Fiabilidad de la teledermatología de almacenamiento en un escenario real

Introduction and objectivesAlthough many studies have evaluated the diagnostic reliability of store-and-forward (SF) teledermatology, the reliability of the technique for the diagnosis of general skin conditions in a clinical practice setting has never been demonstrated. We evaluated the reliability of SF teledermatology in clinical practice by analyzing the diagnostic agreement achieved in a subgroup of patients from the DERMATEL-2 study.Material and methodsPatients referred from primary care settings were randomized to 3 groups: SF, a combination of videoconferencing and SF technology (VC-SF), and a control group. This article focuses on the SF group. Clinical data were recorded and photographs taken by primary care physicians, who forwarded the data electronically. Each SF consultation package was assessed by 3 dermatologists (D1,D2,D3). Subsequently all the patients were assessed by a single dermatologist (D1) in a face-to-face consultation. Finally, 2 other dermatologists (D4,D5) assessed the agreement between the diagnoses obtained by SF and FF.ResultsIn total, 457 patients (200 males and 257 females) aged between 2 months and 86 years were randomized (192 to SF, 176 to VC-SF, and 89 to the control group). The diagnostic categories were as follows: tumors (49.4%), inflammatory (25.7%), adnexal (11%), infectious (9.4%) and other processes (4.4%) Since 170 patients had consultations deemed valid for analysis, the study included a total of 510 SF assessments. Most of the images and clinical records were of high quality (71.2% and 91.2% respectively), and diagnostic confidence was high in 81.4% of the cases studied.In 58.4% of cases the condition was managed exclusively by teledermatology. Levels of complete and aggregate interobserver agreement between SF and face-to-face evaluators were 0,72 and 0.90, respectively, for diagnosis and 0.61 and 0.80 for treatment. Diagnostic agreement correlated with the image quality (P  <  .001), diagnostic confidence (P < .001), felt need for conventional consultation (P < .001), and the quality of the clinical record (P = .013).ConclusionThe interobserver reliability of SF diagnosis in clinical practice is good. Dermatologists are able to predict errors in diagnosis by analyzing their own diagnostic confidence and evaluating the quality of the images.     

Authors’ willingness for second‐opinion teledermatology in difficult‐to‐manage cases: ‘an online survey’

Background Expert non‐availability for an instant difficult‐to‐manage case may limit the online discussion group to provide second‐opinion teledermatology for registered dermatologists. Author‐based second‐opinion teledermatology (AST) is proposed and assessment of authors’ response to answer queries and their willingness to participate in teledermatology consultation is analysed. Materials and methods Authors of 292 articles from seven non‐open access dermatology and three general medical journals addressing difficult‐to‐manage cases from June 2007 to December 2008 participated in this online dermatology authors’ survey. Authors’ response to reprint requests, answer literature queries and willingness to offer second‐opinion teledermatology were the main outcome measures. Perceived views were also documented. Results The scores for reprints requests vs. received were (χ² = 13.57, n = 292), P = 0.000. The scores for articles read, analysed and literature queries sent vs. authors answered were (χ² = 11.09, n = 190), P = 0.001. The scores for authors responded to reprints vs. willing to offer second‐opinion teledermatology consultation were (χ² = 5.65, n = 190), P = 0.017 and authors responded to reprint requests, answered queries and willing to offer second‐opinion (χ² = 5.65, n = 190), P = 0.017. Conclusion A dermatologist obtains literature, answered queries and constructive suggestions with additional informative material and pools second‐opinions from the authors using their e‐mail to deliver quality health care. AST is an alternative to online discussion group for second‐opinion teledermatology practice in difficult‐to‐manage cases. Uniform international laws are to be framed to facilitate telemedicine care for a difficult‐to‐manage case.     

