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LETTER TO THE EDITOR

IMAGES IN DERMATOLOGY

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Open Access

Multi-task AI models in dermatology: Overcoming critical clinical translation challenges for enhanced skin lesion diagnosis

  • Version of Record online: 07 February 2025
Multi-task AI models in dermatology: Overcoming critical clinical translation challenges for enhanced skin lesion diagnosis

Our All-In-One framework for skin lesion diagnosis—Hierarchical-Out of Distribution—Clinical Triage (HOT) model provides three outputs—(1) Hierarchical classification; (2) An Out-of-Distribution (OOD) alert; and (3) A clinical triage recommendation for the input clinical image of lesion. Our web demonstration with some sample images is available at https://lesion.ai.cloud.monash.edu/.

IMAGES IN DERMATOLOGY

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Open Access

Hidradenitis suppurativa with and without draining tunnels: A real-world study characterizing differences in treatment and disease burden

  • Version of Record online: 04 February 2025
Hidradenitis suppurativa with and without draining tunnels: A real-world study characterizing differences in treatment and disease burden

This real-world study found that patients with moderate–severe hidradenitis suppurativa (HS) and draining tunnels experienced a greater clinical and health-related quality of life burden compared with patients without draining tunnels. This study indicates that more effective treatments are needed for patients with moderate–severe HS with draining tunnels.

LETTER TO THE EDITOR

Towards a more comprehensive evaluation: Addressing limitations in the study of dupilumab and pregnancy outcomes

  • Version of Record online: 03 February 2025

ORIGINAL ARTICLE

Increased sodium consumption is associated with psoriasis: A population-based cohort study

  • Version of Record online: 28 January 2025
Increased sodium consumption is associated with psoriasis: A population-based cohort study

This scheme summarizes notable findings from this work: increased estimated sodium intake was associated with an increased adjusted odds of psoriasis in both the UK Biobank and US-based National Health and Nutrition Examination Survey population-based cohorts. Our results support clinical trials assessing the impact of dietary salt reduction on psoriasis.

Risk score stratification of cutaneous melanoma patients based on whole slide images analysis by deep learning

  • Version of Record online: 24 January 2025
Risk score stratification of cutaneous melanoma patients based on whole slide images analysis by deep learning

SmartProg-MEL enhances risk stratification of melanoma patients by analysing digitized WSI of primary cutaneous tumours at diagnosis. It integrates two neural networks to extract both tissue and cellular morphological information that provides a final risk score per patient, and discriminates two risk groups of patients in terms of 5-y OS.

Open Access

Long-term safety and efficacy of ritlecitinib in adults and adolescents with alopecia areata and at least 25% scalp hair loss: Results from the ALLEGRO-LT phase 3, open-label study

  • Version of Record online: 23 January 2025
Long-term safety and efficacy of ritlecitinib in adults and adolescents with alopecia areata and at least 25% scalp hair loss: Results from the ALLEGRO-LT phase 3, open-label study

ALLEGRO-LT (NCT04006457) is an open-label, phase 3 study investigating the long-term safety and efficacy of ritlecitinib in patients with alopecia areata (AA). In this analysis in 449 de novo patients with AA and ≥25% scalp hair loss, ritlecitinib demonstrated clinical efficacy and had an acceptable safety profile through Month 24.

REVIEW ARTICLE

Open Access

Plastics in dermatology: A review and solutions

  • Version of Record online: 21 January 2025
Plastics in dermatology: A review and solutions

This review explores the environmental and health impacts of plastics, particularly microplastics in dermatological products. It discusses the plastic life cycle, routes of exposure, health risks and provides science-based recommendations to reduce plastic use in dermatology. It emphasizes the role of dermatologists in curbing plastic pollution and improving human/planetary health.

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Open Access

Impact of particulate matter exposure on melanoma risk: A multicentre case–control study

  • Version of Record online: 17 January 2025
Impact of particulate matter exposure on melanoma risk: A multicentre case–control study

Long-term exposure to higher levels of PM10 and PM2.5 may have a protective effect against melanoma, potentially due to the reduction in ultraviolet radiation.

LETTER TO THE EDITOR

Concerns regarding the systematic review and editorial on oral dutasteride for frontal fibrosing alopecia

  • Version of Record online: 08 January 2025

ORIGINAL ARTICLE

Trends in cutaneous melanoma mortality and incidence in European Union 15+ countries between 1990 and 2019

  • Version of Record online: 08 January 2025
Trends in cutaneous melanoma mortality and incidence in European Union 15+ countries between 1990 and 2019

Almost all countries demonstrated increasing male ASDRs over the observation period. There was greater heterogeneity between countries regarding female ASDRs. The most recent Joinpoint analysis 2016–2019 shows significantly decreasing mortality in all countries except the United Kingdom. Incidence rates increased in all countries, with evidence of plateau from 2015 onwards.

