BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with cardiometabolic morbidity, yet published estimates of cardiovascular comorbidities and cardiovascular risk in HS vary widel...BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with cardiometabolic morbidity, yet published estimates of cardiovascular comorbidities and cardiovascular risk in HS vary widely. OBJECTIVES: To quantify the prevalence of cardiovascular comorbidities among individuals with HS and to evaluate associations between HS and cardiovascular outcomes compared with individuals without HS. METHODS: This systematic review and meta-analysis is reported in accordance with PRISMA 2020. CINAHL, Cochrane, Embase, PubMed and Scopus were searched from inception through 16 June 2025. Eligible studies included individuals with clinician-diagnosed HS, ascertained by medical records, diagnostic codes, or physician assessment, that reported cardiovascular comorbidity prevalence or association estimates. For prevalence analyses, studies reported cardiovascular comorbidity prevalence within HS cohorts; for association analyses, studies included both participants with HS and a comparison group without HS. The most adjusted estimate available was preferentially selected for each study-outcome pair; when adjusted estimates were unavailable, the only reported estimate was retained. Risk of bias was assessed using Joanna Briggs Institute checklists, and certainty of evidence was evaluated using GRADE. Random-effects meta-analyses were used for pooled estimates. RESULTS: Twenty-five studies met inclusion criteria, comprising 373,689 individuals with HS; 24 contributed prevalence data and 17 contributed association estimates. Hypertension was the most frequently reported cardiovascular comorbidity, affecting approximately one-quarter of patients, followed by coronary artery disease, cerebrovascular disease, congestive heart failure and myocardial infarction. Meta-analyses demonstrated that HS was associated with increased risk of multiple cardiovascular outcomes compared with individuals without HS, with relative risks generally ranging from 1.3- to 1.8-fold for ischemic or coronary heart disease, composite cardiovascular disease, myocardial infarction, heart failure, venous thromboembolism and all-cause mortality. Associations remained directionally consistent in sensitivity analyses, although substantial heterogeneity was present across most analyses. Certainty of evidence was low, reflecting the observational design of included studies and variability in confounder adjustment. CONCLUSIONS: HS is associated with a substantial burden of cardiovascular comorbidities and increased risk of several major cardiovascular outcomes. These findings support consideration of cardiovascular risk assessment in the clinical management of HS while highlighting the need for prospective studies with standardized cardiovascular outcome definitions and more consistent adjustment for key confounders.
BACKGROUND: Data on the incidence and mortality rates of mucous membrane pemphigoid (MMP) are limited and outdated. OBJECTIVES: This study aimed to estimate the incidence and standardized mortality ratios (SMR) of MMP an...BACKGROUND: Data on the incidence and mortality rates of mucous membrane pemphigoid (MMP) are limited and outdated. OBJECTIVES: This study aimed to estimate the incidence and standardized mortality ratios (SMR) of MMP and identify prognostic factors for mortality. METHODS: We screened patients with MMP diagnosed in 20 dermatology departments in France between 2000 to 2021, using the French national database of rare diseases. The incidence rate was calculated based on the number of inhabitants in the corresponding administrative regions and patients' vital status was obtained from the national institute of demography (INSEE) death register. RESULTS: A total of 663 patients (376 women, 287 men) with a mean age of 70.57 ± 13.58 years were included. Annualized incidence rates progressively increased over the years, from 1.38 cases/million inhabitants/year in 2012 to a peak of 3.86 in 2019. The highest annualized incidence rate was observed in patients aged between 80 and 85 years (9.91 cases/million inhabitants/year; 95% CI =6.43 to 15.28).The 1-, 3- and 5-year SMRs were 1.00 (95% CI = 0.73 to 1.33), 1.05 (95% CI = 0.85 to 1.26), and 1.01 (95% CI = 0.85 to 1.18), respectively. A higher SMR was observed in patients with ear, nose, and throat (ENT) involvement (SMR=1.26, 95% CI = 1.00 to 1.55). Predictors of mortality included age (Hazard ratio [HR]=3.65 for ages 75-85 years vs <65 years, 95% CI =1.67 to 7.99; p=0.001, and HR=11.94 for ages >85 years, 95% CI =5.40 to 26.41; p<0.0001), cancer (HR=2.66, 95% CI = 1.75 to 4.06; p<0.0001), and diabetes (HR=1.80, 95% CI = 1.17 to 2.77; p=0.008). Patients with ocular-only involvement (HR=1.96, 95% CI = 0.95 to 4.05; p=0.07) and ENT involvement (HR=1.63, 95% CI = 0.96 to 2.78; p=0.07) had a trend towards a higher risk of mortality compared with oral ± skin forms of MMP. CONCLUSIONS: The incidence rate of MMP in France has more than doubled over the last decade. Ocular-only and ENT involvement were associated with a higher risk of mortality.
