JEADV clinical practice最新文献

{"title":"A case of double-mutant resistant tinea indotineae","authors":"R. Koncan,&nbsp;A. Benini,&nbsp;G. Lo Cascio,&nbsp;N. Di Meo,&nbsp;V. Lepera,&nbsp;G. Palladino,&nbsp;L. Clemente,&nbsp;F. Barbone,&nbsp;I. Zalaudek","doi":"10.1002/jvc2.563","DOIUrl":"https://doi.org/10.1002/jvc2.563","url":null,"abstract":"<p>In recent years, there has been a concerning increase in a challenging-to-treat dermatophyte lineage of the <i>Trichophyton mentagrophytes</i> complex, known as <i>Trichophyton indotineae</i>. We report the first case of resistant <i>T. indotineae</i> bearing a double mutation in the squalene epoxidase gene (SQLE), isolated in Italy from a 26 -year-old Nepali woman affected by a persistent tinea corporis. Topical terbinafine yielded minimal to no improvement while itraconazole provided partial relief but failed to eradicate the infection. Molecular identification through Sanger sequencing of the internal transcribed spacer region confirmed <i>T. indotineae</i> and sequencing of the SQLE gene revealed the presence of a double mutation (Phe397Leu/Ala448Thr) associated with antifungal resistance. Broth microdilution susceptibility testing demonstrated resistance to fluconazole, but susceptibility to itraconazole. Ultimately complete cure was achieved with prolonged high-dose itraconazole therapy.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"248-252"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.563","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530665","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 infections caused by Mycobacterium chelonae: Underestimated, especially in immunocompromised patients","authors":"Celine De Krock,&nbsp;Otto Van de gaer,&nbsp;Emmanuel André,&nbsp;Jan Leo Lenaerts,&nbsp;Patrick Verschueren,&nbsp;Paul De Munter,&nbsp;Petra De Haes","doi":"10.1002/jvc2.575","DOIUrl":"https://doi.org/10.1002/jvc2.575","url":null,"abstract":"<p><i>Mycobacterium chelonae</i> infections are rare but significant in immunocompromised patients, often leading to delayed diagnosis due to a specific clinical signs and the difficulty to culture and identify the causative agent with conventional laboratory techniques. We report a case series of five patients presenting with cutaneous infection due to <i>M. chelonae</i>. An extensive review of the literature was accomplished to provide summary data on the clinical presentation, diagnostic methods and treatment options for these infections. Four out of five patients were receiving immunosuppressive treatments. All patients presented after a prolonged history of painful lesions on the extremities. Sampling and definitive diagnosis implied repeated tissue biopsies and a combination of mycobacterial tests. All patients received a combination of antibiotics comprising a macrolide and achieved complete healing of the skin lesions after 4–12 months. Our case report aims to increase awareness of skin infections caused by <i>M. chelonae</i> and emphasises the importance of early implementation of mycobacterial cultures in the diagnosis of painful ulcerations on the extremities that do not improve to standard systemic antibiotics.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"262-268"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.575","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530664","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":"Honey as a rare cause of severe anaphylaxis: Case report and review of literature","authors":"Julian Steininger,&nbsp;Stefanie Heyne,&nbsp;Susanne Abraham,&nbsp;Stefan Beissert,&nbsp;Andrea Bauer","doi":"10.1002/jvc2.581","DOIUrl":"https://doi.org/10.1002/jvc2.581","url":null,"abstract":"<p>Food allergies are a significant health concern worldwide, with anaphylaxis being one of the most severe manifestations. This report describes a case of a 65-year-old male patient with recurrent grade III anaphylaxis of unknown origin. Through detailed diagnostic testing, a prick-to-prick test revealed an allergy to honey, identifying it as the trigger for his severe allergic reactions. Honey allergies are rare but often associated with sensitization to pollen from the Compositae family, to which our patient was also sensitized. Based on these findings, the patient was advised to strictly avoid honey and was provided with an emergency kit. To date, the patient experienced no further anaphylactic episodes.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"273-276"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.581","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530687","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":"Improved photoprotection in the UVA/visible radiation boundary region is essential to prevent DNA damage, oxidative stress and gene expression changes in human skin","authors":"Karl P. Lawrence,&nbsp;Thierry Douki,&nbsp;Robert P. E. Sarkany,&nbsp;Stephanie Acker,&nbsp;Bernd Herzog,&nbsp;Antony R. Young","doi":"10.1002/jvc2.586","DOIUrl":"https://doi.org/10.1002/jvc2.586","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Studies have demonstrated the potential for damage caused by exposure to radiation at the UVR/visible border region (380–410 nm) and beyond. This includes potentially mutagenic delayed DNA damage, increased gene expression related to photoageing and inflammation, pigmentation and the production of reaction oxygen species. Photoprotection in this region is limited, with a focus on shorter, more