JEADV clinical practice最新文献

{"title":"Experiences of patients with cutaneous manifestations of monoclonal gammopathy of undetermined significance (MGUS): Insights from the first disease-specific support group","authors":"Emily R. Gordon, Caroline Chen, Oluwaseyi Adeuyan, Brigit A. Lapolla, Megan H. Trager, Celine M. Schreidah, Lauren M. Fahmy, Larisa J. Geskin","doi":"10.1002/jvc2.427","DOIUrl":"https://doi.org/10.1002/jvc2.427","url":null,"abstract":"<p>Monoclonal gammopathy of undetermined significance (MGUS) is a clonal plasma cell disorder characterized by monoclonal immunoglobulins or an abnormal ratio of free immunoglobulin light chains in blood or urine. Affecting 5% of adults aged 50 and older, MGUS is often asymptomatic and is typically incidentally diagnosed. In most cases, it requires only conservative observation and follow-up. However, MGUS may result in severe complications, such as significant cutaneous morbidity, which is not currently considered part of the diagnostic ‘requirement’ for multiple myeloma.<span><sup>1, 2</sup></span></p><p>Dermatologic manifestations linked to MGUS, which we named ‘gammopathic dermopathy’, include cutaneous light chain amyloidosis, POEMS syndrome, and scleromyxedema, among others.<span><sup>3-6</sup></span> Despite their existence, cutaneous MGUS manifestations remain poorly understood, leading to diagnostic delays and patient morbidity.<span><sup>7, 8</sup></span></p><p>While there are numerous multiple myeloma support groups, no official groups exist for those with MGUS. These patients struggle to find appropriate care and have difficulty obtaining effective medications because of the lack of diagnostic recognition, challenges with insurance coverage, and increased cost of medications. Thus, we organized the inaugural support group through Columbia Dermatology for patients with gammopathic dermopathy, titled ‘MGUS 4 Us’, to better understand the experiences of these patients.</p><p>Ten patients attended the meeting, sharing stories that highlighted common themes such as uncertainty and confusion about diagnosis, challenges in communicating diagnoses with families, difficulties in finding doctors with expertise, and struggles in obtaining effective treatment.</p><p>All 10 patients completed an optional survey with skin conditions reported including eczema, pyoderma gangrenosum, and scleromyxedema (Table 1). Notably, at least five patients experienced skin symptoms without an established diagnosis. Symptoms included itching (70%), pain (20%), rash (20%), and tightness (10%). Timelines varied, with one patient recently diagnosed with MGUS, five diagnosed 1–5 years ago, three diagnosed 5–10 years ago, and one diagnosed over 10 years ago. Two patients developed skin symptoms this year, three developed symptoms 1–5 years ago, two developed symptoms 5–10 years ago, two developed symptoms over 10 years ago, and one was unknown.</p><p>Of the 10 patients, six received treatment for skin symptoms, including topical steroids (4), multiple myeloma drugs (lenalidomide/ixazomib, 2), hydroxychloroquine (1), intravenous immunoglobulin (1), oral steroids (1), antibiotics (1), and dupilumab (1). While one patient reported feeling ‘a lot better’ after treatment, three felt ‘a little better’, two reported no change, and four did not receive treatment. The survey also revealed that most patients had dermatologists, oncologists, haematologists or rheumatologists invo","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 4","pages":"1294-1297"},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.427","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142123407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Full-body skin examination in screening for cutaneous malignancy: A focus on concealed sites and the practices of international dermatologists","authors":"James P. Pham,&nbsp;Nicholas Allen,&nbsp;Phoebe Star,&nbsp;Anne Cust,&nbsp;Pascale Guitera,&nbsp;Ashfaq A. Marghoob,&nbsp;John Paoli,&nbsp;Iris Zalaudek,&nbsp;Annika Smith","doi":"10.1002/jvc2.437","DOIUrl":"https://doi.org/10.1002/jvc2.437","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Full-body skin examination (FSE) is fundamental to the diagnosis of cutaneous malignancy but may not always include concealed site examination (CSE).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To determine the approach of international dermatologists to CSE during FSE and examine influencing factors, barriers and attitudes toward CSE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Members of the International Dermoscopy Society were surveyed using an online 12-question survey disseminated via email.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 706 completed responses among 1249 unique clicks to the survey, representing a completion rate of 56.5%. Fifty-four percent of respondents reported always examining the breasts, while 52.8%, 18.8%, and 11.8% always examined the scalp, oral, and anogenital mucosa, respectively. The most frequent reason for examining concealed sites was patient concern, whilst common reasons for not examining concealed sites included low incidence of pathology and concern regarding allegations of sexual misconduct.