Sixty-Eighth issue
September 4, 2024
Changes in smoking habits modulate the risk of developing hidradenitis suppurativa
JAMA Dermatology
JAMA Dermatology
Clearing the air might just clear your skin!
Hidradenitis suppurativa (HS) is an inflammatory skin condition that presents with painful nodules and abscesses. Cigarette smoking is associated with a higher risk of HS and greater disease severity, along with reduced treatment efficacy. However, the influence of smoking habits, such as quitting or starting, on HS has not been thoroughly studied. This 14-year longitudinal cohort study used the Korean National Health Insurance Service database to analyze how changes in smoking habits influence the risk of developing HS.
What did they find?
Main Takeaway: Smoking-free status is associated with a decreased risk of developing HS, demonstrating the role of smoking cessation and avoidance in preventing HS.
Hidradenitis suppurativa (HS) is an inflammatory skin condition that presents with painful nodules and abscesses. Cigarette smoking is associated with a higher risk of HS and greater disease severity, along with reduced treatment efficacy. However, the influence of smoking habits, such as quitting or starting, on HS has not been thoroughly studied. This 14-year longitudinal cohort study used the Korean National Health Insurance Service database to analyze how changes in smoking habits influence the risk of developing HS.
What did they find?
- Compared to ongoing smokers, recent smoking quitters (adjusted hazard ratio [AHR]: 0.68; 95% CI: 0.56-0.83), former smokers (AHR: 0.67; 95% CI: 0.57-0.77), and never smokers (AHR: 0.57; 95% CI: 0.52-0.63) had a reduced risk of developing HS.
- 3 to 4 years after smoking cessation, quitters demonstrated decreased HS risk, comparable to never-smokers (3 to 6 years - AHR: 0.58; 95% CI: 0.36-0.92; 12 years - AHR: 0.70; 95% CI: 0.50-0.97).
- 2 to 3 years after smoking initiation, new smokers demonstrated an increased risk of HS, comparable to ongoing smokers.
Main Takeaway: Smoking-free status is associated with a decreased risk of developing HS, demonstrating the role of smoking cessation and avoidance in preventing HS.
Inpatient management of epidermolysis bullosa: Consensus-based hands-on instructions for neonates and postneonates
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
Now there’s no need to EBe afraid of inpatient EB management!
Epidermolysis bullosa (EB) is a genetic blistering disorder with four subtypes that range in severity and depth of skin blistering. Currently, no inpatient management guidelines exist for patients with EB in North America. Using a modified Delphi method, this study set out to develop inpatient management recommendations for neonates and postneonates with EB. Dermatologists, nurses, and caregivers collaborated to create recommendations in 10 focus areas. Consensus threshold was met if 70% of respondents agreed with a statement.
What did they find?
Main Takeaway: The authors report the first expert-based inpatient management guidelines in North America for neonatal and postneonatal EB.
Epidermolysis bullosa (EB) is a genetic blistering disorder with four subtypes that range in severity and depth of skin blistering. Currently, no inpatient management guidelines exist for patients with EB in North America. Using a modified Delphi method, this study set out to develop inpatient management recommendations for neonates and postneonates with EB. Dermatologists, nurses, and caregivers collaborated to create recommendations in 10 focus areas. Consensus threshold was met if 70% of respondents agreed with a statement.
What did they find?
- Of the generated neonatal and postneonatal statements, 87% (n = 103/119) and 86% (n = 105/122) were established as consensus, respectively.
- Guideline recommendations fell within the following categories: preparing the environment, psychosocial care, pain and itch management, deflating blisters, dressing changes, infected and recalcitrant wounds, patient monitoring, oral, nutritional, and gastrointestinal management, procedure care, and operating room measures.
Main Takeaway: The authors report the first expert-based inpatient management guidelines in North America for neonatal and postneonatal EB.
Possibility of melanoma overdiagnosis is suggested by unchanged mortality rates in the setting of increased melanoma incidence and biopsy rates
British Journal of Dermatology
British Journal of Dermatology
Dig deep into why there are MORE biopsies and MORE melanomas but no MORtality.