energetic UVR regions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the ability of two sunscreens for their ability to prevent photodamage in the UVA/visible region. Both sunscreens were labelled as SPF 15 and would meet requirements for labelling as UVA protective in the EU and USA. Their ingredients were identical apart from the addition of bis- (diethylaminohydroxybenzoyl benzoyl) piperazine (BDBP), a recently approved organic filter that absorbs between 350 and 425 nm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sunscreens were assessed in vitro in human cell lines and in vivo in healthy human volunteers (Fitzpatrick skin type I–II volunteers). Endpoints were assessed including oxidative stress, gene expression and DNA damage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The formulation including the new filter provided significantly more protection than the conventional sunscreen for almost all endpoints tested. The conventional formulation provided some protection compared to unprotected skin or placebo control.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study demonstrates the requirement for improved photoprotection at the UVR-visible border region and the importance of assessing sunscreens across a broader range of wavelengths than currently approved protocols require.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 2","pages":"440-450"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.586","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190743","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":"Is eosinophil cationic protein (ECP) a new predictor for assessing disease control in chronic spontaneous urticaria?","authors":"Özge Atik,&nbsp;Fatma Merve Tepetam,&nbsp;Şeyma Özden,&nbsp;Emek Kocatürk","doi":"10.1002/jvc2.576","DOIUrl":"https://doi.org/10.1002/jvc2.576","url":null,"abstract":"&lt;p&gt;Chronic spontaneous urticaria (CSU) is mostly a mast cell (MC)-driven disease, but the interaction of skin MCs with other cells such as monocytes, basophils, neutrophils, T-lymphocytes and eosinophils plays a role in its pathogenesis.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The role of eosinophils in the pathogenesis of CSU is not fully understood; however, histological studies have shown that eosinophil infiltration correlates with high disease activity.&lt;span&gt;&lt;sup&gt;2-4&lt;/sup&gt;&lt;/span&gt; Eosinophils and MCs engage in bidirectional communication, with reciprocal activation and degranulation in CSU. MC-mediated cytokine release triggers eosinophil infiltration into CSU lesions followed by the production of stem cell factor from eosinophils which promotes the proliferation and differentiation of MCs and may contribute to the persistence of high numbers of MCs at the site of wheals and in nonlesional skin.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Furthermore eosinophil-derived proteins, such as the major basic protein (MBP) and eosinophil cationic protein (ECP), can induce MC degranulation via Mas-related G protein-coupled receptor-X2, thus perpetuating the inflammatory cycle.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In previous studies, deposition of MBP and ECP in the skin has been observed in CSU, delayed pressure urticaria,&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; solar urticaria,&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; cold urticaria, and dermographic urticaria.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; Lorenzo et al.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; identified a correlation between eosinophil proteins and the severity of urticaria, demonstrating that serum levels of ECP were significantly related to the severity of CSU. However, no studies have evaluated the association between eosinophil proteins and disease control.&lt;/p&gt;&lt;p&gt;In this retrospective cross-sectional study, we analyzed the electronic or written records of patients diagnosed with CSU between 2018 and 2022 in an Allergy and Immunology Department in Türkiye. Patients whose urticaria could not be controlled despite standard single-dose of second-generation H1-antihistamines (sgAHs) and whose dosage was increased to fourfolds were included in the study. Exclusion criteria were: isolated inducible urticaria, atopic dermatitis, severe systemic and infectious disease, concomitant neoplastic disease, pregnancy and use of systemic steroids and immunosuppressives.&lt;/p&gt;&lt;p&gt;The patients were treated with fourfolds of sgAHs for 4 weeks and response to treatment was evaluated by the urticaria control test (UCT) (UCT scores ≥ 12 [well-controlled urticaria] and UCT &lt; 12 [poor disease control]). Serum ECP levels were measured (Siemens Immulite device [clia, chemmulinescence method]) only at one-time inclusion before the escalation of antihistamines. Receiver operating characteristic (ROC) curve analysis was performed to define an optimal cut-off value for serum ECP. The study protocol was approved by the local ethics committee of our hospital.