Tag: nevin manimala

Dermatol Pract Concept. 2025 Jan 30;15(1). doi: 10.5826/dpc.1501a4871.

ABSTRACT

INTRODUCTION: Pustular psoriasis (PP) is a rare life-threatening skin disease with negatively impact on quality of life (QoL). Clinically, it may be systemic (generalized pustular psoriasis [GPP]) or localized on palms and soles (palmoplantar pustulosis [PPP]). It is not rare to observe plaque psoriasis associated with GPP.

OBJECTIVES: We explored the therapies used for PP and their correlation with patient QoL scores, through a cross-sectional study using retrospective data from a monocentric database in the period 2017-2021.

METHODS: Patient characteristics were summarized using descriptive statistics and treatment predictors of QoL were identified by multiple regression analysis. Among 108 patients with PP, 57.4% had GPP + PSO whereas 42.6% had PPP. The therapeutic management is based on systemic conventional treatments and biological therapies in both GPP and PPP.

RESULTS: GPP + PSO patients with an impaired QoL (DLQI≥10) were associated with biological therapy including certolizumab (odds ratio [OR]=2.38), etanercept (OR=2.25), secukinumab (OR=2.03) or ustekinumab (OR=2.79) whereas, PPP patients were positively associated with secukinumab (OR=2.85) or apremilast (OR 4.28, 95%-CI 0.56-9.62).

CONCLUSIONS: Currently, systemic conventional therapy remains the therapeutic fulcrum of PP management. A great effect on QoL, especially for GPP+PSO, was assessed regardless the ongoing treatment and only newer biologic options were able to somehow positively impact.

PMID:40117644 | DOI:10.5826/dpc.1501a4871

Dermatol Pract Concept. 2025 Jan 30;15(1). doi: 10.5826/dpc.1501a4648.

ABSTRACT

INTRODUCTION: Non-vitiligo hypopigmented skin lesions may be close clinical mimickers of vitiligo, resulting in a diagnostic dilemma. Dermoscopic features of vitiligo have been studied, but those of other hypopigmentation disorders are not well-characterized.

OBJECTIVES: We aimed to describe and compare the dermoscopic features of vitiligo and other hypopigmented skin lesions.

METHODS: This was a cross-sectional study including 105 vitiligo and 137 other hypopigmented skin lesions, including ash-leaf macules (N=17), nevus depigmentosus (N=16), post-inflammatory hypopigmentation (N=16), pityriasis alba (N=15), pityriasis versicolor (N=14), idiopathic guttate hypomelanosis (IGH) (N=14), lichen sclerosus (N=12), leprosy (N=9), and others. Dermoscopic findings were recorded by concordance of at least two qualified dermatologists.

RESULTS: Common dermoscopic findings in vitiligo were intermediate or ill-defined margins (96/105, 91.4%) and a complete absence of pigment network (70/105, 66.7%). Nevus depigmentosus lesions were mostly hypopigmented, with a faint pigment network throughout the lesion. In 15/17 (88.2%) ash-leaf macules, a characteristic pattern of sharply demarcated areas of normal pigment network was seen within a depigmented lesion. Almost all lesions of IGH had a sharply defined margin with completely absent pigment network; discernible eccrine openings within the lesion were seen in 9/14 (64.3%). Dermoscopic findings of a complete absence of pigment network, perifollicular retention of pigment, presence of vascular pattern, loss of discernibility of eccrine openings within the lesion, and lack of scaling were statistically significantly more common in vitiligo than other hypopigmented skin lesions (P <0.001).

CONCLUSION: Vitiligo, nevus depigmentosus, ash-leaf macule, and IGH have distinctive dermoscopic features. Dermoscopy can aid in the differential diagnosis of vitiligo and other hypopigmented skin lesions.

PMID:40117638 | DOI:10.5826/dpc.1501a4648

Dermatol Pract Concept. 2025 Jan 30;15(1). doi: 10.5826/dpc.1501a4481.

ABSTRACT

INTRODUCTION: Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are primary scarring alopecias that few authors consider the same entity, and some consider them different. Only a few reviews focus on trichoscopic findings in delineating these two alopecias.

OBJECTIVE: We describe and summarize the trichoscopic features of both conditions.