Open Access

Desmoplastic melanoma in Sweden in 2009–2022: A population-based registry study demonstrating distinctive tumour characteristics, incidence and survival trends

  • Version of Record online: 08 January 2025
Desmoplastic melanoma in Sweden in 2009–2022: A population-based registry study demonstrating distinctive tumour characteristics, incidence and survival trends

The incidence of desmoplastic melanoma (DM) in Sweden remains stable, unlike rising cutaneous melanoma rates. Despite advanced tumour features, DM patients have better survival outcomes. However, recent survival improvements are lacking, potentially due to limited treatment options compared to other melanoma subtypes.

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Open Access

Impact of light dose and fluence rate on the efficacy and tolerability of topical 5-ALA photodynamic therapy for actinic keratoses: A randomized, controlled, observer-blinded intrapatient comparison study

  • Version of Record online: 31 December 2024
Impact of light dose and fluence rate on the efficacy and tolerability of topical 5-ALA photodynamic therapy for actinic keratoses: A randomized, controlled, observer-blinded intrapatient comparison study

In this randomized trial on the impact of modification of light dose and fluence rate in ALA-PDT for actinic keratoses, we found that halving the light dose and/or fluence rate did not negatively affect the therapeutic outcome. In addition, halving the fluence rate significantly decreased cPDT-induced pain during illumination.

LETTER TO THE EDITOR

HISTORICAL PERSPECTIVE

GUIDELINES

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Line-field confocal optical coherence tomography coupled with artificial intelligence algorithms as tool to investigate wound healing: A prospective, randomized, single-blinded pilot study

  • Version of Record online: 17 December 2024
Line-field confocal optical coherence tomography coupled with artificial intelligence algorithms as tool to investigate wound healing: A prospective, randomized, single-blinded pilot study

The combination of high-resolution imaging (LC-OCT) and artificial intelligence (AI) represents a promising tool for better understanding wound healing, evaluating the efficacy of current wound care interventions and analysing keratinocyte behaviour in detail during the wound healing process.

Baseline dermoscopic patterns predict long-term changes in nevus diameter and in dermoscopic features

  • Version of Record online: 16 December 2024
Baseline dermoscopic patterns predict long-term changes in nevus diameter and in dermoscopic features

In the study, the authors have identified dermoscopic patterns that are associated with different stages in the life cycle of nevi. New nevi were associated with peripheral globules and smudgy patterns. Growing nevi were associated with peripheral globules and negative network patterns. Stable nevi were associated with reticular, structureless and central globules with peripheral network patterns.

LETTER TO THE EDITOR

POSITION STATEMENT

Open Access

Oral health care pathways for patients with epidermolysis bullosa: A position statement from the European reference network for rare skin diseases

  • Version of Record online: 13 December 2024
Oral health care pathways for patients with epidermolysis bullosa: A position statement from the European reference network for rare skin diseases

The European Reference Network for Rare Skin Diseases has developed consensus-based oral health care pathways for dental referral, treatment and follow-up for patients with EB according to their risk for oral and dental manifestations and complications. Referral for early preventive strategies is key to reducing the burden of disease.

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Open Access

Long-term follow-up of a randomized, double-blind, phase III, multi-centre study to evaluate the safety and efficacy of field-directed photodynamic therapy (PDT) of mild to moderate actinic keratosis using BF-200 ALA versus placebo and the BF-RhodoLED® lamp

  • Version of Record online: 12 December 2024
Long-term follow-up of a randomized, double-blind, phase III, multi-centre study to evaluate the safety and efficacy of field-directed photodynamic therapy (PDT) of mild to moderate actinic keratosis using BF-200 ALA versus placebo and the BF-RhodoLED® lamp

Follow-up data 6 and 12 months after field-directed photodynamic therapy (PDT) for treatment of actinic keratosis (AK) in a phase III study. Sustained participant complete clearance. Participants who showed clinical complete clearance of AK lesions 12 weeks after PDT were assessed for recurrences. The sustained complete clearance was higher for BF-200 ALA than for placebo throughout the follow-up. Reduction in skin quality impairment. All parameters of skin quality improved during follow-up.

LETTER TO THE EDITOR

ORIGINAL ARTICLE

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Assessment of image quality on the diagnostic performance of clinicians and deep learning models: Cross-sectional comparative reader study

  • Version of Record online: 10 December 2024
Assessment of image quality on the diagnostic performance of clinicians and deep learning models: Cross-sectional comparative reader study

This graphical abstract illustrates the impact of dermoscopic image quality on the performance of clinicians and a CNN model. It presents examples from the 303-image test set and compares the CNN's AUROC across different image qualities against clinician performance.

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Effect of patient-contextual skin images in human- and artificial intelligence-based diagnosis of melanoma: Results from the 2020 SIIM-ISIC melanoma classification challenge

  • Version of Record online: 08 December 2024
Effect of patient-contextual skin images in human- and artificial intelligence-based diagnosis of melanoma: Results from the 2020 SIIM-ISIC melanoma classification challenge

Effect of patient-contextual dermoscopy sets (right panel) was assessed. Participants classified (melanoma versus benign) the index lesion (blue border) before and after the remaining set was presented. Specificity decreased without significant change in sensitivity. 27.8% of human-readers outperformed the winning AI algorithm (AUROC = 0.930) from an online competition in enhanced-contextual assessment.