Geriatric teledermatology: store‐and‐forward vs. face‐to‐face examination

Background Telemedicine could be useful in countries like Italy to meet the needs of elderly patients and in particular in those in precarious general conditions, for whom travelling even short distances can pose considerable practical and economical difficulties. Objective The aim of this study was to determine the efficacy of store‐and‐forward teledermatology vs face‐to‐face consultations in elderly patients. Methods A total of 130 geriatric patients with skin diseases requiring dermatological examination were enrolled. The patients examined, consisting of 60 men (46.15%) and 70 women (53.85%), were aged between 66 and 97 years (mean age 80.58 years). Three dermatologists of the department, with equal experience took turns in face‐to‐face examination and teledermatology (store‐and‐forward). To compare face‐to‐face dermatological examinations with the asynchronous store‐and‐forward approach of teledermatology, we considered diagnostic agreement (ICD‐9 code), therapeutic agreement and concordance of diagnostic confidence. Results One hundred and fourteen of 130 patients were diagnosed with the same ICD‐9 code, making a total observed agreement of 87.7% with a Cohen’s κ estimated of 0.863. Agreement between therapies was 69.6% (Cohen’s κ = 0.640). As it concerns diagnostic confidence, dermatologists appeared generally slightly less certain of their diagnosis by telemedicine. Conclusions Store‐and‐forward teledermatology can improve diagnostic and therapeutic care for skin disease in elderly who lack easy and/or direct access to dermatologists.     

A multicentre,cross‐sectional study on quality of life in patients with cutaneous lupus erythematosus

Background A study at the University of Pennsylvania (UPenn) Medical Center demonstrated that quality of life in patients with cutaneous lupus erythematosus (CLE) is negatively impacted. Whether patients with CLE in other geographic locations have similar quality of life is unknown. Objectives We sought to compare quality of life indicators between patients with CLE at the University of Texas Southwestern (UTSW) Medical Center at Dallas and those at UPenn. Methods Patients with CLE (total n = 248) at UTSW (n = 91) and UPenn (n = 157) completed the Skindex‐29 + 3 and Short Form‐36 (SF‐36) surveys related to quality of life. Additional information, including demographics, presence of systemic lupus erythematosus (SLE) and disease severity, was collected from UTSW patients with CLE. Results Most Skindex‐29 + 3 and SF‐36 subdomain scores between UTSW and UPenn patients with CLE were similar. However, UTSW patients with CLE were significantly more affected in the functioning and lupus‐specific Skindex‐29 + 3 domains, and physical functioning, role‐physical and general health SF‐36 subscales than UPenn patients with CLE (P < 0·05). Factors related to poor quality of life in UTSW patients with CLE include sex, income, education, presence of SLE, and skin disease activity. Conclusions Most quality of life indicators were similar between the two CLE populations. Differences in psychosocial behaviour, and a larger proportion of patients with SLE and females in the UTSW group likely attributed to differences in a minority of Skindex‐29 + 3 and SF‐36 subdomains. Capturing data from CLE populations in different locations provides a more thorough picture of the quality of life that patients with CLE experience on a daily basis with special attention to quality of life issues in select patients with CLE.     

Prognostic value of galectin‐3 in primary cutaneous melanoma

Background Galectin‐3, one of the β‐galactoside‐binding lectins, has been suggested as a marker of disease progression in melanoma patients because of its overexpression observed in recent studies. However, prognostic value of galectin‐3 in primary cutaneous melanoma (PCM) has not been clearly defined. Objectives The aim of the study was to analyse whether the intensity of galectin‐3 expression can predict survival in patients with PMC. Methods Galectin‐3 expression was evaluated using immunohistochemistry in 104 PCM samples, including 71 (68.2%) superficial spreading (SSM) and 33 (31.8%) nodular melanomas (NM). Results Significant difference of galectin‐3 expression between SSM and NM was determined (P < 0.001). Increased galectin‐3 expression was positively correlated with tumour thickness (P < 0.001), Clark (P < 0.001) and Breslow (P < 0.001) stage, mitotic rate (P < 0.001), presence of tumour ulceration (P < 0.001), lymphatic invasion (P = 0.018), positive sentinel lymph node (P < 0.022) and distant metastases (P < 0.001). Kaplan–Meier analysis showed an association between increased galectin‐3 expression and reduced recurrence‐free survival (RFS) (P = 0.001) and reduced disease‐specific survival (DSS) (P = 0.015). In Cox proportional hazards regression analysis, significant predictors of reduced RFS were positive sentinel lymph node (P = 0.025) and lymphovascular invasion (P = 0.021), whereas predictors of DSS were tumour thickness (P = 0.012), lymphovascular invasion (P = 0.047), Clark stage (P = 0.029) and location of tumour on upper extremities (P = 0.024). Conclusions Our results support the potential role of galectin‐3 in PCM development, progression and metastasis. Moreover, galectin‐3 could serve as an additional prognostic marker that might help in further stratifying the risk of disease progression and metastasis in patients with PMC.     

