Journal of the European Academy of Dermatology and Venereology最新文献

{"title":"Prolonged drug survival of adalimumab in hidradenitis suppurativa: The importance of early intervention","authors":"Maria Polina Konstantinou, Konstantinos Krasagakis","doi":"10.1111/jdv.20435","DOIUrl":"10.1111/jdv.20435","url":null,"abstract":"<p>PIONEER I and II trials proved the efficacy and safety of adalimumab for moderate-to-severe hidradenitis suppurativa (HS).<span><sup>1</sup></span> When stringent eligibility criteria are applied in randomized trials, the extrapolation of research findings can become problematic, as studied populations lack heterogeneity. The PIONEER trials excluded Hurley stage 1 and ‘difficult’ patients with more than 20 fistulas and those requiring analgesics for HS-related pain.<span><sup>1</sup></span> Upon its approval, however, and as the only available drug in this indication, adalimumab was prescribed to an unselected, sometimes difficult-to-treat population.</p><p>Drug survival is an established endpoint of treatment success in real-world settings, encompassing drug efficacy and safety, cost, convenience, patient satisfaction, disparities in refund policies between countries, and access to care. In this issue, Garbayo-Salmons et al.<span><sup>2</sup></span> present a retrospective, multicentre study with real-world survival data from 539 patients who received at least one dose of adalimumab from May 2015 to December 2022. A pre-pandemic and post-pandemic treatment group were compared, using March 2020 as a time point. The median overall survival of adalimumab was 56.2 (95% CI 51.2 to 80.3) months, which is longer than previous reports.<span><sup>3, 4</sup></span> The drug survival of adalimumab at 12 and 48 months was 82.95% and 58%, respectively, comparable to other indications like psoriasis. The reasons for discontinuation were loss of efficacy (51.69%) and adverse events (21.35%).</p><p>Long-term data from the Open-Label Extension of PIONEER studies showed that 52.3% of HS patients maintained a HiSCR response through Week 168.<span><sup>1</sup></span> Real-life studies have failed, however, until now to reproduce these results.<span><sup>3, 4</sup></span> In 2021, a Dutch dual-center study of 104 patients calculated the median overall survival of adalimumab at 18.1 months [95% CI 11.4–24.8].<span><sup>3</sup></span> In a 2024 Danish nationwide cohort, the median survival of adalimumab barely exceeded 8 months [33 weeks (IQR 16–63)].<span><sup>4</sup></span> Male sex and being bio-naïve predicted prolonged survival.<span><sup>4</sup></span></p><p>It can be difficult to compare drug survival studies. From the authors' standpoint, the longer survival of adalimumab can be attributed to the favourable refund policies of biologics in Spain and to low switching rates due to limited alternatives.<span><sup>2</sup></span> The study by Garbayo-Salmons et al. is the largest to date drug survival study in HS. Studying large, heterogeneous groups of prescribers and patients have been shown to better capture drug interruption thresholds and to provide a more robust representation of real-world practices. The study consisted mainly of bio-naïve patients (95.29%) who are known to better respond to adalimumab.<span><sup>4</sup></span></p><p>In univariate analyses","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 1","pages":"29-30"},"PeriodicalIF":8.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20435","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The power of next-generation-sequencing: A game-changer with limitations","authors":"Alfred Klausegger,&nbsp;Johann W. Bauer","doi":"10.1111/jdv.20433","DOIUrl":"10.1111/jdv.20433","url":null,"abstract":"<p>The article by Baardman et al.<span>¹</span> tackles the power of next-generation sequencing (NGS) in the context of the evolution of genome diagnostics in epidermolysis bullosa (EB), a prototypic group of rare disorders with skin fragility characterized by blistering after minimal trauma with disruption at the dermo-epidermal junction. The authors investigated the utility of NGS in EB diagnostics by systematically evaluating the performance of different types of genome diagnostics based on data from the Dutch EB Registry.</p><p>A basic prerequisite for early prognostication of the disease course, genetic counselling and future gene therapeutic approaches is the exact detection of the disease-causing gene variants in EB and other genodermatoses which is carried out using various methods of genome diagnostics that are currently considered as gold standard. However, skin biopsy and subsequent immunofluorescence mapping may still be valuable. Particularly severe phenotypes of EB often require rapid initial diagnosis and parents might not want to wait for the result of a lengthy NGS procedure. Furthermore, the absence of laminin-332 and collagen VII protein expression at the BMZ can be a more sensitive marker than the type of mutation in laminin-332 genes and in <i>COL7A1</i>, respectively. For example, splice site mutations have unpredictable effects on the open reading frame of mature transcripts and can result in either premature protein truncation (severe) or a partially functional protein (non-severe). Finally, the level of the residual protein expression and the type of gene mutation can have a major impact on patient enrolment in clinical trials for EB molecular therapies.