JEADV clinical practice最新文献

{"title":"Assessing the efficacy of narrowband UVB phototherapy using digital patient questionnaires and patient-reported outcome measures (PROMs): An observational cohort study of patients with psoriasis and eczema","authors":"Evangelos Christou, Myrto Kastrisiou, John Ferguson","doi":"10.1002/jvc2.535","DOIUrl":"https://doi.org/10.1002/jvc2.535","url":null,"abstract":"<p>Phototherapy is a cost-effective and safe treatment for various inflammatory skin disorders. To enhance the efficiency of phototherapy delivery and understand its effects on patient outcomes, we designed digital phototherapy-specific patient questionnaires. These were administered via text message before initiation and after completion of phototherapy. We present a single-centre observational cohort study of psoriasis and eczema patients treated with Narrowband UVB (NB-UVB) phototherapy between March 2021 and December 2023.</p><p>Data was collected as part of a service improvement project and is consequently exempt from ethical approval requirements. NB-UVB phototherapy (311–312 nm) was administered using Waldmann UV7002 and UB5002 cabinets equipped with Philips NB-UVB TL F79-120W/01 and F72-100W/01 bulbs, respectively. The treatment frequency was 2–3 times per week at an initial dose of 70% of the minimal erythema dose, with 20% increments. Phototherapy was stopped once the skin was clear or almost clear, except for eczema, where the treatment frequency and dose were reduced until discontinuation.<span><sup>1</sup></span></p><p>Patient questionnaires incorporated demographic and clinical information, and patient-reported outcome measures (PROMs). PROMs collected included the Dermatology Life Quality Index (DLQI), assessing dermatology-related quality of life (QoL); the 5-point Patient Global Assessment (PtGA), measuring patient-perceived disease activity (“0 = clear” to “4 = severe”); and the 11-point Itch Numeric Rating Scale (INRS), examining itchiness severity over the previous 24 h (“0 = no itch” to “10 = worst imaginable itch”).<span><sup>2-4</sup></span> Eczema patients also completed the Patient Oriented Eczema Measure (POEM), evaluating eczema disease severity.<span><sup>5</sup></span></p><p>In total, 379 patients (psoriasis: <i>n</i> = 221, eczema: <i>n</i> = 158) treated with NB-UVB phototherapy completed the pretreatment questionnaire. The final study sample comprised 97 patients (psoriasis: <i>n</i> = 72/221 [32.6%]; eczema: <i>n</i> = 25/158 [15.8%]) who completed both pre- and posttreatment questionnaires. Wilcoxon signed-rank test with calculation of the Vargha–Delaney A effect size was performed to compare the pre- and posttreatment PROMs scores. <i>p</i> < 0.05 was considered statistically significant. All statistical analyses were performed using R software version 4.3.2.</p><p>The demographic and clinical characteristics of the study cohort are presented in Table 1.</p><p>Table 2 shows the pre- and post-phototherapy PROMs scores in psoriasis and eczema patients. In psoriasis, NB-UVB significantly improved QoL measured by DLQI, reducing disease impact from moderate before treatment to no effect afterward (<i>p</i> < 0.001). 80.6% (<i>n</i> = 58/72) of patients achieved the minimal clinically important difference (MCID) of 4 points in DLQI improvement.<span><sup>6</sup></span> NB-UVB reduced disease severity based on Pt","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"281-284"},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.535","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530669","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 clinical trial on the efficacy of mesotherapy with dutasteride for frontal fibrosing alopecia","authors":"Patrizia Elva Aguilar-Calderón, Sonia Sofia Ocampo-Garza, Maira Herz-Ruelas, Jorge Ocampo-Candiani, Adrian Cuellar-Barboza, Emmanuel Sánchez-Meza, Andrea Guerra-Garza, Minerva Gómez-Flores","doi":"10.1002/jvc2.518","DOIUrl":"https://doi.org/10.1002/jvc2.518","url":null,"abstract":"<p>Frontal fibrosing alopecia (FFA) is a lymphocytic cicatricial alopecia characterised by a progressive alopecic band, that affects the hairline, typically in the frontal region of the scalp, responsible for around 40% of all cicatricial alopecias.<span><sup>1</sup></span> It predominantly affects post-menopausal women aged 55–70 years.<span><sup>2</sup></span> Different treatments have been proposed, though oral dutasteride is considered the most effective therapeutic option.</p><p>However, adverse effects (AE) such as libido alterations, depression, and teratogenicity, warrant consideration. Consequently, intralesional dutasteride has emerged as an alternative without systemic AE.