Teledermatology in the times of COVID‐19 – a systematic review

The COVID‐19 pandemic restricts the care of dermatological patients in many ways. Teledermatology such as video consultation or “store‐and‐forward” teledermatology could at least partly compensate for this. This systematic review summarizes all published studies on teledermatology during the COVID‐19 pandemic. It is based on a MEDLINE search for articles from 2020 in English and German. Two surveys among dermatologists from the USA and India showed that more than 80 % offered teledermatology. Among German dermatologists 17.5 % of 480 respondents offered online video consultation, 11.3 % offline consultation (store and forward) and 10.0 % both. Five cohort studies on teledermatology during the pandemic were identified. Three of them investigated teledermatology in chronic dermatoses (acne, inflammatory skin diseases), one dealt with the care of oncological patients with dermatological complications, and one analyzed teleconsultation in suspected COVID‐19 cases. In all studies, teledermatology largely reduced the number of personal consultations. The results indicate that the limitations of personal dermatological care of patients with skin diseases during the COVID‐19 pandemic can be at least partially compensated by an extension of teledermatology. Findings from the use of teledermatology during the pandemic should be employed to improve the use and acceptance of teledermatology by patients and dermatologists.     

Increased risk of incident psoriasis in end‐stage renal disease patients on chronic hemodialysis: A nationwide population‐based cohort study

Patients with end‐stage renal disease (ESRD) on chronic hemodialysis (HD) experience chronic inflammation and immune dysregulation; whether these affect the development of chronic inflammatory disease such as psoriasis is unknown. We aimed to investigate the impact of ESRD on the development of psoriasis. We performed a retrospective cohort study using records between 1999 and 2013 from Taiwan's National Health Insurance Research Database. Among 74 916 patients with ESRD on chronic HD and the control group comprising 74 916 sex and age group‐matched patients, 165 and 81 incident psoriasis developed after a mean follow up of 2.4 and 2.9 years, respectively. The incidence rates of psoriasis in HD patients and the control group were 91.7 and 37.1 per 100 000 person‐years, respectively (difference between groups, P < 0.001). HD patients had a shorter time to psoriasis diagnosis than the control group (P < 0.05). Cox proportional hazard adjustment showed the hazard ratio (HR) for psoriasis in HD patients as 2.09 (95% confidence interval [CI], 1.49–2.94; P < 0.001) than that of the control group. Younger HD patients had relatively higher risk of psoriatic development (age <60 years; adjusted HR, 3.68; 95% CI, 1.93–7.02; P < 0.001). The relative risk of psoriatic arthritis was not increased in HD patients compared with the control group. In conclusion, patients with ESRD on chronic HD had a greater risk of developing psoriasis. Physicians should be aware of the predisposition to psoriasis in patients with ESRD on chronic HD.     