<span>²</span></p><p>NGS refers to a high-throughput nucleotide sequencing method that allows the sequencing of multiple genes in parallel. It has significantly increased the speed of DNA sequencing in genetic diagnostics, making it more accessible for research institutions and clinics. However, despite these advancements, NGS is not without challenges.</p><p>To improve current EB diagnostics and identify all causative variants in EB patients, the development and implementation of additional powerful techniques (e.g. whole-genome-, long-read- and RNA sequencing) and the improvement of bioinformatic data analysis algorithms are necessary.</p><p>Supported by DEBRA Austria.</p><p>None.</p>","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 1","pages":"19-20"},"PeriodicalIF":8.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dermoscopy and reflectance confocal microscopy, a synergistic approach: The (very) difficult differential diagnosis of flat solitary unpigmented lesions demonstration","authors":"Luc Thomas,&nbsp;Félix Pham","doi":"10.1111/jdv.20422","DOIUrl":"10.1111/jdv.20422","url":null,"abstract":"&lt;p&gt;Diagnosis of solitary flat unpigmented skin lesions is a challenge since, aside many benign counterparts, these lesions, most often tumours, may correspond to several skin cancers including melanoma.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Moreover, dermoscopy (DS) of totally unpigmented tumours, at the noticeable exception of vascular tumours and unlike pigmented ones, relies on indirect criteria.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; These may be reflecting either the volumetric impact of the tumour on normal vessels of the dermal papilla (hairpin-like vessels, coma like vessels, dotted vessels, glomerular vessels) or of the superficial sub epidermal horizontal plexuses (arborizing and coronal vessels) or the presence of a neo-vascularization produced by the stroma of the tumour (so called ‘atypical vascular patterns’ encompassing milky red areas, serpentine vessels and polymorphic vessels). Needless to say that these two categories of indirect vascular symptoms are neither specific of any pathological entity (at the remarkable exception of clear cell acanthoma maybe, that does not represent a major public health problem anyway) nor of a nosographic category of lesion (erythema, benign or malignant tumour). In vivo reflectance confocal microscopy (RCM) adds to diagnostic accuracy yet its additional benefit compared with dermoscopy alone was not clearly demonstrated by a systematic review.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The originality of the study by Spadafora et al.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; published in this issue was to combine DS + RCM in order to compensate one-another the possible insufficiencies, inherent to these two techniques themselves, in the difficult differential diagnosis of amelanotic or hypomelanotic flat skin tumours. The reader will find in their text that this approach was successful and that further work is planned to validate their model. There is no need to develop this point here.&lt;/p&gt;&lt;p&gt;More interestingly in our view for an editorial comment, the reasons for such a synergy could be worth the trial for some speculations in order to propose a potential list of similarly promising combined approaches in other difficult diagnostic challenges in tumoral as well as inflammatory dermatology. Spadafora et al. underlined that, in the studied situation, DS was particularly efficient in disclosing papillary and reticular dermis ‘architectural’ changes mainly affecting the red dermoscopy chromophore (i.e. haemoglobin containing cells in vessels) that was more difficult to appreciate within the RCM narrow fields. On the opposite, RCM was adding a ‘cellular level’ by evidencing lightly pigmented or unpigmented cells lacking by definition the black chromophore (i.e. melanin) that could have revealed them to the eye of the dermoscopy examiner. Synergistic approaches of these two non-invasive skin-imaging techniques can certainly be extrapolated from their findings in many other conditions including the difficult differential diagnosis of mycosis fungoides or of ","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 1","pages":"21-22"},"PeriodicalIF":8.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultraviolet-induced fluorescence dermoscopy improves the differential diagnosis in the field of general dermatology","authors":"Dimitrios Ioannides,&nbsp;Ilias Papadimitriou","doi":"10.1111/jdv.20436","DOIUrl":"10.1111/jdv.20436","url":null,"abstract":"&lt;p&gt;The use of UV-light, as a diagnostic tool for dermatologists, dates to the eve of the previous century. In its 100 years of existence the small, mobile and easy-to-use Wood's lamp has proven to be a valuable contribution to the diagnosis of pigmented skin disorders, infections of the skin, porphyria and non-melanoma skin cancer.