficacy assessments were gravimetrically measured sweat production, Hyperhidrosis Disease Severity Scale responder rate (≥ 2 grade improvement), and Dermatology Life Quality Index/children's Dermatology Life Quality Index.

Of 651 patients completing the double-blind trials, 564 (86.6%) entered the open-label extension; 550 were analyzed. Most patients experiencing treatment-emergent adverse events had mild or moderate events (> 90%). Discontinuation because of treatment-emergent adverse events remained low and relatively stable, with a cumulative rate of 8.0% (44/550) over 44 weeks. Common treatment-emergent adverse events (> 5%) were dry mouth (16.9%), vision blurred (6.7%), application-site pain (6.4%), nasopharyngitis (5.8%), and mydriasis (5.3%). Most patients (67.5%) had no local skin reactions; those occurring were predominantly mild/moderate. Glycopyrronium tosylate efficacy was maintained throughout the trial; at week 44, the Hyperhidrosis Disease Severity Scale responder rate was 63.2%, and improvements from baseline (double blind) in sweat production were - 71.3% and 8.7 ± 6.2/6.2 ± 4.9 for Dermatology Life Quality Index/children's Dermatology Life Quality Index.

Daily long-term application of glycopyrronium tosylate for up to 48 weeks (double blind plus open label) was generally well tolerated and efficacy was maintained. No new safety signals emerged.

Onychomycosis in Athletes.

American Journal of Clinical Dermatology

Onychomycosis is a common disorder that is difficult to cure. Prevalence is lower in children (0.7%), but athletes are 2.5-fold more likely to deve...

Does the gene matter? Genotype-phenotype and genotype-outcome associations in congenital melanocytic naevi.

British Journal of Dermatology

Genotype-phenotype studies can identify subgroups of patients with specific clinical features or differing outcomes, which can help shape managemen...

Detection of cell-free circulating BRAFV600E by droplet digital PCR in melanoma and non-melanoma patients under dermatological surveillance.

British Journal of Dermatology

The p.V600E mutation in the BRAF gene (BRAFV600E ) is the most frequent mutation in cutaneous melanoma and is a recurrent alteration found in common benign naevi. The analysis of cell-free BRAFV600E mutation (cfBRAFV600E ) in plasma has emerged as a biomarker for monitoring prognosis and treatment response in melanoma patients.

To quantify cfBRAFV600E levels in plasma from melanoma patients and from patients without melanoma having regular follow-up of their melanocytic lesions, in order to assess the clinical significance of the test.

We quantified cfBRAFV600E by droplet digital PCR in plasma from 146 patients without melanoma undergoing continuous dermatological screening, 26 stage III and 7 stage IV patients with BRAF-mutant melanoma, and 32 melanoma patients free of disease for 3 or more years.

Among disease-free patients and non-melanoma individuals, 52% presented a high naevus count (>50) and 49% had clinically atypical naevi. cfBRAFV600E was detected in 71·4% of stage IV and 15·4% of stage III melanoma patients and in 1·4% of non-melanoma individuals. No cfBRAFV600E was detected in disease-free melanoma patients. Non-melanoma individuals had lower cfBRAFV600E levels compared to melanoma patients. We established a variant allelic frequency of 0·26% or five cfBRAFV600E copies/mL as the optimal cut-off value for identifying melanoma patients with >99% of specificity.

The study suggests that naevus related factors do not influence the detection of cfBRAFV600E in non-melanoma individuals, and support the clinical diagnostic value of plasma cfBRAFV600E quantification in melanoma patients. This article is protected by copyright. All rights reserved.

Secukinumab dosing optimization in patients with moderate to severe plaque psoriasis: Results from the randomised, open-label OPTIMISE study.

British Journal of Dermatology

Secukinumab is a fully human monoclonal antibody that selectively binds to and neutralises interleukin-17A.

To assess the efficacy and safety of different maintenance-dosing regimens of secukinumab 300 mg based on PASI response at Week 24 in patients with moderate to severe plaque psoriasis.

OPTIMISE was a randomised, open-label, rater-blinded Phase 3b study. Subjects (n=1,647) received secukinumab 300 mg at baseline, Weeks 1, 2, 3, and 4, and every 4 weeks (q4w) to Week 24. At Week 24, PASI 90 responders (n=1306) were randomised to secukinumab 300 mg q4w (n=644) or every 6 weeks (q6w, n=662) regimen to Week 52; PASI ≥75 to <90 responders (n= 206) were randomised to secukinumab 300 mg q4w (n=114) or every 2 weeks (q2w, n=92) regimen to Week 52.

