BACKGROUND: Dupilumab is a known treatment for atopic dermatitis (AD). However, there is limited data on the effectiveness and safety of its use within the paediatric population. OBJECTIVE: The objective of this study wa...BACKGROUND: Dupilumab is a known treatment for atopic dermatitis (AD). However, there is limited data on the effectiveness and safety of its use within the paediatric population. OBJECTIVE: The objective of this study was to determine the effectiveness and safety of dupilumab in children under 16 years with moderate-to-severe AD. METHODS: 162 children aged 6 months to 16 years with moderate-to-severe AD were treated with dupilumab. Dupilumab was accessed through the Pharmaceutical Benefits Scheme (PBS) for those aged 12 and above. Those aged under 12 years accessed dupilumab with applications to the Therapeutic Goods Administration (TGA) Special Access Scheme (SAS) as a category B application. Such applications were then processed through the hospital pharmacy as an individual patient approval (IPA). Treatment was surveyed over a 3-year period from 2020 to 2023. Treatment effect was determined by overall clinical disease severity with the Eczema Area and Severity Index (EASI) score. Scores were repeated at serial appointments following dupilumab doses. All data were collected from a single Australian tertiary referral paediatric hospital and tabulated in an Excel spreadsheet. RESULTS: A significant improvement was observed for almost all patients, with 87% achieving at least a 75% reduction in EASI scores. Adverse effects occurred in 30% of patients, although these were mostly minor and transient. Only four patients (2.4%) ceased dupilumab due to adverse effects or failure to respond. LIMITATIONS: Retrospective cohort design. CONCLUSION: Our findings demonstrate dupilumab's long-term effectiveness and safety in treating atopic dermatitis in the paediatric population.
We reviewed the role of technologies, including artificial intelligence (AI), confocal microscopy (CM), optical coherence tomography (OCT), and Raman micro-spectroscopy (RMS) to assist in detecting keratinocyte carcinoma...We reviewed the role of technologies, including artificial intelligence (AI), confocal microscopy (CM), optical coherence tomography (OCT), and Raman micro-spectroscopy (RMS) to assist in detecting keratinocyte carcinoma (KC) from Mohs micrographic surgery (MMS) fresh frozen sections (FFS). AI is potentially capable of screening MMS FFS while also improving the accuracy of the imaging modalities. Further developments and validation studies are required.
We report a case of disseminated superficial actinic porokeratosis (DSAP) in a 73-year-old woman with metastatic pancreatic cancer undergoing chemotherapy with capecitabine and nab-paclitaxel. This case suggests a possib...We report a case of disseminated superficial actinic porokeratosis (DSAP) in a 73-year-old woman with metastatic pancreatic cancer undergoing chemotherapy with capecitabine and nab-paclitaxel. This case suggests a possible association between DSAP and the use of these chemotherapeutic agents, emphasising the need for awareness of atypical dermatologic reactions in such patients.
BACKGROUND: Referral guidelines and anecdotal evidence from public dermatology services indicate that patients referred to these services are often at high risk of developing future skin cancers or having poor skin cance...BACKGROUND: Referral guidelines and anecdotal evidence from public dermatology services indicate that patients referred to these services are often at high risk of developing future skin cancers or having poor skin cancer outcomes due to immunosuppression, a high skin cancer burden, or lesions that are difficult to manage. The Sunshine study aimed to capture knowledge, attitudes and behaviours related to sun exposure, sun protection and vitamin D among public hospital dermatology outpatients. METHODS: Adult patients attending the dermatology outpatient service at the University Hospital from August to December 2023 completed a survey assessing sun exposure knowledge, attitudes and behaviours. We reported these overall and within three patient groups: immunosuppressed; history of skin cancer; presenting with an inflammatory dermatology condition. RESULTS: We analysed data from 311 participants (immunosuppressed = 81; skin cancer = 122; inflammatory conditions = 108). Over 60% of patients were unaware of the UV index threshold for sun protection and over-estimated the time outdoors required to maintain adequate vitamin D status. Most patients did not routinely apply sunscreen, including those in the immunosuppressed and skin cancer groups, and this was particularly poor on body sites other than the face. There was also inadequate use of sun protection during outdoors exposure across all groups. CONCLUSIONS: Knowledge and use of sun protection were poor in this high-risk population. Dermatologists are ideally placed to identify and address patients' barriers to sun protection, and this should be a priority in this high-risk setting where prevention is paramount.
