A newsletter that delivers the latest in dermatology research directly to you.
seventy-FoUrth issue
November 27, 2024
Are physicians spot on at spotting cancer?
Skin cancer is the most commonly diagnosed cancer in the United States. With the emergence of innovative diagnostic tools such as artificial intelligence, tape sampling, and dermoscopy, establishing baseline diagnostic accuracy of current methods is essential for meaningful comparisons of new technologies. Previous studies have assessed the diagnostic accuracy of skin cancers; however, they are often heterogeneous. This systematic review and meta-analysis examines diagnostic accuracy by lesion type, practitioner type, dermatologist experience level, and examination modality.
What did they find?
Main Takeaway: Lesion type, physician specialty and experience, and examination methods influence the accuracy of skin cancer diagnosis. Combining in-person clinical examination with dermoscopy yields the highest diagnostic accuracy. These findings provide critical baseline data to evaluate emerging diagnostic technologies for skin cancer detection.
Skin cancer is the most commonly diagnosed cancer in the United States. With the emergence of innovative diagnostic tools such as artificial intelligence, tape sampling, and dermoscopy, establishing baseline diagnostic accuracy of current methods is essential for meaningful comparisons of new technologies. Previous studies have assessed the diagnostic accuracy of skin cancers; however, they are often heterogeneous. This systematic review and meta-analysis examines diagnostic accuracy by lesion type, practitioner type, dermatologist experience level, and examination modality.
What did they find?
- For keratinocytic carcinomas, experienced dermatologists had sensitivity and specificity of 79.0% (95% CI: 62.8%-89.3%) and 89.1% (95% CI: 70.5%-96.5%) when using clinical examination. Using dermoscopy, they demonstrated sensitivity and specificity of 83.7% (95% CI: 76.6%-89.0%) and 87.4% (95% CI: 78.9%-92.8%).
- Among experienced dermatologists, the accuracy of keratinocytic carcinoma diagnosis was 2.5-fold (95% CI: 1.3-5.0) higher when using dermoscopy, compared to clinical examination.
- For melanomas, experienced dermatologists had sensitivity and specificity of 76.9% (95% CI: 69.3%-83.1%) and 89.1% (95% CI: 76.9%-95.3%) when using clinical examination. When using dermoscopy, they demonstrated sensitivity and specificity of 85.7% (95% CI: 82.5%-88.3%) and 81.3% (95% CI: 76.3%-85.4%).
- When using dermoscopy, dermatologists had a 5.7-fold (95% CI: 2.2-15.2) greater odds of accurately diagnosing melanoma, compared to clinical examination.
- When using dermoscopy, experienced dermatologists had 13.3-fold (95% CI: 7.2-24.5) higher odds of accurately diagnosing melanoma, compared to PCPs.
Main Takeaway: Lesion type, physician specialty and experience, and examination methods influence the accuracy of skin cancer diagnosis. Combining in-person clinical examination with dermoscopy yields the highest diagnostic accuracy. These findings provide critical baseline data to evaluate emerging diagnostic technologies for skin cancer detection.
Efficacy and safety of low-dose interleukin 2 in the treatment of moderate-to-severe bullous pemphigoid: A single center prospective-controlled trial
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
Need help controlling bullous pemphigoid? IL-2 the rescue!
Bullous pemphigoid (BP) is a chronic autoimmune blistering disorder that predominantly affects elderly individuals (over 70 years old). Characterized by tense subepidermal bullae, BP can significantly impact patients' quality of life. Central to its pathogenesis is a reduction in regulatory T-cells, which play a critical role in modulating immune responses and maintaining self-tolerance. This 8-week, single-center, prospective-controlled trial evaluated the efficacy and safety of low-dose interleukin-2 (IL-2), a cytokine known to promote regulatory T-cell differentiation, in patients with moderate-to-severe BP.
What did they find?
Main Takeaway: Low-dose IL-2 may offer faster disease control in moderate-to-severe BP by promoting regulatory T-cell expansion. While the safety profile appears acceptable, larger, multi-center trials are warranted to validate its efficacy and long-term safety.
Bullous pemphigoid (BP) is a chronic autoimmune blistering disorder that predominantly affects elderly individuals (over 70 years old). Characterized by tense subepidermal bullae, BP can significantly impact patients' quality of life. Central to its pathogenesis is a reduction in regulatory T-cells, which play a critical role in modulating immune responses and maintaining self-tolerance. This 8-week, single-center, prospective-controlled trial evaluated the efficacy and safety of low-dose interleukin-2 (IL-2), a cytokine known to promote regulatory T-cell differentiation, in patients with moderate-to-severe BP.
What did they find?
- Patients receiving low-dose IL-2 (0.5 million IU) achieved disease control significantly faster than the control group (7.60 ± 3.00 days vs. 10.43 ± 3.06 days, P < 0.008).