LETTER TO THE EDITOR

SYSTEMATIC REVIEW

Experience of patients and healthcare practitioners with interdisciplinary care in immune-mediated inflammatory diseases with skin manifestations: A systematic scoping review

  • Version of Record online: 07 December 2024
Experience of patients and healthcare practitioners with interdisciplinary care in immune-mediated inflammatory diseases with skin manifestations: A systematic scoping review

This scoping review gathers evidence on patient- and HCP perceptions on interdisciplinary care (IC) for Immune-mediated inflammatory Diseases with Skin manifestations (skIMID) and state-of-the-art of measurement. IC experience is captured very heterogeneously and strongly depends on the context of the care provider. Experience seems to be better in local programmes than systems rolled out in larger geographical regions. Future need is to develop a standardized core IC outcome set, including medical-, process- and financial indicators, patient and HCP care experience measures. Such data will support benchmarking and identification of improvement areas in quality of care.

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Open Access

Beyond the scoreboard: Coaches' UV-related skin cancer knowledge in outdoor sports

  • Version of Record online: 05 December 2024
Beyond the scoreboard: Coaches' UV-related skin cancer knowledge in outdoor sports

The nationwide representative C3O study shows clear deficits in UV-specific skin cancer knowledge among 1200 German coaches interviewed. Significant differences were evident across different sports as well as between micro and meso-level characteristics.

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Line-field confocal optical coherence tomography of basal cell carcinoma: A retrospective study on diagnostic performance

  • Version of Record online: 02 December 2024
Line-field confocal optical coherence tomography of basal cell carcinoma: A retrospective study on diagnostic performance

LC-OCT markedly increases the diagnostic accuracy in the differentiation of BCC from imitators and in the discrimination across BCC subtypes. LC-OCT criteria such as lobule content, shape and location are crucial for BCC diagnosis and subtype classification. A straightforward, user-friendly diagnostic algorithm is proposed for BCC diagnosis and subtype discrimination.

Open Access

The integration of dermatology experts into primary care to assess and treat patients with skin lesions is cost-effective: A quasi-experimental study

  • Version of Record online: 02 December 2024
The integration of dermatology experts into primary care to assess and treat patients with skin lesions is cost-effective: A quasi-experimental study

The integration of dermatologist into primary care settings is cost-effective and streamlines the management of patients with skin conditions. The cost for each additional pre-malignancy or malignancy treated is €853 lower, and for any additional skin finding treated, €381 lower than that of the standard care pathway.

LETTER TO THE EDITOR

GUIDELINES

Open Access

2024 European guidelines for the management of genital herpes

  • Version of Record online: 02 December 2024
2024 European guidelines for the management of genital herpes

Genital herpes—guidelines for diagnostic and treatment (2024): strategies for diagnosis, management and follow-up of the most common sexually transmitted infection. The guidelines covers common clinical scenarios (including recurrent genital herpes), infection during pregnancy and coinfection with human immunodeficiency virus.

REVIEW ARTICLE

Open Access

Topographical variations in the skin barrier and their role in disease pathogenesis

  • Version of Record online: 28 November 2024
Topographical variations in the skin barrier and their role in disease pathogenesis

Unlike the gut, the skin appears uniform at first glance. However, histological and molecular biological research has revealed significant regional variations in the composition and function of its main barrier elements. In this review, we describe the topographical differences of four barrier elements in healthy skin: microbiome, chemical, physical and immunological barriers. We also discuss the role of these regional variations in the pathogenesis of certain inflammatory skin diseases.

Open Access

Darier disease: Current insights and challenges in pathogenesis and management

  • Version of Record online: 28 November 2024
Darier disease: Current insights and challenges in pathogenesis and management

Darier disease (DD) is characterized by the following: Disrupted Ca2+ gradients, impaired desmosomes, impaired keratinocyte differentiation, type 17 inflammation, DC and LC ↓, Th17 cells ↑. DD treatment: First line: keratinocyte focused and/or anti-inflammatory. Second line: experimental approaches like specific targeting of the inflammatory infiltrate.

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Long-term effects of sirolimus treatment for slow-flow vascular malformations: Real-world evidence from the French observational multicentre SIROLO study

  • Version of Record online: 25 November 2024
Long-term effects of sirolimus treatment for slow-flow vascular malformations: Real-world evidence from the French observational multicentre SIROLO study

Overall, 67 patients were included from 15 French centres (35 children and 32 adults). After the first sirolimus temporary withdrawal, mean time to recurrence of symptoms was 6.4 ± 9.6 months (survival curve). Sirolimus was overall well-tolerated (radar chart). Serious adverse events occurred in six patients (9.0%), especially respiratory infections. There were two cases of ovarian cysts. Conclusion. The real-life study SIROLO provides answers on persistence of efficacy over time, long-term side effects and time to recurrence in case of sirolimus withdrawal.

