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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Dermatomyositis: An Update on Diagnosis and Treatment.

American Journal of Clinical Dermatology

Dermatomyositis is a rare inflammatory disease with characteristic cutaneous findings and varying amounts of systemic involvement. Patients may pre...

Artificial intelligence in dermatology: the 'unsupervised' learning.

British Journal of Dermatology

The potential areas of application of artificial intelligence in dermatology are ever increasing. With the wide availability of smartphones equippe...

Baseline Characteristics from UNITE: An Observational, International, Multicentre Registry to Evaluate Hidradenitis Suppurativa (Acne Inversa) in Clinical Practice.

American Journal of Clinical Dermatology

Hidradenitis suppurativa (HS), also known as acne inversa, is a recurring, painful, chronic, and sometimes disfiguring inflammatory skin disease.

Our objective was to report the baseline clinical characteristics, natural history, and associated outcomes of patients with HS from the ongoing, prospective, non-interventional UNITE registry that is collecting data regarding the natural history and associated outcomes of HS.

Patients with inflammatory HS lesions were enrolled, including adolescents (aged 12 to < 18 years) and adults (aged ≥ 18 years). None had participated in previous or current originator-adalimumab studies/registries. Patients received treatment consistent with site-specific, routine clinical practice. HS disease status was assessed by HS lesions and disease flare; treatment and outcomes data were collected at enrolment and every 6 months for ≤ 4 years.

Enrolment (N = 594; 89.1% adults; 10.9% adolescents) occurred from 29 October 2013 to 29 December 2015 at 73 sites in 12 countries. At baseline, the majority were female (69.7%) and White (81.2%), had moderate-to-severe disease (Hurley stage II or III; 93.3%), and had undergone prior procedures/surgery for HS (68.7%). In total, 61.6% of adults and 49.2% of adolescents were obese; 40.2% of patients reported current tobacco use. Scarring due to lesions occurred in 91.2% of patients. The prevalence of comorbidities of interest was as follows: depression (13.3%), other psychiatric disorders (9.6%), inflammatory bowel disease (2.7%), diabetes (9.1%), and polycystic ovary syndrome (5.2%).

In this population from the UNITE HS registry, obesity and smoking were common, and disease burden was high, manifesting as multiple lesions, scarring, surgical history, and considerable comorbidities.

Topical imiquimod monotherapy for indolent primary cutaneous B-cell lymphomas (PCBCL): a single-institution experience.

British Journal of Dermatology

Primary cutaneous B-cell lymphomas (PCBCL) are rare extranodal lymphoproliferative disorders that present in the skin and seldom disseminate system...

Incidence of different cancer types in dermatomyositis, polymyositis and dermatopolymyositis: results of a registry analysis.

British Journal of Dermatology

Studies confirming Dermatomyositis/polymyositis/dermatopolymyositis (DM/PM/DPM) as a paraneoplastic disease have found cancer incidence rates eleva...

Reliability and validity of the Vitiligo Signs of Activity Score (VSAS).

British Journal of Dermatology

The association between disease activity and several clinical signs in vitiligo has been described, but a widely accepted and validated scoring system is lacking.

To validate the Vitiligo Signs of Activity Score (VSAS) for physicians.

Three visible clinical signs were scored on 15 body locations: Confetti-like depigmentation (c), Koebner phenomenon (k) and hypochromic areas/borders (b). The inter- and intra-rater reliability of the global VSAS and VSAS subscores (c-VSAS; k-VSAS and h-VSAS) were tested by 4 and 3 raters (physicians) respectively. Construct validity and feasibility were evaluated.

The VSAS demonstrated good interrater reliability [intraclass correlation (ICC) VSAS: 0.86 first round; ICC 0.90 second round]. The intrarater reliability ICCs were all ≥ 0.86. Interrater reliabilities of the subscores were excellent for c-VSAS and fair for k-VSAS and h-VSAS (ICC= 0.83, 0.51 and 0.53 respectively; first round). Evidence for construct validity was provided. Completion time by the raters (median 2.18 min/patient) improved during the second round (median 1.33 min/patient).

The VSAS appears to be a valid and reliable instrument to score visible clinical signs linked to disease activity in a standardised way.

The efficacy and safety of topical rapamycin/calcitriol for facial angiofibromas in patients with tuberous sclerosis complex: a prospective, double-blind randomized clinical trial.

British Journal of Dermatology

The efficacy of topical rapamycin is well-documented for tuberous sclerosis complex (TSC)-related facial angiofibromas (FAs). Calcitriol has been shown to lessen skin fibrosis and may be therapeutically beneficial to FAs.

To evaluate if topical rapamycin-calcitriol combination an effective and safe treatment for TSC-related FAs.

Fifty-two TSC patients with FAs were enrolled in this prospective study including three 12-week periods. In period 1, either topical rapamycin (0.1%) or calcitriol (0.0003%) single-agent therapy versus their combination were applied by a double-blind, left-right randomized, split-face comparison. The primary outcome was the reduction of modified Facial Angiofibroma Severity Index (mFASI) at week 12. In period 2, the patients were reassigned to use the ointment which resulted in better primary outcome in period 1 on both cheeks. The treatment was discontinued in period 3 (week 25-36) and a follow-up mFASI was scored to evaluate the degree of recurrence.