PASI 90 response was maintained at Week 52 by 85.7% subjects with q4w dosing vs 74.9% with q6w dosing; odds ratio 1.91 (95% confidence interval 1.44, 2.55). The primary endpoint, non-inferiority of q6w vs q4w dosing, was not met. In PASI ≥75 to <90 responders, the proportion of subjects with PASI 90 response at Week 52 was numerically higher in q2w vs. q4w group (56.5% vs. 46.5%, respectively; P=0.1013). Heavier subjects (≥90 kg) demonstrated numerically higher PASI 90 response with q2w (57.1%) vs q4w regimen (39.6%, P=0.1053).

Standard q4w dosing of secukinumab 300 mg is the optimal dosing regimen to achieve and maintain clear or almost clear skin. Subjects with body weight ≥90 kg not achieving PASI 90 at Week 24 may benefit from the q2w dosing regimen. This article is protected by copyright. All rights reserved.

Responsiveness of the EQ-5D-3L, DLQI, and DLQI-R for Patients With Psoriasis in the United States.

British Journal of Dermatology

Since psoriasis is associated with substantial impairment in health-related quality of life (HRQoL), this outcome has become an important endpoint ...

Utilization Patterns and Performance of Commercial Myositis Autoantibody Panels in Routine Clinical Practice.

British Journal of Dermatology

Identifying idiopathic inflammatory myopathies (IIM), including dermatomyositis (DM), clinically amyopathic dermatomyositis (CADM), and polymyositi...

A qualitative analysis of psychological distress in Hidradenitis Suppurativa.

British Journal of Dermatology

Hidradenitis Suppurativa (HS) can negatively impact on patients' quality of life (QoL) and is associated with a higher risk of depression, as well as difficulties in employment and relationships OBJECTIVES: This study sought to evaluate the lived experience of psychological distress in hidradenitis suppurativa (HS).

Structured interviews were conducted with twelve participants. These were later transcribed and analysed using thematic analysis. The transcripts and analysis were reviewed by an independent researcher.

The results indicated that there were three main themes: shame, pain and coping mechanisms. Participants' indicated that their feelings of shame were due to disgust at their symptoms. They feared that others would be disgusted if their symptoms were obvious. Participants reported feeling invalidated when others did not understand the severity of their pain. Additionally, they reported that pain left them with a sense of powerlessness over their own bodies. In regards, coping mechanisms, adaptive strategies included social support while maladaptive strategies included social withdrawal.

This study has highlighted that feelings of shame and physical pain are associated with psychological distress in HS. This article is protected by copyright. All rights reserved.

Severe Gastrointestinal Toxicity of MEK Inhibitors.

Melanoma Research

Gastrointestinal toxicities of MEK inhibitors in melanoma patients are frequent. In clinical trials, the most common digestive adverse events were ...

Nivolumab for patients with metastatic uveal melanoma previously untreated with ipilimumab: a single-institution retrospective study.

Melanoma Research

We evaluated the efficacy of nivolumab in patients with metastatic uveal melanoma previously untreated with ipilimumab.

We performed a retrospective study at the National Cancer Center Hospital in Tokyo, Japan, where nivolumab was approved 1 year earlier than ipilimumab. Clinical efficacy outcomes were determined by assessing best overall response according to the Response Evaluation Criteria in Solid Tumors (version 1.1), progression-free survival and overall survival.

Fourteen patients were analyzed; none had received any prior systemic therapies although eight had undergone transarterial chemoembolization. The median follow-up period was 15 months. The objective response and disease control rates were 7.1% and 42.9%, respectively (one partial response and five stable diseases). The median progression-free survival and overall survival were 10 (range, 4-105) and 60 (range, 5-105) weeks, respectively. Liver metastases in three patients were all programmed cell death-1 ligand negative. Lower lactate dehydrogenase, development of vitiligo, and a neutrophil-to-lymphocyte ratio less than 5 at week 6 were associated with favorable progression-free survival and overall survival; of these, only a neutrophil-to-lymphocyte ratio less than 5 at week 6 was statistically significant.

Even with the use of nivolumab before ipilimumab, metastatic uveal melanoma appears to remain refractory to nivolumab monotherapy. However, because one patient in our cohort achieved an objective response, and the median overall survival exceeded 1 year, treatment strategies that incorporate anti-PD1 antibody should be further investigated. Whether a neutrophil-to-lymphocyte ratio less than 5 at week 6 is a favorable early on-treatment marker should be validated in larger cohorts.