</p><p>We performed a clinical trial involving 16 adult women with FFA, diagnosed according to IFFACG criteria.<span><sup>3</sup></span> This study was approved by our Institutional Review Board (code DE22-00002) and adheres to the Code of Ethics of the World Medical Association, following the Declaration of Helsinki.</p><p>After meticulous antiseptic procedures,1 mL of local anaesthesia of 2% lidocaine solution was applied (ring block). Subsequently, multiple 0.1 mL injections of 0.01% dutasteride were administered 1 cm apart into the frontal scalp region using 30 G × 4 mm needles to 1 mL. This monthly procedure was repeated for a total of four sessions.</p><p>Statistical analysis was performed with SPSS v. 22.0 (IBM Corp.). Wilcoxon test was conducted to compare density, vellus hair, terminal hair, vellus/terminal hair ratio, thickness and Dermatology Life Quality Index (DLQI) between Visit 1 (V1) and Visit 5 (V5). A <i>p</i>-value < 0.05 was significant.</p><p>Trichoscopic findings indicated significant improvements in hair density and vellus hair count between V1 and V5, as detailed in Table 1. Additionally, there was a notable improvement in perifollicular erythema and scaling, enhancing overall patient satisfaction.</p><p>Hair density, hair thickness, vellus hairs and vellus/terminal hair ratio (VTHR) were evaluated using Fotofinder Trichoscale (Bad Birnbach). General characteristics are summarised in Table 1.</p><p>GPA showed important improvement in 9 (56.3%) with a Kappa index of 0.81. There was a decrease in perifollicular erythema and perifollicular scale between V1 and V5 (<i>p</i> = 0.020) and (<i>p</i> = 0.01), respectively (Table 1).</p><p>Regarding the comparison of trichoscopic findings, patients had a density of 71.43 in V1 versus 95.58 hairs/cm<sup>2</sup> in V5 (<i>p</i> = 0.036). They presented 12.50 vellus hairs in V1 compared with 29.63 in V5, respectively (<i>p</i> = 0.008). The VTHR was 0.253 in V1 versus 0.548 in V5 (<i>p</i> = 0.016) (Figure 1). Concerning the DLQI, patients had a mean score of 3.43 ± 2.58 at V1 compared with 1.56 ± 1.26 at V5 (<i>p</i> = 0.004).</p><p>Our findings suggest significant improvements in hair density and patient satisfaction. This aligns with previous studies that have highlighted the potential of dutasteride","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 5","pages":"1694-1697"},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.518","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762655","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":"Trichoscopy of tinea capitis caused by Microsporum audouinii","authors":"Oscar Ariel Bautista, Vanessa Castro, Carolina Rodriguez, Eduardo Mastrangelo Marinho Falcão, Regina Casz Schechtman, Luna Azulay-Abulafia","doi":"10.1002/jvc2.530","DOIUrl":"https://doi.org/10.1002/jvc2.530","url":null,"abstract":"<p><i>Tinea capitis</i> (TC), primarily affecting children aged 3–7, has globally increased in prevalence, and <i>Microsporum canis, a</i> zoophilic fungi, and <i>Trichophyton tonsurans, an</i> anthropophilic fungi, have become the major aetiologic agents.<span><sup>1</sup></span> In the 21st century, reports indicate an increase in the number of cases of anthropophilic transmission due to migrations, urbanization, changes in lifestyle and socioeconomic levels.<span><sup>1</sup></span></p><p><i>Microsporum audouinii</i>, an anthropophilic fungi endemic to Africa, causes milder inflammatory and chronic TC with late detection due to the lack of subjective symptoms, in comparison with <i>M. canis</i> infections which are more severe and accompanied by erythema.<span><sup>2</sup></span></p><p>In 2017, the first two cases of TC caused by <i>M. audouinii</i> in South America were reported in Brazil, involving two siblings without a history of prior travel, indicating possible autochthonous transmission.<span><sup>3</sup></span></p><p>Mycological examination is considered the gold standard diagnostic method of TC.<span><sup>4</sup></span> However, trichoscopy can be useful for making a correct and early diagnosis before culture results are available.<span><sup>4</sup></span> Trichoscopy exhibits higher sensitivity (94% vs. 49.1%) and specificity (83%) compared to direct KOH testing in diagnosing TC.