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Open Access

Immune checkpoint inhibitor-induced pancreatic enzyme elevation in melanoma patients: Incidence, management and therapy—A multicentre analysis

  • Version of Record online: 20 November 2024
Immune checkpoint inhibitor-induced pancreatic enzyme elevation in melanoma patients: Incidence, management and therapy—A multicentre analysis

Background, key points, current state of management in dermato-oncology centres and algorithm for standardized monitoring and management of ICIPI; *routine radiographic imaging according to respective guidelines; **3 months after routine radiographic staging (6-monthly); ***if not recently performed as part of the routine staging. Abbreviations: ICI, Immune Checkpoint Inhibitor; ICIPI, Immune Checkpoint Inhibitor-Associated Pancreatic Injury; Q3M/Q6M, 3- and 6-monthly interval; Tx, treatment.

LETTER TO THE EDITOR

REVIEW ARTICLE

Review of doxycycline for prophylaxis of sexually transmitted infections

  • Version of Record online: 18 November 2024
Review of doxycycline for prophylaxis of sexually transmitted infections

This study found that doxycycline prophylaxis offers signification reductions in common bacterial sexually transmitted infections (STIs), specifically in men who have sex with men. Both doxycycline pre- and post-exposure prophylaxis offer significant reduction in the transmission of STIs and have benign safety profiles. However, additional research is needed to determine the effects of doxycycline prophylaxis in other subpopulations as well as its effects on antimicrobial resistance.

LETTER TO THE EDITOR

SYSTEMATIC REVIEW

Reflectance confocal microscopy for margin mapping of melanoma of the lentigo maligna type: A systematic review and meta-analysis

  • Version of Record online: 15 November 2024
Reflectance confocal microscopy for margin mapping of melanoma of the lentigo maligna type: A systematic review and meta-analysis

When compared with the gold standard histopathologic examination, the non-invasive RCM imaging technique has a negative predictive value (true negative margins confirmed by histopathology among all negative margins analysed by RCM) of 89.15%, highlighting its efficacy for margin mapping of melanoma of the lentigo maligna type.

In vivo reflectance confocal microscopy role for early to advanced lentigo maligna melanoma spectrum: A systematic review and pooled analysis

  • Version of Record online: 13 November 2024
In vivo reflectance confocal microscopy role for early to advanced lentigo maligna melanoma spectrum: A systematic review and pooled analysis

Key confocal features in LM/LMM progression: Architecture: AIMP: Preserved; LM: Non-edged papillae; LMM: Epidermal/junctional disarray, collagen fibre destruction. Cellular distribution: AIMP: Junctional scattered atypical cells; LM: Widespread pagetoid and junctional atypical cells with junctional nests; LMM: Widespread pagetoid and junctional atypical cells with junctional and dermal nests. Cell Types: AIMP: Dendritic cells with mild atypia; LM/LMM: Dendritic cells with mild atypia, round nucleated cells with marked atypia.

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Open Access

Efficacy and safety of tozorakimab in moderate-to-severe atopic dermatitis: A Phase 2a randomized controlled trial (FRONTIER-2)

  • Version of Record online: 13 November 2024
Efficacy and safety of tozorakimab in moderate-to-severe atopic dermatitis: A Phase 2a randomized controlled trial (FRONTIER-2)

In FRONTIER-2 (NCT04212169), a Phase 2a, randomized, placebo-controlled study of 148 adults with moderate-to-severe atopic dermatitis, no statistically significant differences between tozorakimab and placebo were observed in the percentage change in EASI score from baseline to Week 16. The proportion of EASI-75 and IGA 0/1 responders at Week 16 was numerically higher in the tozorakimab 600 mg group than in the placebo group. Serum pharmacokinetics were dose-dependent, immunogenicity incidence was low and tozorakimab was well tolerated.

LETTER TO THE EDITOR

POSITION STATEMENT

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Declining invasive and rising in situ melanoma incidence trends in Iceland: A nationwide cohort study

  • Version of Record online: 24 October 2024
Declining invasive and rising in situ melanoma incidence trends in Iceland: A nationwide cohort study

Utilizing the Icelandic Cancer Registry, this whole-population study found a surge in invasive and in situ melanoma incidence in the early 2000s. This surge was primarily observed in urban populations, with females consistently exhibiting higher incidence than males. Though incidence has decreased since the early 2000s, in situ melanomas are again on the rise in recent years in males and females, as well as invasive melanoma in rural females.