The mean reduction of mFASI at week 12 comparing to baseline was -0.92, -0.44, and -1.09 for rapamycin (P < .001), calcitriol (P = .039), and rapamycin-calcitriol combination (P < .001), respectively. Although rapamycin-calcitriol combination and rapamycin had similar statistically significant decreases of mFASI at week 12, rapamycin-calcitriol combination resulted in faster improvement in erythema, greater reduction of papule elevation and longer durability after discontinuing treatment than rapamycin along. The treatments were well tolerated.

This randomized clinical trial demonstrated that topical rapamycin-calcitriol combination therapy is an effective and safe regimen for TSC-related FAs.

GNAQ and GNA11 mutant non-uveal melanoma, a subtype distinct from both cutaneous and uveal melanoma.

British Journal of Dermatology

GNAQ and GNA11 mutant non-uveal melanoma represent a poorly characterized, rare subgroup of melanoma with a gene mutation profile similar to uveal melanoma.

To characterize these tumours in terms of clinical behaviour and genetic characteristics.

Patients with non-uveal GNAQ/11 mutated melanoma were identified from the prospective multicentre tumour tissue registry ADOREG, Tissue Registry in Melanoma (TRIM) and additional cooperating skin cancer centres. Extensive data on patient, tumour and treatment characteristics were collected retrospectively. Targeted sequencing was used to determine tumour mutational burden. Immunohistochemistry staining was done for PD-L1 and BAP1. Existing whole-exome cutaneous and uveal melanoma data was analysed for mutation type and burden.

We identified 18 patients with metastatic GNAQ/11 mutant non-uveal melanoma. Tumours had a lower tumour mutational burden and less UV-signature mutations than cutaneous melanomas. In addition to GNAQ and GNA11 mutations (9 each), 6 SF3B1, 3 EIF1AX and 4 BAP1 mutations were detected. In contrast to uveal melanoma, GNAQ/11 mutant non-uveal melanomas frequently metastasized lymphatically and concurrent EIF1AX, SF3B1 and BAP1 mutations were not apparently associated with patient prognosis. Objective response to immunotherapy was poor with only one partial response observed in ten treated patients (10%).

Our findings suggest that GNAQ/11 mutant non-uveal melanomas are a melanoma subtype distinct both clinically and genetically from cutaneous and uveal melanoma. As they respond poorly to available treatment regimens, novel effective therapeutic approaches for affected patients are urgently needed.

Association of Indoor Tanning Regulations With Health and Economic Outcomes in North America and Europe.

JAMA Dermatology

UV radiation emissions from indoor tanning devices are carcinogenic. Regulatory actions may be associated with reduced exposure of UV radiation at a population level.

To estimate the long-term health and economic consequences of banning indoor tanning devices or prohibiting their use by minors only in North America and Europe compared with ongoing current levels of use.

This economic analysis modeled data for individuals 12 to 35 years old in North America and Europe, who commonly engage in indoor tanning. A Markov cohort model was used with outcomes projected during the cohort's remaining life-years. Models were populated by extracting data from high-quality systematic reviews and meta-analyses, epidemiologic reports, and cancer registrations.

Main outcomes were numbers of melanomas and deaths from melanoma, numbers of keratinocyte carcinomas, life-years, and health care and productivity costs. Extensive sensitivity analyses were performed to assess the stability of results.

In an estimated population of 110 932 523 in the United States and Canada and 141 970 492 in Europe, for the next generation of youths and young adults during their remaining lifespans, regulatory actions that ban indoor tanning devices could be expected to gain 423 000 life-years, avert 240 000 melanomas (-8.2%), and avert 7.3 million keratinocyte carcinomas (-7.8%) in North America and gain 460 000 life-years, avert 204 000 melanomas (-4.9%), and avert 2.4 million keratinocyte carcinomas (-4.4%) in Europe compared with ongoing current levels of use. Economic cost savings of US $31.1 billion in North America and €21.1 billion (US $15.9 billion) in Europe could occur. Skin cancers averted and cost savings after prohibiting indoor tanning by minors may be associated with one-third of the corresponding benefits of a total ban.

Banning indoor tanning may be associated with reduced skin cancer burden and health care costs. Corresponding gains from prohibiting indoor tanning by minors only may be smaller.

Prevalence, Incidence, and Risk of Cancer in Patients With Psoriasis and Psoriatic Arthritis: A Systematic Review and Meta-analysis.

JAMA Dermatology

The association between psoriasis and risk of cancer remains debatable.

To evaluate the association and risk of cancer in patients with psoriasis or psoriatic arthritis, including risk of specific cancer subtypes.

Two databases (PubMed and Embase) were screened from inception to January 1, 2019, using the search string psoriasis or psoriatic and neoplasms or malignancy or cancer. The search was filtered to only include human participants and publications in English.

Observational cohort studies with a population of patients with psoriasis or psoriatic arthritis were included. Studies had to be original and report the incidence or prevalence of cancer within this population. Studies evaluating pediatric populations and cancer types not included in the protocol were excluded.