<span><sup>5</sup></span></p><p>An observational, descriptive cross-sectional study was conducted at Instituto de Dermatologia Professor Rubem David Azulay of the Santa Casa da Misericórdia do Rio de Janeiro. We describe the trichoscopic findings of nine children, eight males and one female, aged between 3 and 14 years, average age 7 years, diagnosed with TC caused by <i>M. audouinii</i> from 2019 to 2023. Fluorescence with Wood lamp was performed identifying bluish-green fluorescence in all of them (Figure 1). Data were extracted from the patients' medical records to analyze clinical and sociodemographic characteristics. Statistical analysis involved calculating absolute frequencies (<i>n</i>) and relative frequencies (percentages).</p><p>The diagnosis of TC caused by <i>M. audouinii</i> was confirmed by direct KOH testing and culture. KOH testing showed ectothrix parasitism in all samples, while culture on Sabouraud agar displayed colonies of <i>Microsporum</i> spp. Slide cultures on potato dextrose agar were assessed under light microscopy using lactophenol cotton blue identifying species-specific structures. Growth pattern on boiled rice confirmed the identification. Trichoscopy performed without immersion liquid showed specific TC signs in at least two hairs per analyzed field, assessed by two independent dermatologists. Patients with recent antifungal medication use or inflammatory TC were excluded.</p><p>The characteristic trichoscopic findings evaluated for TC observed in the patients were as follows (<i>n</i> = 9): Morse code-like hairs in seven (78%","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 5","pages":"1698-1700"},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.530","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762195","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":"Skin matrix meets immunomatrix—Implications for genetic and acquired diseases","authors":"Alexander Nyström,&nbsp;Gregor Conradt,&nbsp;Saskia Lehr,&nbsp;Dimitra Kiritsi","doi":"10.1002/jvc2.532","DOIUrl":"https://doi.org/10.1002/jvc2.532","url":null,"abstract":"<p>An extracellular matrix (ECM) is essential for multicellular life. Apart from being a scaffold, it is an actively signalling unit, orchestrating homo- and heterocellular communication to uphold tissue homeostasis or elicit an appropriate regenerative response after injury. The skin as a barrier organ meeting unremittent physical biological and chemical challenges is dependent on both a specialized ECM and attentive yet balanced immune surveillance. Intriguingly, skin-like ECM composites occur in primary and secondary lymphoid organs. Evolutionary, the expansion of the ECM coincides with development of adaptive immunity. Studies of acquired and genetic skin diseases suggest that the skin and lymphoid ECMs are essential, emerging, but yet-under-appreciated, gatekeepers of dermal immune homeostasis. Here, we summarize knowledge of the dermal and skin-distal lymphoid ECM as a mediator of skin immune homeostasis. We argue that increased awareness of the lymphoid-ECM as a potential regulator of skin immunity will increase our understanding of diseases linked to skin inflammation and allow for improved treatment options of them.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 5","pages":"1399-1409"},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.532","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762653","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":"No need for a p value. Comments on analytical decisions in “Rosacea fulminas: An anti-inflammatory-based therapeutic approach”","authors":"Yung Gonzaga,&nbsp;Ana Luísa Sampaio","doi":"10.1002/jvc2.533","DOIUrl":"https://doi.org/10.1002/jvc2.533","url":null,"abstract":"<p>We read with interest the study by Handgretinger and colleagues entitled <i>Rosacea Fulminans: An Anti-inflammatory-based Therapeutic Approach</i>,<span>¹</span> and although the topic addressed is of great clinical relevance, the presentation of the results, particularly concerning the choice of the statistical test, warrants discussion.</p><p>The study tracked the evolution of the skin condition in six6 patients diagnosed with Rosacea fulminans before and after treatment with azithromycin. According to the methodological section, a <i>t</i> test for independent samples was used to compare the before and after treatment. This choice seems inappropriate to us, as it overlooks some fundamental assumptions in selecting statistical tests that assess the association between two variables.<span>^{2, 3}</span></p><p>The first issue concerns the independence between observations: The ‘before’ and ‘after’ measurements for the same individual are dependent, as they are related to the same subject. The independent samples <i>t</i> test assumes that the observations in each group are independent, which is not the case here.