SYSTEMATIC REVIEW

Open Access

Systematic review and indirect treatment comparisons of ritlecitinib against baricitinib in alopecia areata

  • Version of Record online: 24 October 2024
Systematic review and indirect treatment comparisons of ritlecitinib against baricitinib in alopecia areata

In this systematic review and network meta-analysis of Janus kinase (JAK) inhibitors for alopecia areata (AA), no evidence of a difference between ritlecitinib 50 mg and baricitinib 4 mg on Severity of Alopecia Tool (SALT) ≤10 (odds ratio,OR: 0.96, 95% credible interval,CrI: 0.18–7.21) and SALT ≤20 (OR: 1.19, 95% CrI: 0.23–10.67) at Week 24 was found. Using individual patient data from the ALLEGRO trial (NCT03732807), evidence of effect modification by sex, SALT score at baseline, duration of current episode and disease duration was found, although the results were unchanged due to a small number of included trials. Further research on novel treatment for AA is warranted.

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Open Access

Secukinumab efficacy in patients with hidradenitis suppurativa assessed by the International Hidradenitis Suppurativa Severity Score System (IHS4): A post hoc analysis of the SUNSHINE and SUNRISE trials

  • Version of Record online: 19 October 2024
Secukinumab efficacy in patients with hidradenitis suppurativa assessed by the International Hidradenitis Suppurativa Severity Score System (IHS4): A post hoc analysis of the SUNSHINE and SUNRISE trials

Given that both dynamic IHS4 and dichotomous IHS4-55 use validated method of quantifying lesion types including draining tunnels, these results indicate that IHS4 and IHS4-55 can detect changes in response to treatment in clinical trial setting. DLQI, Dermatology Life Quality Index; HiSCR, hidradenitis suppurativa clinical response; HS, hidradenitis suppurativa; PBO, placebo; Q2W, every 2 weeks; Q4W, every 4 weeks; SEC, secukinumab 300 mg.

LETTER TO THE EDITOR

GUIDELINES

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Open Access

Impact of skin biopsy practices: A comprehensive nationwide study on skin cancer and melanoma biopsies

  • Version of Record online: 12 October 2024
Impact of skin biopsy practices: A comprehensive nationwide study on skin cancer and melanoma biopsies

Skin biopsy decision-making is challenging. From a comprehensive national pathology registry including all biopsies, we investigated benign to malignant ratios (BMR) and number needed to biopsy (NNB) for lesions that might clinically mimic melanoma, for all biopsies and biopsies clinically suspected of cancer or melanoma. From 4.5 million included biopsies we found that (1) clinical suspicion of cancer impacts the BMR for malignancy and drastically affects the NNB for melanoma. (2) The amount of skin biopsies increased by 39% from 2007 to 2021. (3) The public funded healthcare system in Denmark spends €6.5M on benign skin lesions suspected of being melanoma—with the vast majority of these expenses from the hospital sector of the healthcare system. We therefore conclude that (1) layered triage helps separate low-risk from high-risk biopsies to achieve world-class NNB for melanoma and (2) it is crucial to include the clinical reason for biopsy in diagnostic accuracy studies focusing on NNB.

Open Access

Psychometric properties of the revised internalized skin bias questionnaire

  • Version of Record online: 09 October 2024
Psychometric properties of the revised internalized skin bias questionnaire

This two-part study included consensus-building surveys and a cross-sectional survey among participants with self-reported dermatological conditions to assess instrument psychometric properties of the revised Internalized Skin Bias Questionnaire (ISBQ-R). Overall, 33 experts participated including 22 (66.7%) dermatologists or dermatology researchers and 11 (33.3%) patients. The revised survey was completed by 214 participants with various dermatological conditions. Adding and modifying new items (9 in total) resulted in an instrument with stronger internal consistency (Cronbach's alpha = 0.92) and a stronger correlation with other existing stigma measures (ρ = 0.72) as well as health-related quality of life (ρ = −0.68), anxious (ρ = 0.51) and depressive (0.53) symptoms. Additionally, the study further expanded upon previous research by exploring a two-factor structure, suggesting that the ISBQ-R could be used as a single or dual factor instrument depending on investigator goals.

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Open Access

Hand eczema and changes in the skin microbiome after 2 weeks of topical corticosteroid treatment

  • Version of Record online: 03 October 2024
Hand eczema and changes in the skin microbiome after 2 weeks of topical corticosteroid treatment

Our results suggest that the microbiome, and not only Staphylococcus aureus, in moderate-to-severe hand eczema is significantly altered in lesional skin; however, shifting towards that of nonlesional skin following 2 weeks of treatment with a potent topical corticosteroid. We propose that the skin microbiome in hand eczema benefits from improved skin barrier function, that is, decreased disease severity, as seen in this study. Furthermore, this implies, that future research on microbial changes may generate therapeutic targets.

