JEADV clinical practice最新文献

{"title":"Protocol for high-intensity focused ultrasound (HIFU) treatment of cutaneous neurofibromas","authors":"Mimmi Tang, Katrine Elisabeth Karmisholt, Martin Gillstedt, Jaishri O. Blakeley, Joshua Roberts, Jørgen Serup, Torsten Bove, Sirkku Peltonen","doi":"10.1002/jvc2.543","DOIUrl":"https://doi.org/10.1002/jvc2.543","url":null,"abstract":"<p>High-intensity focused ultrasound (HIFU) is widely used for various applications including treatment of cancers of the thyroid,<span><sup>1</sup></span> prostate,<span><sup>2</sup></span> pancreas<span><sup>3</sup></span> and bone metastases<span><sup>4</sup></span> as well as targeting deep brain nuclei to treat tremor.<span><sup>5</sup></span> HIFU systems for these treatments operate at frequencies of 0.5–3 MHz. Ultrasound is also used for aesthetic applications, such as body contouring, at frequencies of 4–12 MHz.</p><p>The 20 MHz HIFU device used in this study is developed for selective destructive treatments of very small targets in the epidermis and the dermis while sparing the surroundings.<span><sup>6</sup></span> Each dose produces a combination of mechanical disruption and local heating to approximately 60–65°C at the focal point of the focused ultrasound beam emitted from a concave transducer. The primary effect is cell necrosis. This 20 MHz HIFU has previously been documented useful in actinic keratoses basal cell carcinoma, Kaposi sarcoma and superficial vascular lesions.<span><sup>7-9</sup></span></p><p>The present study reports on efforts to optimise the dose of HIFU applied to cutaneous neurofibroma (cNF) in patients with Neurofibromatosis Type 1 (NF1). This is a second phase extension of an original study of the tolerability and safety of HIFU.<span><sup>10</sup></span> The two studies are referred to as Phase A and Phase B, respectively. There are no currently approved therapies for NF1-associated cNFs. These skin tumours can count in the hundreds or thousands for a given individual. Due to their associated symptoms of itching, pain and disfigurement, cNF represents a major unmet need.</p><p>The study was a 6-month prospective open-label study conducted at the Department of Dermatology and Venereology, University of Gothenburg, Gothenburg, Sweden. The study was registered on www.clinicaltrials.gov under number NCT05119582. The original study included 20 participants across two centres, Bispebjerg Hospital in Copenhagen, Denmark and University of Gothenburg.<span><sup>10</sup></span> Seven patients from the original cohort were recruited for an additional dosimetry study.</p><p>Written informed consent with permission to use anonymized data and photos was obtained on study start in February 2023. All patients had clinically or otherwise verified NF1. cNFs were categorised into flat, sessile and globular types.</p><p>Tumours were numbered, and the locations of the included tumours were drawn on a plastic registration sheet to identify the treatment sites at follow-up visits. Tumours were documented by conventional 2D clinical photos at baseline, 1 week, 3 months and 6 months after treatment. A total of four to nine cNFs per patient were treated. An additional two cNFs were included as control tumours. Data were collected in case report forms on the Research Electronic Data Capture (RedCap) platform.</p><p>Each selected cNF rec","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 5","pages":"1723-1729"},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.543","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762650","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":"Novel biophysical skin biomarkers discriminate topical anti-inflammatory treatments based on their potential for local adverse effects","authors":"Simon G. Danby,&nbsp;Stephen Matcher,&nbsp;Robert Byers,&nbsp;Rosie Taylor,&nbsp;Sura Sahib,&nbsp;Paul Andrew,&nbsp;Kirsty Brown,&nbsp;Linda Kay,&nbsp;Carl Wright,&nbsp;Abi Pinnock,&nbsp;John Chittock,&nbsp;Mengqiu Duan,&nbsp;Amy Cha,&nbsp;Roni Adiri,&nbsp;Chuanbo Zang,&nbsp;John Werth,&nbsp;Michael J. Cork","doi":"10.1002/jvc2.540","DOIUrl":"https://doi.org/10.1002/jvc2.540","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Topical corticosteroids (TCS) are efficacious treatments for inflammatory skin conditions, however, there is a risk of adverse effects; understanding how best to use these treatments is an unmet research priority shared by patients and healthcare professionals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To develop non-invasive biomarkers of local adverse effects to facilitate the optimisation of topical therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An observer-blind randomised within-subject controlled trial in atopic dermatitis patients was undertaken (NCT04194814) comparing betamethasone valerate 0.1% cream (BMV) to a non-steroidal anti-inflammatory treatment, crisaborole 2% ointment (CRB). Participants underwent 4 weeks twice-daily treatment with CRB on one forearm and BMV on the other (left/right randomised). Skin properties were assessed on days 1, 15, 29 of treatment and again on day 57, including imaging of skin microstructure using Optical Coherence Tomography (OCT) and Attenuated Total Reflectance (ATR)-Fourier Transform Infrared (FTIR) spectroscopic assessment of stratum corneum molecular structure. The primary outcome was the difference in the change in epidermal thickness from days 1 to 29.