</p><p>The second issue concerns the nature of the variable being studied. The Clinical Erythema Assessment (CEA), for example, is an ordinal categorical variable. For instance, on a scale from 0 to 4, as in this case, the differences between ‘0 and 1’ may not represent the same quantitative change as a difference between ‘3 and 4.’ The <i>t</i> test assumes that the data are numbers, meaning that the differences between the values are consistent and quantifiable. For example, the difference between ages 25 and 20 is the same as the difference between 37 and 32, which is 5 years. The <i>t</i> test works with numerical variables, making it inappropriate for dealing with categorical variables, even if they are represented by numbers and have a natural order.</p><p>The third issue pertains to the necessity of a statistical test at all. In this regard, we would like to emphasize that the reason for writing this letter is not merely to criticize the choice of the statistical test, but to highlight that the value of a study like this should not rely on statistical significance. It is much more related to the descriptive and visual nature capable of creating a clear sensorial perception of clinical benefit and generating a relevant hypothesis to be explored more thoroughly in future studies.<span>⁴</span> In this regard, in our opinion, the study by Handgretinger and colleagues achieves the goal. It is a beautiful and illustrative case series that does not need <i>p</i> values to demonstrate its importance.</p><p>Yung Gonzaga conceived and wrote the article. Ana Luísa Sampaio wrote and reviewed the article.</p><p>The authors declare no conflict of interest.</p><p>Not applicable.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 5","pages":"1711-1712"},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.533","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762654","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":"Implementation and evaluation of a patient action plan for patients with atopic dermatitis","authors":"K. Thormann,&nbsp;L. Lupe,&nbsp;S. Radonjic-Hoesli,&nbsp;C. von Dach,&nbsp;D. Simon","doi":"10.1002/jvc2.531","DOIUrl":"https://doi.org/10.1002/jvc2.531","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Management and treatment of atopic dermatitis (AD) are complex and therefore bear the risk of therapeutic failure. Individualised patient action plans for patients and for caregivers have been shown to improve AD management, eczema monitoring and therapy adherence. Little is known about the use of patient action plans in the adult setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This project aimed at implementing a patient action plan to improve eczema management and evaluating its effects on disease severity and patient-related outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This quality improvement project had a pretest–posttest design and evaluated AD severity and patient-related outcomes after implementing a patient action plan. A convenience sample of 20 adult patients with AD was included. Socio-demographic, diagnostic and clinical variables were collected from the electronic health records. Trained staff assessed AD severity using SCORing Atopic Dermatitis (SCORAD) and person-centred dermatology self-care index (PeDeSI-G) pre as well as 1-month postintervention. Patients completed dermatology life quality index (DLQI) and patient benefit index (PBI). For comparison of SCORAD, DLQI, PeDeSI-G, paired <i>t</i>-test was applied. PBI was presented using descriptive statistics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Upon intervention, a significant decrease of disease severity (<i>p</i> &lt; 0.0001), in parallel with a significant decrease of DLQI (<i>p</i> &lt; 0.001) and PeDeSI-G (<i>p</i> &lt; 0.0001) was observed. A PBI ≥ 1 was reached in 95% of participants (mean 2.73; SD 0.9).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings confirm the importance of providing patient action plans to AD patients to achieve best treatment results. Based on our experience, we plan to modify the action plan by including both topical and systemic therapies, and to translate it into several languages.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"95-102"},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.531","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530670","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":"Extensive polymorphic eruption and lymphocytosis in a 56-year-old male—A difficult diagnosis!","authors":"Berbie Byrne,&nbsp;Marion Leahy,&nbsp;Kevin Molloy,&nbsp;Mary Laing","doi":"10.1002/jvc2.484","DOIUrl":"https://doi.org/10.1002/jvc2.484","url":null,"abstract":"&lt;p&gt;A 56-year-old male presented with a 5-month history of a pruritic, papular truncal rash with partial response to oral steroids. He reported no systemic symptoms. Initial differential diagnosis included dermatitis herpetiformis, drug-induced rash, a viral exanthem and lymphomatoid papulosis. Multiple skin biopsies were inconclusive, demonstrating a normal epidermis with mixed B-cell and T-cell dermal lymphohistiocytoc infiltrate. A skin biopsy for direct immunofluorescence was negative.