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Open Access

Long-term remission of Hailey–Hailey disease by Er:YAG ablative laser therapy

  • Version of Record online: 01 October 2024
Long-term remission of Hailey–Hailey disease by Er:YAG ablative laser therapy

Upper left panel: Hailey–Hailey lesion at baseline, directly after, 6 weeks and 3 years after a single Er:YAG laser ablation. Long-term remission was noted in 75/77 Hailey–Hailey plaques after a median follow-up of 38 months. Upper right panel: Median quality of life scores at baseline, 6 weeks and 3 years after laser ablation with a significant improvement at 6 weeks and 3 years after laser ablation. Bottom left panel: Electron microscopy of keratinocytes in the stratum spinosum at baseline and 6 weeks after laser ablation. Laser-treated skin showed an increased number of desmosomes, decreased intercellular distance and decreased perinuclear retraction of keratin filaments. Bottom right panel: Cross-section of the skin on the right side showing the depth of laser ablation. Laser ablation up to mid-dermis induced long-term remission of Hailey–Hailey disease.

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Open Access

Health-related quality of life in cutaneous T-cell lymphoma: A post hoc analysis of a phase 3 trial in mycosis fungoides and Sézary syndrome

  • Version of Record online: 24 September 2024
Health-related quality of life in cutaneous T-cell lymphoma: A post hoc analysis of a phase 3 trial in mycosis fungoides and Sézary syndrome

This study found that all aspects of HRQL were compromised in patients with relapsed/refractory stage IB–IVB MF/SS. Different aspects of HRQL were worse in patients who were female, younger, Black/African American or who had worse mSWAT score, itch or performance status. Understanding of the individual's symptom burden, including patient-reported measures, should be used to inform treatment goals and therapeutic choice.

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Open Access

Effectiveness and safety of methotrexate in the treatment of mycosis fungoides: Real-world data from a multicentre study

  • Version of Record online: 19 September 2024
Effectiveness and safety of methotrexate in the treatment of mycosis fungoides: Real-world data from a multicentre study

Methotrexate (MTX) has been a longstanding therapeutic option for mycosis fungoides (MF); however, data on its real-world effectiveness remain limited. This study aimed to assess real-world outcomes of oral MTX in the treatment of MF. Data from five referral centres for cutaneous lymphoma in Greece were retrospectively reviewed with the baseline- and treatment-related characteristics of patients extracted and analysed accordingly. In total, 211 patients were included in the study. MTX demonstrated greater effectiveness as a first-line treatment compared to subsequent use with no significant differences between monotherapy and combination therapy. No significant differences were observed between MTX monotherapy and MTX combined with other treatments. Patients with early-stage disease (IA-IIA) achieved favourable outcomes along with patients with erythrodermic disease (Stage III). Patients with Stage IV and IIB disease had the worst responses. The presence of the folliculotropic variant of MF did not affect responses to treatment while large cell transformation had a negative impact on responses. Overall, MTX demonstrated acceptable safety and a small amount of patients discontinued the medication due to adverse events. The findings of this large multicentric study support MTX as a viable treatment option for MF, particularly when used in the first line setting, offering a favourable benefit/risk profile. Response rates are stage-dependent, with erythrodermic patients achieving superior and durable responses.

LETTER TO THE EDITOR

ORIGINAL ARTICLE

Educational, labour market and relationship outcomes in people with acne

  • Version of Record online: 18 September 2024
Educational, labour market and relationship outcomes in people with acne

In this study, Danish patients with acne had a lower risk of not completing upper secondary education (relative risk (RR): 0.79; 95% confidence interval [CI]: 0.76–0.83) and higher education (RR: 0.90; 95% CI: 0.88–0.91), slightly higher income (mean percentile difference: 2.6%, 95% CI: 2.2–2.9) and lower risk of long-term unemployment than those without acne (9.8% vs. 11.4%; RR: 0.90; 95% CI: 0.87–0.93). The prevalence of being single until age 30 was similar (19.7% vs. 20.1%; adjusted RR: 0.96; 95% CI: 0.94–0.98) but childlessness was slightly more prevalent (60.5% vs. 57.5%; adjusted RR: 1.03; 95% CI: 1.02–1.04). However, all associations were attenuated or lost in a secondary analysis restricted to exposure-discordant siblings to address confounding from family-related factors.

Open Access

Identification of two molecularly and prognostically distinct subtypes in acral melanoma using network prediction method

  • Version of Record online: 16 September 2024
Identification of two molecularly and prognostically distinct subtypes in acral melanoma using network prediction method

A novel disease classification method is constructed using the combination of multi-omics data analysis and network-based disease gene prediction algorithm CIPHER-SC. It showed that the presence of two acral melanoma subtypes which greatly differed in clinical performance, cellular and molecular mechanisms and discovered a biomarker panel that accurately distinguished these two subtypes, which has been verified by clinical samples.

LETTER TO THE EDITOR

SYSTEMATIC REVIEW

Open Access

Acne and the cutaneous microbiome: A systematic review of mechanisms and implications for treatments

  • Version of Record online: 13 September 2024
Acne and the cutaneous microbiome: A systematic review of mechanisms and implications for treatments

Impact of Acne Therapies on the Skin Microbiome: This graphical abstract illustrates how various acne treatments affect the cutaneous microbiome, particularly focusing on Cutibacterium acnes and overall microbial diversity. Common treatments like doxycycline and benzoyl peroxide generally decrease C. acnes and reduce alpha diversity, while isotretinoin has variable effects. Newer therapies, including probiotics and plant extracts, are highlighted for their potential to restore microbial balance, suggesting a shift towards microbiome-focused treatment strategies.

