Australasian Journal of Dermatology最新文献

{"title":"Cost-utility of sirolimus in the treatment of vascular malformations.","authors":"Grace Xiaoying Li, Deshan Frank Sebaratnam","doi":"10.1111/ajd.14369","DOIUrl":"https://doi.org/10.1111/ajd.14369","url":null,"abstract":"<p><p>Sirolimus is being increasingly employed to manage specific vascular anomalies. We performed an exploratory cost-utility analysis to evaluate sirolimus as a treatment for vascular malformations from the Australian healthcare system perspective. Over a one-year time horizon, sirolimus treatment was associated with an increased expenditure of AU$2832.80 and a gain of 0.08 quality-adjusted life years (QALYs) when compared to supportive care, resulting in an incremental cost-effectiveness ratio of AU$35,410/QALY. By most metrics, sirolimus would be considered a cost-effective treatment for vascular malformations.</p>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in non-invasive imaging for dermatofibrosarcoma protuberans: A review.","authors":"Yanci A Algarin, Anika Pulumati, Jiali Tan, Nathalie C Zeitouni","doi":"10.1111/ajd.14366","DOIUrl":"https://doi.org/10.1111/ajd.14366","url":null,"abstract":"<p><p>Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma characterized by an asymmetric, infiltrative growth pattern and a high risk of local recurrence. This study aims to evaluate the effectiveness of various imaging modalities in the assessment and management of DFSP. Nine imaging modalities were reviewed including: Ultrasound (US), High-Frequency Doppler Ultrasound (HFUS), Computed tomography (CT), Positron emission tomography-computed tomography (PET-CT), and Magnetic Resonance Imaging (MRI), High-resolution-MRI (HR-MRI), Magnetic Resonance Spectroscopy (MRS), Optical Coherence Tomography (OCT), and Dermatoscopy. Imaging is mainly used for preoperative assessment and surgical planning, not routine diagnosis. US is effective for initial evaluations, demonstrating superior ability in detecting muscle invasion and defining tumour boundaries (sensitivity - 81.8%, specificity - 100%). MRI is valuable for preoperative evaluation, surgical planning, and monitoring DFSP recurrence. It more accurately assesses tumour depth than palpation, with a sensitivity of 67% and specificity of 100%, but was inferior when compared to US. CT is utilized in cases of suspected bone involvement or pulmonary metastasis. For advanced or recurrent DFSP, PET-CT helps manage treatment responses and imatinib therapy. Emerging technologies like MRS and OCT show potential in improving diagnostic accuracy and defining surgical margins, though more data are needed. US, MRI, and CT are the primary imaging modalities for DFSP. Emerging technologies like HR-MRI, PET-CT, MRS, and OCT hold promise for refining diagnostic and management strategies. Integrating multiple technologies could enhance management, particularly in atypical or aggressive cases. Further studies are required to refine imaging protocols and improve DFSP outcomes.</p>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142370868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pyoderma gangrenosum during infliximab in severe hidradenitis suppurativa: A paradoxical event.","authors":"Silvia Giordano, Federica Repetto, Sara Boskovic, Gabriele Roccuzzo, Michela Ortoncelli, Paolo Dapavo, Simone Ribero, Pietro Quaglino","doi":"10.1111/ajd.14367","DOIUrl":"https://doi.org/10.1111/ajd.14367","url":null,"abstract":"","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142370869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Melanoma documented arising in an involuting naevus 3 years after cessation of monitoring","authors":"Christine Lee Bachelor Nursing, SFC (Skin Cancer Diagnostics),&nbsp;Sarah Coleman Grad Cert Nursing, SFC (Skin Cancer Diagnostics),&nbsp;Aksana Marozava MD,&nbsp;Blake O'Brien MBBS, FRCPA,&nbsp;Cliff Rosendahl MBBS, PhD","doi":"10.1111/ajd.14365","DOIUrl":"10.1111/ajd.14365","url":null,"abstract":"&lt;p&gt;A 35-year-old female, with no family history of melanoma but with a personal history of three previous melanomas, presented for a routine skin examination in 2023. She had been treated for melanoma in situ on the right forearm at age 12, with subsequent primary invasive melanomas on the scalp at ages 21 and 26. Because of her categorisation as high risk, she was having 6-monthy whole-body skin examinations as well as sequential digital dermatoscopic imaging (SDDI) of multiple randomly selected skin lesions.