JAMA dermatology最新文献

{"title":"Mendelian Randomization for Dermatology Research.","authors":"Gary Hettinger, David J Margolis, Nandita Mitra","doi":"10.1001/jamadermatol.2024.6068","DOIUrl":"10.1001/jamadermatol.2024.6068","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"328-329"},"PeriodicalIF":11.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189499","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":"Imiquimod Cream Preceded by Superficial Curettage vs Surgical Excision for Nodular Basal Cell Carcinoma: A Secondary Analysis of a Randomized Clinical Trial.","authors":"Babette J A Verkouteren, Patty J Nelemans, Kelly A E Sinx, Nicole W J Kelleners-Smeets, Véronique J L Winnepenninckx, Aimée H M M Arits, Klara Mosterd","doi":"10.1001/jamadermatol.2024.5572","DOIUrl":"10.1001/jamadermatol.2024.5572","url":null,"abstract":"<p><strong>Background: </strong>Interest in noninvasive treatment of basal cell carcinoma (BCC) has been increasing. For superficial BCC, it has been demonstrated that imiquimod cream, 5%, has high long-term efficacy, but for nodular BCC (nBCC), long-term evidence is sparse.</p><p><strong>Objectives: </strong>To evaluate whether superficial curettage (SC) followed by imiquimod cream, 5%, is noninferior to surgical excision (SE) in nBCC after 5 years of treatment.</p><p><strong>Design, setting, and participants: </strong>In this secondary analysis of the noninferiority Surgery Versus Combined Treatment With Curettage and Imiquimod for Nodular Basal Cell Carcinoma (SCIN) randomized clinical trial, patients with a primary nBCC of 4 to 20 mm were assigned to either SC plus imiquimod, 5%, or SE between January 1, 2016, to November 30, 2017, at 2 outpatient dermatology departments in the Netherlands. The primary outcome of the SCIN trial was the 1-year probability of remaining free from treatment failure; the prespecified secondary trial outcomes were the probability after 5 years of follow-up, completed September 7, 2022. Both an intention-to-treat analysis and per-protocol analysis were planned.</p><p><strong>Intervention: </strong>SC plus imiquimod vs SE.</p><p><strong>Main outcomes and measures: </strong>The 5-year probability of remaining free from treatment failure (ie, freedom from recurrence; with 95% CI) was estimated with Kaplan-Meier analysis using data on treatment response from 3 planned follow-up visits at 3 months and 1 and 5 years after the end-of-treatment date. Additional analyses accounting for death as competing risk were also performed.</p><p><strong>Results: </strong>A total of 145 patients (77 [53.1%] male; median age, 68 [IQR, 31-89] years) with a primary, histologically proven nBCC were randomized to treatment with SC plus imiquimod (n = 73) or SE (n = 72). In total, 15 treatment failures occurred in the SC plus imiquimod group (5 treatment failures occurred between 1 and 5 years after treatment) and 1 in the SE group. The 5-year probability of remaining free from treatment failure was 77.8% (95% CI, 65.7%-86.0%) after SC plus imiquimod and 98.2% (95% CI, 88.0%-99.8%) after SE. The relative risk of treatment failure was 15.93 (95% CI, 2.10-120.64). The 95% CI does not exclude the noninferiority margin of 5.22. Death due to causes unrelated to BCC occurred in 20 patients, and the subhazard ratio from competing risk regression was 16.16 (95% CI, 2.18-119.72).</p><p><strong>Conclusions: </strong>This secondary analysis of a randomized clinical trial found that although it cannot be concluded that SC plus imiquimod is noninferior to SE, SC plus imiquimod was substantially less effective at 5 years after treatment. Most treatment failures occurred in the first year after treatment, and the probability of tumor-free survival 5 years after treatment with SC plus imiquimod was still 77.8%. The information in this trial can be used to c","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"299-304"},"PeriodicalIF":11.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059045","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":"Outpatient Dermatology Productivity Measures by Patient Race, Sex, and Age.","authors":"Lauren A V Orenstein, John S Barbieri, Meron Siira, Ethan Borre, Krittin J Supapannachart, Eric Viera, Courtney Ann Prestwood, Robert Swerlick, Rachel E Patzer, Suephy C Chen","doi":"10.1001/jamadermatol.2024.5286","DOIUrl":"10.1001/jamadermatol.2024.5286","url":null,"abstract":"<p><strong>Importance: </strong>Clinical productivity measures may incentivize clinical care to specific patient populations and thus perpetuate inequitable care. Before the 2021 Medicare physician fee schedule changes, outpatient dermatology encounters for patients who were younger, female, and races other than White systematically generated fewer work relative value units (wRVUs).