&lt;/p&gt;&lt;p&gt;The response rate to updosed antihistamines in 34","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"311-313"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.576","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530788","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":"Visual explainability of 250 skin diseases viewed through the eyes of an AI-based, self-supervised vision transformer—A clinical perspective","authors":"Ramy Abdel Mawgoud,&nbsp;Christian Posch","doi":"10.1002/jvc2.580","DOIUrl":"https://doi.org/10.1002/jvc2.580","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Conventional supervised deep-learning approaches mostly focus on a small range of skin disease images. Recently, self-supervised (SS) Vision Transformers have emerged, capturing complex visual patterns in hundreds of classes without any need for tedious image annotation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to form the basis for an inexpensive and explainable AI system, targeted at the vastness of clinical skin diagnoses by comparing so-called ‘self-attention maps’ of an SS and a supervised ViT on 250 skin diseases—visualizations showing areas of interest for each skin disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a public data set containing images of 250 different skin diseases, one small ViT was pretrained S) for 300 epochs (=ViT-SS), and two were fine-tuned supervised from ImageNet-weights for 300 epochs (=ViT-300) and for 78 epochs due to heavier regularization (=ViT-78), respectively. The models generated 250 self-attention maps each. These maps were analyzed in a blinded manner using a ‘DermAttention’ score, and the models were primarily compared based on their ability to focus on disease-relevant features.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Visual analysis revealed that ViT-SS delivered superior self-attention-maps. It scored a significantly higher accuracy of focusing on disease-defining lesions (88%; confidence interval [CI] 95%: 0.840–0.920) compared to ViT-300 (78.4%; CI 95%: 0.733–0.835; <i>p</i> &lt; 0.05) and ViT-78 (51.2%; CI 95%: 0.450–0.574; <i>p</i> &lt; 0.05). It also exceeded in other subcategories of ‘DermAttention’.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SS pretraining did not translate to better diagnostic performance when compared to conventional supervision. However, it led to more accurate visual representations of varying skin disease images. These findings may pave the way for large-scale, explainable computer-aided skin diagnostic in an unfiltered clinical setting. Further research is needed to improve clinical outcomes using these visual tools.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"145-155"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.580","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530753","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":"Therapeutic inertia in the management of patients with moderate to severe psoriasis: A systematic review of cross-sectional studies","authors":"Jennifer Lavina Ngo,&nbsp;Czarina Chavez","doi":"10.1002/jvc2.566","DOIUrl":"https://doi.org/10.1002/jvc2.566","url":null,"abstract":"<p>Therapeutic inertia (TI) is defined as the inability of physicians to intensify or initiate a more aggressive treatment in patients who need it. This study aims to explore the evidence behind TI in the management of patients with moderate to severe psoriasis and to determine the factors that contribute to its occurrence. An extensive literature search was conducted systematically in Cochrane Library, Medline, Epistemonikos, Google Scholar, and HERDIN Plus from their inception up to June 2023. Cross-sectional studies that looked into TI in patients with moderate to severe psoriasis and discussed the factors that lead to its occurrence were included in the study. The review was limited to peer-reviewed journals in the English language. Outcomes were presented as counts and percentages, and notable findings from each study were highlighted. Three thousand two hundred and fifty six records were identified but only 4 studies met the inclusion criteria and were included in the analysis. Based on the available evidence, the prevalence of TI in psoriasis varies from 25.4% to 35.6%. Its occurence is largely caused by physician-related factors (reluctance to escalate treatment due to lack of knowledge and experience) and patient-related factors (satisfaction with current treatment or refusal to change treatment due to psychological barriers). Healthcare system-related factors were not directly explored. The limited data on TI in the management of moderate to severe psoriasis presents opportunities to further explore its prevalence, the factors contributing to it, and its effect on treatment outcomes.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"61-71"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.566","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530754","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":"Field therapies for actinic keratosis: an Australian cost-effectiveness analysis","authors":"Yaron Gu,&nbsp;Kinar Mistry Shah,&nbsp;Grace Xiaoying Li,&nbsp;Deshan Frank Sebaratnam,&nbsp;Helen Yiling Sun","doi":"10.1002/jvc2.564","DOIUrl":"https://doi.org/10.1002/jvc2.564","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Actinic keratoses have a high prevalence in the older Australian population, with most patients presenting with field actinic damage. Despite this high prevalence, no field therapies are subsidised under the Pharmaceutical Benefits Scheme.