Methotrexate/narrowband UVB phototherapy combination vs. narrowband UVB phototherapy in the treatment of chronic plaque‐type psoriasis – a randomized single‐blinded placebo‐controlled study

Background Psoriasis is a chronic, recurring inflammatory disease affecting the skin, joints and nails that has a significant negative impact on the quality of life. Efficacy of combination of methotrexate/narrowband ultraviolet B (NBUVB) phototherapy in the treatment of psoriasis has been rarely assessed. Objectives To compare the efficacy of methotrexate/NBUVB phototherapy combination vs. NBUVB phototherapy in the treatment of chronic plaque psoriasis. Methods Forty patients with chronic plaque‐type psoriasis (body surface area involvement >10%) were randomized to receive either methotrexate/NBUVB phototherapy (group A) or placebo/NBUVB phototherapy (group B). End point of treatment was 75% reduction in Psoriasis Area and Severity Index (PASI) Score or upto 6 months, whichever was earlier. Patients were then followed up for a period of 12 weeks for assessment of relapse. Results Of 40 patients, 37 completed the treatment period and 29 both the treatment period and follow‐up. PASI 75 was achieved in 19/20 patients in group A and 14/20 patients in group B (P < 0.04). The mean number of weeks(P = 0.001), the mean cumulative dose of NBUVB (P = 0.001) and the mean number of phototherapy sessions (P = 0.0001) required to achieve PASI 75 were significantly less in group A compared with group B. There was no significant difference in the number of patients who relapsed during the follow‐up period (P = 0.68). Conclusion Combination of methotrexate and NBUVB phototherapy provides more rapid clinical improvement compared with NBUVB monotherapy in the treatment for chronic plaque‐type psoriasis.     

Store-and-forward teledermatology: assessment of validity in a series of 2000 observations

Background and objectivesThe aim of this study was to assess the validity of store-and-forward teledermatology as a tool to support physicians in primary care and hospital emergency services and reduce the requirement for face-to-face appointments. Diagnostic validity and the approach chosen for patient management (face-to-face vs teledermatology) were compared according to patient origin and diagnostic group.Material and methodsDigital images from 100 patients were assessed by 20 different dermatologists and the diagnoses offered were compared with those provided in face-to-face appointments (gold standard). The proposed management of the different groups of patients was also compared.ResultsThe percentage complete agreement was 69.05% (95% confidence interval [CI], 66.9%–71.0%). The aggregate agreement was 87.80% (95% CI, 86.1%–89.0%). When questioned about appropriate management of the patients, observers elected face-to-face consultation in 60% of patients (95% CI, 58%–61%) and teledermatology in 40% (95% CI, 38%–41%). Diagnostic validity was higher in patients from primary care (76.1% complete agreement and 91.8% aggregate agreement) than those from hospital emergency services (61.8% complete agreement, 83.4% aggregate agreement) (p < 0.001) and teledermatology was also chosen more often in patients from primary care compared with those from emergency services (42% vs 38%; p = 0.003). In terms of diagnostic group, higher validity was observed for patients with infectious diseases (73.3% complete agreement and 91.3% aggregate agreement) compared to those with inflammatory disease (70.8% complete agreement and 86.4% aggregate agreement) or tumors (63.0% complete agreement and 87.2% aggregate agreement) (p <0.001). Teledermatology was also chosen more often in patients with infectious diseases (52%) than in those with inflammatory disease (40%) or tumors (28%) (p <0.001).ConclusionsStore-and-forward teledermatology has a high level of diagnostic validity, particularly in those cases referred from primary care and in infectious diseases. It can be considered useful for the diagnosis and management of patients at a distance and would reduce the requirement for face-to-face consultation by 40%.     

Patient‐reported symptoms and signs of moderate‐to‐severe psoriasis treated with guselkumab or adalimumab: results from the randomized VOYAGE 1 trial

Background

How patients experience the symptoms/signs of psoriasis is highly relevant for assessing treatment response.

Objectives

Compare outcomes with guselkumab, placebo and adalimumab utilizing the novel, validated Psoriasis Symptoms and Signs Diary (PSSD).

Methods

VOYAGE 1 is an ongoing, phase III, double‐blinded, controlled trial of patients with moderate‐to‐severe psoriasis. Patients were randomized to guselkumab 100 mg every 8 weeks; placebo‐to‐guselkumab 100 mg every 8 weeks; or adalimumab 40 mg every 2 weeks. The PSSD was self‐administered to assess symptoms (i.e. itch, skin tightness, burning, stinging and pain) and signs (i.e. dryness, cracking, scaling, shedding/flaking, redness and bleeding) of psoriasis (0–10 [absent‐to‐worst‐imaginable]) every 24 h. Symptom and sign summary scores were derived (0–100) based on average scores of the individual symptoms and signs. Proportions of patients with clinically meaningful improvements and symptom‐ and sign‐free scores of 0 were evaluated across treatment groups at weeks 16, 24 and 48.