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-seven participants received the first dose, of which 32 completed the study (all 37 were included in the analysis). Pathologic epidermal thinning at day 29 was significantly greater (<i>p</i> &lt; 0.0001) at sites treated with BMV (−31.66; 95% confidence interval: −35.31, −28.01 µm) compared to CRB (−13.76; −17.42, −10.10 µm). From a panel of exploratory biomarkers, superficial plexus depth and stratum corneum carboxyl group levels had the greatest ability to discriminate the effects of the TCS treatment (<i>p</i> &lt; 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>BMV induced 2.3x more pathologic epidermal thinning than CRB after 4 weeks of treatment, suggesting that CRB may be more appropriate for longer-term, proactive-based, treatment strategies where the risks of adverse effects are greatest. By monitoring treatment effects using OCT and ATR-FTIR spectroscopy, two new non-invasive biomarkers of skin health have been identified with the potential to help optimise future safe treatment strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"103-116"},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.540","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530573","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":"How green are emollients?","authors":"A. Long,&nbsp;C. Quigley,&nbsp;L. Murphy,&nbsp;J. Gale","doi":"10.1002/jvc2.541","DOIUrl":"https://doi.org/10.1002/jvc2.541","url":null,"abstract":"&lt;p&gt;We live in an era where the impact of climate change is being increasingly felt, and public opinion is shifting towards consciously living in a more environmentally friendly way. Health and the environment are deeply interconnected, with each significantly influencing the other. This intricate relationship is evident in many ways such as the effects of air pollution on atopic dermatitis, and the harm caused by human activity to environmental health. Healthcare systems have a huge impact on climate change and are responsible for 4% of global emissions.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Dermatology is unique as a specialty in that large quantities of topical treatments are used. Some studies have looked at the environmental consequence of topical product packaging,&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; but few have looked at their constituents. In the clinical setting, patients are asking more questions about product sustainability.&lt;/p&gt;&lt;p&gt;Emollients are essential components of many skincare regimens. While they offer significant benefits for skin health, the production, distribution and disposal of emollients have notable environmental challenges. Petrolatum and mineral oil based emollients are frequently prescribed for their highly efficacious occlusive and hydration properties, however they are derived from fossil fuels. Their extraction and refinement are energy-intensive processes that contribute to greenhouse gas emissions. A portion of the world's squalene comes from shark liver oil, which over the last decade led to overfishing of sharks for the coveted substance; &lt;i&gt;squalus&lt;/i&gt; being a genus of shark.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Palm oil and its many useful derivatives including glycerine, have also come under heavy scrutiny because of their contribution to tropical deforestation and biodiversity loss.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Silicones have exceptional physicochemical and sensory properties; linear dimethicone with its smooth, non-tacky feel, and cyclic cyclomethicones helpfully increase volatility of substances. However silicones have low biodegradability, leading to concern regarding bioaccumulation in aquatic ecosystems. Volatile cyclomethicones octamethylcyclotetrasiloxane (D4) and decamethylcyclopentasiloxane (D5) have been banned from wash-off cosmetic products in the European Union (EU) for the protection of the environment.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Mitigating the environmental impact of emollient ingredients involves several strategies. Green chemistry (principles that reduce production of hazardous materials), upcycling of agri-food waste such as used coffee-grounds, and use of fair-trade materials are empowering the sustainability movement. Non-profit organisations safeguarding natural resources are strengthening, such as the Roundtable on Sustainable Palm Oil and the Roundtable on Responsible Soy. Bioengineering is identifying ways to substitute unsustainable materials. Squalene is present, albeit in smaller quantities, in plants (phytosqual","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"288-289"},"PeriodicalIF":0.