&lt;/p&gt;&lt;p&gt;Laboratory investigations revealed mild iron deficient anaemia and CT Thorax Abdomen Pelvis (CT TAP) and colonoscopy confirmed diverticulosis. The patient responded minimally to oral doxycycline, topical clobetasol proprionate and antihistamines.&lt;/p&gt;&lt;p&gt;After 18 months he developed rapid extensive skin involvement with atypical targetoid polymorphic plaques on his limbs, pink coalescing urticated plaques with a geographical border on his trunk (Figure 1a), and ecchymosis of the anterior shoulders (Figure 1b). Fixed, annular, scaly plaques were evident on the dorsum of his hands (Figure 2a) and bilateral thighs (Figure 2b). This was associated with severe itch, fatigue and dyspnoea. Investigations revealed a lymphocytosis (44.7 × 10̂&lt;sup&gt;9&lt;/sup&gt;/L) thrombocytopenia (72 × 10̂&lt;sup&gt;9&lt;/sup&gt;/L), anaemia (Hb 9.4 × 10̂&lt;sup&gt;9&lt;/sup&gt;/L) and atypical lymphocytes on blood film. CT imaging confirmed widespread lymphadenopathy.&lt;/p&gt;&lt;p&gt;A skin biopsy was done (Figure 3a,b).&lt;/p&gt;&lt;p&gt;The rapid deterioration in our patient after 18 months with extensive cutaneous involvement, in association with systemic symptoms, widespread lymphadenopathy and lymphocytosis progressed the differential diagnosis to include Sezary syndrome or transformed mycosis fungoides (T-MF). Clinically the patient was not erythrodermic and did not meet Sezary syndrome diagnostic criteria&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; and no Sezary cells were identified in the skin, blood, or lymph nodes. Regarding T-MF, the patient did not progress through the patch-plaque stages of MF and skin biopsy did not reveal features of MF such as epidermotropism or pautrier microabscess. There was a patchy expression of CD30+ cells but significantly less than 25% of the infiltrate required to meet the diagnostic criteria of T-MF.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The atypical T-cell population and T-cell clonality identified on multiple BM, LN and skin biopsies resulted in a suspected diagnosis of leukemic dissemination of peripheral T-cell lymphoma not otherwise specified (PTCL NOS), but formal classification remained challenging. PTCL NOS is a heterogeneous group of aggressive nodal and extranodal T-cell lymphomas that are not characterized by any known clinicopathological criteria.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Following expert hematopathology review the histology, molecular results and immunophenotypic studies were repeated. Among the BM, LN and skin specimens three TFH markers, namely CD10, BCL6 and PD1, were collectively identified th","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 5","pages":"1745-1748"},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.484","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762723","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 case of mogamulizumab-induced vitiligo in a patient with mycosis fungoides","authors":"Charissa N. Obeng-Nyarko,&nbsp;Ciara G. Robinson,&nbsp;Anna R. Axelson","doi":"10.1002/jvc2.523","DOIUrl":"https://doi.org/10.1002/jvc2.523","url":null,"abstract":"&lt;p&gt;Vitiligo is an acquired disorder of pigmentation characterized by the development of asymptomatic, well-defined, depigmented macules and/or patches on the skin. The pathogenesis involves an interplay of genetic, environmental triggers, autoimmunity and oxidative stress mechanisms, thus leading to chemokine-driven melanocyte destruction by autoreactive cytotoxic CD8+ T lymphocytes.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Drug-induced vitiligo has been associated with biologic medications, including monoclonal antibodies, TNF-⍺ inhibitors, and interleukin inhibitors. Vitiligo-like depigmentation has also been reported in patients on immune checkpoint inhibitors.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Mogamulizumab is an anti-CC chemokine receptor-4 (CCR4) monoclonal antibody used to treat recalcitrant mycosis fungoides (MF) and Sézary syndrome (SS). The most common dermatologic adverse event is the ‘mogamulizumab-associated’ rash characterized by papules/plaques, folliculotropic MF-like plaques and cutaneous granulomatous drug eruption.