JAMA dermatology最新文献

{"title":"Methotrexate and Interstitial Lung Disease-Reply.","authors":"Jill T Shah, Alisa Femia","doi":"10.1001/jamadermatol.2024.5554","DOIUrl":"10.1001/jamadermatol.2024.5554","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"232"},"PeriodicalIF":11.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skin Cancer Diagnosis by Lesion, Physician, and Examination Type: A Systematic Review and Meta-Analysis.","authors":"Jennifer Y Chen, Kristen Fernandez, Raj P Fadadu, Rasika Reddy, Mi-Ok Kim, Josephine Tan, Maria L Wei","doi":"10.1001/jamadermatol.2024.4382","DOIUrl":"10.1001/jamadermatol.2024.4382","url":null,"abstract":"<p><strong>Importance: </strong>Skin cancer is the most common cancer in the US; accurate detection can minimize morbidity and mortality.</p><p><strong>Objective: </strong>To assess the accuracy of skin cancer diagnosis by lesion type, physician specialty and experience, and physical examination method.</p><p><strong>Data sources: </strong>PubMed, Embase, and Web of Science.</p><p><strong>Study selection: </strong>Cross-sectional and case-control studies, randomized clinical trials, and nonrandomized controlled trials that used dermatologists or primary care physicians (PCPs) to examine keratinocytic and/or melanocytic skin lesions were included.</p><p><strong>Data extraction and synthesis: </strong>Search terms, study objectives, and protocol methods were defined before study initiation. Data extraction was performed by a reviewer, with verification by a second reviewer. A mixed-effects model was used in the data analysis. Data analyses were performed from May 2022 to December 2023.</p><p><strong>Main outcomes and measures: </strong>Meta-analysis of diagnostic accuracy comprised sensitivity and specificity by physician type (primary care physician or dermatologist; experienced or inexperienced) and examination method (in-person clinical examination and/or clinical images vs dermoscopy and/or dermoscopic images).</p><p><strong>Results: </strong>In all, 100 studies were included in the analysis. With experienced dermatologists using clinical examination and clinical images, the sensitivity and specificity for diagnosing keratinocytic carcinomas were 79.0% and 89.1%, respectively; using dermoscopy and dermoscopic images, sensitivity and specificity were 83.7% and 87.4%, and for PCPs, 81.4% and 80.1%. Experienced dermatologists had 2.5-fold higher odds of accurate diagnosis of keratinocytic carcinomas using in-person dermoscopy and dermoscopic images compared with in-person clinical examination and images. When examining for melanoma using clinical examination and images, sensitivity and specificity were 76.9% and 89.1% for experienced dermatologists, 78.3% and 66.2% for inexperienced dermatologists, and 37.5% and 84.6% for PCPs, respectively; whereas when using dermoscopy and dermoscopic images, sensitivity and specificity were 85.7% and 81.3%, 78.0% and 69.5%, and 49.5% and 91.3%, respectively. Experienced dermatologists had 5.7-fold higher odds of accurate diagnosis of melanoma using dermoscopy compared with clinical examination. Compared with PCPs, experienced dermatologists had 13.3-fold higher odds of accurate diagnosis of melanoma using dermoscopic images.</p><p><strong>Conclusions and relevance: </strong>The findings of this systematic review and meta-analysis indicate that there are significant differences in diagnostic accuracy for skin cancer when comparing physician specialty and experience, and examination methods. These summary metrics of clinician diagnostic accuracy could be useful benchmarks for clinical trials, practitioner trainin","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"135-146"},"PeriodicalIF":11.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Melanoma Tumor Mutational Burden and Indoor Tanning Exposure.","authors":"Grace B Hanrahan, Anita Giobbie-Hurder, Blair Allais, Jayne Vogelzang, Christopher Fay, Hillary C Tsibris","doi":"10.1001/jamadermatol.2024.4819","DOIUrl":"10.1001/jamadermatol.2024.4819","url":null,"abstract":"<p><strong>Importance: </strong>UV-induced mutagenesis leads to a higher tumor mutational burden (TMB) in cutaneous melanoma relative to other cancer types. TMB is an important prognostic marker in advanced melanoma; higher TMB is associated with greater clinical response to immune checkpoint inhibition and improved survival.