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;On the other hand, dermoscopy has been established as a necessary part of the clinical evaluation of pigmented and non-pigmented skin tumours, as well as of inflammatory and infectious diseases of the skin. The ability of dermoscopy to reveal morphological structures, which could not be identified by the naked eye or a magnifying lens, can improve the recognition of any skin eruption in daily practice.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In inflammatory and infectious entities, however, the main dermoscopic features do not result from the deposition of pigment, like in skin tumours, but from certain histologic alterations. These include cellular infiltrations, vascular structures and alterations of the thickness or the anatomy of the epidermis, findings that could not easily be detected by the common light-based dermoscopy. Therefore, the use of a dermatoscope with polarized light that preserves these morphological features, especially of those of vessels, is necessary when applying dermoscopy in general dermatology.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;After the application of polarized dermoscopy, the combination of the ultraviolet light use, ‘borrowed’ by the Wood's lamp, with the hand-held dermatoscope was a natural evolution. In this study,&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Enzo Erricheti, Pawel Pietkiwicz, Yasmeen Bhat, et al. moved forward and compared the accuracy of the polarized light-based dermoscopic findings with the UV-induced fluorescent dermoscopic features (UVF dermoscopy) in the diagnosis of general dermatologic disorders in 208 patients. The application of UVF dermoscopy has the advantage, as compared to wood light, that a darkened room is not necessary to perform the diagnostic procedure.&lt;/p&gt;&lt;p&gt;The dermatoses included in the study were foot intertrigo, intertrigo of major creases, papulopustular acne, malassezia folliculitis, papulosquamous dermatoses and hypopigmented macular dermatoses of the trunk. UVF dermoscopy was found to show the finding with the highest D-OR value in nine out of 17 analysed dermatoses, including pseudomonas, &lt;i&gt;Corynebacterium&lt;/i&gt; and dermatophytic foot intertrigo, erythrasma, candidiasis, acne, Malassezia folliculitis, macular hypomelanosis and achromic pityriasis versicolor. Additionally, the most accurate feature on polarized dermoscopy was seen in inverse psoriasis, tinea of the major creases, guttate psoriasis, lichen planus, pityriasis rosea and lichenoides chronica, idiopathic guttate hypomelanosis and vitiligo.&lt;/p&gt;&lt;p&gt;One other interesting finding of this study is that UVF dermoscopy may offer substantial evidence for the diagnosis in clinical scenarios, i","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 1","pages":"15-16"},"PeriodicalIF":8.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing existing gaps in the management of young adults with atopic dermatitis","authors":"Magdalena Trzeciak,&nbsp;Weronika Zysk","doi":"10.1111/jdv.20437","DOIUrl":"10.1111/jdv.20437","url":null,"abstract":"&lt;p&gt;The research by Carmanius et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; analyse drug utilization among young adults with atopic dermatitis (AD) providing valuable insights into important gaps.&lt;/p&gt;&lt;p&gt;The study revealed that nearly half of young adults with AD were undertreated or completely untreated.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; It is particularly concerning that none of them received the recommended emollient amounts, and only less than five were dispensed sufficient topical corticosteroids (TCS).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Patients were dispensed an average per month of only 40 grams of emollients and 5.65 grams of TCS&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; – much below recommended monthly amounts of 60–90 grams for TCS and 1000 grams for emollients.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The fact that none of these patients received the recommended amount of emollients indicates a critical gap in primary care, as emollients are the foundation of every step of AD treatment.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Moreover, more patients with moderate-to-severe AD received emollients than those with mild AD&lt;sup&gt;1&lt;/sup&gt; suggesting patients only use emollients during flares rather than daily, diverging from guidelines.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The underuse of TCS reveals a broader issue, as sufficient dosage, together with appropriate potency, and correct application is key to effective topical anti-inflammatory therapy.