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; Alopecia areata universalis&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; and a few cases of vitiligo have been reported.&lt;span&gt;&lt;sup&gt;6, 7&lt;/sup&gt;&lt;/span&gt; In this case report, we add to the existing literature by presenting another case of mogamulizumab-induced vitiligo.&lt;/p&gt;&lt;p&gt;An 83-year-old African American male with a history of hypertension and stage IV-A2 MF with leukaemic disease and lymph node involvement presented to the dermatology clinic for follow-up visit and complaint of skin discoloration. The patient's initial peripheral blood smear revealed 60% atypical lymphocytes with cerebriform morphology. Flow cytometry findings revealed CD4:CD8 ratio of 48:1, and CD4+ population was divided into: 89% CD7− and 91% CD26−. His skin disease was initially controlled on topical corticosteroids; however, he began to have progression of his MF as evidenced by erythroderma, persistent skin erosions, new lymphadenopathy, and multiple hospitalizations for superinfection. Repeat biopsies were consistent with MF and negative for infection. Due to progression and lack of adequate disease control on topical corticosteroids and pulse dexamethasone, mogamulizumab was recommended and subsequently initiated. Approximately 6 months following the initial dose of mogamulizumab, the patient developed depigmented macules and patches on his bilateral upper extremities that slowly progressed in a symmetrical, generalized distribution consistent with non-segmental vitiligo (Figures 1a,b; 2a,b; and 3). The patient's vitiligo was not affecting him psychosocially, and he was not interested in pursuing treatment.&lt;/p&gt;&lt;p&gt;In this report, we present the case of a patient who developed vitiligo 6 months following the initiation of mogamulizumab. In Algarni et al.'s report of three cases, patients presented with well-demarcated hypopigmented patches ranging from acrofacial to scalp, truncal and upper extremity distribution from 6 to 8 months after initial treatment ","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 5","pages":"1705-1707"},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.523","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762724","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 toolkit to facilitate skin research participation in underrepresented ethnic populations: A co-designed, mixed methods refinement exercise","authors":"S. P. Choy,&nbsp;M. Naveed,&nbsp;J. Prasad,&nbsp;K. Quadry,&nbsp;L. Moorhead,&nbsp;C. H. Smith,&nbsp;S. K. Mahil","doi":"10.1002/jvc2.516","DOIUrl":"https://doi.org/10.1002/jvc2.516","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;Inclusive, generalisable research is vital to inform evidence-based patient care. However, people from ethnic minority backgrounds remain underrepresented in research, increasing health disparities in under-served communities.&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;Codevelop a toolkit to increase the representation of people from ethnic minority groups in skin research.&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;Our four-phase approach comprised: (1) focus group discussions with individuals from ethnic minority groups with skin diseases to identify barriers and enablers to participate in skin research, (2) a narrative literature review, (3) development of a skin research inclusion toolkit, (4) dissemination of findings.&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;Focus group discussions (phase 1) identified a positive value model (belief in the value of research) and inclusive recruitment strategies (e.g. strong patient–recruiter relationships) as enablers to participation. Barriers included mistrust in research (e.g. poor information on personal data use) and social stigma of skin disease. Our narrative literature review (phase 2) reinforced these themes. Social stigma may accentuate feelings of shame or embarrassment associated with a skin condition. Mistrust is accentuated by a lack of information or understanding about research processes. Understanding distinct motivators for research participation across ethnic groups may help to cultivate a positive value model. Inclusive recruitment strategies should be codeveloped with populations of interest and culturally competent research teams to build lasting partnerships.