- In the low-dose IL-2 arm, flow cytometry studies showed a regulatory T-cell increase of 10.14% at week 1 (P = 0.0069) and 6.65% at week 2 (P = 0.0190).
- Low-dose IL-2 was associated with mild-to-moderate dose-dependent adverse effects, including local injection site reactions, transient fever, flu-like symptoms, and myalgia. No infections were reported during the trial.
Main Takeaway: Low-dose IL-2 may offer faster disease control in moderate-to-severe BP by promoting regulatory T-cell expansion. While the safety profile appears acceptable, larger, multi-center trials are warranted to validate its efficacy and long-term safety.
Dupilumab: Skinning the Risk of Infections!
Atopic dermatitis (AD) is associated with a dysregulated type 2 immune response, leaving infants and young children vulnerable to skin and systemic infections such as herpetic infections, molluscum contagiosum, and Staphylococcus aureus-driven bacterial infections. Dupilumab, a monoclonal antibody targeting IL-4 and IL-13, addresses this immune dysregulation while preserving the body's natural defenses against infections. A post-hoc analysis of the 16-week placebo-controlled LIBERTY AD PED-OLE trial examined the impact of long-term dupilumab use on infection rates in children aged 6 months to 5 years with moderate-to-severe AD.
What did they find?
Main Takeaway: Long-term dupilumab treatment in infants and young children with moderate-to-severe AD was not associated with increased overall infection rates and showed a reduction in bacterial and non-herpetic skin infections.
Atopic dermatitis (AD) is associated with a dysregulated type 2 immune response, leaving infants and young children vulnerable to skin and systemic infections such as herpetic infections, molluscum contagiosum, and Staphylococcus aureus-driven bacterial infections. Dupilumab, a monoclonal antibody targeting IL-4 and IL-13, addresses this immune dysregulation while preserving the body's natural defenses against infections. A post-hoc analysis of the 16-week placebo-controlled LIBERTY AD PED-OLE trial examined the impact of long-term dupilumab use on infection rates in children aged 6 months to 5 years with moderate-to-severe AD.
What did they find?
- Reduced infection rates:
- Total infection rates were 101.0 patients per 100 patient-years (PY)
- Non-herpetic skin infections: 22.7 patients/100PY
- Herpetic infections: 7.3 patients/100PY
- Non-skin infections: 92.9 patients/100PY
- Total infection rates were 101.0 patients per 100 patient-years (PY)
- Severe infections were rare (3.1 patients/100 PY), and no infections led to treatment discontinuation
Main Takeaway: Long-term dupilumab treatment in infants and young children with moderate-to-severe AD was not associated with increased overall infection rates and showed a reduction in bacterial and non-herpetic skin infections.
History of hypersensitivity to hymenoptera venom with no previous immunotherapy is associated with sensitivity to medical hyaluronidase
British Journal of Dermatology
British Journal of Dermatology
Being sensitive to hyaluronidase really stings like a wasp!
Hyaluronidases, enzymes used medically to degrade hyaluronic acid fillers, are also present in the venom of hymenoptera insects such as honey bees and wasps—the primary culprits of insect allergies. This prospective study evaluated 90 patients with a history of hymenoptera venom reactions to assess their sensitivity to medical hyaluronidase through skin-prick tests (SPT). Participants were categorized based on their allergy type (honey bee, wasp, or both) and whether they had undergone venom immunotherapy.
What did they find?
Main Takeaway: Patients with hymenoptera venom allergies—particularly those allergic to wasps—who have not received venom immunotherapy are more likely to exhibit sensitivity to medical hyaluronidase.
Hyaluronidases, enzymes used medically to degrade hyaluronic acid fillers, are also present in the venom of hymenoptera insects such as honey bees and wasps—the primary culprits of insect allergies. This prospective study evaluated 90 patients with a history of hymenoptera venom reactions to assess their sensitivity to medical hyaluronidase through skin-prick tests (SPT). Participants were categorized based on their allergy type (honey bee, wasp, or both) and whether they had undergone venom immunotherapy.
What did they find?
- 5 out of 90 patients (6%) showed a positive SPT to medical hyaluronidase. All five patients were allergic to wasps and had no history of immunotherapy.
- Patients who had not undergone venom immunotherapy were significantly more likely to be sensitive to hyaluronidase (P = 0.003).
- There was no significant difference in sensitivity based on insect type (P = 0.642).
Main Takeaway: Patients with hymenoptera venom allergies—particularly those allergic to wasps—who have not received venom immunotherapy are more likely to exhibit sensitivity to medical hyaluronidase.
How equipped are clinicians at diagnosing and treating drug-resistant dermatophyte infections?
Global Dermatology
Global Dermatology
Drug-resistant dermatophyte infections are more than a tinea-y problem!