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Inadequate topical treatment could lead to disease progression and more harder-to-treat cases of AD. Since the study focused only on dispensed medications, patients may have received a prescription but did not have it dispensed, what the authors emphasized.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Hence, the underutilization of treatments may result from either the patient's side—such as a lack of understanding of the medication's importance and low treatment adherence—or the physician's side, such as a lack of patient education or failure to adhere to treatment guidelines.&lt;/p&gt;&lt;p&gt;Interestingly, men were more likely to be dispensed TCS than women.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Perhaps gender plays a role, or there are differences in disease severity. Men more often experience severe forms of AD than women.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; However, the current study did not find any gender differences in disease severity,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; suggesting other involved factors. Topical corticosteroid phobia is common among AD patients,&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; which could make women more hesitant to use TCS. This indicates an unmet need for personalized care that addresses patients' medication concerns to improve adherence. Conversely, the study showed that women more often than men were dispensed systemic corticosteroids (SCS).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; This raises questions about whether women seek treatment more actively or if treatment patterns differ by gender due to healthcare providers' or patient preferences. To understand this phenomenon, further investigation is needed.&lt;/p&gt;&lt;p&gt;Moreove","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 1","pages":"31-32"},"PeriodicalIF":8.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20437","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Eczema Area and Severity Index: An important update on validity and reliability","authors":"Laura B. von Kobyletzki,&nbsp;Åke Svensson","doi":"10.1111/jdv.20415","DOIUrl":"10.1111/jdv.20415","url":null,"abstract":"&lt;p&gt;Atopic dermatitis (AD) is a common chronic inflammatory disease that places a large burden on the patients, their families and society.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;For all clinical trials for AD, the Harmonizing Outcome Measures for Eczema (HOME) initiative recommended the Eczema Area and Severity Index (EASI) for assessing signs of AD.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; An objective measure to evaluate treatment effect is usually required from regulatory agencies. EASI is therefore commonly used in addition to instruments which assess other domains such as symptoms, control of AD and quality of life.&lt;/p&gt;&lt;p&gt;Recently, EASI has been recommended for clinical practice and is used in numerous AD registries globally.&lt;/p&gt;&lt;p&gt;The study of Jacobson et al.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; summarizes the current evidence of the validity and reliability of EASI, assessing all relevant measurement properties across different populations. The authors have conducted this important work in a methodologically excellent manner. Their research adheres to COSMIN&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; guidelines for patient-reported outcome measures.&lt;/p&gt;&lt;p&gt;The study of Jacobson et al.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; is therefore of great importance, as the worldwide widespread use of the EASI requires in depth knowledge of its validity across varying groups of individuals with AD, as well as awareness of the possible limitations in certain populations in order to ensure correct interpretation of outcomes.&lt;/p&gt;&lt;p&gt;Despite the initial selection of EASI by the HOME group, the need of further validation studies had been pointed out.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; For example, there was a lack of evidence on the interpretability and feasibility of EASI.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The recent paper by Jacobson et al.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; explores whether these questions still persist; and answer new occurring questions about the validity in varying groups of individuals with AD defined by severity, age and skin phototype.&lt;/p&gt;&lt;p&gt;In severe AD, EASI is considered as valid, while in mild AD, changes in severity might be difficult to assess.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; In mild AD, the measurement error was greater than the MIC and a floor effect has been observed in this subset of patients with mild AD. For individuals with melanin-rich skin, further validation studies might be needed to correctly calculate and interpret the EASI, as the current evidence is still limited although promising. Questions pertain regarding the interpretability of the EASI. Although evaluated in studies with excellent study design, variations in severity strata across different studies suggest that the interpretation of EASI might benefit from further studies for developing strata. EASI is generally considered feasible, especially when performed by trained investigators. The increasing use of EASI in clinical trials, clinical practice and registries has created a demand for technological adaptations and applications.