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.541","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530294","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":"Knowledge of Jimmy Buffett's Merkel cell carcinoma and the impact on self-reported expected skin cancer prevention behaviours","authors":"Katie K. Lovell,&nbsp;Max E. Oscherwitz,&nbsp;Anthony Marcelletti,&nbsp;Matthew C. Johnson,&nbsp;Steven R. Feldman","doi":"10.1002/jvc2.542","DOIUrl":"https://doi.org/10.1002/jvc2.542","url":null,"abstract":"&lt;p&gt;Merkel cell carcinoma (MCC) is a rare neuroendocrine tumour of the skin.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The incidence of MCC has been increasing in recent decades, with elderly males most commonly affected.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Risk factors include ultraviolet (UV) exposure, increased age, immunosuppression, fair skin tones and infection with Merkel cell polyomavirus.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; However, due to MCC's relatively low incidence, many people are unaware of this form of skin cancer.&lt;/p&gt;&lt;p&gt;In September 2023, Jimmy Buffett passed away from MCC after a 4-year battle.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Mr. Buffett was famous among Americans amassing $1 billion in net worth with over 20 million albums sold.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Given the intersection of dermatology and pop culture associated with Mr. Buffett's death, we evaluated how the knowledge of his cause of death impacted the general public's perception of skin cancer prevention measures.&lt;/p&gt;&lt;p&gt;Following Institutional Review Board approval, 210 individuals were recruited on Amazon Mechanical Turk (mTurk), an online survey platform. Participants completed an online survey study through Qualtrics. Respondents were asked if they were familiar with Jimmy Buffett's cause of death and subsequently asked their likelihood (more, less or no change) to practice certain sun protective behaviours in the next year. Statistical analysis was performed using SPSS Version 29.0.2.0 (20). Cross-tabulation and chi-square tests were used to analyze how these demographic variables and personal factors related to participants' behaviours after learning about MCC. An alpha significance threshold of 0.05 was utilized.&lt;/p&gt;&lt;p&gt;The majority of the 210 participants were male (64%), aged between 25 and 34 years (60%), were college educated (including advanced degrees) (73%), and from the Midwest region of the United States (41%) (Table 1).&lt;/p&gt;&lt;p&gt;Awareness of Jimmy Buffett's cause of death was reported by 65.7% of respondents (&lt;i&gt;n&lt;/i&gt; = 138). Those aware of his cause of death were more inclined to schedule a dermatologist appointment within the next year (&lt;i&gt;p&lt;/i&gt; ≤ 0.001). Of those aware, 67.4% were more likely to schedule an appointment, 24.6% were less likely, and 8.0% reported no change. Conversely, among those unaware (&lt;i&gt;n&lt;/i&gt; = 72), 22.5% were more likely, 50.0% were less likely and 27.8% reported no change (Figure 1).&lt;/p&gt;&lt;p&gt;Similarly, awareness of Jimmy Buffett's cause of death correlated with increased likelihood of wearing sunscreen when going outside (&lt;i&gt;p&lt;/i&gt; = 0.048) and conducting self-skin exams or seeking assistance for skin inspection (&lt;i&gt;p&lt;/i&gt; ≤ 0.001). Among those aware, 91.3% initiated a self-skin exam or sought assistance versus 40.3% of those unaware. Of aware participants, 62.3% reported they were more likely to wear sunscreen, 32.6% were less likely and 5.1% reported no change, compared to participants who did not report awareness: 47.2%, 40.3% and 12.5%, respectively (Figure 1).&lt;/p&gt;&lt;p&gt;The impact o","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"290-292"},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.542","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530284","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":"Role of interleukins in dermatology: Exploring the immune mechanisms in skin diseases","authors":"Alvaro Prados-Carmona,&nbsp;Francisco J. Navarro-Triviño,&nbsp;Ricardo Ruiz-Villaverde,&nbsp;Alfredo Corell","doi":"10.1002/jvc2.537","DOIUrl":"https://doi.org/10.1002/jvc2.537","url":null,"abstract":"<p>Interleukins are central in the modulation of immune responses. This narrative review aims to summarize the growing evidence on their significance as key drivers of numerous cutaneous diseases with a special focus in some of the more prevalent chronic inflammatory dermatologic diseases such as psoriasis, atopic dermatitis, allergic contact dermatitis, urticaria, and hidradenitis suppurativa. Additionally, we discuss their relevance in the recent developments in targeted therapies that have significantly transformed the management of these skin conditions. To this end, we have conducted a comprehensive search through the Cochrane Library and Database of Systematic Reviews and the MEDLINE search engine, and we have summarized the available clinical evidence considering up to 466 records including meta-analyses, systematic reviews, reviews and clinical trials. Ultimately, this review intents to foster both dermatologist and non-dermatologist physicians' understanding of the immunology behind the clinical manifestations of some of the most common inflammatory skin diseases and engage with the novel therapeutic approaches by providing accessible insights into the implications of interleukin pathways dysregulation.