Australasian Journal of Dermatology最新文献

{"title":"Biologic treatment outcomes in generalized pustular psoriasis of pregnancy: A systematic review.","authors":"YuFei Wang, ChaoJing Zhou, YiYun Hou, YaMei Gao, JiLiang Lu, ZhiQiang Yin","doi":"10.1111/ajd.14357","DOIUrl":"https://doi.org/10.1111/ajd.14357","url":null,"abstract":"","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141858851","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":"A narrative review of the literature: The role of biologics and JAK inhibitors in vitiligo","authors":"Rhiannon Russell MD,&nbsp;Benjamin S. Daniel MBBS","doi":"10.1111/ajd.14353","DOIUrl":"10.1111/ajd.14353","url":null,"abstract":"<p>Vitiligo is a chronic depigmenting disorder that significantly impacts the quality of life of patients. Though there have been significant advancements in targeted therapies in skin diseases such as psoriasis or eczema, the progress in the treatment of vitiligo has been slow, with minimal studies assessing the effect of biologics, though there has been recent evidence of the effectiveness of JAK inhibition. This paper reviews the published case reports and studies for the use of systemic targeted therapies including biologics and JAK inhibitors in vitiligo.</p>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":"65 7","pages":"539-549"},"PeriodicalIF":2.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajd.14353","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141858850","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":"The cardiovascular risk in bullous pemphigoid: Insights from a population-based study","authors":"Khalaf Kridin PhD,&nbsp;Rina Goychberg BSc,&nbsp;Mouhammad Kridin MD,&nbsp;Niv Kafri BSc,&nbsp;Masad Barhoum MHA,&nbsp;Arnon D. Cohen PhD","doi":"10.1111/ajd.14355","DOIUrl":"10.1111/ajd.14355","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The risk of life-threatening major cardiovascular outcomes among patients with bullous pemphigoid (BP) is inconsistent in the current literature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the risk and prognostic outcomes of myocardial infarction (MI), cerebrovascular accident (CVA), peripheral vascular disease (PVD) and pulmonary embolism (PE) in patients with BP. We additionally aimed to explore the influence of different therapeutic approaches on the risk of these outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A population-based retrospective cohort study was conducted to compare BP patients (<i>n</i> = 3924) with age-, gender- and ethnicity-matched control subjects (<i>n</i> = 19,280) with regard to incident cases of MI, CVA, PVD and PE. Adjusted hazard ratio (HR) and 95% confidence intervals (CI) were estimated by multivariate Cox regression analysis. Data were retrieved from Clalit Health Services' computerized database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Relative to their matched controls, patients with BP were at an elevated risk of MI (fully-adjusted HR: 1.44; 95% CI: 1.14–1.81; <i>p</i> = 0.002), CVA (fully-adjusted HR: 1.24; 95% CI: 1.06–1.45; <i>p</i> = 0.007), PVD (fully-adjusted HR: 1.60; 95% CI: 1.27–2.03; <i>p</i> = 0.003) and PE (fully-adjusted HR: 1.72; 95% CI: 1.28–2.32; <i>p</i> &lt; 0.008). Patients with BP experienced heightened risk of all-cause mortality in the presence of comorbid MI (fully-adjusted HR: 1.61; 95% CI: 1.44–1.81; <i>p</i> &lt; 0.001), CVA (fully-adjusted HR: 1.70; 95% CI: 1.52–1.89; <i>p</i> &lt; 0.001), PVD (fully-adjusted HR: 1.38; 95% CI: 1.20–1.58; <i>p</i> &lt; 0.001) and PE (fully-adjusted HR: 1.44; 95% CI: 1.10–1.88; <i>p</i> = 0.007). The therapeutic approach utilized to manage BP did not significantly influence the risk of cardiovascular outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>BP is associated with an elevated risk of MI, CVA, PVD, PE and cardiovascular mortality. Primary, secondary and tertiary cardiovascular prevention measures should be implemented among patients with BP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":"65 7","pages":"e187-e193"},"PeriodicalIF":2.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajd.14355","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141858853","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":"Bullous pemphigoid in infancy","authors":"Lois Zhang BMed, MMed,&nbsp;Gloria Fong BMLSc, MBBS, PhD, FACD,&nbsp;Andrew Ming BSC(MED), MBBS(HONS), DCH, FRACP, FACD,&nbsp;Melanie Wong MBBS(Hons), PhD, FRACP, FRCPA","doi":"10.1111/ajd.14354","DOIUrl":"10.1111/ajd.14354","url":null,"abstract":"&lt;p&gt;Bullous pemphigoid (BP) is an autoimmune, subepidermal blistering disease typically affecting the elderly and remains rare in children and infants. Paediatric BP often presents with mucosal involvement, and in infants, commonly affects the hands and feet. The pathogenesis is thought to be similar to that of adult BP with autoantibodies to BP180 (type VII collagen) having been described in the literature. Here, we present a case of BP occurring in a 2-month-old, investigating the potential role of vertical transmission of autoantibodies.