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To determine which therapy for field actinic damage is the most cost-effective when comparing 5-fluorouracil (5-FU), imiquimod (IMQ), and methyl-aminolevulinate photodynamic therapy (MAL-PDT) at 12 months post-treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A decision tree was constructed using TreeAge Pro, representing the likely clinical trajectories of patients with field actinic damage treated with 5-FU, IMQ, and MAL-PDT. The cost-effectiveness analysis was performed from the patient perspective, assuming an outpatient setting. Efficacy data was derived from a single-blinded, multi-centre prospective randomised control trial. Cost data were derived from Australian dermatology clinics and pharmacies. One-way and probabilistic sensitivity analyses were conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>5-FU was the most cost-effective treatment. It was cheaper and more effective than all other treatments, with a cost-effectiveness ratio of AU$201 per patient achieving ≥75% clearance in field actinic damage. The cost-effectiveness ratios of IMQ, and MAL-PDT were AU$940, and AU$8058 per patient achieving ≥75% clearance respectively. Both sensitivity analyses showed certainty in 5-FU's dominance over the other treatments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>5-FU is the most cost-effective treatment option for Australian patients presenting with actinic field damage on the head area.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"137-144"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.564","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530752","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":"Angioedema following venipuncture in a patient on angiotensin-converting enzyme inhibitor and dipeptidyl peptidase-IV inhibitor therapy: A case report","authors":"Adrien Bénic,&nbsp;Adrien Boyard,&nbsp;Alexan Pogossian,&nbsp;Laurent Misery,&nbsp;Anne-Marie Roguedas-Contios","doi":"10.1002/jvc2.582","DOIUrl":"https://doi.org/10.1002/jvc2.582","url":null,"abstract":"<p>Acquired angioedema (AAE) is a rare, potentially life-threatening condition, primarily induced by medications, with attacks typically triggered by major trauma. We report a rare case of AAE triggered locally by minor trauma—a forearm venipuncture—in a 77-year-old male taking ramipril and sitagliptin. The venipuncture and these medications acted synergistically through distinct pathways in bradykinin metabolism, resulting in localized AAE. This case highlights the importance of recognizing minor trauma as a potential trigger in patients on multiple AAE-inducing medications.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 2","pages":"510-513"},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.582","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190723","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":"Herpes zoster admissions: The majority of patients are not immunised","authors":"Mina Raahimi,&nbsp;Martin Hartmann","doi":"10.1002/jvc2.574","DOIUrl":"https://doi.org/10.1002/jvc2.574","url":null,"abstract":"<p>Herpes zoster (HZ) is usually self-limiting, however, can lead to significant morbidity, especially in the immunosuppressed or elderly individual. The adjuvant recombinant subunit HZ vaccine Shingrix has been on the market since 2017 and can reduce the risk of varicella zoster virus (VZV) reactivation.<span>¹</span></p><p>To date, we report a total of 300 HZ admissions to our tertiary care Dermatology department in 2023 and 2024, of which only two patients were fully immunised with the zoster vaccine, meaning having received the two full doses. One was a 57-year-old female taking fingolimod for relapsing-remitting multiple sclerosis (MS), and the other was a 76-year-old male who was taking low-dose prednisolone (2.5 mg once daily) for polymyalgia rheumatica. All other admitted patients had not or had only been partially immunised with the HZ vaccine (one patient). Physicians should be aware of the various drug classes which may increase the risk of VZV reactivation and consider recommending immunisation to patients taking any of these. Fingolimod, for example, is a sphingosine 1-phosphate receptor modulator which inhibits the migration of CD4-naive T cells and central memory T cells from lymphoid organs; it can cause lymphopenia and is licensed for the treatment of recurrent remittent forms of MS.<span>^{2, 3}</span> Other examples of the same drug group are ozanimod and ponesimod. Dimethyl fumarate and diroximel fumarate are further options for the treatment of MS and are also known to increase the risk of VZV reactivation. Their direct mode of action is not fully understood; however, they are thought to modify immune cell migration and can cause lymphopenia.<span>⁴</span> Other immunosuppressants such as cladibrine, Janus kinase inhibitors and corticosteroids are also known to increase the risk of VZV reactivation considerably.<span>^{5, 6}</span> Given the notable lack of fully immunised patients presenting to our department, we recommend discussing this risk of HZ with all patients at risk (adults aged 50 years and older, as well as adults aged 18 years and older who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression) and immunisation should be considered.</p><p><b>Mina M. Raahimi</b>: Conceptualisation; visualisation; writing. <b>Martin Hartmann</b>: Supervision.</p><p>The authors declare no conflict of interest.</p><p>Not applicable.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"314-315"},"PeriodicalIF":0.0,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.574","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530299","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}