&lt;/p&gt;&lt;p&gt;The findings of the ","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 1","pages":"11-12"},"PeriodicalIF":8.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20415","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing diagnostic precision in dermatology: A new standardized lexicon for skin neoplasms","authors":"Mariano Suppa,&nbsp;Elisa Cinotti","doi":"10.1111/jdv.20438","DOIUrl":"10.1111/jdv.20438","url":null,"abstract":"&lt;p&gt;We read with great interest the article by Scope et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The study, performed by experts from the International Skin Imaging Collaboration (ISIC), addresses a critical need in dermatology: the development of a standardized terminology for skin neoplasms. As diagnostic challenges increase with advances in artificial intelligence (AI) and molecular pathology, a common lexicon is essential for clinical communication, research and AI model training. By using a modified Delphi consensus approach, the authors have created a comprehensive, hierarchically organized system of diagnostic terms for skin neoplasms, which offers substantial implications for clinical practice and future AI applications.&lt;/p&gt;&lt;p&gt;Historically, dermatology has lacked a unified terminology for skin neoplasms, which complicates diagnoses, especially when benign, malignant and indeterminate lesions share overlapping features. With the increasing use of AI in dermatology, precise and consistent terminology is more important than ever. Structured data is essential for training AI algorithms, and imprecise terms could hinder their effectiveness. A standardized lexicon enhances clinical communication, facilitates research and underpins the development of accurate AI diagnostic tools.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The authors employed a modified Delphi process, gathering input from 18 experts across three rounds to refine a comprehensive set of proposed terms: during this process, the authors could suggest modifying, deleting or adding terms. This iterative approach ensures broad agreement and flexibility in incorporating expert insights. The hierarchical mapping of terms into 3 super-categories (i.e. ‘benign’, ‘malignant’ and ‘indeterminate’) and cellular/tissue-differentiation categories (e.g. ‘melanocytic’ and ‘keratinocytic’) increases the utility of the system for clinical and research settings, providing a framework for AI systems and clinical decision support.&lt;/p&gt;&lt;p&gt;Overall, 94% of the 379 proposed terms reached agreement in the first round, which demonstrates the reliability of the process. Most terms requiring further refinement belonged to the ‘indeterminate’ super-category (which displayed by far the lower agreement among the experts), signalling the complexity of certain diagnoses and the need for continued refinement. Importantly, this process underscores the need for a dynamic, adaptable system that can evolve alongside new scientific findings and clinical practices.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; The final taxonomy includes 362 terms, mapped to the 3 super-categories and 41 cellular/tissue-differentiation categories. The structure offers a comprehensive classification of skin neoplasms, ranging from benign conditions like seborrheic keratosis to malignant ones such as melanoma. We feel that one of the advantages of the study was the use of the ‘intermediate’ super-category, contrary to many previous investigations on skin neoplasm diagnosis that empl","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 1","pages":"33-34"},"PeriodicalIF":8.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20438","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contact allergy may enhance further sensitization to new chemicals, but individual susceptibility traits are important for polysensitization","authors":"Margarida Gonçalo","doi":"10.1111/jdv.20434","DOIUrl":"10.1111/jdv.20434","url":null,"abstract":"&lt;p&gt;Polysensitization occurs in a significant number of individuals with allergic contact dermatitis (ACD) and is usually associated with a higher impact on patient's quality of life.&lt;/p&gt;&lt;p&gt;Mechanisms underlying polysensitization are not completely understood. T-cell sensitization to an exogenous chemical is highly specific, but some individuals get sensitized to new allergens, either chemically related allergens (cross-reactivity) or non-related chemicals.