</p><p><strong>Objective: </strong>To evaluate the association between cutaneous melanoma TMB and indoor tanning exposure, as well as other demographic, dermatologic, and tumor characteristics.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study took place at Dana-Farber Cancer Institute, a tertiary-care cancer treatment center in Boston, Massachusetts, between 2013 and 2022. Patients with a diagnosis of cutaneous melanoma for whom next-generation sequencing data and tanning bed exposure history were available were included.</p><p><strong>Exposures: </strong>Indoor tanning exposure history, tumor characteristics, demographics, and dermatologic history were collected via retrospective medical record review.</p><p><strong>Main outcomes and measures: </strong>The association of tanning bed use with TMB was modeled using inverse probability of treatment weighted, multivariable modeling.</p><p><strong>Results: </strong>Among 617 patients (median [IQR] age at diagnosis, 61 [50-71] years; 337 [62.9%] male), there was no association between indoor tanning exposure and TMB after adjustment for demographic, tumor, and dermatologic characteristics (yes vs no: log2 TMB [SE], 4.07 [0.44] vs 3.97 [0.45]; P = .39). However, there was a statistically significant association between higher TMB and older age at diagnosis, history of nonmelanoma skin cancer, and head and neck tumors relative to other primary sites. Average TMB was statistically significantly lower in patients with a history of abnormal nevi (yes vs no: log2 TMB [SE], 3.89 [0.44] vs 4.15 [0.44]; P = .01).</p><p><strong>Conclusions and relevance: </strong>This cohort study suggests that indoor tanning exposure, while known to increase risk of melanoma, may not be meaningfully associated with melanoma TMB. Additional characteristics were associated with higher TMB and, thus, potentially improved immune checkpoint inhibitor response.</p>","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"198-202"},"PeriodicalIF":11.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-Institutional Clinical Forensic Dermatology Training for Dermatology Residents.","authors":"Maha Kazmi, Mehar Maju, Rubi Danielle Montejano, Ivan Rodriguez, Coleen Kivlahan, Herbert B Castillo Valladares","doi":"10.1001/jamadermatol.2024.5301","DOIUrl":"10.1001/jamadermatol.2024.5301","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"223-225"},"PeriodicalIF":11.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interobserver and Intraobserver Agreement on the Treatment of Infantile Hemangiomas.","authors":"María Colmenero-Sendra, Javier Del Boz-González, Mercè Grau-Pérez, Ricardo Ruiz-Villaverde, Miguel Ángel Descalzo-Gallego, Ignacio García-Doval, Eulalia Baselga Torres","doi":"10.1001/jamadermatol.2024.5125","DOIUrl":"10.1001/jamadermatol.2024.5125","url":null,"abstract":"<p><strong>Importance: </strong>Although clinical practice guidelines exist for the treatment of infantile hemangiomas (IHs), recommendations are heterogeneous, and wide practice variations in IH management have been reported.</p><p><strong>Objective: </strong>To analyze the degree of agreement in treatment choices for IH among pediatric dermatologists in North America and Europe and assess whether there are differences across IH risk categories.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional interrater and intrarater agreement study was conducted through a survey based on the Spanish Academy of Dermatology and Venereology IH prospective cohort. The survey used 50 vignettes of IH cases that were randomly selected from the cohort. It was administered twice in 2023, 1 month apart, to allow for interrater and intrarater agreement assessments. Data were analyzed in January 2024. The study involved pediatric dermatologists from North America (via the Pediatric Dermatology Research Alliance) and Europe (via the European Society of Pediatric Dermatologists).</p><p><strong>Exposures: </strong>Participants were asked to choose 1 of 3 treatment options (propranolol, topical timolol, or observation) for each vignette.