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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Analysis of Specialist and Patient Perspectives on Strategies to Improve Cardiovascular Disease Prevention Among Persons With Psoriatic Disease.

JAMA Dermatology

Patients with psoriatic disease are at increased risk of cardiovascular disease (CVD), which is a leading cause of mortality in this population. However, many of these patients do not have an active relationship with a primary care physician, and there may be a role for specialist-led care in prevention of CVD.

To explore clinician and patient perspectives regarding strategies to improve CVD prevention via specialist-led care.

Using electronically collected surveys, a best-worst scaling experimental survey study was conducted among dermatologists through the National Psoriasis Foundation as well as the American Academy of Dermatology from October 27, 2020, to April 1, 2021, to rank the strategies according to their potential to improve CVD prevention among patients with psoriatic disease. Participants were asked about the feasibility of specialist-led screening through an electronically delivered survey from the National Psoriasis Foundation conducted between February 1 and April 21, 2021. Patients with psoriatic disease were asked about whether they would like the specialist to screen for CVD risk factors. In addition, patients reported their likelihood to engage in CVD risk screening and management behaviors in scenarios in which either the primary care physician or specialist was making the recommendations.

For the clinician surveys, the primary outcome was the ratio scaled preference score (range, 0-100; higher is more preferred), as well as whether they think calculating a 10-year CVD risk score and prescribing statins seems feasible. For the patient surveys, the primary outcome was the likelihood to check cholesterol level, incorporate diet and exercise, or use statin therapy depending on whether recommended by the specialist or primary care physician, whether they would like their specialist to educate them about CVD risk, and whether they would find it convenient to have their cholesterol level checked by their specialist.

Among 183 dermatologists (102 [55.7%] women; mean [SD] age not collected), clinical decision support (preference score, 22.3; 95% CI, 20.7-24.0), patient education (preference score, 14.1; 95% CI, 12.5-15.7), and clinician education (preference score, 15.8; 95% CI, 14.3-17.3) were ranked as strategies likely to improve CVD prevention in patients with psoriatic disease. In addition, 69.3% (95% CI, 62.2%-76.0%) of dermatologists agreed or strongly agreed that checking lipid levels was feasible. Among 160 patients with psoriasis and 162 patients with psoriatic arthritis (226 [70.2%] women; mean [SD] age, 54 [13.3] years), patients reported they were as likely to engage in cardiovascular risk screening and management behaviors whether recommended by their primary care physician or their specialist. In addition, 60.0% (95% CI, 52.0%-67.7%) of patients with psoriasis and 75.3% (95% CI, 67.9%-81.7%) of those with psoriatic arthritis agreed that it would be convenient for them to have their cholesterol checked by their dermatologist/rheumatologist.

In this survey study, dermatologists and patients with psoriatic disease expressed positive perspectives about engaging in a specialist-led model of care to improve CVD prevention. Dermatologists appear to view several strategies as having potential to improve cardiovascular risk prevention.

Identification of Biomarkers and Critical Evaluation of Biomarker Validation in Hidradenitis Suppurativa: A Systematic Review.

JAMA Dermatology

The identification and validation of biomarkers in hidradenitis suppurativa (HS) has potential to improve the understanding and management of this chronic, burdensome disease.

To systematically identify all known HS biomarkers, categorize them by biomarker type, and critically evaluate their validity according to established criteria.

Eligibility criteria for this review (PROSPERO Registration 230830) included randomized clinical trials, uncontrolled clinical trials, cohort studies, case-control studies, and other observational studies with no restrictions of patient age, sex, race or ethnicity, or language of publication up until December 31, 2020. All articles were categorized into biomarker type, defined using the US Food and Drug Administration Biomarkers, Endpoints, and other Tools (BEST) glossary. Assessment of each identified biomarker was undertaken in line with the US Food and Drug Administration and European Medicines Agency guidelines for the validation of proposed biomarkers. Assessment of the strength of overall data regarding individual biomarkers was undertaken using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.

A total of 3953 nonduplicate articles were screened, of which 1429 articles were retrieved based on the include/exclusion criteria applied. After full-text screen and data extraction, 106 articles were included in this review. The evidence of strength of 6 categories of biomarkers (susceptibility/risk, diagnostic, monitoring, predictive, prognostic, and pharmacodynamic/response biomarkers) was assessed using GRADE criteria. A total of 48 biomarkers were identified with a minimum GRADE rating of moderate. Only 1 diagnostic (serum IL-2R), 1 monitoring (dermal Doppler vascularity), and 2 predictive biomarkers (epithelialized tunnels and positive family history of HS) achieved a GRADE rating of high. None of the identified biomarkers had sufficient clinical validity to be recommended for routine use in the clinical setting.