Results

At baseline, 652 of 837 randomized patients had PSSD scores. The proportion of patients achieving clinically meaningful improvements in PSSD summary scores was significantly higher in the guselkumab group compared with the placebo group at week 16 (P < 0.001) and compared with the adalimumab group at weeks 24 (P = 0.002) and 48 (P < 0.001). The proportions of patients achieving PSSD symptom and sign summary scores of 0 (i.e. symptom‐ and sign‐free) were significantly higher for guselkumab vs. placebo at week 16 and vs. adalimumab at weeks 24 and 48 (all P < 0.001).

Conclusions

Based on PSSD scores, greater improvements in symptoms and signs of psoriasis were reported by patients treated with guselkumab compared with placebo at week 16 or adalimumab through 48 weeks.     

Quality of life and health‐related utility analysis of adults with moderate and severe atopic dermatitis treated with tacrolimus ointment vs. topical corticosteroids

Background The purpose of this study was to measure change in quality of life (QoL) and estimate health‐related utility in adults with moderate and severe atopic dermatitis (AD) following the use of either tacrolimus ointment or topical corticosteroids. Methods Data were analysed from a double‐blind, randomized controlled trial comparing the treatment of adults with moderate and severe AD with either tacrolimus ointment or a standard corticosteroid regimen. Following randomisation, patients applied their medication twice‐daily for 6 months. Monthly assessments determined response and QoL. Health‐related utility (EQ5Dindex) was estimated by Monte Carlo simulation from SF‐12 responses via a published mapping algorithm. Results At baseline, estimated utility data were available for 926 (95%) of the intention‐to‐treat patients, 57% of whom had AD of moderate severity (43% severe). The mean age at baseline was 32.5 years (SD ± 11.8), 46.2% were male, with a mean EQ5Dindex for moderate cases of 0.770 (SD ± 0.157), and 0.665 (SD ± 0.225) for those with severe disease (P < 0.001). Patients treated with tacrolimus ointment showed significantly greater improvement in all but one domain of the SF‐36. At baseline, there was no difference in estimated utility between the two groups; however, a difference in utility in favour of tacrolimus ointment emerged after 1 month’s treatment (0.849 vs. 0.820; P = 0.004). Over the 6‐month study period, the mean, marginal utility difference between the study arms was 0.032 U (utility) in favour of tacrolimus (P < 0.001). Conclusion Treatment with 0.1% tacrolimus ointment rather than a standard topical corticosteroid ointment regimen was associated with clinically significant, incremental improvement in QoL, sustained over a 6‐month period. A within‐trial cost‐utility estimate based on study medication cost alone suggests that tacrolimus ointment is highly cost‐effective given existing willingness‐to‐pay thresholds.     

Comparison of teleconsultations and face-to-face consultations: preliminary results of a United Kingdom multicentre teledermatology study

The objective of this multicentre study was to undertake a systematic comparison of face-to-face consultations and teleconsultations performed using low-cost videoconferencing equipment. One hundred and twenty-six patients were enrolled by their general practitioners across three sites. Each patient underwent a teleconsultation with a distant dermatologist followed by a traditional face-to-face consultation with a dermatologist. The main outcome measures were diagnostic concordance rates, management plans and patient and doctor satisfaction. One hundred and fifty-five diagnoses were identified by the face-to-face consultations from the sample of 126 patients. Identical diagnoses were recorded from both types of consultation in 59% of cases. Teledermatology consultations missed a secondary diagnosis in 6% of cases and were unable to make a useful diagnosis in 11% of cases. Wrong diagnoses were made by the teledermatologist in 4% of cases. Dermatologists were able to make a definitive diagnosis by face-to-face consultations in significantly more cases than by teleconsultations (P = 0.001). Where both types of consultation resulted in a single diagnosis there was a high level of agreement (κ = 0.96, lower 95% confidence limit 0.91–1.00). Overall follow-up rates from both types of consultation were almost identical. Fifty per cent of patients seen could have been managed using a single videoconferenced teleconsultation without any requirement for further specialist intervention. Patients reported high levels of satisfaction with the teleconsultations. General practitioners reported that 75% of the teleconsultations were of educational benefit. This study illustrates the potential of telemedicine to diagnose and manage dermatology cases referred from primary care. Once the problem of image quality has been addressed, further studies will be required to investigate the cost-effectiveness of a teledermatology service and the potential consequences for the provision of dermatological services in the U.K.     