LETTER TO THE EDITOR

SYSTEMATIC REVIEW

Open Access

The Dermatology Life Quality Index (DLQI) used as the benchmark in validation of 101 quality-of-life instruments: A systematic review

  • Version of Record online: 13 September 2024
The Dermatology Life Quality Index (DLQI) used as the benchmark in validation of 101 quality-of-life instruments: A systematic review

This study systematically analysed peer-reviewed publications describing use of the DLQI in validation of other PRO and QoL measures and identified widespread use of the DLQI as a benchmark in validation of other dermatology PRO/QoL measures. It confirms the central role DLQI plays in the development of novel instruments and validation across dermatology and beyond.

LETTER TO THE EDITOR

REVIEW ARTICLE

Open Access

Hair regrowth in alopecia areata and re-pigmentation in vitiligo in response to treatment: Commonalities and differences

  • Version of Record online: 11 September 2024
Hair regrowth in alopecia areata and re-pigmentation in vitiligo in response to treatment: Commonalities and differences

Hair Regrowth in Alopecia Areata. This scheme summarizes recent findings in hair follicle stem cell biology and their implication to regrow hair in alopecia areata. Hair follicle stem cells reside in hair bulge abundantly. Anagen drivers are enhanced and suppressed expression levels of activators and repressors at telogen, respectively. Noradrenaline secreted from niche activates hair follicle regeneration via ADRB2, FOXP1 and FGF18. Hair plucking at high density regenerate hair follicles via TNF-α. JAG1 + regulatory T lymphocytes regenerate hair follicles. Loss of COL17A1 results in hair follicle miniaturization. Burgundy and navy arrows indicate downregulation and upregulation, respectively. ADRB2, adrenergic receptor B2; BMP2, bone morphogenic protein 2; COL17A1, collagen XVII; DKK1, dickkopf 1; FGF18, fibroblast growth factor 18; FOXP1, forkhead box P1; JAG1, jagged 1; SFRP4, secreted frizzled-related protein 4; SHH, sonic hedgehog; TNFα, tumour necrosis factor-α. Re-pigmentation in Vitiligo. This scheme summarizes recent findings in melanocyte stem cell biology and their implication to re-pigment vitiligo skin. Melanocyte stem cells reside in lower portion of hair bulge and hair germ at telogen phase and contribute to perifollicular re-pigmentation. Amplifying melanocytes tend to lose proliferation and migration potential. BMI + CXCR2 + melanocyte stem cells exist in interfollicular epidermis and may contribute to marginal re-pigmentation. Hair follicle stem cells regulate melanocyte stem cells via cKIT, Wnt and other signals. PAX3 activates MITF, followed by DCT activation, whereas PAX3 directly downregulates DCT and maintains stemness. Noradrenaline induces melanocyte stem cell differentiation and migration via ADRB2. BMI1, B lymphoma Mo-MLV insertion region 1; cKIT, receptor tyrosine kinase for stem cell factor; CXCR2, chemokine C-X-C motif receptor 2; DCT, dopachrome tautomerase; MCAM, melanoma cell adhesion molecule; MITF, microphthalmia associated transcription factor; PAX3, paired box gene 3. Melanocyte Distribution Pattern Differences. The distribution pattern of melanocyte stem cells is different depending on the density of pigmented terminal hair and that of vellus hair. As compared with hair follicle stem cells, melanocyte stem cells are sparsely distributed. Volar melanocyte stem cells reside in eccrine sweat gland and require a long travel to distribute melanocytes in the epidermis. Volar melanocytes is sparse, as compared with melanocytes in hairy skin.

LETTER TO THE EDITOR

SYSTEMATIC REVIEW

Open Access

Predictors and mechanisms of self-stigma in five chronic skin diseases: A systematic review

  • Version of Record online: 09 September 2024
Predictors and mechanisms of self-stigma in five chronic skin diseases: A systematic review

Along with experiencing stigmatization in social contexts, individuals with visible chronic skin disease often deal with self-stigma. The graphical abstract depicts an adapted model from Germain and colleagues (2021) and highlights correlates, predictors and outcomes associated with self-stigma for people with atopic dermatitis, psoriasis, vitiligo, alopecia areata or hidradenitis suppurativa according to the present systematic literature review of 27 included studies. Study quality ratings were good although majority of the reviewed studies were cross-sectional and causal inferences could not be made. Psychosocial correlates to self-stigmatization with supporting evidence in both Germain and colleagues' (2021) model and the current review were noted with an asterisk (*), whereas additional correlates found in our review were emphasized in red text. Several psychosocial correlates were considered modifiable, such as social stigma, coping strategies and social support, and therefore potential targets for psychosocial interventions (highlighted in green and pathways depicted with solid green lines), while others were not (depicted with dashed grey lines). The figure also identifies measurable outcomes (highlighted in blue) for future interventions.