Melanoma incidence is on the rise, but with a lack of change in mortality rates, researchers are investigating possible explanations. Overdiagnosis is defined as diagnosing a condition that would never go on to cause symptoms or death. This retrospective study investigated if overdiagnosis, a lower diagnostic threshold, increased diagnostic activity, UV exposure, or improved treatments could explain the discrepancy. Biopsy and histological diagnoses of patients with melanoma between 1999 and 2019 in Denmark were obtained from the Danish Pathology Data Bank. For analysis, the Nordic Cancer Database, NORDCAN, was used to obtain melanoma mortality rates in Denmark.
What did they find?
Limitations: Researchers could not differentiate if nevi were biopsied for a suspected melanoma or cosmetic reasons.
Main Takeaway: Increased diagnostic activity, seen by higher biopsy rates, correlates with increased melanoma incidence; however, stagnant mortality rates may suggest potential overdiagnosis.
Melanoma incidence is on the rise, but with a lack of change in mortality rates, researchers are investigating possible explanations. Overdiagnosis is defined as diagnosing a condition that would never go on to cause symptoms or death. This retrospective study investigated if overdiagnosis, a lower diagnostic threshold, increased diagnostic activity, UV exposure, or improved treatments could explain the discrepancy. Biopsy and histological diagnoses of patients with melanoma between 1999 and 2019 in Denmark were obtained from the Danish Pathology Data Bank. For analysis, the Nordic Cancer Database, NORDCAN, was used to obtain melanoma mortality rates in Denmark.
What did they find?
- Biopsy rates were strongly correlated with incidence of invasive melanoma in males (r = 0.82) and females (r = 0.86) with minimal change in mortality.
- No evidence of increased UV exposure in patients during this time period was identified, ruling it out as a possible explanation.
- Increased diagnostic activity was seen, especially in younger patients who have the lowest melanoma risk and mortality, supporting overdiagnosis as a possible explanation.
Limitations: Researchers could not differentiate if nevi were biopsied for a suspected melanoma or cosmetic reasons.
Main Takeaway: Increased diagnostic activity, seen by higher biopsy rates, correlates with increased melanoma incidence; however, stagnant mortality rates may suggest potential overdiagnosis.
What are the increased healthcare burdens and comorbidity risks for pediatric patients with dystrophic epidermolysis bullosa?
Pediatric Dermatology
Pediatric Dermatology
Blistering Stats: Unwrapping the ED Burden of Dystrophic Epidermolysis Bullosa!
Epidermolysis bullosa (EB) encompasses genetic disorders causing fragile skin and mucous membranes. Dystrophic epidermolysis bullosa (DEB) is primarily caused by mutations in the COL7A1 gene, leading to blistering and scarring. DEB patients frequently visit emergency departments, yet there is limited data on the characteristics and risk factors of these visits in the US. This retrospective cohort study aimed to analyze the frequency, demographics, costs, and comorbidities associated with emergency department visits for DEB.
What did they find?
Main Takeaways: DEB is a complex blistering disorder leading to significantly more frequent emergency department visits, complications, and hospital admissions in patients with DEB than in those without.
Epidermolysis bullosa (EB) encompasses genetic disorders causing fragile skin and mucous membranes. Dystrophic epidermolysis bullosa (DEB) is primarily caused by mutations in the COL7A1 gene, leading to blistering and scarring. DEB patients frequently visit emergency departments, yet there is limited data on the characteristics and risk factors of these visits in the US. This retrospective cohort study aimed to analyze the frequency, demographics, costs, and comorbidities associated with emergency department visits for DEB.
What did they find?
- 53 cases of dystrophic epidermolysis bullosa (DEB) were identified in a sample of 27,223,220 pediatric emergency department visits, with a weighted total of 242 cases.
- Patients with DEB were significantly more likely to visit the ED in summer (35.7%) compared to those without DEB (21.4%, P < 0.05).
- Over half of patients with DEB were admitted to the hospital (56.2%, 95% CI: 39.3-72.5, P < 0.001), while only 3.4% of other patients were admitted (95% CI: 3.1-3.7).
- Common primary diagnoses for ED visits with a secondary DEB diagnosis included fever, constipation, and bone marrow transplant aftercare.
- Patients with DEB had significantly higher rates of visit complications, including hypertension, sepsis, and anxiety (all P < 0.001).
Main Takeaways: DEB is a complex blistering disorder leading to significantly more frequent emergency department visits, complications, and hospital admissions in patients with DEB than in those without.