Dermatophytes, commonly responsible for fungal infections of the hair, skin, and nails, are often caused by species from the Trichophyton genus. Over the past decade, antimicrobial-resistant superficial fungal infections, particularly those caused by T. indotineae, T. mentagrophytes VII, and terbinafine-resistant T. rubrum, have been on the rise. These infections often lead to severe, widespread lesions and are resistant to standard treatments, including over-the-counter antifungals and oral terbinafine. This U.S.-based survey of 158 infectious disease (ID) specialists aimed to evaluate awareness and identify strategies to enhance early diagnosis and treatment of drug-resistant dermatophytosis.
What did they find?
Main Takeaway: This study emphasizes the need for increased clinician awareness and access to lab testing for drug-resistant dermatophytosis to combat the growing global concern of resistant fungal infections.
Dermatophytes, commonly responsible for fungal infections of the hair, skin, and nails, are often caused by species from the Trichophyton genus. Over the past decade, antimicrobial-resistant superficial fungal infections, particularly those caused by T. indotineae, T. mentagrophytes VII, and terbinafine-resistant T. rubrum, have been on the rise. These infections often lead to severe, widespread lesions and are resistant to standard treatments, including over-the-counter antifungals and oral terbinafine. This U.S.-based survey of 158 infectious disease (ID) specialists aimed to evaluate awareness and identify strategies to enhance early diagnosis and treatment of drug-resistant dermatophytosis.
What did they find?
- Of the 158 respondents, 80% were adult ID physicians, 12% pediatric ID physicians, and 8% “other” healthcare providers.
- Only 65% of respondents were aware of drug-resistant dermatophytosis, with 17% having encountered or consulted on a suspected case in the past year.
- Nearly half (47%) reported being unsure (31%) or unable (16%) to access lab testing for dermatophyte species identification.
- An even greater percentage (61%) were unsure (45%) or unable (16%) to access testing for antifungal resistance in suspected cases.
Main Takeaway: This study emphasizes the need for increased clinician awareness and access to lab testing for drug-resistant dermatophytosis to combat the growing global concern of resistant fungal infections.
ReconGPT: Stitching AI into Mohs reconstruction
Reconstruction after Mohs micrographic surgery is a complex process requiring careful consideration of the defect’s size, shape, and depth, along with the patient’s unique anatomy and desired cosmetic outcomes. This study explored the potential of artificial intelligence, specifically a Retrieval-Augmented Generation (RAG)-enabled Generative Pretrained Transformer 4 Model with vision, dubbed “ReconGPT,” to assist surgeons in planning repairs for challenging post-Mohs defects. ReconGPT was trained on 100 raw digital images from the Dermatologic Surgery Journal’s “Reconstruction Conundrums” section, allowing it to predict possible repair methods based on anatomical defect location. The AI provided general repair suggestions (e.g., advancement flaps), specific techniques (e.g., V-Y advancement flaps), and combinations of repair methods, as well as potential complications associated with the proposed repairs.
What did they find?
Main Takeaway: ReconGPT shows promise as a support tool for post-Mohs reconstruction planning, offering useful repair suggestions and highlighting potential challenges. However, its predictive capabilities still fall short of the nuanced expertise and decision-making of experienced surgeons, emphasizing its role as an adjunct rather than a replacement.
Reconstruction after Mohs micrographic surgery is a complex process requiring careful consideration of the defect’s size, shape, and depth, along with the patient’s unique anatomy and desired cosmetic outcomes. This study explored the potential of artificial intelligence, specifically a Retrieval-Augmented Generation (RAG)-enabled Generative Pretrained Transformer 4 Model with vision, dubbed “ReconGPT,” to assist surgeons in planning repairs for challenging post-Mohs defects. ReconGPT was trained on 100 raw digital images from the Dermatologic Surgery Journal’s “Reconstruction Conundrums” section, allowing it to predict possible repair methods based on anatomical defect location. The AI provided general repair suggestions (e.g., advancement flaps), specific techniques (e.g., V-Y advancement flaps), and combinations of repair methods, as well as potential complications associated with the proposed repairs.
What did they find?
- ReconGPT achieved 97.7% concordance in identifying the true defect location.
- 60.2% of general repair predictions was agreeable with actual repairs performed with 30.7% agreeable with specific repairs.
- The highest concordance occurred when predicting single-repair methods compared to double or multiple graft repairs.
- ReconGPT predicted 47.6% of the 21 actual repair complications
Main Takeaway: ReconGPT shows promise as a support tool for post-Mohs reconstruction planning, offering useful repair suggestions and highlighting potential challenges. However, its predictive capabilities still fall short of the nuanced expertise and decision-making of experienced surgeons, emphasizing its role as an adjunct rather than a replacement.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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Copyright © 2023 - All Rights Reserved.