Opioid overprescribing is a major contributor to the opioid crisis. The lack of procedure-specific guidelines contributes to the vast differences in prescribing practices.Create opioid-prescribing consensus guidelines for common dermatologic procedures.We […]» Read more
Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients.
Psoriasis is a chronic, multisystem, inflammatory disease that affects approximately 1% of children, with onset most common during adolescence. This guideline addresses important clinical questions that arise in psoriasis management […]» Read more
Publication productivity of authors of psoriasis clinical practice guidelines with and without ties to industry.
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Abstract: Reporting of SRs using PRISMA increases transparency and reproducibility; adherence in the dermatology literature has not been assessed.To assess selected, primarily methodological items from the PRISMA reporting guideline among […]» Read more
A risk prediction model for development of subsequent primary melanoma in a population-based cohort.
Abstract: Guidelines for follow-up of melanoma patients are based on limited evidence.To guide skin surveillance, we developed a risk prediction model for subsequent primary melanoma based on demographic, phenotypic, histopathologic, […]» Read more
Abstract: Bullous pemphigoid (BP) is an autoimmune sub-epidermal blistering condition which typically affects the elderly population.To undertake a national clinical audit based on standards derived from the British Association of […]» Read more
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Abstract: To provide service providers and users with an evidence-based set of current best practice guidelines for people and their families and carers, living with Epidermolysis bullosa (EB). A systematic […]» Read more
Recommendations for rosacea diagnosis, classification and management: Update from the global ROSacea COnsensus (ROSCO) 2019 panel.
Abstract: A transition from subtyping to a phenotyping approach in rosacea is underway, allowing individual patient management according to presenting features instead of categorisation by pre-defined subtypes. The ROSCO 2017 […]» Read more
Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 3.2% of the world’s population. In this section of the guidelines of care for psoriasis, we will focus the discussion on ultraviolet light-based therapies, which include narrowband and broadband UVB, UVA in conjunction with photosensitizing agents (PUVA), targeted UVB treatments like excimer laser, and several other modalities and variations of these core phototherapies, including newer applications of pulsed dye laser, intense pulse light, and light emitting electrodes. We will provide an in-depth, evidence-based discussion of efficacy and safety for each treatment modality and provide recommendations and guidance for the use of these therapies alone or in conjunction with other topical and/or systemic psoriasis treatments.» Read more
Complete Skin Clearance and PASI response rates in clinical practice- Predictors, Health Related Quality of Life improvements and implications for treatment goals.
PASI90 is suggested to be the new standard endpoint RCTs of biologics for psoriasis, whereas treatment guidelines often still refer to PASI75.To analyse in a real-world setting: Firstly, what factors are associated with higher levels of treatment response to biologics. Secondly, the Health-Related Quality of Life gains associated with different response levels in clinical practice.Biologically-naïve patients with PASI, DLQI and EQ-5D outcomes before (maximum 6 months) and after (3-12 months) switch to biologics during registration in the Swedish Register for systemic treatment of psoriasis, PsoReg, were included (n=515). Patient characteristics associated with higher treatment response were analysed by regression analyses. Improvements in absolute PASI, DLQI and EQ-5D were assessed in different PASI percent response levels.High PASI percentage response was associated with higher PASI before switch and lower BMI. DLQI and EQ-5D improved within all responder groups (p<0·001). The magnitude of improvements in DLQI (p=0·02) differed between responder groups. The mean (SD) DLQI improvement for PASI75-<90, PASI90-<100 responders and patients achieving Complete Skin Clearance (PASI100) were 9·9 (7·4), 11·5 (7·0) and 8·0 (6·1), respectively.PASI percentage change is largely dependent on absolute PASI before switch. Patients in clinical practice lack "baseline" PASI values as they may switch directly from one treatment to another or stay successfully treated for a longer time period. Treatment goals such as PASI90 are thus not suitable for treatment guidelines or for follow-up in clinical practice. This article is protected by copyright. All rights reserved.» Read more
Grading immunohistochemical markers p16INK4a and HPV E4 identifies productive and transforming lesions caused by low- and high-risk HPV within high-grade anal squamous intraepithelial lesions.