~Spot~ cancer early with regular skin checks!
Skin cancer is a global public health issue, with rising cases of melanoma and non-melanoma skin cancers in recent years. Primary prevention focuses on reducing exposure to ultraviolet rays, while secondary prevention emphasizes early detection through skin examinations. This study aims to evaluate the frequency of dermatologist skin examinations in 17 countries and how demographic, socioeconomic, and sun-protective behaviors influence these habits.
What did they find?
Main Takeaway: The significant variability in melanoma incidence across countries underscores the need for increased awareness and more frequent skin checks, especially in regions with higher incidence rates, to enhance early detection and improve outcomes
Skin cancer is a global public health issue, with rising cases of melanoma and non-melanoma skin cancers in recent years. Primary prevention focuses on reducing exposure to ultraviolet rays, while secondary prevention emphasizes early detection through skin examinations. This study aims to evaluate the frequency of dermatologist skin examinations in 17 countries and how demographic, socioeconomic, and sun-protective behaviors influence these habits.
What did they find?
- This study included 17,001 participants, of which 47% were men and the mean age was 44.4 years (SD: 16.0).
- There was significant variability in melanoma incidence between countries, with Egypt having the lowest incidence (0.17 per 100,000 inhabitants) and Australia having the highest incidence (63.46 per 100,000 inhabitants).
- Countries’ melanoma incidence was positively correlated with skin check frequency (Spearman’s rho = 0.498).
- Countries’ melanoma incidence was positively correlated with skin check frequency (Spearman’s rho = 0.498).
- Only 4.8% of all participants performed skin checks more than once a year.
- The countries with the highest prevalence of skin checks occurring more than once a year were Egypt (15.9%), Brazil (8.3%), and the USA (8.1%).
Main Takeaway: The significant variability in melanoma incidence across countries underscores the need for increased awareness and more frequent skin checks, especially in regions with higher incidence rates, to enhance early detection and improve outcomes
Could a CAD system outperform a CNN system in detecting melanomas– OR are they better together?
Sk(inDepth) Scoop
Sk(inDepth) Scoop
Hue did it better? New computer models use color to identify melanomas!
The use of computer-aided diagnosis (CAD) and convolutional neural networks (CNN) has shown promise in detecting and differentiating melanoma from melanocytic nevi. This study explored a novel approach to integrating this technology by focusing on color and organizational patterns within lesions. A new model, called the "Disorder" model, was developed based on the principle that nevi exhibit an organized color distribution, while melanoma is characterized by disordered color patterns. The performance of this model was compared to that of a previously trained CNN architecture, ResNet-50.
What did they find?
Main Takeaway: CAD and CNNs continue to show promise in detecting and differentiating melanoma from melanocytic nevi. A new model utilizing lesion color and organization shows further potential in enhancing the accuracy of these technological tools.
The use of computer-aided diagnosis (CAD) and convolutional neural networks (CNN) has shown promise in detecting and differentiating melanoma from melanocytic nevi. This study explored a novel approach to integrating this technology by focusing on color and organizational patterns within lesions. A new model, called the "Disorder" model, was developed based on the principle that nevi exhibit an organized color distribution, while melanoma is characterized by disordered color patterns. The performance of this model was compared to that of a previously trained CNN architecture, ResNet-50.
What did they find?
- A data set of 6296 nevi and 1361 melanomas from the International Skin Imaging Collaboration (ISIC) public data set was utilized.
- The disorder model resulted in a sensitivity of 91%, specificity of 74%, and accuracy of 83%.
- The ResNet-50 model showed a sensitivity of 86%, specificity of 75%, and accuracy of 81%.
- When used together, the performance was enhanced with a sensitivity of 86%, specificity of 82%, and accuracy of 84%.
Main Takeaway: CAD and CNNs continue to show promise in detecting and differentiating melanoma from melanocytic nevi. A new model utilizing lesion color and organization shows further potential in enhancing the accuracy of these technological tools.
DERMLITE QUESTION OF THE WEEK
ContactInterested in joining the team or advertising with us? Do you have questions or feedback?
Contact us below! |
PODCAST & RESEARCH |
Content of sk(in depth) is for medical education purposes only.
Copyright © 2023 - All Rights Reserved.
Copyright © 2023 - All Rights Reserved.