BACKGROUND: Lentigo maligna (LM) is a melanoma in situ usually found sun on exposed skin in older adults. Data on the risk of progression to lentigo maligna melanoma (LMM) are limited. Outcomes without surgical treatment...BACKGROUND: Lentigo maligna (LM) is a melanoma in situ usually found sun on exposed skin in older adults. Data on the risk of progression to lentigo maligna melanoma (LMM) are limited. Outcomes without surgical treatment remain unknown. OBJECTIVES: To describe the patient characteristics of those with LM/LMM, identify the incidence of LM/LMM in England over 2013 to 2023, calculate the survival of this cohort and estimate the risk of progression of LM to LMM, as well as its modifying factors. METHODS: Pseudonymised data for LM/LMM in England between 2013-2023 were provided by the National Disease Registration Service. Joinpoint regression was used to calculate incidence rates for LM and LMM. Kaplan-Meier curves were used for melanoma-specific and all-cause survival. Cumulative incidence of LMM after LM was calculated using a latency period of 6-months or 1-year, for identical or plausibly matching sites. Cox regression was used to explore the influence of covariates on survival and progression. RESULTS: Age-standardised incidence rates of LM (4.91-5.03 per 100,000 person years, APC: 0.25, 95% CI: -2.68 to 3.35) and LMM (1.84-1.97 per 100,000 person years, APC: 0.59, 95% CI: -2.31 to 3.76) remained stable over 2013-2019, reduced in 2020 and further increased to higher than pre-pandemic levels in 2023. Patients with LM and LMM were more likely to die from other cancers or cardiovascular disease than from melanoma. Female gender (hazard ratio (HR) 0.56, 95% CI: 0.49 to 0.66, p<0.001) was protective, while increasing age conferred a higher risk of dying from melanoma. The risk of progression of LM to LMM was 1.0% (95% CI: 0.8% to 1.1%) at 10 years and increased with age and for tumours located on the head and neck. CONCLUSIONS: LM/LMM incidence rates in the future will clarify if the post-Covid-19 increases are due to delayed presentations or a true rise in cases. The excellent net and overall survival of patients with LM, together with the low risk of progression to LMM, favour patient-centred discussions in the management of LM in older, frailer adults. The risk of progression without treatment requires further evidence.