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 5","pages":"1381-1398"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.537","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762196","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":"The clinical landscape of HPV vaccination in preventing and treating cutaneous squamous cell carcinoma","authors":"Shi Huan Tay,&nbsp;Choon Chiat Oh","doi":"10.1002/jvc2.538","DOIUrl":"https://doi.org/10.1002/jvc2.538","url":null,"abstract":"&lt;p&gt;Cutaneous squamous cell carcinoma (cSCC) is a malignancy with rising global incidence and burden especially amongst the immunosuppressed. The human papillomavirus (HPV) has been strongly implicated as a risk factor for cSCC.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Hence, HPV vaccination may be a viable adjuvant to established practices in preventing and treating cSCC and its precancerous lesions (actinic keratosis [AK], Bowen's disease).&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The study aimed to review clinical studies that investigated HPV vaccination in the prevention or treatment of cSCC and its precancerous entities. We conducted a systematic search of literature databases (PubMed, Embase, Scopus, Cochrane Library) on 16 May 2024 in accordance to PRISMA guidelines (Figure 1; PROSPERO registry number CRD42024550413). Article screening and data extraction were performed in duplicate. Full-text clinical studies published in English that investigated HPV vaccination in the prevention or treatment of cSCC and its precancerous entities in ≥1 patient were included. We identified four full-text clinical studies (Table 1). Firstly, systemic α-HPV vaccination (Gardasil-9®) demonstrated benefits in the secondary prevention of AK and cSCC amongst immunosuppressed adults with recurrent keratotic skin lesions. Nichols et al. reported substantial reduction (63%–88%) in post-vaccine keratinocyte carcinoma incidence in two patients.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Bossart et al. noted fewer visits (0.7/year to 0.2/year, &lt;i&gt;p&lt;/i&gt; &lt; 0.05) with major dermatological interventions after vaccination in a larger cohort of 38 immunosuppressed adult patients with keratinotic skin lesions (warts, AK, Bowen's disease, cSCC), of which 21/38 have previous cSCC and/or AK.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Secondly, systemic α-HPV vaccination (Gardasil-9®) displayed merit in the primary treatment of AK and cSCC in immunocompetent adults. Wenande et al. reported an 85% reduction in AK lesions after vaccination in 12 immunocompetent adult patients with high AK burden.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Nichols et al. described a case of cSCC regression following combinatorial systemic and intratumoral α-HPV vaccination (Gardasil-9®) in an elderly immunocompetent patient.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; No local or systemic side effects were reported in all studies. Although promising, the studies were limited by small sample sizes, their observational nature, the lack of unvaccinated controls, and opacity regarding the patients’ HPV status. This hampers our understanding of vaccine response, especially since&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; better responders might have had mixed α- and β-HPV infections, and&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; better responders might have been colonized by β-HPV subtypes that are phylogenetically closer to α-HPV. Bossart et al. had also indirectly measured vaccination response through the number of dermatological interventions required in the postvaccination period. There is an ongoing Phase II trial on systemic α-HPV","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"285-287"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.538","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530694","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":"Treatment switching and associated economic outcomes in patients with plaque psoriasis treated with biologics: A retrospective analysis of German claims data 2016−2021","authors":"Andreas Pinter,&nbsp;Ahmed M. Soliman,&nbsp;Karina C. Manz,&nbsp;Valeria Weber,&nbsp;Paul Ludwig,&nbsp;Anja Mocek,&nbsp;Ariane Höer,&nbsp;Mark G. Lebwohl","doi":"10.1002/jvc2.512","DOIUrl":"https://doi.org/10.1002/jvc2.512","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Biologics are therapeutic options for the management of moderate−severe plaque psoriasis. Some patients need to switch biologic treatment to achieve satisfactory outcomes, which might have a considerable economic impact.