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings allude to the need for international consensus guidelines regarding the conduct and inclusion of concealed or sensitive sites in routine FSE. This is essential to define clinician responsibilities, inform patient expectations of care, and thereby mitigate potential medicolegal repercussions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 4","pages":"1132-1139"},"PeriodicalIF":0.0,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.437","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142123424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum vitamins and trace elements in vitiligo patients: A systematic review and meta-analysis of observational studies","authors":"Fariba Iraji,&nbsp;Sarah Seyedyousefi,&nbsp;Asieh Heidari","doi":"10.1002/jvc2.432","DOIUrl":"https://doi.org/10.1002/jvc2.432","url":null,"abstract":"<p>Vitiligo is one of the most common pigmentary skin disorders, which significantly impacts the quality of life. The aetiology and pathophysiology of vitiligo are still unclear, but one of the proposed mechanisms is oxidative damage interrupting melanogenesis. The purpose of this study was to demonstrate the serum levels of trace elements and vitamins and to systematically review the evidence comparing vitiligo patients with a healthy group. We comprehensively retrieved all studies related to vitiligo and the serum levels of vitamins and minerals from databases such as PubMed, EMBASE, Scopus, Web of Science, Magiran, SID and ISC up to December 2022. Quality assessment and data extraction were conducted by two independent reviewers. Pooled standard mean differences with 95% confidence intervals were estimated using random-effects models. Our meta-analysis revealed no significant differences in serum levels of Vitamin B12 and copper. It was concluded that serum concentrations of Vitamin D, Vitamin E, and zinc were lower in vitiligo patients. Conversely, these patients exhibited higher levels of selenium and folic acid compared with healthy individuals. These results might affect the potential use of vitamin and mineral supplementation in vitiligo treatment.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 5","pages":"1430-1446"},"PeriodicalIF":0.0,"publicationDate":"2024-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.432","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of atopic dermatitis lesion locations and extent on patient burden: A real-world study","authors":"Eric Simpson,&nbsp;Peter Lio,&nbsp;Evangeline Pierce,&nbsp;Angel Cronin,&nbsp;Robert R. McLean,&nbsp;Thomas Eckmann,&nbsp;Amber Reck Atwater,&nbsp;Zach Dawson,&nbsp;Jonathan I. Silverberg","doi":"10.1002/jvc2.413","DOIUrl":"https://doi.org/10.1002/jvc2.413","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Atopic dermatitis (AD) is associated with patient burden, but few studies describe the anatomic distribution of the disease or the impact of number of lesion locations.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To describe lesion locations and assess the relationship between the number of lesion locations (disease extent) and disease burden in patients with AD.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This cross-sectional study included adults with dermatologist- or dermatology practitioner-diagnosed AD enroled in the CorEvitas AD Registry (2020–2021) who initiated systemic therapy within 12 months prior to or at enrolment or had moderate-to-severe AD (vIGA-AD® ≥3 and EASI ≥12) at enrolment. Thirteen areas of lesion involvement were assessed using a body map, and numbers of lesion locations were categorised as: 0, 1, 2–3, 4–6 and ≥7. Demographics, disease characteristics, PROs by number of lesion locations were descriptively compared using effect sizes (ES). The ES thresholds for small, medium, and large differences, respectively, were 0.10, 0.30, and 0.50 for phi (categorical outcomes) and 0.10, 0.25 and 0.40 for Cohen's f (continuous outcomes).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Among 1211 patients, lesion involvement was most frequent on the arms (69.5%) and lower limbs (61.7%). A total of 10.6%, 9.3%, 20.1%, 26.3% and 33.8% of patients had 0, 1, 2–3, 4–6 and ≥7 lesion locations, respectively. Current use of systemic (≥81.2%) and topical ( ≥74.7%) therapies was common, irrespective of lesion location. Disease severity increased with number of lesion locations: mean total BSA (ES = 1.17), EASI (ES = 1.11), and SCORAD (ES = 1.21). vIGA-AD ≥3 was observed in 28.3%, 45.3%, 78.0%, and 93.9% of patients with 1, 2–3, 4–6 and ≥7 locations, respectively (ES = 0.63). Greater number of lesion locations was associated with worse PROs: mean POEM (ES = 0.57), sleep loss (ES = 0.41), peak pruritus (ES = 0.50), DLQI (ES = 0.40), and ADCT (ES = 0.53). Uncontrolled AD (ADCT ≥7) was observed in 48.2%, 52.9%, 70.4%, 81.6% of patients with 1, 2–3, 4–6 and ≥7 locations, respectively (ES = 0.42).