检测一种改善银屑病患者依从性的appSvendsen, M.T.; Andersen, F.; Andersen, K.H.; Pottegård, A.; Johannessen, H.; Möller, S.; August, B.; Feldman, S.R.; Andersen, K.E.
doi: 10.1111/bjd.17226pmid: N/A
Summary银屑病是一种常见慢性皮肤病,会导致红色鳞屑状斑块 (皮肤斑片), 通常位于膝部、肘部、头皮和躯干。银屑病可能对患者的生活质量造成负面影响, 并因医疗保健费用、误工等带来额外的“社会经济负担”。局部外用卡泊三醇和皮质类固醇是轻度至中度银屑病的推荐一线治疗, 但很多患者因众多不同原因并不按处方使用这些乳膏或软膏。这项研究调查了使用智能手机患者支持应用 (apps) 能否改善患者局部外用 (用于皮肤) 药物 (皮肤泡沫样卡泊三醇/丙酸倍他米松复方制剂) 的使用, 并额外降低银屑病的严重程度和改善短期和长期生活质量。丹麦皮肤科医生在丹麦 Odense 大学医院皮肤科进行了一项实验。纳入134 名患者, 这些患者被分配使用药物 (66 名患者) 或使用药物+来自 app 的支持 (68 名患者) 共计 4周。这种 app 每天提供一次强制治疗提醒, 还可以通过安装在泡沫给药器顶部的电子监测芯片监测患者是否正在使用他们的药物。通过蓝牙®将这些信息同步到患者的智能电话中。91% 患者在半年期间返回接受所有随访。这项对照试验显示, 使用此 app 的患者在 4 周期间的药物使用显著改善, 并短期减轻银屑病的严重程度。作者们得出结论说, 此 app 可能改善银屑病患者中局部外用药物的使用。
Quantitative sensory testing in patients with sensitive skinHuet, F.; Dion, A.; Batardière, A.; Nedelec, A.S.; Le Caër, F.; Bourgeois, P.; Brenaut, E.; Misery, L.
doi: 10.1111/bjd.17221pmid: N/A
SummarySensitive skin is defined as unpleasant sensation, such as itch, pain or burning, in response to stimuli that would not normally cause these symptoms. It does not include patients with skin diseases such as eczema, which can cause these symptoms. Sensitive skin is claimed to affect 50% of women and 30% of men in Europe, and impairs their quality of life. It can be measured using a questionnaire, the Sensitive Scale. It is not clear whether these symptoms are due to changes in the skin's blood supply, a defect in the skin barrier or due to changes in the nerve supply to the epidermis (outermost layer of skin). The authors, based in Brittany, France, quantified heat‐pain threshold, a measure of touch sensitivity, in 21 individuals with Sensitive Skin Syndrome (having a Sensitive Scale score greater than 50) and 21 control subjects (Sensitive Scale score less than 20). The authors also quantified the degree of neuropathic (nerve‐related) pain in both groups using two questionnaires. They found a significantly reduced heat‐pain threshold and higher neuropathic pain scores in the individuals with sensitive skin, compared with controls. They conclude that these findings support the idea that sensitive skin is linked with abnormal function of the nerve endings in the skin. Conventionally, sensitive skin has been treated with moisturisers but the authors suggest that at least the more severely affected individuals may require a different approach to treatment.
TEWL reference values in healthy adultsAkdeniz, M.; Gabriel, S.; Lichterfeld‐Kottner, A.; Blume‐Peytavi, U.; Kottner, J.
doi: 10.1111/bjd.17215pmid: N/A
SummaryTransepidermal water loss (TEWL) is the amount of water which passes from inside the human body through the skin layers to the outside. This diffusion cannot be observed directly so we use different measurement devices to detect it. Measurement of TEWL can be useful to identify healthy or diseased skin. Higher TEWL can be a sign of skin impairment, meaning the skin's protective barrier is damaged or not working properly, and therefore letting more water pass through. However, TEWL is affected by many factors such as temperature, humidity, age, gender, anatomical region (body part), skin temperature, measurement device and many other factors. Therefore, TEWL must be carefully interpreted and a “normal” TEWL does not exist. This systematic review and meta‐analysis, from Germany, aimed to find out TEWL reference estimates for healthy skin in adults by combining many different individual studies published in the last 60 years. The authors provided TEWL estimates for 86 skin areas from 212 studies in healthy adults. They found that TEWL is highly dependent on skin area and seems to show a symmetrical pattern between the right and left body sites. TEWL in the elderly seems to be generally similar or decreased compared with younger adults. The difference between TEWL estimates for different measurement devices seems to be minimal.