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We assessed the characteristics and switch rates of patients with plaque psoriasis initiating biologic treatment and compared healthcare resource utilization (HCRU) and associated costs for switching and non-switching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study was a retrospective claims-based analysis comprising a 182-day baseline period to identify patient characteristics and a 365-day follow-up to assess switch rates, HCRU and associated costs. Data covering claims activity from 2016 to 2021 in a representative sample of four million individuals with statutory insurance in Germany was used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 2565 patients with psoriasis initiating biologic treatment with anti-IL-17 (<i>n</i> = 1037), anti-IL-23 (<i>n</i> = 704), anti-TNF-α (<i>n</i> = 583) and anti-IL-12/23 (<i>n</i> = 241) agents. A total of 9.2% of patients switched therapy to another biologic during follow-up, ranging from 4.9% (secukinumab) to 16.5% (etanercept). The probability of treatment switching was significantly lower in patients treated with risankizumab (<i>p</i> &lt; 0.05) than in patients treated with other biologics except guselkumab (<i>p</i> = 0.14). HCRU and associated costs during the follow-up were generally higher with a therapy switch (all-cause: 32,263 ± 15,381€) than without (25,041 ± 12,090€). This applied to direct costs (outpatient services, hospitalization, drug treatment) and indirect costs (sickness benefits). Drug treatment accounted for the largest share of costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Treatment switching is frequent in patients with moderate−severe plaque psoriasis initiating biologic therapy and is associated with increased HCRU and associated costs. As the probability that a switch occurs within 365 days after treatment initiation widely differs between biologic agents, further research is warranted to determine the underlying reasons for switching to help establish clinically and economically sound therapy sequences.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 5","pages":"1537-1547"},"PeriodicalIF":0.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.512","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762697","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":"Refractory pyoderma gangrenosum in Caucasian adolescent with Takayasu arteritis and life-threatening infections","authors":"Ting Fong Yeo,&nbsp;Sofia Labbouz,&nbsp;Nicholas Lawrance,&nbsp;Hemalatha Bhuvanai Sitaraaman,&nbsp;Rachel S. Tattersall,&nbsp;Michael J. Cork","doi":"10.1002/jvc2.534","DOIUrl":"https://doi.org/10.1002/jvc2.534","url":null,"abstract":"<p>Pyoderma gangrenosum (PG) in Caucasians with Takayasu's arteritis (TA) is uncommon. We described a case of refractory PG in an 18-year-old Caucasian man with TA since the age of 10 and was treated with corticosteroids, methotrexate, anti-TNF therapy (adalimumab), anti-CD20 therapy (rituximab), cyclophosphamide and most latterly tocilizumab and leflunomide. He has vascular stenosis complicated with renovascular hypertension and is steroid-dependent. He presented with a 6-week history of a left cheek rapidly enlarging lesion associated with pain, bleeding and purulent discharge not responding to flucloxacillin. Incisional biopsy suggested PG. He later developed similar lesions on the volar aspect of the right hand and at venepuncture sites. Despite topical immunosuppressive medication and high-dose pulsed intravenous methylprednisolone, the left cheek lesion continued to grow rapidly. These painful, unsightly ulcers caused significant psychosocial stress and limited his daily life. Following a multidisciplinary team (MDT) discussion, tocilizumab was switched to abrocitinib. While initial improvement of lesions was observed, he subsequently developed an acneiform eruption which evolved into PG and became superinfected with herpes zoster virus and <i>Staphylococcus aureus</i>, requiring hospitalisation for intravenous (IV) acyclovir and antibiotics. Following several MDT discussions, abrocitinib was discontinued and a new regimen consisting of ciclosporin, dapsone and enhanced frequency IV immunoglobulin (IVIg) every 2 weeks was initiated, effectively stabilising his PG. This case highlights the rare association of PG and TA in Caucasians, the complexities of managing PG complicated by severe infections and underlying immunodeficiency, and the significant psychosocial burden of PG.