BACKGROUND: Systemic treatments for psoriasis could increase the risk of serious infection due to their inhibitory effect on the immune system. OBJECTIVES: To estimate and compare the serious infection risk associated wi...BACKGROUND: Systemic treatments for psoriasis could increase the risk of serious infection due to their inhibitory effect on the immune system. OBJECTIVES: To estimate and compare the serious infection risk associated with systemic treatments for psoriasis. METHODS: Adult psoriasis patients who received at least one of the systemic treatments and had 6-month follow-up data in BADBIR database were included in the analysis. Patients were followed from the time of drug initiation to drug discontinuation, death or last available follow-up date. Infections that occurred during or up to 90 days after treatment discontinuation resulting in hospitalization, administration of intravenous antimicrobials or death were considered serious. Inverse probability of treatment weighting was used to balance baseline covariates. Hazard ratios and corresponding 95% confidence intervals were calculated using a piece-wise Cox proportional hazards model. A recurrent event analysis was also performed using Prentice-Williams-Peterson (PWP) model. Missing data were handled using multiple imputation. RESULTS: 46,770 treatment episodes from 18,976 patients were analyzed. Patients were predominantly male (n = 10,893; 57.4%) and had a mean age of 45.64 years (± 13.67) and mean BMI of 31.60 kg/m2 (± 7.28). The incidence rate of serious infections was 27.67 (95% CI, 26.72 to 28.65) and the rate of recurrent serious infection in those with prior infection was 78.70 (95% CI 75.17 to 82.36) events per 1000 person-years. The piecewise Cox proportional hazards model showed increased risk of serious infection with apremilast (HR 1.53; 95% CI 1.27 to 1.80) and secukinumab (HR 1.34; 95% CI 1.18 to 1.50) compared to adalimumab. However, these findings were not consistent across sensitivity analyses. The recurrent event analysis demonstrated lower risk with risankizumab compared with brodalumab (HR 0.74; 95% CI 0.55 to 0.99), etanercept (HR 0.75; 95% CI 0.60 to 0.94), and standard treatments (HR 0.80; 95% CI 0.65 to 0.98). Serious infection-associated deaths were rare (IR 1.81; 95% CI 1.57 to 2.07 per 1000 person-years). CONCLUSIONS: Despite isolated signals in the time-to-first event analysis, the more robust recurrent event analysis showed that risankizumab was associated with a lower risk of serious infections, while no significant differences were observed among the other systemic treatments for psoriasis.
INTRODUCTION: The COVID-19 pandemic significantly disrupted melanoma care worldwide, raising concerns about diagnosis and treatment delays. OBJECTIVES: To compare changes in incidence and prognostic factors of invasive c...INTRODUCTION: The COVID-19 pandemic significantly disrupted melanoma care worldwide, raising concerns about diagnosis and treatment delays. OBJECTIVES: To compare changes in incidence and prognostic factors of invasive cutaneous melanomas across two regions with contrasting COVID-19 infection control strategies. METHODS: A retrospective population-based registry study using the Swedish quality registry for cutaneous melanoma (SweMR) and the Cancer Council in Victoria, Australia was performed. Incident invasive melanomas diagnosed between 2013 and 2021 were used for trend analyses considering the long-term underlying trends and seasonality. Regression models were used for analyses of prognostic variables (Breslow thickness, ulceration, lymph node status), comparing the time periods, "before COVID" and "during COVID" (using 1 March 2020 as interruption point). RESULTS: In Victoria, melanoma diagnoses declined during COVID across all age groups, most notably among patients <50 years. Median Breslow thickness remained 0.7mm, but the distribution shifted significantly (p<0.001), with an 8% increase in geometric mean ratio (95% CI, 5%-12%). In Sweden, measures of thickness remained unchanged during COVID, but the odds of ulceration increased slightly (OR 1.09; 95% CI 1.01-1.19). Lymph node metastasis rates were stable in both regions. A significant immediate drop in overall incidence followed COVID-19 onset in both regions, primarily driven by thin melanomas. In Victoria, the lower incidence level persisted without a subsequent slope change. In contrast, the Swedish melanoma incidence gradually realigned with the pre-COVID trend after the initial level change. The immediate incidence drop was most prominent among older age groups in both regions. CONCLUSIONS: COVID-19 influenced melanoma incidence and prognostic features in both Sweden and Victoria. Reduced incidence of particularly thin melanomas and modest worsening of prognostic markers were observed. Victoria showed a more sustained impact, possibly reflecting the stricter and longer-lasting pandemic control measures.