</p><p><strong>Main outcome and measure: </strong>The primary outcome was the interrater agreement in treatment choices for IH cases, measured using κ statistics (Gwet AC1 coefficient).</p><p><strong>Results: </strong>The global interobserver agreement among 90 pediatric dermatologists was fair (AC1, 0.38; 95% CI, 0.29-0.46). In North America (45 pediatricians), agreement was moderate (AC1, 0.41; 95% CI, 0.33-0.49), while in Europe (45 pediatricians) it was fair (AC1, 0.37; 95% CI, 0.28-0.46). The degree of agreement varied depending on the risk category of IH, with excellent agreement in high-risk IH and only moderate agreement in intermediate-risk and low-risk IHs. Propranolol was predominantly chosen for high-risk IH, while observation was most frequent for low-risk IH (55.9%). The second survey had 61 respondents, with no significant intrarater differences.</p><p><strong>Conclusions and relevance: </strong>The results of this survey study suggest that there is an important variability in the treatment of intermediate-risk and low-risk IH. The study findings support the need for more evidence regarding the role of topical timolol in IH treatment, which may help harmonize treatment approaches and improve consistency in IH management globally.</p>","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"203-207"},"PeriodicalIF":11.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbon Footprint Analysis of an Outpatient Dermatology Practice at an Academic Medical Center.","authors":"Genevieve S Silva, Alex Waegel, Joshua Kepner, Greg Evans, William Braham, Misha Rosenbach","doi":"10.1001/jamadermatol.2024.5669","DOIUrl":"10.1001/jamadermatol.2024.5669","url":null,"abstract":"<p><strong>Importance: </strong>There is growing awareness of the US health sector's substantial contribution to the country's greenhouse gas (GHG) emissions, exacerbating the health threats from climate change. Reducing health care's environmental impact requires understanding its carbon emissions, but there are few published audits of health systems and fewer comprehensive emissions analyses at the clinic or department level.</p><p><strong>Objective: </strong>To quantify the annual GHG emissions from a large outpatient dermatology practice, compare relative sources of emissions, and identify actionable targets.</p><p><strong>Design and setting: </strong>This quality improvement study involving a comprehensive carbon footprint analysis (scopes 1-3) of a large (nearly 30 000 visits/y), outpatient medical dermatology practice within the University of Pennsylvania's academic medical complex was conducted following the GHG Protocol Corporate and Corporate Value Chain reporting standards for fiscal year 2022 (ie, July 2021 through June 2022). Data were obtained through energy metering, manual audits, electronic medical records, and administrative data.</p><p><strong>Exposure: </strong>Data were converted into metric tons of carbon dioxide equivalent (tCO2e), allowing comparison of global-warming potential of emitted GHGs.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes were tCO2e by scope 1 (direct emissions), scope 2 (indirect, purchased energy), and scope 3 (indirect, upstream/downstream sources), as well as by individual categories of emission sources within each scope.</p><p><strong>Results: </strong>Scope 3 contributed most to the clinic's carbon footprint, composing 165.5 tCO2e (51.1%), followed by scope 2 (149.9 tCO2e [46.3%]), and scope 1 (8.2 tCO2e [2.5%]). Within scope 3, the greatest contributor was overall purchased goods and services (120.3 tCO2e [72.7% of scope 3]), followed by patient travel to and from the clinic (14.2 tCO2e [8.6%]) and waste (13.1 tCO2e [7.9%]). Steam and chilled water were the largest contributors to scope 2. Clinic energy use intensity was 185.4 kBtu/sqft.</p><p><strong>Conclusions and relevance: </strong>In this quality improvement study, the composition of emissions at the clinic level reflects the importance of scope 3, paralleling the health sector overall. The lower-resource intensity of the clinic compared to the average energy requirements of the total clinical complex led to a relatively large contribution from scope 2. These findings support efforts to characterize high-yield emissions-reduction targets and allow for identification of actionable, clinic-level steps that may inform broader health system efforts.