Intra‐ and inter‐observer reliability of the application of the cellulite severity scale to a Spanish female population

Background ‘Hexsel, dal’Forno and Hexsel Cellulite Severity Scale’ (CSS) was developed to evaluate cellulite with an objective and easy to apply tool. Objective Study CSS intra‐ and inter‐observer reliability in a Spanish female population by evaluating patients’ cellulite through photographs of their overall gluteofemoral zone as opposed to its creators who distinguished between buttocks and thigh. Methods Cellulite Severity Scale was applied to 27 women, evaluating gluteofemoral cellulite, differentiating between left and right. Evaluations were made by three expert examiners each at three times with a 1‐week separation. Variables were the five CSS dimensions (number of evident depressions; depth of depressions; morphological appearance of skin surface alterations; grade of laxity, flaccidity, or sagging skin; and the Nürnberger and Müller classification scale), and the overall CSS score. Cronbach’s alpha, intra‐class correlation and item total correlation were analysed. Results Cronbach’s alpha values were 0.951 (right) and 0.944 (left). In the intra‐observer reliability analysis, intra‐class correlation coefficient ranged from 0.993 to 0.999 (P < 0.001) and in the inter‐observer analysis were 0.937 (right) and 0.947 (left) (P < 0.001). Item total correlation showed all dimensions to be needed except grade of laxity, flaccidity or sagging skin (0.959 right; 0.955 left). Conclusion Cellulite Severity Scale has excellent reliability and internal consistency when used to evaluate cellulite on the buttocks and back of the thighs considered together. Nevertheless, the dimension grade of laxity, flaccidity or sagging skin does not contribute positively to the final consistency of the scale. This dimension needs to be analysed in greater depth in future studies.     

Evaluation of anti‐wrinkle effects of a novel cosmetic containing niacinamide

Niacinamide is known to have effectiveness on sallowness, wrinkling, red blotchiness and hyperpigmented spots in aging skin. In this study, we have evaluated the anti‐wrinkle effects of a new cosmetic containing niacinamide. A randomized, placebo‐controlled, split face study was performed in 30 healthy Japanese females who had wrinkles in the eye areas. The tested cosmetic containing 4% niacinamide was applied on wrinkles of one side for 8 weeks, and a control cosmetic without niacinamide on another site. Anti‐wrinkle effects were evaluated with two methods: (i) doctors’ observation and photographs based on the guideline of the Japan Cosmetic Industry Association; and (ii) average roughness of skin surface (Ra value) using skin replica. This cosmetic showed marked and moderate improvement in 64% of the subjects with a significant difference as compared with the control site (P < 0.001). Wrinkle grades in the tested area significantly reduced more than pre‐application (P < 0.001) and the control (P < 0.001). Reduction in Ra value on the tested area was more than pre‐application (P < 0.01) and the control site (P < 0.05) with significant differences Only one subject stopped the study with minimal irritation. These results indicated that the tested lotion was well tolerated and may be an optional preparation for the treatment of wrinkles in the eye areas.     