&lt;/p&gt;&lt;p&gt;As part of this process one pigmented skin lesion over the upper thoracic spine (Figure 1, black arrow) was monitored annually from 2017 and as it was observed to become smaller, then stable on sequential images (Figure 2, 2017–2020), monitoring was suspended in 2020.&lt;/p&gt;&lt;p&gt;In 2023 at routine examination by the treating clinician, assisted by a qualified nurse-diagnostician, with active reference to total body photography (TBP) images, an observation was made by the nurse that the lesion previously monitored (Figure 1, black arrow) was now a similar size to a previously larger lesion below it (Figure 1, white arrow). A dermatoscopic image was taken and when compared with the previous image from 2020, significant progressive change in all quadrants was identified (Figure 2, 2023). The lesion was excised and submitted for histology, accompanied by relevant clinical information and dermatoscopic images. Histological examination was consistent with early melanoma in situ, with regression, arising in a pre-existing compound naevus (Figure S1). The subject patient has provided informed consent to the publication of their information contained within this manuscript.&lt;/p&gt;&lt;p&gt;Sequential digital dermatoscopic imaging of randomly selected multiple naevi has been shown to have diagnostic efficacy for patients at high risk of melanoma.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; As well as facilitating diagnosis of early, and even featureless melanomas,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; it has been demonstrated to improve specificity, avoiding excision of biologically indolent lesions.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; It has been shown that monitoring may need to be continued long-term to detect slow-growing melanomas, in one large study major changes only being evident after a mean follow-up of 33 months.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; The use of TBP and SDDI, known as the ‘two-step method of digital follow-up’ has been suggested as an ideal surveillance strategy for high-risk melanoma patients.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; It is also known that the provision of relevant clinical information has been shown to improve pathologists' confidence in, and accuracy of histological diagnosis.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;A meta-analysis of naevus-associated melanomas in 2017 reported that most cutaneous melanomas arose de novo, 29.1% arising in association with a naevus. In contrast to a commonly held misconception, melanoma-associated naevi were most frequently non-dysplastic, the bland dermal nae","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":"65 7","pages":"e221-e223"},"PeriodicalIF":2.2,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajd.14365","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142256665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tuberculosis reactivation following apremilast therapy for psoriasis: Time to consider routine TB screening?","authors":"Lucinda Adams, Emma L. Smith, Dev Tilakaratne, Vicki Krause","doi":"10.1111/ajd.14364","DOIUrl":"https://doi.org/10.1111/ajd.14364","url":null,"abstract":"Apremilast is a relatively new oral treatment for psoriasis, which reduces expression of pro‐inflammatory factors, including tumour necrosis factor‐α (TNFα), critical to the immune control of <jats:italic>Mycobacterium tuberculosis</jats:italic> infection. In randomised controlled trials (RCTs) for apremilast no new cases of active tuberculosis (TB) were identified, thus, screening for latent TB infection (LTBI) is not currently recommended prior to apremilast initiation. We describe a case of <jats:italic>M.tuberculosis</jats:italic> reactivation shortly after commencement of apremilast for psoriasis. We are recommending clinicians perform LTBI risk assessment in all patients, and appropriate LTBI screening in select populations prior to apremilast initiation.","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":"318 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142226885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of oral benzodiazepines for patient anxiety associated with Mohs micrographic surgery: An Australian survey","authors":"Adam G. Harris, Simon Lee","doi":"10.1111/ajd.14361","DOIUrl":"https://doi.org/10.1111/ajd.14361","url":null,"abstract":"A survey of Mohs surgery specialists in Australia showed diazepam was the preferred agent and felt to be the safest oral benzodiazepine for perioperative