Major barriers to the identification, validation, and introduction of routine biomarkers in the management of HS include lack of independent biomarker validation studies (especially assumption-free "omics"-based techniques); insufficient assessment of collinearity between identified or proposed biomarkers; and a lack of routine integration of biomarkers into the structure of clinical trials. International consensus among researchers, clinicians, and pharmaceutical stakeholders is required to standardize goals and methods and encourage biomarker integration into future HS clinical trials. This systematic review presents a number of priorities for near-term future research to overcome such barriers and limitations of biomarkers in HS.

Body dysmorphia in common skin diseases: Results of an observational, cross-sectional multi-centre study among dermatological out-patients in 17 European countries.

British Journal of Dermatology

Body dysmorphic disorder (BDD) is a common psychiatric disorder associated with high costs for healthcare systems as patients may repeatedly ask for different, often not effective interventions. BDD symptoms are more prevalent in patients with dermatological conditions than the general population, but there are no large sample studies comparing the prevalence of BDD symptoms between patients with dermatological conditions and healthy skin controls.

To compare the prevalence of BDD symptoms between patients with different dermatological conditions and healthy skin controls and to describe sociodemographic, physical and psychological factors associated with BDD symptoms to identify patients who may have a particularly high chance of having this condition.

This observational cross-sectional, comparative multi-centre study included 8295 participants: 5487 consecutive patients with different skin diseases (56% female) recruited among dermatological out-patients at 22 clinics in 17 European countries and 2808 healthy skin controls (66% female). All patients were examined by a dermatologist. BDD symptoms were assessed by the Dysmorphic Concern Questionnaire (DCQ). Sociodemographic data, information on psychological factors and physical conditions were collected. Each patient was given a dermatological diagnosis according to ICD-10 by a dermatologist.

The participation rate of invited dermatological patients was 82.4% on average across all centres. BDD symptoms were five times more prevalent in patients with dermatological conditions than in healthy skin controls (10.5% vs. 2.1%). Patients with hyperhidrosis, alopecia and vitiligo had a more than eleven-fold increased chance (adjusted Odds Ratio (OR) > 11) of having BDD symptoms compared to healthy skin controls, and patients with atopic dermatitis, psoriasis, acne, hidradenitis suppurativa, prurigo and bullous diseases had a more than six-fold increased chance (adjusted OR > 6) of having BDD symptoms. Using a logistic regression model, BDD symptoms were significantly related to lower age, female sex, higher psychological stress and feelings of stigmatisation.

This study reveals that clinical BDD symptoms are significantly associated with common dermatological diseases. As such symptoms are associated with higher levels of psychological distress and multiple unhelpful consultations, general practitioners and dermatologists should consider BDD and refer patients when identified to an appropriate service for BDD screening and management.

Mogamulizumab induces long term immune restoration and reshapes tumor heterogeneity in Sézary syndrome.

British Journal of Dermatology

Mogamulizumab, an anti-CCR4 monoclonal antibody, has been shown to increase progression-free survival in cutaneous T-cell lymphoma.

We hypothesized that besides the targeted depletion of Sézary cells (SCs), mogamulizumab may reshape the immune tumor microenvironment.

Both malignant and benign compartments from 26 Sézary patients with B2 stage before mogamulizumab initiation were prospectively analyzed using KIR3DL2 and TCR-Vβ markers, serological markers and molecular assessments of clonality.

Prior to mogamulizumab, the benign subset of CD4+ T-cells displayed exhausted phenotypes, with an increased gradient in PD1/TIGIT/DNAM/CD27/CD28 and CD70 expression from age- matched controls to patient benign CD4+T cells and to SCs. All patients presented SCs with heterogeneous phenotypes and differential expression of individual markers were found within distinct malignant subsets. Early complete blood response was observed in 17/26 patients and was associated to a higher baseline CCR4 expression. A drastic decrease in benign T cells and activated Treg counts was observed during the first 4 weeks. Long-term follow-up revealed the emergence of an immune restoration involving CD8+, naive and stem-memory CD4+T cells, with almost complete disappearance of exhausted lymphocytes. Development of resistance/tumor escape to mogamulizumab was associated to the emergence of CCR4- SCs in blood and skin, displaying significant changes in their heterogeneity patterns, and not univocally explained by mutations within CCR4 coding regions.