ORIGINAL ARTICLE

Real-life effectiveness and safety of baricitinib in patients with severe alopecia areata: A 24-week Italian study

  • Version of Record online: 09 September 2024
Real-life effectiveness and safety of baricitinib in patients with severe alopecia areata: A 24-week Italian study

Alopecia areata (AA) is an autoimmune condition characterized by rapid hair loss in the scalp, eyebrows and eyelashes, for which treatments are limited. Baricitinib, an oral inhibitor of Janus kinases 1 and 2, has been recently approved to treat alopecia areata. A total of 118 patients were enrolled, with a mean age of 39 years and a mean SALT >95. The mean value of the SALT score decreased from an average of 96.6 (±8.23 sd) to 48 (±35.2 sd) after 24 weeks of treatment and 42.3% of patients achieved a SALT 30, 31.3% a SALT 20 and 20.3% a SALT 10 by Week 24. Trichoscopic signs showed fewer yellow dots and black dots significantly earlier than hair regrowth. Adverse events during the treatment period (mild laboratory test abnormalities) were reported in 12.7% patients. No drop-out were registered. In conclusion, data on the effectiveness and safety of baricitinib are promising and support the use of this drug in severe forms of AA, also in the early stages. We also suggest performing trichoscopy in order to reveal early response to therapy.

REVIEW ARTICLE

Open Access

Considerations for defining and diagnosing generalized pustular psoriasis

  • Version of Record online: 06 September 2024
Considerations for defining and diagnosing generalized pustular psoriasis

Generalized pustular psoriasis (GPP) is a rare chronic skin disease with inconsistent definitions and diagnostic criteria. It is characterized by widespread pustules and erythema, which are often accompanied by other signs and symptoms. Cases of suspected GPP may benefit from laboratory testing to assess organ function as well as genetic and histopathological testing to support a diagnosis. Increased awareness and education of this rare and highly variable disease will improve diagnosis and timely treatment.

SYSTEMATIC REVIEW

Open Access

Low-dose isotretinoin for the management of rosacea: A systematic review and meta-analysis

  • Version of Record online: 06 September 2024

Low-dose isotretinoin for the management of rosacea: A systematic review and meta-analysis

Isotretinoin, a vitamin A derivative primarily known for treating acne vulgaris, has been investigated for rosacea despite its off-label use. This systematic review and meta-analysis of 16 studies involving 1445 patients examined low-dose isotretinoin (defined as ≤0.5 mg/kg/day) for the four main types of rosacea. This study found significant reduction in lesion count (p = 0.03) and erythema (p = 0.01), with low-dose isotretinoin outperforming topical retinoids and antimicrobials in reducing lesion count (p = 0.03). Its effect on erythema in rosacea however, did not meet statistical significant (p = 0.18). Improvements persisted 16 weeks post-treatment, with a relapse rate of 35% at 5.5 months. Study design heterogeneity limited comprehensive comparisons. Overall, low-dose isotretinoin appears to be an effective, well-tolerated, and safe treatment for rosacea.

REVIEW ARTICLE

SYSTEMATIC REVIEW

The risk of ultraviolet exposure for melanoma in Fitzpatrick skin types I–IV: A 20-year systematic review with meta-analysis for sunburns

  • Version of Record online: 04 September 2024
The risk of ultraviolet exposure for melanoma in Fitzpatrick skin types I–IV: A 20-year systematic review with meta-analysis for sunburns

Risk of ultraviolet exposure and melanoma in Fitzpatrick skin types I–IV. A systematic review of 19,852 studies from January 2002 to December 2021 was performed analysing UV exposure and melanoma risk in Fitzpatrick type I–IV individuals. Twenty studies (77%, 20/26) identified a significant association between UV exposure and melanoma incidence. There is a significant ongoing association between UV exposure, specifically sunburns (unadjusted odds ratio:1.66; pooled adjusted odds ratio: 1.23) and melanoma incidence in Fitzpatrick skin types I–IV. Other forms of UV exposure were more heterogeneously captured and had mixed results. UV exposure should continue to be considered a modifiable risk factor for melanoma in individuals of Fitzpatrick skin types I–IV. Counselling on photoprotection remains valuable for mitigating the risk of melanoma in this population. Thank you to Rebecca S. Xu, MD, for creating the images for use in this graphical abstract.

ORIGINAL ARTICLE

BAUSSS biomarker improves melanoma survival risk assessment

  • Version of Record online: 31 August 2024
BAUSSS biomarker improves melanoma survival risk assessment

The range of mortality risk within individual AJCC staging brackets is very wide. Administering adjuvant drug therapy based solely on AJCC T3b, T4a and T4b staging will result in many high-risk patients over 60 years of age being denied such drugs while other patients under young patients will be offered drug therapy despite having a relatively low risk primary tumour.

LETTER TO THE EDITOR