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"234-239"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.534","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530769","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":"The global epidemiology of vitiligo: A systematic review and meta-analysis of the incidence and prevalence","authors":"Morten Bahrt Haulrig,&nbsp;Rownaq Al-Sofi,&nbsp;Subisan Baskaran,&nbsp;Mie Siewertsen Bergmann,&nbsp;Marianne Løvendorf,&nbsp;Beatrice Dyring-Andersen,&nbsp;Lone Skov,&nbsp;Nikolai Loft","doi":"10.1002/jvc2.526","DOIUrl":"https://doi.org/10.1002/jvc2.526","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>Vitiligo is described with a prevalence of 0.5%−1%. Recent studies suggest an increasing prevalence, but there is a scarcity of studies that have systematically evaluated the global incidence and prevalence. We examined the incidence and the global, regional, and country-specific prevalence of vitiligo in the general population (PROSPERO: CRD42021261643). We systematically searched PubMed, EMBASE, and Web of Science. Each study was categorised in subgroups. The overall analysis comprised all studies, except for studies only examining children and adolescents. Pooled proportions were calculated with the DerSimonian-Laird method for random-effects models with 95% confidence intervals (CI). Of the 7,838 identified studies, 171 were eligible for analysis (participants <i>n</i> = 572,334,973). The overall incidence was 1.59 per 10,000 person-years (95% CI: 0.70−2.83). The overall prevalence was 0.40% (95% CI: 0.37−0.44); no difference was observed between females (0.50%, 95% CI: 0.36−0.66) and males (0.49%, 95% CI: 0.35−0.65). West Asia showed the highest prevalence (0.77%, 95% CI: 0.44−1.10) and East Asia the lowest (0.12%, 95% CI: 0.10−0.14). The highest country-specific prevalence was reported in Jordan (1.34%, 95% CI: 0.12−3.87) and the lowest in Sweden (0.19%, 95% CI: 0.08−0.34). Children and adolescents showed a lower prevalence (0.27%, 95% CI: 0.24−0.31) compared to adults (0.70%, 95% CI: 0.59−0.81). Questionnaire-based studies showed a higher prevalence (0.73%, 95% CI: 0.52−0.98) compared to examination-based studies (0.59%, 95% CI: 0.46−0.73) and register-based studies (0.13%, 95% CI: 0.10−0.17). The prevalence in examination-based studies increased from 0.40% (95% CI: 0.17−0.73) between 1943 and 1979 to 0.89% (95% CI: 0.68−1.13) between 2020 and 2023. Questionnaire-based studies also showed an increasing prevalence, while in register-based studies, the prevalence was continuously low. This study shows the global impact of vitiligo and how subgroup analyses influence the prevalence. The overall prevalence of vitiligo is lower than previously assumed; females and males are equally affected, and vitiligo is more common in adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 5","pages":"1410-1419"},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.526","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762656","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":"A systematic review of isotretinoin and its contraindications in peanut, soybean and cashew nut allergies","authors":"Naayema Hussaini,&nbsp;Nabihah Hussaini,&nbsp;Jousef Bakir,&nbsp;Rabeea Mirza,&nbsp;Rubina Fatima","doi":"10.1002/jvc2.536","DOIUrl":"https://doi.org/10.1002/jvc2.536","url":null,"abstract":"<p>Should oral isotretinoin be considered contraindicated in patients with peanut, soybean, and cashew allergies? A systematic literature search of PubMed, EMBASE and The Cochrane Library up to July 2023 was conducted to identify randomised control trials (RCTs), cohort studies, case reports, and cross-sectional studies investigating if isotretinoin should be contraindicated in patients with various allergies including peanut, soybean, and cashew allergies. Primary outcomes explored included relapse, adverse effects, and safety profiles of oral isotretinoin at varying doses. Secondary outcomes included efficacy as well as economic considerations. The quality of studies, including risk of bias, was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). A total of eight studies were included. The majority of studies suggested that isotretinoin should not be considered inadvisable. In cases with peanut allergies, minimal adverse effects were noted with various dosages of isotretinoin and prolonged treatment duration. In cases with soybean allergies, similar results and conclusions were obtained to the cases with peanut allergies, however the number of studies were not of similar value to those of peanut allergies. Comparison between studies was challenging due to differing methods of assessment, subjective interpretation of severity and duration of follow-up. This review highlights the need for an adequately powered RCT, to decipher whether isotretinoin should not be given to patients with peanut, soybean or cashew allergies.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"42-48"},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.536","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530628","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}