Study of pro‐ and anti‐inflammatory cytokine profile in the patients with parthenium dermatitis

Background: Parthenium dermatitis is a common airborne allergic contact dermatitis induced by exposures to the weed Parthenium hysterophorus. The disease manifests as itchy erythematous papules, papulovesicular and plaque lesions on exposed areas of the body. Objectives: The aim of this study was to show the alterations in pro/anti‐inflammatory cytokines in parthenium dermatitis. Methods: The study included 50 patients with parthenium dermatitis confirmed by patch testing using aqueous extracts of P. hysterophorus and 50 age‐matched healthy controls. The levels of pro‐inflammatory [tumour necrosis factor‐α (TNF‐α), interleukin (IL)‐6, IL‐8, and IL‐17] and anti‐inflammatory (IL‐4 and IL‐10) cytokines were estimated by commercially available high sensitivity enzyme‐linked immunosorbent assay (ELISA) kits. Results: All the dermatitis patients showed significantly (P < 0.001) elevated levels of TNF‐α, IL‐6, IL‐8, and IL‐17 levels as compared to healthy controls. In contrast, the anti‐inflammatory cytokine IL‐4 showed an insignificant decrease (P < 0.217) and a decrease in level of IL‐10 was statistically significant (0.001) compared with controls. Conclusions: The present study suggests the involvement of pro‐inflammatory cytokines in the pathogenesis of parthenium dermatitis. A decrease in levels of anti‐inflammatory cytokines was demonstrated, which could not downregulate pro‐inflammatory cytokines in parthenium dermatitis.     

Clinical clues for differential diagnosis between verruca plana and verruca plana‐like seborrheic keratosis

Sometimes the clinical differentiation between verruca plana (VP) and VP‐like seborrheic keratosis (SK) could be challenged. However, there have been no studies on this issue to date. The aim of this study was to elucidate clinical and dermoscopic differences between these two diseases, and also to suggest a diagnostic algorithm of VP and VP‐like SK without skin biopsy. The patients who had lesions clinically considered as VP or VP‐like SK were the target of our study. We took clinical and dermoscopic photos with informed consent and conducted a questionnaire. All patients had their diagnoses confirmed by biopsy. Thirty‐three patients were enrolled in our study. Seventeen patients were finally diagnosed with VP (51.5%) and 16 patients with VP‐like SK (48.5%). In clinical findings, VP‐like SK showed significantly more scattered distribution than VP (P = 0.039), which exhibited more clustered or grouped distribution (P = 0.039). In dermoscopic findings, brain‐like appearance was more commonly observed in VP‐like SK (P = 0.003) whereas VP showed more red dots or globular vessels (P = 0.017) and even‐colored light brown to yellow patch (P < 0.001). Sex, onset age, the size of each lesion, location, color and shape showed no significant differences between them (P > 0.05). Based on our results, we suggest a diagnostic algorithm using Koebner's phenomenon, dermoscopic findings, distribution of each lesion and biopsy for multiple VP‐like lesions in adults, and we think it will be a very useful diagnostic tool in daily clinical dermatological practice.     

Comparison of the diagnostic accuracy of whole‐body MRI and whole‐body CT in stage III/IV malignant melanoma

Background: Malignant melanoma (MM) is dramatically increasing in light‐skinned populations worldwide. Staging and regular follow‐up examinations are essential. The purpose of this study was to compare the diagnostic accuracy of whole‐body MRI with the standard diagnostic algorithm (whole‐body CT and brain MRI) in patients with stage III/IV MM. Patients and methods: A group of 50 consecutively admitted patients with stage III/IV MM were included in the study. Whole‐body CT and brain MRI scans were performed. Additionally, all patients underwent a whole‐body MRI (1.5 Tesla Magnetom Avanto, Siemens Healthcare Sector, Erlangen). The findings were compared on a lesion‐by‐lesion basis as part of clinical routine follow‐up. Results: 33 patients received a follow‐up CT and were evaluated. Overall, 824 lesions were detected. The sensitivity of whole‐body MRI was observer‐dependent. MRI was slightly less sensitive than CT according to the findings of the two most experienced observers (73.4 % vs. 78.2 %, p = 0.0744). CT was significantly more sensitive in the detection of small (1–5 mm) pulmonary nodules (2.9 % vs. 66.9 %, p < 0.0001). Yet overall, MRI was significantly more specific than CT (83.4 % vs. 50.4 %, p < 0.0001). Conclusions: Whole‐body MRI in compliance with standard requirements for the observers (high level of experience) should be considered as an appropriate alternative to CT without ionizing radiation, particularly for young patients with advanced MM.     