Alopecia areata: a review of disease pathogenesisRajabi, F.; Drake, L.A.; Senna, M.M.; Rezaei, N.
doi: 10.1111/bjd.17209pmid: N/A
SummaryAlopecia areata is a disease that causes hair loss, although it does not always look the same and its course is unpredictable. It typically presents as small spots of reversible hair loss on the beard or scalp that can easily be treated. It can also result in total scalp baldness (called alopecia totalis) with devastating psychological impacts for some patients, inadequate treatment options, and frequent relapses. This article is a narrative review of the main events that cause alopecia areata, conducted by researchers based in Iran and the U.S.A. Many environmental and genetic factors are involved in the development of alopecia areata but the mainstream event is an attack on hair follicles by the immune system, which usually serves to protect the body from harmful ‘foreign’ substances or illnesses. In a normal state, hair follicles are kept in a sanctuary out of reach of the immune system. A breach in this sanctuary activates the immune cells against hair follicles. This happens because the immune system has never been exposed to the hair follicles so it recognizes them as foreign material. What causes this breach is a matter of debate. It could happen as a result of a problems in the central immune system or a disturbance in the follicular environment, i.e. close to the follicles. Psychological stress has also been linked to both the initiation and exacerbation of alopecia areata. A cell line called the mast cells is the link between the immunologic (immune system) events and psychological stress. Stress activates mast cells leading to the release of histamine and other inflammation‐causing factors. Multiple treatment strategies have emerged in recent years aiming at immunological targets, called biologic agents, but most of them have not been able to establish long‐lasting remissions. This may be due to the complex nature of the immunologic events which cannot be targeted with a single agent. Overlooking strategies that aim to kick‐start the regrowth of hair, after treatments that restore the immune sanctuary, might be another reason for treatment failures.
Increased risk of depression in patients with lupus erythematosusHesselvig, J.H.; Egeberg, A.; Kofoed, K.; Gislason, G.; Dreyer, L.
doi: 10.1111/bjd.17216pmid: N/A
SummaryLupus is a chronic autoimmune disease, meaning the body's immune system works against the body instead of protecting it. Systemic lupus may not only involve the skin but also internal organs such as lungs, heart, and kidneys, and is potentially a fatal disease, whereas cutaneous lupus is mainly restricted to the skin. It affects women more often than men and symptoms usually first appear when patients are aged in their 30s. This study, from Denmark, investigated if patients with lupus (cutaneous or systemic) have increased risk of depression. By using the unique Danish nationwide registers, the authors found that patients diagnosed with systemic or cutaneous lupus both had a 2‐fold increased risk of a subsequent diagnosis of depression compared with the general population in Denmark. Likewise, the risk of severe depression was increased for patients with cutaneous or systemic lupus. On the other hand, the risk of self‐harm and death from suicide were not significantly increased in patients with lupus. Surprisingly, the risk of depression is of similar magnitude for patients with systemic lupus, a potentially fatal disease, as for patients with cutaneous lupus. This indicates that the involvement of the skin has the same important impact as the systemic disease on the patients’ mental health. It is relevant that both dermatologists and patients know about this significant increase in risk of depression.