This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search string, objectives, and study protocol methods were defined before the study was initiated. A total of 365 studies were included for full-text assessment. Owing to the heterogeneity of the included studies, a random-effects model was used.

Main outcome was cancer (overall and specific subtypes) and measures were prevalence, incidence, and risk estimate for cancer in patients with psoriasis or psoriatic arthritis.

Of the 365 studies assessed, 112 were included in the analysis (N = 2 053 932 patients). The overall prevalence of cancer in patients with psoriasis was 4.78% (95% CI, 4.02%-5.59%), with an incidence rate of 11.75 per 1000 person-years (95% CI, 8.66-15.31) and a risk ratio (RR) of 1.21 (95% CI, 1.11-1.33). There was an increased risk of several cancers, including keratinocyte cancer (RR, 2.28; 95% CI, 1.73-3.01), lymphomas (RR, 1.56; 95% CI, 1.37-1.78), lung cancer (RR, 1.26; 95% CI, 1.13-1.40), and bladder cancer (RR, 1.12; 95% CI, 1.04-1.19). No increased risk of cancer for patients with psoriasis treated with biologic agents was found (RR, 0.97; 95% CI, 0.85-1.10). Psoriatic arthritis was not associated with increased risk of cancer overall (RR, 1.02; 95% CI, 0.97-1.08).

Patients with psoriasis appear to have a slightly increased risk of cancer, particularly keratinocyte cancer and lymphomas. Data on treatment with biologic agents did not show an increased risk of cancer. Data on cancer in patients with psoriatic arthritis remain scarce, and further research is warranted in this area.

The European TREatment of ATopic eczema Taskforce (TREAT) Survey; prescribing practices in Europe for phototherapy and systemic therapy in moderate-to-severe adult atopic eczema patients.

British Journal of Dermatology

For many years dermatologists have had access to few therapies for patients with moderate-to-severe atopic eczema (AE). New promising therapies are entering the market but conventional phototherapies and systemic therapies have more well-known safety-profiles, lower costs and wider availability.

To provide insight into current prescribing practices of conventional photo- and systemic immunomodulatory therapies for adults with chronic AE and the factors influencing these prescribing practices before biologics and other novel therapeutics become routine clinical practice.

In this exploratory study dermatologists were invited to participate in an online survey via a mailing list of the European Academy of Dermatology and Venereology and national societies. Data were collected on participant characteristics (including clinical practices data), the use of phototherapies and systemic therapies and factors influencing their use.

From 30 European countries, 238 out of 361 dermatologists willing to participate (65.9%) completed the survey. For phototherapy (prescribed by 84.7%), most preferred narrow-band ultraviolet-B as first line (80.9%) and psoralen and ultraviolet-A as second (21.6%). For systemic therapy (prescribed by 95.2%) ciclosporin (54.1%), oral corticosteroids (32.6%) and methotrexate (30.7%) were used first line. Dermatologists mostly relied on personal experience for prescribing phototherapy and systemic therapy. Azathioprine and mycophenolate acid were prescribed by only 135 (59%) and 85 (37.1%) participants in total, mostly due to a lack of personal experience.

This study provides insight into prescribing practices for conventional photo- and systemic therapies in Europe and shows that off-label therapies are also preferred as first line choice of systemic therapy.

Assessing the Effect of Clinical Trial Evidence and Anecdote on Caregivers' Willingness to Use Corticosteroids: A Randomized Controlled Trial. A Critical Appraisal.

British Journal of Dermatology

Johnson et al. [1] aimed to assess caregivers' willingness to treat childhood atopic dermatitis (AD) with a corticosteroid when presented with clinical trial evidence, anecdote, or both.

This prospective parallel group (1:1; 8 groups) randomised control trial was carried out with caregivers recruited from a tertiary care dermatology clinic in the United States of America (USA) and an online crowdsourcing platform using caregivers who may not have had a child with AD.

Caregivers were randomised to 8 groups. The 3 main groups were given clinical trial evidence, anecdote, or a combination of both. Each of these 3 groups was further divided and presented with either the term "medication" or "topical steroid." These were compared to the 2 remaining groups which included a group told that they would not be informed of a medication's efficacy or safety profile, and a group informed that the medication was recommended by the doctor.

A total of 476 caregivers were recruited (80 clinic, 396 online), 48% of whom had a history of a child with AD. Caregivers' willingness to treat was higher in all information assignment groups compared to those not provided with safety information: clinical trial evidence of a "medication" (P = .003; Cohen's d = 0.83) or "topical steroid" (P = .030; d = 0.55), anecdote of a "medication" (P < .0001; d = 1.37) or "topical steroid" (P < .0001; d = 0.85), both clinical trial evidence and anecdote of a "medication" (P < .0001; d = 1.00) or "topical steroid" (P = .000; d = 0.89), and simply the doctor's recommendation (P < .0001; d = 0.92).

Johnson et al. conclude that the provision of anecdotal reassurance may be an effective strategy to improve caregivers' willingness to use topical steroid.