&lt;/p&gt;&lt;p&gt;A 2-month-old female infant presented with blistering eruptions initially localised to the hands and feet, which rapidly extended to the groin, neck, arms, and chest. The antenatal and birth history were unremarkable, and there was no family history of autoimmune diseases. The infant was systemically well. Physical examination revealed tense and flaccid bullae on the hands and feet, deep-seated vesicles on an erythematous base on the torso, and some erosions (Figure 1). Mucosal surfaces were unaffected. Viral and bacterial swabs were negative. Histopathology of skin biopsies showed eosinophilic spongiosis and subepidermal bulla formation, with indirect immunofluorescence demonstrating linear C3 and IgG deposition at the dermal-epidermal junction. Serum indirect immunofluorescence was positive for BP180 antibodies, confirming the diagnosis of BP. The infant was treated with high-potency topical corticosteroids (0.05% betamethasone dipropionate) and a short course of oral antibiotics. Significant improvement and complete resolution of the lesions were observed by 6 months of age, with no relapse. The mother had no history of BP or pemphigoid gestationis and no peripartum skin lesions. However, serum indirect immunofluorescence testing of the mother revealed the presence of BP230 antibodies. Six months later, repeat testing showed the absence of antibodies in both mother and child.&lt;/p&gt;&lt;p&gt;The exact cause of BP remains unclear, although certain triggers have been identified such as drug-induced BP and infections.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; A potential trigger in neonates and infants may include the transplacental transfer of antibodies, a known mechanism that forms the foundation for maternal immunisation strategies where antibodies may be present up to 6–12 months from birth.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; Transfer of pathogenic antibodies has been seen to cause transient disease in infants from asymptomatic mothers such as in neonatal lupus and thyroid disease. In neonatal BP, BP180 antibodies are recognised as the pathogenic cause of the neonatal onset of disease.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;We postulate that our patient's mother developed low levels of BP180 as well as BP230 antibodies, during pregnancy, with active transplacental transfer of BP180 antibodies, leading to levels capable of inducing clinical disease in her baby. Due to the half-life of IgG antibodies (21 days), by the time of testing, mater","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":"65 7","pages":"e219-e220"},"PeriodicalIF":2.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajd.14354","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141858852","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":"Diversifying dermatology: Improving skin of colour representation","authors":"Alyssa Susanto PhD,&nbsp;Vaishnavi Nathan PhD,&nbsp;Monika Janda PhD,&nbsp;Kiarash Khosrotehrani MD, PhD,&nbsp;Erin McMeniman MD, PhD,&nbsp;H. Peter Soyer MD, PhD,&nbsp;Brigid Betz-Stablein PhD","doi":"10.1111/ajd.14356","DOIUrl":"10.1111/ajd.14356","url":null,"abstract":"&lt;p&gt;Current recruitment strategies in dermatology research have segregated those with skin of colour (SOC).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; In Australia, SOC describes a heterogenous group with non-European or mixed ancestry, in addition to First Nations Australians.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; As darker skin differs substantially in biology, structure and function compared with lighter skin,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; a diverse participant pool is crucial for understanding human variation and disease pathology. However, dermatology data sets are historically homogenous and tend to be biased towards those with European ancestry.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Factors contributing to this phenomenon include physician, investigator, industry and patient-related barriers.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; An example of a physician-related barrier is the light skin model recognised in medical education,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; which evokes clinical uncertainty when conditions present differently in darker skin, despite the addition of SOC to the Australian dermatology training curriculum in 2017.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Australia has the highest incidence of melanoma per capita worldwide, with 36.6 cases per 100,000 age standardised rate (ASR).&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; This includes 14.1 cases per 100,000 ASR for Aboriginal and Torres Strait Islanders, and 30.4 cases per 100,000 ASR for non-Indigenous Australians.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; It is concerning that these data are not stratified further by ethnicity, as melanoma tends to present at more advanced stages in SOC with poorer prognosis.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; Acral lentiginous melanoma is the most common subtype in SOC, yet its atypical presentation in non-sun-exposed areas may contribute to oversight or misdiagnosis.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; Without conscious effort to incorporate all skin types in research studies, the unique manifestations, risk factors and treatment for melanoma in SOC will remain unknown, whilst mortality rates in these minority populations continue to rise.&lt;span&gt;&lt;sup&gt;6, 7&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The ongoing Australian Centre of Excellence in Melanoma Imaging and Diagnosis (ACEMID) cohort study&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; aims to create a large repository of three-dimensional total body photography to aid the development of artificial intelligence (AI) for early melanoma detection. Participants were recruited across 15 metropolitan and regional Australian sites through referrals, social media, traditional media and previous skin cancer research studies,&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; without actively targeting those with SOC.&lt;/p&gt;&lt;p&gt;In our subanalysis of two ACEMID sites with completed recruitment in Brisbane, Australia, we identified 4% of participants (Table 1) with SOC (i.e. self-reported non-European ancestry). This proportion differs substantially from the Australian population, since census data report that 30% have non-European ancestry.