&lt;/p&gt;&lt;p&gt;Polysensitization in contact allergy, defined as sensitization to three or more non-related allergens revealed by positive patch tests within the baseline series,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; occurs in 5%–12% of regularly patch tested patients, depending on patient selection and the extent of the baseline series. Pesqué et al.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; also found 8.34% of polysensitized patients among 10,176 patients patch tested with the Spanish baseline series, even though some of the clusters of allergens found possibly represent cross-reactivity. In highly sensitized individuals, T-cell receptors may recognize similar chemicals, as &lt;i&gt;p&lt;/i&gt;-phenylenediamine (PPD) from hair dyes, isopropyl-PPD from black rubber and the local anaesthetic benzocaine, all sharing amine groups at the para position on a benzene ring.&lt;/p&gt;&lt;p&gt;Polysensitization occurs typically when individuals get sensitized and develop ACD from chemically distinct allergens, for instance due to concomitant or sequential exposure in the same setting. Also, when a new allergen is applied in inflamed skin (irritant contact dermatitis, stasis dermatitis, chronic hand dermatitis), dendritic cells may already be in an ‘alert’ state, they express high levels of adhesion and co-stimulatory molecules and produce relevant cytokines that enhance antigen presentation. This may explain the high frequency of polysensitization in patients with leg or hand dermatitis, who have epidermal barrier disruption that favours allergen penetration and skin inflammation that enhances antigen presentation.&lt;/p&gt;&lt;p&gt;Polysensitized individuals may also have a particular genetic susceptibility. Initial studies have shown they are more easily sensitized to experimental allergens, like DNCB, and have a lower reactivity threshold. More recent studies have shown the predominance of the TNFα 308G&gt;A polymorphism&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; associated with high production of TNF-alfa, which may occur within the innate response of keratinocytes to allergens, and this cytokine is important to activate dendritic cells and enhance their migration to lymph nodes for antigen presentation. Other studies found association between polysensitization and polymorphisms of IL16, a chemoattractant to dendritic and T cells, or the chemokine CXCL11, important for T-cell chemotaxis.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Also, the higher frequency of atopic dermatitis and filaggrin mutations among polysensitized patients suggests other genetic traits within the innate or acquired immune response t","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 1","pages":"17-18"},"PeriodicalIF":8.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20434","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pioneers in Dermatology and Venereology: An interview with Professor Sabine Werner","authors":"Sabine Werner","doi":"10.1111/jdv.20426","DOIUrl":"10.1111/jdv.20426","url":null,"abstract":"&lt;p&gt;Year of birth: 1960&lt;/p&gt;&lt;p&gt;1980–1986:\tUndergraduate student in Biochemistry, Eberhard Karls University, Tübingen, Germany&lt;/p&gt;&lt;p&gt;November 1989:\tPhD in Cell and Molecular Biology, Ludwig Maximilian University, Munich, Germany&lt;/p&gt;&lt;p&gt;July 1995:\tHabilitation in Biochemistry, Ludwig Maximilian University, Munich, Germany&lt;/p&gt;&lt;p&gt;1986–1989:\tPhD student, Max Planck Institute of Biochemistry, Martinsried, Germany&lt;/p&gt;&lt;p&gt;1989–1990:\tPostdoctoral fellow, Max Planck Institute of Biochemistry, Martinsried, Germany&lt;/p&gt;&lt;p&gt;1990–1992:\tPostdoctoral fellow, University of California, San Francisco, USA&lt;/p&gt;&lt;p&gt;1992–1999:\tHead of a research group, Max Planck Institute of Biochemistry, Martinsried, Germany&lt;/p&gt;&lt;p&gt;1995–1999:\tAssociate Professor of Biochemistry, Department of Chemistry and Pharmacy, Ludwig Maximilian University, Munich, Germany&lt;/p&gt;&lt;p&gt;1996–1999:\tHermann-and-Lilly-Schilling-Professor of Medical Research&lt;/p&gt;&lt;p&gt;Since 1999:\tFull Professor of Cell Biology, ETH Zurich, Switzerland&lt;/p&gt;&lt;p&gt;Since 10/2022:\tChair, Department of Biology, ETH Zurich&lt;/p&gt;&lt;p&gt;1987:\tKékulé fellowship from the ‘Verband der Chemischen Industrie’&lt;/p&gt;&lt;p&gt;1990:\tOtto Hahn Medal from the Max Planck Society&lt;/p&gt;&lt;p&gt;1994:\tWound Healing Society Young Investigator Award&lt;/p&gt;&lt;p&gt;1995:\tHermann und Lilly Schilling Professorship for Medical Research&lt;/p&gt;&lt;p&gt;1998:\tPfizer Academic Award&lt;/p&gt;&lt;p&gt;2002:\tGerman Surgical Society Wound Healing Award&lt;/p&gt;&lt;p&gt;2003:\tResearch Award from the AETAS Foundation&lt;/p&gt;&lt;p&gt;2008:\tCloëtta Award (Stiftung Prof. Dr. Max Cloëtta)&lt;/p&gt;&lt;p&gt;2009:\tRené Touraine Lecture at the European Society for Dermatological Research Annual Meeting&lt;/p&gt;&lt;p&gt;2009:\tCE.R.I.E.S. Research Award for Achievements in Dermatological Research&lt;/p&gt;&lt;p&gt;2010:\t30th Alfred Marchionini Memorial Lecture&lt;/p&gt;&lt;p&gt;2011:\tElected Member of the Leopoldina (German Academy of