</p>","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"191-197"},"PeriodicalIF":11.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"C-Reactive Protein and Response to Adalimumab in Patients With Hidradenitis Suppurativa: A Post Hoc Analysis of 2 Randomized Clinical Trials.","authors":"Simon J Gunter, Martina L Porter, Alexa B Kimball","doi":"10.1001/jamadermatol.2024.5146","DOIUrl":"10.1001/jamadermatol.2024.5146","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"221-223"},"PeriodicalIF":11.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methotrexate and Interstitial Lung Disease.","authors":"Anuradha Bishnoi, Surender Singh, Davinder Parsad","doi":"10.1001/jamadermatol.2024.5564","DOIUrl":"10.1001/jamadermatol.2024.5564","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"230-231"},"PeriodicalIF":11.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"JAMA Dermatology.","authors":"","doi":"10.1001/jamadermatol.2024.4052","DOIUrl":"https://doi.org/10.1001/jamadermatol.2024.4052","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":"161 2","pages":"122"},"PeriodicalIF":11.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Immunoglobulin G Levels and Nicastrin Variation in Hidradenitis Suppurativa.","authors":"Dillon Mintoff, Nikolai P Pace","doi":"10.1001/jamadermatol.2024.5684","DOIUrl":"10.1001/jamadermatol.2024.5684","url":null,"abstract":"<p><strong>Importance: </strong>Variation in nicastrin (NCSTN) is associated with a monogenic subtype of hidradenitis suppurativa. Dysregulation of humoral immunity has been suggested as a potential mechanistic link between NCSTN variation and hidradenitis suppurativa. There is a paucity of biomarkers that can predict disease-associated variation.</p><p><strong>Objective: </strong>To investigate whether serum immunoglobulin levels, as a surrogate marker of humoral immunity, can identify individuals with hidradenitis suppurativa who have a specific disease-associated NCSTN variant.</p><p><strong>Design, setting, and participants: </strong>Maltese individuals with hidradenitis suppurativa genotyped for a disease-associated NCSTN in-frame deletion prevalent in the local patient cohort were invited to participate in this cross-sectional study from January to July 2023. Participation was restricted to adult individuals with hidradenitis suppurativa without known or suspected pathologies that would be associated with serum immunoglobulin levels. Data were analyzed between October 2023 and December 2023.</p><p><strong>Exposure: </strong>Serum immunoglobulin G levels and other hematological paraments were analyzed.</p><p><strong>Main outcome and measure: </strong>Main outcomes were the associations between serum immunoglobulin levels and an underlying NCSTN variation in individuals with hidradenitis suppurativa.</p><p><strong>Results: </strong>A total of 125 individuals (64 female individuals [51.2%]) with hidradenitis suppurativa of Maltese ethnicity were recruited in the study, of whom 17 (13.6%) who were from 7 genealogically unrelated families were heterozygous for the disease-associated NCSTN variant. Deletion carriers had a higher serum immunoglobulin G level (1370 mg/dL vs 1140 mg/dL [to convert to g/L, multiply by 0.01]; P < .001). The association between NCSTN variation and elevated immunoglobulin G levels retained significance despite adjusting for multiple confounders, including markers of disease severity, age of recruitment, age of disease onset, treatment with adalimumab, and liver transaminase levels. Serum immunoglobulin G demonstrated a strong discriminatory capacity in identifying patients who were heterozygous for the NCSTN variant.</p><p><strong>Conclusion and relevance: </strong>The results of this cross-sectional study suggest an altered humoral immune state in patients harboring a specific NCSTN variant and support the role of serum immunoglobulin G levels as a potential predictive biomarker of monogenic hidradenitis suppurativa. This may aid in identifying and prioritizing individuals with monogenic hidradenitis suppurativa.</p>","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}