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;AD lesions were reported for each body area assessed. Greater number of lesion locations was associated with increased disease severity, poor disease control, and decreased quality of life. Patients experienced substantial disease burden regardless of number of les","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 4","pages":"1061-1075"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.413","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142123419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recalcitrant pityriasis rubra pilaris in a Middle Eastern patient and arguments for early anti-IL-23 targeting","authors":"Mohammed N. Al-Abdulla,&nbsp;Wadha Al-Shafi,&nbsp;Hanof Ahmed,&nbsp;Anh Jochebeth,&nbsp;Febu Joy,&nbsp;Shahd Younis,&nbsp;Mahir Petkar,&nbsp;Joerg Buddenkotte,&nbsp;Martin Steinhoff","doi":"10.1002/jvc2.435","DOIUrl":"https://doi.org/10.1002/jvc2.435","url":null,"abstract":"<p>Pityriasis rubra pilaris (PRP) is a rare, chronic cutaneous inflammatory disorder of keratinization affecting adults, children and patients with HIV. The pathogenesis of PRP is not fully understood with clinical presentations, and severity remains highly variable. Current treatment modalities for PRP result in recalcitrant disease with potentially unfavourable therapeutic side effects and low tolerability. Due to the rarity of this condition, limited data on treatment efficacies and established management guidelines are lacking. The psychological burden of PRP is detrimental to the quality of life of patients affected with PRP and remains a persistent gap of knowledge. Here, we provide a review of the literature, summarizing new developments in the treatment of PRP and a case report of a patient treated successfully with the anti-interleukin (IL)-23p19 antibody Risankizumab with sustained clinical improvement. Risankizumab appears to be an effective and safe treatment for PRP in Asian-Arabic patients. Further studies are required to assess the efficacy, safety and tolerability of newer targeted therapies for severe PRP.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 4","pages":"1262-1266"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.435","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142123413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes and practices of inflammatory bowel disease patients towards skin cancer risk and sun protection","authors":"Maeve Herlihy,&nbsp;Eve Blake,&nbsp;Pauline Carroll,&nbsp;Garry Courtney","doi":"10.1002/jvc2.425","DOIUrl":"https://doi.org/10.1002/jvc2.425","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Skin cancer is the most common form of cancer in Ireland with over 13,000 new cases diagnosed annually. People with inflammatory bowel disease are at higher risk of developing skin cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The aim of this study is to assess inflammatory bowel disease (IBD) patients' awareness around skin cancer risk and photoprotection practices and to identify gaps in patient education regarding skin cancer prevention in IBD patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>IBD patients &gt;18 years old were invited to fill out a questionnaire while waiting for their outpatient appointment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 87 patients (52% women) with IBD (Crohn's disease 62.8%, UC 35%,) were included. A total of 38 patients were diagnosed before age 25 (44%). Most patients were on active treatment for their IBD (96.5%, <i>n</i> = 85). Four patients had a personal history, and seven patients had a family history of skin cancer. Nearly half of participants (47.6%) were unaware or unsure of an increased risk of skin cancer associated with IBD and 42.5% were unaware or unsure of an increased risk with some IBD treatments. Behaviours around sun-cream were generally good, however, other sun protective methods were suboptimal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Only half (52.4%) of IBD patients surveyed were aware of a link between skin cancer and IBD. Skin cancer knowledge was generally good, however, photoprotection practices were suboptimal. This underscores the role of healthcare professionals in re-enforcing sun safety information and skin cancer education in the IBD population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 4","pages":"1102-1108"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.425","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142123417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflectance confocal microscopy and clinical evaluation of a product containing Silybum marianum fruit extract in monotherapy for acne vulgaris treatment: A prospective study","authors":"Elisete I. Crocco,&nbsp;Renata O. Alves,&nbsp;Gustavo S. M. Carvalho,&nbsp;Rebeca R. A. Silva,&nbsp;Ricardo S. B. Silva,&nbsp;Karina B. C. V. Calbucci,&nbsp;Ana L. F. Coutinho,&nbsp;Christiano S. Andrade,&nbsp;Juliana C. T. Braga","doi":"10.1002/jvc2.419","DOIUrl":"https://doi.org/10.1002/jvc2.419","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Acne is a common pilosebaceous unit chronic inflammatory disease, with a multifactorial pathogenesis. It involves several processes: increased sebum production, alteration of the follicular keratinization process and bacterial colonization by <i>Cutibacterium acnes</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the effectiveness of reflectance confocal microscopy (RCM) in evaluating the reduction of mild to severe acne lesions in patients treated with an investigational product containing <i>Silybum marianum</i> fruit extract (SMFE).