BACKGROUND: Anti-p200 pemphigoid is a rare autoimmune blistering disorder with limited data from China. This retrospective study aimed to investigate the clinical and serological characteristics of anti-p200 pemphigoid t...BACKGROUND: Anti-p200 pemphigoid is a rare autoimmune blistering disorder with limited data from China. This retrospective study aimed to investigate the clinical and serological characteristics of anti-p200 pemphigoid to enhance disease understanding. METHODS: We analysed 86 confirmed anti-p200 pemphigoid patients, evaluating their clinical manifestations, histopathological findings, and immunoserological profiles. RESULTS: The patients had a mean onset age of 56.92 ± 18.59 years and a male-to-female ratio of 2.31:1. The clinical presentation is highly heterogeneous, mimicking classic BP (57/86, 66.28%), and four cases (4/52, 7.69%) had concurrent psoriasis. Subepidermal blistering with variable dermal infiltrates was observed in 68 cases (68/70, 97.14%): neutrophil-predominant (24.89%), mixed neutrophilic/eosinophilic (31.43%), or eosinophil-predominant (27.14%). The positive rates of DIF, ss-IIF, IB with dermal extract, and IB with laminin γ1 C-terminal domain (LNγ1C) were 94.29% (66/70), 80.23% (69/86), 100% (86/86), and 64.29% (45/70), respectively. CONCLUSIONS: Anti-p200 pemphigoid closely resembles BP clinically but exhibits distinct immunopathological features. The partial reactivity to laminin γ1 (LNγ1) implies antigenic heterogeneity, warranting further investigation.
BACKGROUND: Allergic and irritant reactions on patch testing can be difficult to differentiate clinically. We aim to identify factors associated with irritant reactions and correlate skin barrier function, measured in th...BACKGROUND: Allergic and irritant reactions on patch testing can be difficult to differentiate clinically. We aim to identify factors associated with irritant reactions and correlate skin barrier function, measured in the form of transepidermal water loss (TEWL). METHODS: Consecutive patients undergoing patch testing at a tertiary hospital dermatology department were included. Primary demographic data were collected along with the results of patch testing and clinical confidence scores. TEWL was measured on the volar forearm using a Tewameter TM Hex skin probe at the Day 2 reading. RESULTS: Sixty-six participants from March 2022 to June 2023 were analysed. The median age was 41 years, with participants having at least one irritant reaction being significantly older (p = 0.03). Seventy-nine percent (%) were female, and 47% had atopic dermatitis. Seventeen participants (26%) had irritant reactions recorded on the final patch test reading. The median TEWL in participants with irritant reactions was 21.03 g/h/m, compared with 13.11 g/h/m in participants without (p = 0.09). Clinical confidence scores for irritant patch reactions were generally lower than for positive patch reactions. CONCLUSION: Apart from age, there were no significant correlations between demographic or clinical factors such as atopic dermatitis and TEWL, with irritant reactions. Further research is required with a larger sample size to ascertain if TEWL may be a useful adjunct to improve confidence in interpreting irritant patch test reactions.
The management of psoriasis in patients with a history of malignancy is challenging. We conducted a multicentre, retrospective study in 17 Spanish centres including 69 patients with moderate-to-severe psoriasis and a pre...The management of psoriasis in patients with a history of malignancy is challenging. We conducted a multicentre, retrospective study in 17 Spanish centres including 69 patients with moderate-to-severe psoriasis and a previous or current malignancy treated with risankizumab; 94.2% of patients showed no recurrence or progression of cancer, while 5.8% experienced progression during therapy. Risankizumab was associated with substantial improvement in psoriasis, with a mean final PASI score of 0.9 ± 1.7 after a mean exposure time of 72 weeks. Tolerance was favourable, and no tumour recurrence was considered treatment-related. These findings support risankizumab as an effective and safe therapeutic option for this subpopulation.
We present a combined ultralow dose rituximab and intravenous immunoglobulin protocol for the treatment of moderate to severe pemphigus vulgaris which has been proven to be safe and effective in a series of 24 rituximab...We present a combined ultralow dose rituximab and intravenous immunoglobulin protocol for the treatment of moderate to severe pemphigus vulgaris which has been proven to be safe and effective in a series of 24 rituximab naïve patients.