anxiolysis.","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":"101 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142215707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skin health of Aboriginal children living in urban communities.","authors":"Bernadette M Ricciardo, Heather-Lynn Kessaris, Noel Nannup, Dale Tilbrook, Nadia Rind, Richelle Douglas, Jodie Ingrey, Jacinta Walton, Carol Michie, Brad Farrant, Eloise Delaney, S Prasad Kumarasinghe, Jonathan R Carapetis, Asha C Bowen","doi":"10.1111/ajd.14363","DOIUrl":"https://doi.org/10.1111/ajd.14363","url":null,"abstract":"<p><strong>Background: </strong>Skin concerns are frequent among urban-living Aboriginal children, yet specialist dermatology consultations are limited with studies highlighting the need for improved cultural security. Through newly established paediatric dermatology clinics at two urban Aboriginal Community Controlled Health Organisations (ACCHOs), we aimed to describe clinic and patient data, including disease frequencies and associations, to inform dermatology service provision and advocacy.</p><p><strong>Methods: </strong>A prospective cohort study of Aboriginal children and young people (CYP, 0-18 years) attending Aboriginal Health Practitioner (AHP) co-ordinated paediatric dermatology clinics at two urban ACCHOs.</p><p><strong>Results: </strong>Data were collected from 32 clinics over 19 months, with 335 episodes of care and a mean attendance rate of 74%. From 78 new patients, 72 (92%) were recruited into the study, only one of whom had previously received dermatologist assessment. Eczema, tinea or acne accounted for 47% (34/72) of referrals, and 60% of patients received their first appointment within 4 weeks of referral. In 47/72 (65%) consultations, the GP referral and dermatologist diagnosis concurred. The most frequent diagnoses (primary or secondary) at first consultation were atopic dermatitis (26%, 19/72), dermatophyte infections (25%, 18/72), acne (21%, 15/72), bacterial skin infections (18%, 13/72) and post-inflammatory dyspigmentation (18%, 13/72). Three categories of the 2022 Australasian College of Dermatologists curriculum (infections, eczema/dermatitis, pigmentary disorders) accounted for 59% of all diagnoses.</p><p><strong>Conclusions: </strong>This study highlights the specialist dermatology needs of urban-living Aboriginal CYP. ACCHO-embedded dermatology clinics co-ordinated by AHPs demonstrated benefits for Aboriginal CYP in accessing care. Opportunities to embed dermatology practice within ACCHOs should be prioritised.</p>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The risk of psychiatric disorders in finasteride users with benign prostatic hyperplasia and androgenetic alopecia: A population-based case-control study.","authors":"Anna Lyakhovitsky, Boaz Amichai, Eran Galili, Arnon Cohen, Khalaf Kridin, Zvi Segal, Doron Netzer","doi":"10.1111/ajd.14359","DOIUrl":"https://doi.org/10.1111/ajd.14359","url":null,"abstract":"<p><strong>Background: </strong>There is a long-standing debate if finasteride, a medication used to treat benign prostatic hyperplasia (BPH) and androgenetic alopecia (AGA), can cause psychiatric side effects.</p><p><strong>Objective: </strong>The goal of this large-scale population-based study was to determine whether finasteride therapy for BPH and AGA is associated with the emergence of mental health conditions.</p><p><strong>Methods: </strong>This observational case-control study compared the data from patients with BPH who received finasteride 5 mg daily and patients with AGA who received finasteride 1 mg daily with age- and gender-matched controls. The incidence of psychological health outcomes such as depression, anxiety, neuroses, bipolar disorder, schizophrenia, psychoses and alcohol abuse within 2 years of the initiation of finasteride therapy has been evaluated and compared between the finasteride groups and controls.</p><p><strong>Results: </strong>The BPH group included 307 men with a mean age of 61.5 (±17.4) years and 1218 controls. Mental health outcomes recorded in 2.3% of the patients, with no significant increase in rate when compared to controls. The AGA group consisted of 23,227 men with a mean age of 31.4 (±10.3) years and 39,444 controls. Only One percent of AGA patients developed psychiatric disorders. In comparison to controls, patients with AGA had higher rates of anxiety and depression (0.6% vs. 0.4%, p = 0.04, and 0.5% vs. 0.4%, p = 0.007, respectively). In multivariate regression models, finasteride was found as one of the risk factors for anxiety (OR 1.449, p = 0.002) and depression (OR 1.439, p = 0.003) when stratified to age, sector, socioeconomic status and comorbidities.