</p><p><strong>Objective: </strong>To examine the association of patient race, age, and sex with wRVUs generated by outpatient dermatology encounters after 2021.</p><p><strong>Design, setting, and participants: </strong>This multi-institutional cross-sectional study evaluated demographic and billing data for outpatient dermatology encounters across 3 academic dermatology practices. The study compared wRVUs generated by outpatient general dermatology encounters in 6-month periods before and after the 2021 fee schedule updates (March 1 to August 31, 2019, and March 1 to August 31, 2021). Eligibility required an age of 18 years or older and available age, race, and sex data. Data analysis was performed from September 2022 to March 2024.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was wRVUs generated per encounter.</p><p><strong>Results: </strong>This study included 89 656 encounters (47 607 before the 2021 Medicare physician fee schedule update and 42 049 after the update). Across all encounters, the mean (SD) patient age was 56.3 (17.8) years; 55 460 encounters (61.9%) were with female patients and 34 196 (38.1%) were with male patients; and 3457 encounters (3.9%) were with Asian patients, 10 478 (11.7%) with Black patients, 72 894 (81.3%) with White patients, and 2287 (3.2%) with patients of other race or ethnicity (Latino and multiracial). The mean (SD) wRVUs per outpatient dermatology encounter was 1.44 (0.88) before the update and 1.80 (0.99) after (P < .001). After 2021, adjusted analyses demonstrated significantly fewer wRVUs per encounter for female (β, -0.11; 95% CI, -0.13 to -0.10) compared with male patients, and for younger (β, 0.04 [95% CI, 0.04 to 0.05] per 10-year increase in age) compared with older patients. After the update, compared with White patients, visits with Asian patients generated fewer wRVUs (β, -0.12; 95% CI, -0.17 to -0.08) as did visits with Black patients (β, -0.14; 95% CI, -0.17 to -0.11), both statistically significant reductions compared with prior comparisons (P < .001 for both). After 2021, mediation analysis identified that premalignant destructions and biopsies mediated many of the remaining differences in wRVU generation by patient age, race, and sex.</p><p><strong>Conclusions and relevance: </strong>This study found that after the 2021 Medicare fee schedule updates, there was a persistent, albeit reduced, gap between wRVU productivity in outpatient dermatology visits for Asian and Black compared with White patients. These persisting differences were attributable to skin biopsies and cryotherapy of premal","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"274-280"},"PeriodicalIF":11.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877264","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":"Hidradenitis Suppurativa Surgery Complication Rates Among Patients With Obesity or Diabetes or Who Smoke: A Review.","authors":"Rayad B Shams, Christopher J Sayed","doi":"10.1001/jamadermatol.2024.5731","DOIUrl":"10.1001/jamadermatol.2024.5731","url":null,"abstract":"<p><strong>Importance: </strong>Surgery is frequently required for hidradenitis suppurativa (HS) treatment, but the impact of common comorbidities such as obesity, diabetes, and smoking on outcomes has been sparsely studied.</p><p><strong>Observations: </strong>A total of 12 studies met final inclusion criteria for investigating complication rates associated with at least 1 comorbidity. Complication rates were associated with obesity in 3 of 10 studies. Obesity was modestly associated with dehiscence and readmission for flap reconstruction, debridement, and skin-grafting techniques in one study, dehiscence in a second, and delayed wound healing in another. One of 5 studies that reported complication rates in patients with diabetes found increased hospital readmissions for debridement (deroofing or excision without flap/graft) and flap reconstruction. No studies evaluating smoking found increased associated risks.</p><p><strong>Conclusions and relevance: </strong>This review highlights a greater need for consistent analysis and reporting of the surgical outcomes among patients with HS and certain comorbidities. Further rigorous clinical trials are needed to validate these findings and improve access to surgery in this patient population.</p>","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"315-319"},"PeriodicalIF":11.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059085","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":"Nevus Anemicus.","authors":"Xuemei Lan, Xiaopo Wang","doi":"10.1001/jamadermatol.2024.6031","DOIUrl":"10.1001/jamadermatol.2024.6031","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"322-323"},"PeriodicalIF":11.