Mogamulizumab is likely contributing to the restoration of an efficient immunity and reshapes not only the malignant lymphocyte subset but also the benign subset. These results have potential implications for optimal therapeutic sequences and/or combinations.

A Randomised Controlled Feasibility Trial of Online Compassion-focused Self-Help for Psoriasis.

British Journal of Dermatology

People with psoriasis can experience psychological distress that might be amenable to psychosocial self-help.

This study tested the feasibility and acceptability of two theoretically developed self-help interventions designed to reduce feelings of shame and improve quality of life.

A randomised controlled feasibility trial was conducted with one hundred and thirty participants with psoriasis who were randomly allocated to receive either compassion-based self-help (n =65) or mindfulness-based self-help (n =65), over a four-week period.

The interventions were found to be acceptable with over 70% of study completers reported finding the materials helpful. Ninety-two participants completed the study with attrition at 30%. Both interventions showed modest yet statistically significant reductions in shame (d = .20) and improvements in quality of life (d = .40).

Self-help based on compassion and mindfulness is acceptable to users and can reduce feelings of shame and improve quality of life for people living with psoriasis.

Prognostic value of ulceration varies across Breslow thicknesses and clinical stages in acral melanoma: a retrospective study.

British Journal of Dermatology

Ulceration is regarded as an adverse prognostic factor and used together with tumor thickness to subcategorize cutaneous melanoma patients. However, the prognostic impact of ulceration in acral melanoma (AM) is controversial.

Assess the prognostic impact of ulceration in AM and the variability across different Breslow thicknesses and clinical stages.

A multi-center retrospective study of patients diagnosed with AM between Jan 2000 and Dec 2017. Differences in melanoma-specific survival (MSS) between patients with and without ulceration were assessed using the multivariable Cox proportional hazards model and log-rank test.

Among 1053 enrolled patients, 62.6% had ulceration. After a median follow-up of 61 months, patients with ulceration had a lower median MSS vs. those without [66.1 months (95% confidence interval, 95% CI 60.0-86.0) vs. not reached; hazard ratio (HR) =1.41, 95% CI 1.09-1.82; P-value=0.012]. Among patients with thin (≤1 mm) melanoma, the survival curves of patients with vs. without ulceration clearly separated over time (P-value<.001). No association between ulceration and MSS was observed for melanomas of thickness >1 mm (Subgroups of T2, T3 and T4; all P-values>0.05) or with stage III disease (HR=1.09, 95% CI 0.71-1.68, P-value=0.391).

Ulceration is an independent negative prognostic factor for patients with AM but the impact varies across Breslow thicknesses and clinical stages. Ulceration has a significant effect on prognosis for patients with thin (≤1 mm) melanoma, but there was no association between ulceration and survival in intermediate/thick or stage III AM.

New Developments in Topical Acne Therapy.

American Journal of Clinical Dermatology

Acne vulgaris is a common chronic inflammatory disease with a multifactorial pathogenesis. Although myriad acne treatments are available, current o...

Artificial Intelligence and Melanoma: A Comprehensive Review of Clinical, Dermoscopic, and Histologic Applications.

Pigment Cell and Melanoma Research

Melanoma detection, prognosis, and treatment represent challenging and complex areas of cutaneous oncology with considerable impact on patient outc...

Biologics in Psoriasis: Updated Perspectives on Long-Term Safety and Risk Management.

Psoriasis (Auckl)

Biologics targeting Th1/Th17 cytokines have revolutionised psoriasis treatment. In addition to treatment effectiveness, it is important to define a...

Interventions for Cutaneous Disease in Systemic Lupus Erythematosus: Summary of a Cochrane Review.

JAMA Dermatology

What is the efficacy of interventions for cutaneous disease in systemic lupus erythematosus (SLE) in randomized clinical trials (RCTs)?

Available RCT evidence on the management of cutaneous disease in SLE is sparse and of limited quality. Among traditional options, methotrexate and hydroxychloroquine have the strongest evidence compared with placebo in the end points of complete clinical response and number of clinical flares, respectively, while chloroquine appears noninferior to methotrexate in achieving complete clinical response.

Treatment of Familial Benign Chronic Pemphigus With Superficial Radiotherapy.

JAMA Dermatology

Hailey-Hailey disease (HHD) is a chronic genodermatosis with recurrent vesicles and erosions mainly in the intertriginous areas. Hailey-Hailey disease severely affects patient quality of life. Standard treatments attempt to control the flares, but often do not result in long-term remission of the disease.