Efficacy and safety of apremilast in subjects with moderate to severe plaque psoriasis: results from a phase II,multicenter, randomized,double‐blind,placebo‐controlled,parallel‐group,dose‐comparison study

Background Apremilast, a small molecule specific inhibitor of phosphodiesterase 4, works intracellularly to modulate pro‐inflammatory and anti‐inflammatory mediator production. Objective Assess apremilast efficacy and safety in moderate to severe plaque psoriasis. Methods Phase II, 12‐week, multicenter, double‐blind, placebo‐controlled, parallel‐group, dose‐comparison study of 259 subjects randomized 1 : 1 : 1 to placebo, apremilast 20 mg QD or apremilast 20 mg BID. Results More subjects receiving apremilast 20 mg BID achieved ≥ 75% reduction in Psoriasis Area and Severity Index (PASI‐75) vs. placebo (24.4% vs. 10.3%; P = 0.023). A similar proportion of subjects receiving apremilast 20 mg QD and placebo achieved PASI‐75 at week 12 [9/87 (10.3%, each group)]. Mean per cent reduction in PASI from baseline was 17.4% for placebo, 30.3% for apremilast 20 mg QD (P = 0.021 vs. placebo) and 52.1% for apremilast 20 mg BID (P < 0.001). Apremilast 20 mg BID significantly decreased mean body surface area involvement vs. placebo (30.8% vs. 3.2%; P < 0.001). The most common adverse events were headache, nasopharyngitis, diarrhoea and nausea. Most events (> 90%) were mild to moderate and did not lead to study discontinuation. Serious adverse events occurred in four placebo subjects (panic attack, hospitalization for rehabilitation, hospitalization for alcoholism, worsening psoriasis), one receiving apremilast 20 mg QD (knee surgery) and in one receiving apremilast 20 mg BID (worsening psoriasis). The panic attack was considered treatment‐related; both cases of worsening psoriasis occurred after medication discontinuation. No deaths or opportunistic infections were reported. Conclusion Apremilast 20 mg BID for 12 weeks was effective and well tolerated in subjects with moderate to severe plaque psoriasis.     

Cutaneous adverse drug reactions in a hospital‐based Chinese population

Background. Cutaneous adverse drug reactions (CADRs) are common skin adverse reactions associated with drugs. Aim. To assess recent trends in CADRs and the drugs associated with them, using data from the past 5 years in the largest single database available on a hospital‐based population in China. Methods. All clinical records of inpatients admitted with a diagnosis of CADR to the Dermatology Ward, Huashan Hospital from January 2004 to December 2008 were retrospectively studied. Results. In the 734 patients, the three most common types of CADRs were nonsevere reactions, erythema multiforme (EM)‐like eruptions (n = 255), urticaria (n = 192) and exanthematous reactions (n = 159), followed by three severe reactions: Stevens–Johnson syndrome (n = 58), toxic epidermal necrolysis (n = 29) and exfoliative dermatitis (n = 22). The most common single drug associated with the development of all drug eruptions was allopurinol, followed by amoxicillin, cephalosporins, antiepileptic agents and antipyretic/analgesic agents. However, the most common single drugs associated with severe reactions were antiepileptic agents, followed by allopurinol, antipyretic/analgesic agents and cephalosporins. In contrast to patients with nonsevere reactions, patients with severe reactions were more likely to be male (P < 0.001) and to have a greater mean age of onset (P < 0.001), a longer latency period (P < 0.001) and a longer duration of hospitalization (P < 0.001). Conclusion. In contrast to previous studies, we found allopurinol to be the most common single drug associated with CADRs followed by antibiotics (amoxicillin and cephalosporins), and antiepileptic, especially carbamazepine. A higher incidence of EM‐like eruptions and urticaria was also seen.