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399183","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":"Comments on Consensus for Generalized Pustular Psoriasis-Reply.","authors":"Siew Eng Choon, Peter van de Kerkhof, Hervé Bachelez","doi":"10.1001/jamadermatol.2024.6061","DOIUrl":"10.1001/jamadermatol.2024.6061","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"341-342"},"PeriodicalIF":11.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005519","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":"Disseminated Pseudovesicles in an Immunocompromised Patient.","authors":"William J Nahm, Michelle C Juarez, Daniel R Mazori","doi":"10.1001/jamadermatol.2024.5875","DOIUrl":"10.1001/jamadermatol.2024.5875","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"324-325"},"PeriodicalIF":11.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005520","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":"An Enlarging Painless Nodule on a Man's Index Finger.","authors":"Sophie Diong, Niamh Leonard, Jennifer M E Boggs","doi":"10.1001/jamadermatol.2024.6242","DOIUrl":"10.1001/jamadermatol.2024.6242","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"326-327"},"PeriodicalIF":11.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189493","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 Editorial Fellowship-What We Have Learned.","authors":"Maria Teresa García-Romero, Andrea D Maderal","doi":"10.1001/jamadermatol.2024.6471","DOIUrl":"10.1001/jamadermatol.2024.6471","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"243-244"},"PeriodicalIF":11.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399182","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":"Epistasis of ERAP1 With 4 Major Histocompatibility Complex Class I Alleles in Frontal Fibrosing Alopecia: A Genome-Wide Association Study Meta-Analysis.","authors":"Tuntas Rayinda, Nick Dand, Sheila M McSweeney, Evangelos Christou, Chuin Ying Ung, Catherine M Stefanato, David A Fenton, Matthew Harries, Ioulios Palamaras, Alice Tidman, Susan Holmes, Anastasia Koutalopoulou, Michael Ardern-Jones, Manjit Kaur, Sofia Papanikou, Vasiliki Chasapi, Sergio Vañó-Galvan, David Saceda-Corralo, Ana Melián-Olivera, Carlos Azcarraga-Llobet, Alejandro Lobato-Berezo, Mariona Bustamante, Jordi Sunyer, Michela Valeria Rita Starace, Bianca Maria Piraccini, Isabel Pupo Wiss, Maryanne Makredes Senna, Rashmi Singh, Kathrin Hillmann, Varvara Kanti-Schmidt, Ulrike Blume-Peytavi, John A McGrath, Michael A Simpson, Christos Tziotzios","doi":"10.1001/jamadermatol.2024.6434","DOIUrl":"10.1001/jamadermatol.2024.6434","url":null,"abstract":"<p><strong>Importance: </strong>Frontal fibrosing alopecia (FFA) is an inflammatory and scarring form of hair loss of increasing prevalence that most commonly affects women. An improved understanding of the genetic basis of FFA will support the identification of pathogenic mechanisms and therapeutic targets.</p><p><strong>Objective: </strong>To identify novel genomic loci at which common genetic variation affects FFA susceptibility and assess nonadditive effects on genetic risk between susceptibility loci.</p><p><strong>Design, setting, and participants: </strong>Four genome-wide association studies were combined using an SE-weighted meta-analysis. Within the major histocompatibility complex (MHC) locus, stepwise conditional analysis was undertaken to determine independently associated classical MHC class I alleles. Statistical tests for epistatic interaction were performed between risk alleles at the MHC and endoplasmic reticulum aminopeptidase 1 (ERAP1) loci.</p><p><strong>Main outcomes and measures: </strong>Genome-wide significant locus associated with FFA and nonadditive effects on genetic risk between susceptibility loci.</p><p><strong>Results: </strong>Of 6668 included patients, there were 1585 European female individuals with FFA and 5083 controls. Genome-wide significant associations were identified at 4 genomic loci, including a novel susceptibility locus at 5q15, and the association signal could be fine-mapped to a single nucleotide substitution (rs10045403) in the 5' untranslated region of ERAP1 (rs10045403; odds ratio, 1.30; 95% CI, 1.19-1.43; P = 3.6 × 10-8). Within the MHC, FFA risk was statistically independently associated with HLA-A*11:01, HLA-A*33:01, HLA-B*07:02, and HLA-B*35:01. FFA risk was affected by genetic variation at the ERAP1 locus only in individuals who carried at least 1 of the MHC class I risk alleles.</p><p><strong>Conclusions and relevance: </strong>In this genome-wide meta-analysis, a supra-additive effect of genetic variation was found that affected peptide trimming and antigen presentation on FFA susceptibility. Patients with FFA may benefit from emerging therapeutic approaches that modulate ERAP-mediated processes.</p>","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"310-314"},"PeriodicalIF":11.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399171","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}