Sciences)&lt;/p&gt;&lt;p&gt;2012:\tElected EMBO (European Molecular Biology Organization) member&lt;/p&gt;&lt;p&gt;2012:\tCharles Lapière Memorial Lecture at the Annual Meeting of the European Tissue Repair Society&lt;/p&gt;&lt;p&gt;2014:\tDistinguished Scientist, Blaffer Lecture Series, Houston, Texas&lt;/p&gt;&lt;p&gt;2014:\t‘Golden Owl’ for best teaching in the Department of Biology, ETH Zurich (selected by students)&lt;/p&gt;&lt;p&gt;2017:\tSpark Award for the most promising invention at ETH Zurich in 2016&lt;/p&gt;&lt;p&gt;2017:\tErnst Klenk Lecture, Ernst Klenk Symposium, Cologne&lt;/p&gt;&lt;p&gt;2019:\t‘Golden Owl’ for best teaching in the Department of Biology, ETH Zurich (selected by students)&lt;/p&gt;&lt;p&gt;2019:\tFEBS National Lecture (70th Ann. Conf. of the Hellenic Society of Biochemistry and Mol. Biol.)&lt;/p&gt;&lt;p&gt;2020:\tElected Member of the European Academy of Sciences (EURASC)&lt;/p&gt;&lt;p&gt;2024:\tElected Honorary Member of the Schweizerische Gesellschaft für Dermatologie und Venerologie (SGDV)&lt;/p&gt;&lt;p&gt;More than 380 invited lectures.&lt;/p&gt;&lt;p&gt;As a PhD student I worked on Kaposi's sarcoma, a tumour that occurs mainly in AIDS patients and strongly affects the skin. I characterized the growth factors that control the proliferation of Kaposi's sarcoma tumour cells and the microenv","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 1","pages":"35-38"},"PeriodicalIF":8.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Private equity in dermatology: A cloud on the horizon of quality care?","authors":"Sarah Walsh,&nbsp;Edward Seaton","doi":"10.1111/jdv.20272","DOIUrl":"10.1111/jdv.20272","url":null,"abstract":"&lt;p&gt;In this edition of the Journal, authors from the United States (US) and Denmark tell a cautionary tale of the entry of private equity (PE) into the field of dermatology practice in the United States.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The last 10 years has seen a growing interface between external investors and dermatology clinics in North America. This represents a departure from the traditional model of physician-owned and operated practices, still the norm in Europe.&lt;/p&gt;&lt;p&gt;The administrative burden of managing all aspects of a dermatology practice may be onerous, and the prospect of being relieved of this an attractive one. A professional investment company may bring expertise in management, human resources, information technology and economies of scale that would be beyond the individual or small group practitioner. Investors may also bring capital to enable expansion of services and acquisition of new technologies. The clinician may be given the impression that they are freed from the burden of practice management to focus on patient care, and furthermore may even be financially incentivized to sell as a part-owner of a clinic.&lt;/p&gt;&lt;p&gt;However, the ‘dark side’ of this financial moon is the focus on profits that such investors bring to clinical enterprise. With a responsibility for returns on investment, the priority of PE is money-making, and not clinical or focussed on academic excellence and training.&lt;/p&gt;&lt;p&gt;A typical PE acquisition involves a series of short-term investments lasting perhaps 4–7 years. PE firms often consolidate clinics into chains and try to maximize profits, typically by making economies of scale or by cutting costs. The ultimate goal of the PE investor is to then ‘flip’, meaning sell, the business and make profits for shareholders. This focus on profits is illustrated by one study comparing 204 hospitals acquired by private equity between 2005 and 2027, and 532 control hospitals without PE backing, it was found that PE acquisition was associated with higher annual net income and higher hospital charges.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;This divergence of focus between clinicians and financial backers results in negative changes to practice, of which several examples are given by Oscherwitz et al. The most striking is a shift in the proportion of cosmetic work in PE clinics—40% compared to 20% in non-PE clinics. This reduction in time devoted to medical or oncological dermatology may yield a healthier balance sheet, but suggests that less clinician resource is being directed to patients with genuine need.&lt;/p&gt;&lt;p&gt;Staffing costs are one of the greatest areas of expenditure for dermatology practices. Those working in a PE clinic may face pressures to increase patient throughput, with shorter appointment times. Clinical work may be reallocated the less-qualified practitioners such as Physician Associates.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; This creates a double threat: first, a reduction in accuracy of diagnosis and treatment, in a hurried consult","PeriodicalId":17351,"journal":{"name":"Journal of the European Academy of Dermatology and Venereology","volume":"39 1","pages":"9-10"},"PeriodicalIF":8.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.20272","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}