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; However, the most prevalent non-Euro","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":"65 7","pages":"e208-e210"},"PeriodicalIF":2.2,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajd.14356","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141750973","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":"Histological diversity in hyperkeratotic flexural erythema-Beyond granular parakeratosis?","authors":"Anna Luo, Fergus Oliver, Harriet Kennedy","doi":"10.1111/ajd.14349","DOIUrl":"https://doi.org/10.1111/ajd.14349","url":null,"abstract":"<p><p>The term 'hyperkeratotic flexural erythema' (HFE) has been used synonymously with granular parakeratosis (GP), to describe a scaly, typically intertriginous rash associated with contact factors such as benzalkonium chloride. However, clinical HFE can occur without the classical GP histological pattern. We reviewed skin biopsies from 10 patients with clinically diagnosed HFE. A progression of histopathological features is suggested. The absence of histological GP should not exclude the clinical diagnosis of HFE when there is a high index of suspicion.</p>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141750974","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":"Biologic treatment sequences in moderate-to-severe psoriasis","authors":"Samantha Ting MD, FRACGP,&nbsp;Patricia Lowe MBBS, MMed, FACD,&nbsp;Annika Smith MBBS, MPHTM, FRACP, FACD,&nbsp;Pablo Fernández-Peñas MD, PhD, FACD","doi":"10.1111/ajd.14350","DOIUrl":"10.1111/ajd.14350","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The advent of novel biologics has led to an increase in biologic-switching as patients and clinicians pursue improved clinical outcomes. However, guidance on treatment sequencing in an Australian setting is sparse. This study examines the patterns of care across two tertiary centres in Australia and characterizes the factors contributing to biologic-switching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study of patients who attended the outpatient Dermatology biologic clinics across two tertiary hospitals was conducted. Data on treatment sequencing and patients' PASI at every visit from April 2006 to December 2020 were collected. Patterns of biologic-switching were examined. The speed of treatment response for each biologic was determined by the time to achieve PASI-90 and -100 for each treatment course.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 440 treatment courses were analysed. Ustekinumab and adalimumab were the most frequently prescribed first-line biologics. The highest proportion of biologic-switching was observed among patients on TNF-α inhibitors (63.8%). After 2015, more patients were prescribed IL-12/23 and IL-17 inhibitors in favour of TNF-α inhibitors. IL-17 inhibitors demonstrated the most rapid treatment response and low PASI scores relative to other biologics. Patients who did not switch biologics had lower rates of psoriatic arthritis and lower BMI, compared to patients who switched biologics. The median PASI on discontinuation generally exceeded 3.0, while on continuation, it was less than 1.2, reflecting patients' and clinicians' thresholds for biologic-switching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study demonstrates an increased uptake of more novel biologics as they become available, due to improved safety profiles and clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":"65 7","pages":"e178-e186"},"PeriodicalIF":2.2,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajd.14350","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141747350","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":"Successful treatment of infantile refractory bullous pemphigoid with baricitinib.","authors":"Weinan Zhou, Yidong Tan, Xuanyi Chen, Wenqing Zhang, Zhe Sun, Yihang Shen, Zhirong Yao, Ruhong Cheng, Yan Gu","doi":"10.1111/ajd.14345","DOIUrl":"https://doi.org/10.1111/ajd.14345","url":null,"abstract":"<p><p>Infantile bullous pemphigoid (BP) is a rare autoantibody-mediated skin disorder. We report the effective treatment of a 6-month-old infant with BP using baricitinib, a Janus kinase (JAK) inhibitor, after failure with steroids and intravenous immunoglobulin. The patient achieved full remission and discontinued all medications without any relapses. To our knowledge, this is the first case of baricitinib used in an infant with BP.</p>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730958","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":"Unveiling the clinical and epidemiological significance of Mycobacterium lepromatosis detection in a patient with severe lepra reaction from India","authors":"Sukhdeep Singh MD,&nbsp;Itu Singh PhD,&nbsp;Rucha Herlekar MBBS,&nbsp;Vinay Kumar Pathak PhD,&nbsp;Debajyoti Chatterjee MD,&nbsp;Tarun Narang MD,&nbsp;Sunil Dogra MD","doi":"10.1111/ajd.14352","DOIUrl":"10.1111/ajd.14352","url":null,"abstract":"","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":"65 7","pages":"596-598"},"PeriodicalIF":2.2,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141615866","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":"Comment on ‘Dupilumab for atopic dermatitis in metastatic cancer’","authors":"Luca Potestio MD,&nbsp;Cataldo Patruno PROF, MD,&nbsp;Maddalena Napolitano PROF, MD","doi":"10.1111/ajd.14351","DOIUrl":"10.1111/ajd.14351","url":null,"abstract":"","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":"65 7","pages":"599-600"},"PeriodicalIF":2.2,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141615865","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}