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Subjects previously examined for counting acne lesions were topically treated in the face, with an investigational product containing SMFE in monotherapy over the course of 60 days (<i>n</i> = 31). They were examined for counting acne lesions. Efficacy and quality of life, tolerability, and safety assessments were performed. The infundibular diameter (ID) measurement of normal and acne skin areas was analyzed using RCM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The RCM data statistical analysis allowed us to identify two ID patterns, 300–750 µm, with a reduction of 33.33% (<i>p</i> &lt; 0.05) and 900–1050 µm with 73.16% (<i>p</i> &lt; 0.05) reduction after 60 days. The noninflammatory lesions had a mean variation of −44.51% and −67.82% after 30 and 60 days, respectively (<i>t</i> test: <i>p</i> &lt; 0.05 and <i>p</i> &lt; 0.001 after Bonferroni's correction). The inflammatory lesions had a mean variation of −69.31% and −79.40% after 30 and 60 days (<i>t</i> test: <i>p</i> &lt; 0.05 and <i>p</i> = 0.118 after Bonferroni's correction).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The authors demonstrated the effectiveness of the monotherapy scheme with an investigational product containing SMFE through the statistically significant results obtained by the RCM in acneic and nonacneic skin, in addition to the reduction in the number of noninflammatory at the end of the 60 days of clinical follow-up. Furthermore, the monotherapy scheme with the investigational product proved safe, with no serious adverse events during the entire clinical study. In summary, the use of RCM proved to be effective in assessing the therapeutic response in patients with moderate to severe acne.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 4","pages":"1085-1094"},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.419","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142123372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical features of drug reaction with eosinophilia and systemic symptoms: A retrospective study in a reference centre of dermatology in Madagascar","authors":"Fandresena Arilala Sendrasoa,&nbsp;Bienvenu Chrismael Imbelona,&nbsp;Tsiory Iarintsoa Razafimaharo,&nbsp;Lala Ramarozatovo,&nbsp;Fahafahantsoa Rapelanoro Rabenja","doi":"10.1002/jvc2.438","DOIUrl":"https://doi.org/10.1002/jvc2.438","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Drug reaction with eosinophilia and systemic symptoms (DRESS) is drug-induced hypersensitivity reaction that can have fatal complications. Three sets of diagnostic criteria have been proposed, however, consensus is lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to describe the causative agents, severity, and the clinical course of patients with DRESS in Antananarivo, Madagascar.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study was conducted in patients seen for DRESS, in the department of dermatology at the University Hospital Antananarivo, Madagascar from 2014 to 2022. European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) criteria was used for the diagnosis. Demographic data, latency periods, clinical and laboratory findings, culprit drugs, and outcomes were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 24 patients were included. Fifteen patients were female. The three most common culprit drugs were carbamazepine (17 patients), phenobarbital (2 patients), and ampicilline (2 patients). Median onset time (interquartile range) was 20 days (range: 7–62 days). Skin rash was present in all patients, and fever in 18 patients. A total of 12 patients showed two or more internal organs involved. Liver and kidney injuries were the most common visceral manifestation. All patients had eosinophilia. Fifteen patients received systemic corticosteroids. Two mortality cases were reported due to DRESS-related fulminant liver failure and to nosocomial respiratory infection. Mortality was associated with higher eosinophilia (<i>p</i> = 0.03), higher creatininemia (<i>p</i> = 0.04), and shorter time of latency (<i>p</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study show that DRESS is associated with severe morbidity. Early detection and withdrawal of the culprit dru gis crucial to save life and reduce morbidity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 3","pages":"865-871"},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.438","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Questions a patient with moderate to severe atopic dermatitis would like to be asked: Data from a qualitative study conducted by anthropologists","authors":"Judith Nicogossian,&nbsp;Stéphane Héas,&nbsp;Claire Thénié,&nbsp;Margaux Noel,&nbsp;Laurent Misery,&nbsp;Sebastien Barbarot,&nbsp;Fabienne Martin Juchat","doi":"10.1002/jvc2.423","DOIUrl":"10.1002/jvc2.423","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A considerable number of patients with moderate to severe atopic dermatitis (AD) are undertreated and have inadequate control of their symptoms leading to a hight patient dissatisfaction during their care. The VECUDA study composed of VECU and DA for french word lived and atopic dermatitis was conducted by anthropologists in cooperation with dermatologists, aimed to better understand the complexity of the care pathway and the physician-patient relationship by questioning patients with moderate to severe AD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The aim was to identify patient's needs and to propose concrete ways of improving the doctor-patient relationship by focusing on the narrative of their affects. Co-designed easy-to-use tools