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;Phases 1-2 informed a skin research inclusion toolkit (phase 3), which recommends researchers formulate (i) an inclusion plan during study design (e.g. consider differences in pathophysiology of skin diseases across ethnic groups), (ii) inclusive enrolment strategies (e.g. skin-of-colour education to clinicians and patients to address disease-associated stigma, codevelop study materials including translations) and (iii) retention strategies (e.g. time or travel reimbursement, timely feedback of findings). In phase 4, findings were disseminated to focus group participants.&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;Our co-designed toolkit has the potential to improve ethnic diversity in skin research cohorts to enable more representati","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 5","pages":"1548-1557"},"PeriodicalIF":0.0,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.516","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762607","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":"Differences in frequency of vulvar dermatoses according to ethnicity: A study of a cohort of patients in a large diverse UK teaching hospital","authors":"Majeeda Patel,&nbsp;Jade Simpson,&nbsp;Beth Stuart,&nbsp;Sujatha Thamban,&nbsp;Arucha Ekeowa-Anderson","doi":"10.1002/jvc2.529","DOIUrl":"https://doi.org/10.1002/jvc2.529","url":null,"abstract":"&lt;p&gt;The National Health Service Hospital Trust in East London, where we are based, serves an ethnically diverse population. The population of England and Wales as a total are 82% White, with the remaining 18% from Black, Asian, Mixed or Other ethnic groups. Tower Hamlets Borough, where one of our hospitals is based, had a population mix 41.8% Asian, 39.3% White and 7.4% Black in the 2021 UK census.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; There is little data on the prevalence of different vulvar dermatoses in different ethnic groups. Lichen sclerosus is a common vulvar dermatosis in Caucasian women but we wanted to investigate the case mix across different ethnicities. We collected information on diagnosis and ethnicity in the population of patients attending the Vulvar Clinics at our hospitals over a total of 6 months in 2022 and 2023. The months were split to avoid duplication of patients and only data from individual patients was analysed. Diagnosis was made by a consultant dermatologist with subspecialty expertise in vulvar disease, sometimes in joint consultation with a consultant gynaecologist.&lt;/p&gt;&lt;p&gt;Data from 246 individual patients was collected. UK census data is collected into five ethnic groups as follows:—‘White’, ‘Asian or Asian British’, ‘Black or Black British, Caribbean or African’, ‘Mixed/Multiple’ and lastly ‘Other’ ethnic group.&lt;/p&gt;&lt;p&gt;The majority of patients seen were White (128/246) with 83 Asian, 17 Black, 15 Mixed/Multiple and 3 from ‘Other’ ethnic groups. Within the Asian group, the most common subdivisions included Asian Bangladeshi (38/83), Asian Indian (12), Asian Pakistani (14) and Asian other/non stated (19).&lt;/p&gt;&lt;p&gt;The mean age of patients in the three largest cohorts was 61 years—White, 46.2 years—Asian and 52.9 years—Black.&lt;/p&gt;&lt;p&gt;The five most common diagnoses varied according to ethnicity and are tabulated below (Table 1).&lt;/p&gt;&lt;p&gt;Lichen sclerosus was the most frequently diagnosed vulvar dermatosis in all ethnic groups except Asian. The mean age of patients of Asian ethnicity was also lower than the other groups. In Asian patients, lichen simplex was the most frequent diagnosis made. Further analysing the data, &lt;i&gt;χ&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; test was performed on the 225 patients with diagnoses of either lichen sclerosus or lichen simplex (Table 2). There were statistically significant differences in patients receiving each diagnosis; according to ethnicity.&lt;/p&gt;&lt;p&gt;Controlling for age, the differences seen in each ethnic group were not statistically significant for lichen sclerosus. Results for lichen simplex were, although confidence intervals were wide. The increased odds of a lichen simplex diagnosis was 20.2 times higher in Asian patients (95% confidence interval [CI]: 4.48, 91.41; &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and 11.71 times higher in Black patients (95% CI: 1.77, 77.59; &lt;i&gt;p&lt;/i&gt; = 0.011) compared with White.&lt;/p&gt;&lt;p&gt;These results suggest lichen simplex of the vulva is more frequently the diagnosis behind a vulval presentation in Asian and Black pa","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"3 5","pages":"1708-1710"},"PeriodicalIF":0.0,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.529","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762679","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}