Current LAST guidelines recognise high- and low-grade anal squamous intraepithelial lesions (HSIL, LSIL) and recommend treatment of all HSIL, but not all HSIL progress to cancer. This study aims to distinguish transforming and productive HSIL by grading immunohistochemical (IHC) biomarkers p16 and E4 in lr- and hr-HPV- associated SIL as a potential basis for more selective treatment.Immunostaining for p16 and HPV E4 was performed and graded in 183 biopsies from 108 HIV+ MSM. Causative HPV genotype of the worst lesion was identified using SPF10-PCR-DEIA-LiPA25v1, with laser capture microdissection (LCM) for multiple infections. Worst lesions were scored for p16 (0-4) to identify activity of hrHPV E7 gene, and panHPV E4 (0-2) marking HPV production and life-cycle completion. There were 37 normal, 60 LSIL and 86 HSIL with 85% LSIL caused by lrHPV and 93% HSIL by hrHPV. No normal biopsy showed E4 but 43% of LSIL and 37% of HSIL were E4 positive. No differences in E4 positivity rates were found between lrHPV and hrHPV lesions. Most (90%) lesions caused by lrHPV showed very extensive patchy p16 staining. p16 grade in HSIL was variable with frequency of productive HPV infection dropping with increasing p16 grade.Combined p16/E4 IHC identifies productive and non-productive HSIL associated with hrHPV within the group of HSIL defined by the Lower Anogenital Squamous Terminology recommendations. This opens the possibility of investigating selective treatment of hrHPV-caused advanced transforming HSIL and a “wait and see” policy for productive HSIL.» Read more
Latin American Clinical Practice Guidelines on the Systemic Treatment of Psoriasis SOLAPSO – Sociedad Latinoamericana de Psoriasis (Latin American Psoriasis Society).
This Clinical Practice Guideline on the systemic treatment of Psoriasis includes the recommendations elaborated by a panel of experts from the Latin American Psoriasis Society SOLAPSO, who assessed the quality of the available evidence using the GRADE system and the PICO process to guide the literature search. To answer each question, the experts discussed the results of randomized controlled trials, observational studies and metanalysis evaluating the interventions identified (non-biologics, biologics and phototherapy) in different populations of patients with moderate to severe plaque-psoriasis, which was summarized in Tables ad-hoc. The main end-points considered to assess efficacy were PASI 50, 75, 90 and 100, PGA 0-1 and significant improvement of health-related quality of life. Specific adverse events, either severe or leading to treatment interruption, were also evaluated. The 31 recommendations included in this CPG follow the structure proposed by GRADE: direction (for or against) and strength (strong or weak). The goal of this CPG is to improve the management of patients with psoriasis by recommending interventions of proved benefit and providing a reference standard for the treating physician. Adhering to the contents of this CPG does not guarantee therapeutic success. The final decision on the specific treatment is the responsibility of the physician based on the individual circumstances and considering the values, the preferences and the opinions of the patient or caregivers.» Read more
Topical treatments in atopic dermatitis: unexpectedly low use of emollients; use of topical corticosteroid is higher in juvenile patients, higher in male vs females, and shows independent associations with asthma and depression.
Abstract: Despite decades of use,the actual amounts of topical corticosteroids (TCS) and emollients used in moderate-to-severe atopic dermatitis (AD) under real-world conditions are unknown. Thus, it remains unclear if inadequate […]» Read more
Histopathologic upgrading of nonmelanoma skin cancer at the time of Mohs micrographic surgery: A prospective review.
Abstract: Anecdotal experience and data from multiple retrospective studies have suggested that a significant percentage of nonmelanoma skin cancers (NMSCs) display an aggressive histologic subtype that is not diagnosed on […]» Read more
Mammalian target of rapamycin (mTOR) inhibitors and skin cancer risk in nonrenal solid organ transplant recipients: systematic review and meta-analysis.
Abstract: Solid organ transplant recipients have an increased risk of malignancy compared with the general population. Mammalian target of rapamycin (mTOR) inhibitors have been used as immunosuppressants in transplant recipients. […]» Read more
Eczema apps conformance with clinical guidelines: A systematic assessment of functions, tools and content.
Abstract: Eczema is a prevalent complex skin condition requiring active disease monitoring and personalized education. No studies have assessed the quality of apps aiming to support eczema self-management.To evaluate quality […]» Read more
Abstract: The International Dermatology Outcome Measures (IDEOM) established a set of core domains to be measured in all psoriasis trials. This set indicates that symptoms of psoriatic arthritis (PsA) should […]» Read more
Association Between Alopecia Areata, Anxiety, and Depression: A Systematic Review and Meta-analysis.
Abstract: To date, there is no comprehensive meta-analysis analyzing the association between alopecia areata, anxiety, and depression.We sought to analyze the existing literature to examine the association between alopecia areata, […]» Read more
Abstract: Hidradenitis suppurativa (HS) is a debilitating and distressing chronic systemic inflammatory skin disease. There have been several prior observational studies which reported a possibility link between HS and metabolic […]» Read more
Abstract: Psoriasis is a chronic inflammatory disease with clinical manifestations of the skin that affect both adults and children. In adults, biologics have revolutionized the treatment of moderate to severe […]» Read more