To describe outcomes of treatment with superficial radiotherapy (SR) for severe treatment-refractory HHD.

This retrospective case-series included 13 patients with severe HHD with a mean (SD) duration of 24 (14) years whose treatments with SR and follow-up were conducted at the Department of Dermatology at Bispebjerg University Hospital (Copenhagen, Denmark) from January 2015 to April 2021.

Patients were treated with SR (20 kilovolt; 8 fractions of 2 gray was equal to 1 cycle) with a total dose of 16 gray in each treatment cycle. Patients received 1 to 6 treatment cycles with 1 to 5 separate body areas treated in each cycle. Sixty-two separate body areas were treated with SR.

Complete long-term remission, defined as no relapse during follow-up of at least 12 months.

For the 13 participants (mean [SD] age, 52 [18] years; 8 women [62%]), 56 of 62 treated areas (90%) achieved long-term remission, and the mean (SD) follow-up was 32 (12) months for the successfully treated areas. Nine of 13 patients (69%) responded with complete remission of all treated areas after the first treatment cycle and an additional 3 patients experienced complete remission after the second SR cycle. One patient with partial remission in 1 of 2 treated skin areas experienced such an improvement in HHD that they chose to abstain from retreatment. The treatment was followed by severe inflammation lasting for up to 1 month followed by temporary slight hyperpigmentation of the treated areas. The average Dermatology Life Quality Index score before treatment with SR was 22 (the disease having extremely large effect on the patient's life) and decreased to an average of 3 (small effect on the patient's life) after treatment with SR.

The results of this case series suggest that treatment with SR was associated with remission in patients with severe HHD and may provide a long-term improvement of treated skin areas.

Association of Cutaneous Immune-Related Adverse Events With Increased Survival in Patients Treated With Anti-Programmed Cell Death 1 and Anti-Programmed Cell Death Ligand 1 Therapy.

JAMA Dermatology

Despite the efficacy of immune checkpoint inhibitors (ICIs), cutaneous immune-related adverse events (cirAEs) occur in 20% to 40% of all treated patients. To our knowledge, little is known about the predictive value of these cutaneous eruptions and their subtypes regarding cancer survival.

To determine the association of developing cirAEs following treatment with anti-programmed cell death 1 (PD-1) or anti-programmed cell death ligand 1 (PD-L1) therapy with patient survival.

This retrospective cohort study used data from the TriNetX Diamond Network, a database of health records and claims data from more than 200 million US and European patients, to conduct a population-level cohort analysis. The study included 7008 eligible patients who developed cirAEs after treatment with anti-PD-1 or anti-PD-L1 therapy for malignant neoplasms of digestive organs, bronchus or lung, melanoma of skin, and urinary tract who were identified through the TriNetX Diamond Network along with 7008 matched controls.

Development of cirAEs within 6 months following anti-PD-1 or anti-PD-L1 therapy.

A 6-month analysis using a Cox proportional hazards model was performed to determine the association of cirAEs with overall survival after adjusting for demographic characteristics, cancer type, and cancer stage.

A total of 7008 patients (3036 women [43.3%]; mean [SD] age, 68.2 [11.2] years) were matched to 7008 (3044 women [43.4%]; mean [SD] age, 68.3 [11.1] years) controls. Pruritus (hazard ratio [HR], 0.695; 95% CI, 0.602-0.803; P < .001), drug eruption (HR, 0.755; 95% CI, 0.635-0.897; P = .001), xerosis (HR, 0.626; 95% CI, 0.469-0.834; P = .001), nonspecific rashes (HR, 0.704; 95% CI, 0.634-0.781; P < .001), and appearance of any cirAE (HR, 0.778; 95% CI, 0.726-0.834; P < .001) were significantly protective of mortality using a Benjamini-Hochberg correction with a significance level of .05. Additionally, psoriasis (HR, 0.703; 95% CI, 0.497-0.994; P = .045) and lichen planus/lichenoid dermatitis (HR, 0.511; 95% CI, 0.279-0.939; P = .03) were significant. Eczematous dermatitis (HR, 0.612; 95% CI, 0.314-1.195), vitiligo (HR, 0.534; 95% CI, 0.254-1.123), bullous pemphigoid (HR, 0.524; 95% CI, 0.140-1.956), and Grover disease (HR, 0.468; 95% CI, 0.115-1.898) were all associated with strong protective clinical effects.

The results of this cohort study suggest that the development of cirAEs is strongly associated with response to ICI therapy and patient survival.