were proposed by these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The exploratory qualitative study involved 24 patients with moderate-to-severe AD. The study was conducted in two stages: a codesign phase with four patients, and a deepening phase with all patients (24), supported by a multidisciplinary scientific committee. During group interviews, conducted using creativity tools, patients' stories related to their experiences of the disease and its management were collected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>By studying the patients' affect stories, researchers were able to identify the needs of patients who might be 1. emotional (better consideration of their experiences); 2. informational (more information about their disease and treatments); 3. participatory (being involved in their care: therapeutic alliance). Mechanisms of therapeutic dissatisfaction and satisfaction were mapped into vicious and virtuous circles. Patients also offered concrete and easy-to-use tools. We are presenting here the grid of questions these patients would like to be asked during their doctor's appointment: the Doctor-Facing Questions Grid that these patients would like to be asked during a consultation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>By facilitating the identification of patients' needs/expectations, these tools would help guide the clinician's discussion and management in a few questions. The VECUDA study confirms the value of considering patients' perspective as a lever for improving the doctor-patient relationship.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 4","pages":"1076-1084"},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.423","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140660438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upadacitinib for management of alopecia areata and rheumatoid arthritis: Letter to the editor","authors":"Ieva Lingytė,&nbsp;Paula Kaminskienė,&nbsp;Arūnas Petkevičius,&nbsp;Asta Baranauskaitė","doi":"10.1002/jvc2.433","DOIUrl":"10.1002/jvc2.433","url":null,"abstract":"&lt;p&gt;We present the case of a 54-year-old woman with a 14-year history of seropositive rheumatoid arthritis (RA) and 12 years of patchy alopecia areata (AA). RA presented with typical symmetric arthritis of small joints of the hands, morning stiffness lasting for more than 1 h, high rheumatoid factor (49.5 kU/L), and anti-cyclic citrullinated peptide antibodies (153.14 kU/L). The treatment of RA involved oral methotrexate at a dose of 17.5 mg per week, along with nonsteroidal anti-inflammatory drugs, prescribed in 2009. Hair loss began 2 years later, and the patient consulted a dermatologist who diagnosed AA. Since methotrexate was suitable for both diseases, no additional systemic AA treatment was prescribed at that time, and topical treatment for the scalp (0.05% clobetasol propionate and 5% minoxidil) was added. However, the topical treatment showed no effect and was discontinued after a few years. Methotrexate was changed to leflunomide at a daily dose of 20 mg due to its ineffectiveness for arthritis at the end of 2011. As RA remained active with a high Disease Activity Score-28 (DAS-28) index, reaching up to 5.43, leflunomide was stopped, and an inhibitor of tumour necrosis factor-alpha etanercept at 50 mg per week, was prescribed in 2013 and continued for 10 years. During this treatment, low disease activity of RA was maintained with short-term exacerbations, and no significant side effects were observed. The DAS-28 index ranged from 1.32 to 3.47. However, AA persisted throughout this period without significant improvement or deterioration. An exacerbation of RA and AA was noticed at the beginning of 2023, leading to the decision to stop etanercept and to start therapy with the selective Janus kinase (JAK) 1 inhibitor upadacitinib at a dose of 15 mg daily. Upadacitinib was prescribed as it was the only JAK inhibitor reimbursed in Lithuania at that time. During the visit, trichoscopy of the scalp was performed and showed broken hairs, black and yellow dots, vellus hairs, with a Severity of Alopecia Tool (SALT) score of 51 (Figure 1a). A significant improvement in RA was observed within 3 months, with the DAS-28 decreasing from 2.21 to 1.18. The hair regrew completely after 6 months with the SALT score of 0 and with no evidence of disease activity on trichoscopy (Figure 1b,c). No side effects were observed with upadacitinib, and laboratory tests performed every 3 months returned normal results.&lt;/p&gt;&lt;p&gt;AA is associated with autoimmune diseases such as RA due to the similar involvement of the JAK and signal transducer and activator of transcription signalling pathway (JAK/STAT).&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Cytokines such interferon-γ, interleukin-2 (IL-2), interleukin-7 (IL-7) and interleukin-15 (IL-15) are believed to play an important role in the pathogenesis of AA. These cytokines activate certain JAK molecules, leading to the phosphorylation of the corresponding domains of the STAT pathway. This phosphorylation ultimately leads to the transcr","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 4","pages":"1298-1300"},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.433","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140659761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}