</p><p><strong>Conclusions: </strong>According to our research, finasteride users had a very low rate of adverse mental health effects, with no increase in psychological sequelae in BPH patients and a slight increase in anxiety and depression in AGA patients.</p>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141974969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dermatological care of gender-diverse patients in Australia.","authors":"Roy Kingsley Wong, Jenny Harrington, Annabel Irene Stevenson","doi":"10.1111/ajd.14360","DOIUrl":"https://doi.org/10.1111/ajd.14360","url":null,"abstract":"<p><p>In recent years, there has been an increasing recognition of the unique healthcare needs of gender-diverse patients in Australia. With the continuous growth of referrals to gender health services, there is an increased demand for specialised dermatological care. There is still a significant knowledge gap and a lack of guidelines specifically tailored to this patient group. In this article, we will provide a brief overview of the journey of Transgender and Gender Diverse (TGD) individuals as they embark on psychological and pharmacologic treatment for gender dysphoria in Australia. We endeavour to contribute to the existing body of knowledge by examining the evidence surrounding the treatment of skin, hair and nail issues for TGD patients. This article will outline how dermatologists can assist in the care of the gender-diverse patient. Although puberty blockade (stage 1 treatments) has minimal dermatological impact, gender-affirming pharmacotherapy (stage 2 treatments) can lead to many dermatological issues including acne, patterned hair loss (PHL) and dermatitis. The dermatologist may also play a role in stage 3 treatments which include surgical or procedural interventions for gender affirmation.</p>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of biologic drugs in children or adolescents with atopic dermatitis: A systematic review and meta-analysis of randomized controlled trials","authors":"Ana Clara Felix de Farias Santos,&nbsp;Fernanda Valeriano Zamora MD,&nbsp;Lorhayne Kerly Capuchinho Scalioni Galvao MD,&nbsp;Nicole dos Santos Pimenta,&nbsp;João Pedro Costa Esteves Almuinha Salles,&nbsp;Kélen Klein Heffel MD","doi":"10.1111/ajd.14358","DOIUrl":"10.1111/ajd.14358","url":null,"abstract":"<p>Children and adolescents suffering from moderate-to-severe atopic dermatitis (AD) face a significant disease burden that greatly impacts their quality of life. Treatment options for AD are currently limited. To assess the safety and efficacy of biologic drugs, dupilumab, lebrikizumab, or tralokinumab, in improving outcomes in patients with moderate to severe inadequately controlled AD. We searched PubMed, Embase and Cochrane databases for randomized controlled trials (RCTs) comparing dupilumab, lebrikizumab or tralokinumab to placebo in patients with AD. We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs), random effects model was used and a <i>p</i>-value &lt;0.05 was considered as statistically significant. We analysed data into Review Manager 5.4. A total of five RCTs and 973 patients were included, of whom 592 were prescribed a biologic drug. Compared with placebo, patients receiving a biologic drug had a greater improvement, achieved an Investigator Global Assessment (IGA) score of 0 or 1 (OR 5.05; 95% CI 3.08–8.29), Eczema Area and Severity Index (EASI) 75 (OR 6.87; 95% CI 4.71–10.02), EASI 50 (OR 8.89; 95% CI 6.18–12.78) and EASI 90 (8.30; 95% CI 4.81–14.31). The proportion of patients with 3 points or more (OR 6.56; 95% CI 4.34–9.90) or 4 points or more (OR 8.09; 95% CI 5.19–12.59) improvement from baseline in peak pruritus NRS was significantly higher with biologic drugs than placebo. There were no significant differences between groups regarding adverse events (OR 0.79; 95% CI 0.58–1.07), and conjunctivitis (OR 2.08; 95% CI 1.00–4.33). In this meta-analysis, dupilumab, lebrikizumab, and tralokinumab have shown significant improvements in signs, symptoms and quality of life in children or adolescents with moderate to severe AD. Larger studies may be needed to continue evaluating the safety and efficacy of these biologic drugs in this patient population.</p>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":"65 7","pages":"550-559"},"PeriodicalIF":2.2,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}