Eosinophilia in BPKridin, K.
doi: 10.1111/bjd.17219pmid: N/A
SummaryBullous pemphigoid (BP) is a skin condition that causes rashes and itchy blistering in the skin. 50‐60% of BP patients are also reported to have peripheral eosinophilia (PE), a painful disease caused by increased levels of disease‐fighting white blood cells called eosinophils. The objectives of this study, from Israel, were to learn more about which BP patients are affected by PE and to study the relationship between above‐average eosinophil levels in the blood (known as serum eosinophilia) and the symptoms of BP. To do this, 225 BP patients and 1125 control participants (control participants are healthy individuals used for comparison, in this case with 5 age, sex and ethnicity matched controls for each BP patient) were enrolled into the study. In total 113 (50.2%) BP patients and 49 (4.9%) control patients had PE. An independent association between eosinophil white blood cell count and diagnosis of BP was observed. BP patients with PE were generally significantly older than the other BP patients and had greater palmoplantar involvement (of the palms and soles of feet), whereas BP patients with normal eosinophil counts had greater involvement in mucosal surfaces (inside the nose, mouth, ears, genitals), the head and the neck. Patients with more severe BP were also noted to have significantly higher eosinophil counts than others with mild‐moderate BP. This study concludes that BP patients with severe peripheral eosinophilia were significantly older when their disease started, as well as proving the correlation between BP severity and PE.
HLA‐Cw6 等位基因和苏金单抗的疗效Costanzo, A.; Bianchi, L.; Flori, M.L.; Malara, G.; Stingeni, L.; Bartezaghi, M.; Carraro, L.; Castellino, G.; ,
doi: 10.1111/bjd.17232pmid: N/A
Summary这项来自意大利的研究调查了中度至重度银屑病成人对苏金单抗 (一种称为人单克隆抗体的治疗形式) 的治疗反应, 尤其是, 在存在称为 HLA‐Cw6 特定基因的人中的效果是更好还是更差。存在这种基因个体发生银屑病的风险增高 10 倍, 他们的银屑病更可能在生命早期开始, 并且更严重。另一种人单克隆抗体优特克单抗已被证实在有HLA‐Cw6 基因的患者中疗效比无此基因患者中更迅速且更有效。在此研究中接受研究的特定类型银屑病患者有着长期存在的大块、红色、高起、平伏银屑病区域, 上有银色鳞屑 (慢性斑块型银屑病)。这项研究证实了一些已知的事实: 如, 苏金单抗是一种起效迅速的极为有效治疗。另外, 如同预期, 存在 HLA‐Cw6 基因的患者组平均较无此基因患者年轻, 他们的银屑病开始年龄更早。就HLA‐Cw6 基因本身而言, 在最初入选此研究的 434 名患者中, 有 431 名接受了此基因的检测。32 名患者脱落。在其余患者中, 227 名有HLA‐Cw6 基因患者在 24 周苏金单抗治疗后的状况并不优于 172 名无此基因的患者。换而言之, 苏金单抗在两个组中似乎一样有效, 似乎没有理由在开始治疗前检测这一基因。
银屑病中 DLQI 新评分公式的提议Rencz, F.; Gulácsi, L.; Péntek, M.; Poór, A. K.; Sárdy, M.; Holló, P.; Szegedi, A.; Remenyik, É.; Brodszky, V.
doi: 10.1111/bjd.17228pmid: N/A
Summary银屑病是一种常见慢性皮肤病, 大约2%的人群受此病影响。银屑病会对患者的日常活动和健康造成负面影响。皮肤生活质量指数 (DLQI) 是一种广泛使用的评估银屑病患者生活质量的指标。它包括 10 个问题, 涵盖症状和感受、日常活动、娱乐、工作和学习、个人关系和治疗。每个问题的评分如下: “完全没有”=0, “有一点”=1, “有些”=2 和“非常”=3。但是, 某些 DLQI 问题, 如运动、性困难和工作/学习并非与所有患者相关。由于“不相关”的回答被视为对患者生活无任何影响的问卷项(=0),它们可能使患者的生活质量评分出现假的改善。对于这些患者, 尽管患有重度银屑病, 他们更难符合临床指南要求成为更强效系统性治疗 (如生物制剂) 候选者的 DLQI 门槛。这项来自匈牙利的研究涉及 242 名银屑病患者。作者们开发了一种称为DLQI‐R的 DLQI 问卷新评分, 这种方法纠正了“不相关”回答选项中的偏倚, 并提供了它的效度 (即问卷的有效性)。DLQI‐R评分公式消除了标记为“不相关”的项目, 同时增加了相关项目在问卷总分中的权重。它主要是努力为那些单纯因为问卷中某些项目与他们不相关而不能符合治疗指南中 DLQI 标准的银屑病患者提供系统治疗的机会。