BACKGROUND: There is a paucity of data on scalp keratinocyte carcinomas (KCs) referred for Mohs micrographic surgery (MMS). This study aimed to perform a descriptive analysis of scalp KCs-specifically basal cell carcinom...BACKGROUND: There is a paucity of data on scalp keratinocyte carcinomas (KCs) referred for Mohs micrographic surgery (MMS). This study aimed to perform a descriptive analysis of scalp KCs-specifically basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs)-treated with MMS at The Skin Hospital in Sydney, Australia. METHODS: We performed a retrospective analysis of all scalp KCs treated with MMS from October 2012 to September 2022 from an electronic database. Extracted data included age, sex, tumour histology and aggressiveness, anatomical location, preoperative tumour size, final defect size, number of MMS stages and sections, extensive subclinical spread and repair method. RESULTS: We identified 1177 scalp KCs treated with MMS in 889 patients, consisting of 948 BCCs (80.5%) and 229 SCCs (19.5%). The median age of patients with BCCs was significantly younger (60 years) than that of SCCs (73 years) (p < 0.001). SCCs were more commonly found in males (182/229, 79%) (p < 0.001). The majority of KCs were located on the frontal scalp (948/1177, 55%). BCCs were more likely to be of an aggressive subtype (58%, 512/876) than SCCs (21%, 44/212) (p < 0.001). The median largest tumour and defect diameter was larger for SCCs than for BCCs (p < 0.001). There was no significant difference in the median number of MMS stages for tumour type (p = 0.121). Extensive subclinical spread was more common for aggressive SCCs (13/44, 29.5%) than for BCCs (84/511, 16.4%) (p = 0.028). Primary closure repair was most common (55%, 644/1177). CONCLUSION: The observed differences in patient, tumour and treatment characteristics may help inform clinical practice and inspire further research.
Tebentafusp, a bispecific TCR-anti-CD3 fusion protein targeting gp100-HLA-A02:01 complexes, is approved for the treatment of unresectable/metastatic uveal melanoma (MUM). In this retrospective, single-centre series, five...Tebentafusp, a bispecific TCR-anti-CD3 fusion protein targeting gp100-HLA-A02:01 complexes, is approved for the treatment of unresectable/metastatic uveal melanoma (MUM). In this retrospective, single-centre series, five HLA-A02:01-positive patients received tebentafusp. Four developed cutaneous toxicity (80%) within hours of the first infusion, primarily symmetric erythematoedematous truncal plaques. Other findings included acral xerosis/exfoliation and vitiligo-like lesions. Histology revealed spongiosis with subcorneal pustules, which have not been previously reported. No patients discontinued treatment due to skin toxicity and lesions resolved in a mean of 14.5 days. One patient died due to disease progression. Dermatological events are likely to be on-target effects of gp100+ melanocyte targeting and correlate with CD8+ T cell infiltration. Dermatological involvement is common and manageable, highlighting the need for early dermatological input in patients receiving tebentafusp. Emerging data suggest a possible association between rash and response, which warrants further investigation.
Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer and, when unresectable, presents a therapeutic challenge. This study retrospectively analysed five multi-morbid patients with unresectable cS...Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer and, when unresectable, presents a therapeutic challenge. This study retrospectively analysed five multi-morbid patients with unresectable cSCC, some with multiple lesions, treated using CO laser vaporization followed by intralesional 5-fluorouracil (5-FU) infiltration. All patients showed positive responses: two achieved complete clinical resolution, and three showed significant tumor reduction. No adverse effects were reported, and no local recurrences were observed at six months in those with resolved lesions. The combination of CO laser and 5-FU, not previously reported, may represent a promising palliative option for selected patients with unresectable cSCC. Further studies are needed to validate its efficacy.
Buerger's disease or thromboangiitis obliterans is a nonatherosclerotic inflammatory disease that affects the small and medium-sized arteries in the extremities. We describe a 46-year-old man with Buerger's disease, who...Buerger's disease or thromboangiitis obliterans is a nonatherosclerotic inflammatory disease that affects the small and medium-sized arteries in the extremities. We describe a 46-year-old man with Buerger's disease, who achieved regression of acute ulceration of his lower limbs and remission of his disease with pentoxifylline. Usually thought to just improve pain-free walking distance, this is the first case that demonstrates pentoxifylline may in fact improve the acute cutaneous features and progression of Buerger's disease.