METHODS: We performed an extensive literature search using the PubMed and Google Scholar databases. The Chi-square test was applied to compare the trichoscopic features in LPP and FFA. P-values less than 0.05 were considered statistically significant.

RESULTS: Out of 60 articles, 33 (16 LPP, 17 FFA) were considered for quantitative analysis due to availability in English literature with full text. We found that peripilar cylindrical casts and perifollicular erythema with arborizing vessels were predominant features suggesting early LPP. In contrast, yellow dots, perifollicular erythema, and scattered pigmentation suggested active FFA. Shiny-white area was seen in both groups in the inactive stages. The target arrangement of blue-grey dots, milky-red areas, and irregularly arranged white fibrotic dots were seen in late LPP, and black dots, lonely hairs, and loss of vellus hairs were detected in the later stages of FFA. Features such as blue-grey structureless areas, blue-white veil, and variability in morphologies of hair shafts were not significantly different between the two groups.

CONCLUSION: This article provides a comprehensive literature review on the trichoscopic features of LPP and FFA, including comparing the similarities, differences, and peculiarities of both conditions.

PMID:40117622 | DOI:10.5826/dpc.1501a4481

Dermatol Pract Concept. 2025 Jan 30;15(1). doi: 10.5826/dpc.1501a4838.

ABSTRACT

INTRODUCTION: Risankizumab and secukinumab are effective treatment options for patients with moderate to severe psoriasis.

OBJECTIVES: We sought to estimate the efficacy and the cost per responder of risankizumab and secukinumab by comparing these two drugs in a real-life setting.

METHODS: A multicentric retrospective study was conducted in patients from the Lazio region of Italy affected by moderate-to-severe psoriasis who initiated risankizumab or secukinumab between September 2020 to September 2022. Psoriasis Area and Severity Index (PASI) was measured at baseline and after 16, 52, and 78 weeks. Clinical responses were evaluated by PASI90 and PASI100 responses at the same timepoints. The cost per responder at week 16 and 52 was adopted as a cost-effectiveness indicator.

RESULTS: Included were 141 patients, 74 (52.5%) treated with risankizumab and 67 (47.5%) treated with secukinumab. PASI90 responses in risankizumab-treated patients were higher than those observed in patients treated with secukinumab at both weeks 16 and 52 (79.7% versus 64.2% (P = 0.041) and 98.6% versus 83.6% (P = 0.003), respectively). Risankizumab also showed superior PASI100 rates at week 52 (85.5% versus 65.6%, P = 0.009). No statistically significant differences were observed in PASI90 and PASI100 rates between the 2 groups at week 78. The cost per PASI90 and PASI100 responder for risankizumab was lower at both weeks 16 (€5833.66 and €8394.78, compared to €8747.18 and €10746.53 for secukinumab) and 52 (€11798.90 and €13598.73 vs €15347.70 and €19568.31, respectively).

CONCLUSIONS: Risankizumab showed superior efficacy than secukinumab and a lower cost per responder.

PMID:40117618 | DOI:10.5826/dpc.1501a4838

Dermatol Pract Concept. 2025 Jan 30;15(1). doi: 10.5826/dpc.1501a4698.

ABSTRACT

INTRODUCTION: Female pattern hair loss (FPHL) is one of the most common forms of diffuse alopecia in females. Despite the availability of multiple treatment options, FPHL management poses challenges for the dermatologist.

OBJECTIVES: We aimed to compare the efficacy and safety of topical finasteride 1% solution and spironolactone 5% solution to minoxidil 5% solution in the treatment of FPHL clinically and trichoscopically.

METHODS: Forty-five adult female patients diagnosed with FPHL were divided into three groups of 15 each. Group A was treated with topical finasteride 1%, group B used topical spironolactone 5%, and group C was treated with topical minoxidil solution 5 %, all groups were treated for 16 weeks.

RESULTS: By the end of 16th week, significant improvement on the Sinclair scale was observed in groups A and C, but the difference between the three groups was statistically insignificant. Trichoscopically, hair density significantly increased in groups A and C. There was a significant reduction in the number of patients with yellow dots, peripilar sign, and single hair follicular units (FU) in group A. In group C, a significant reduction in the number of patients with yellow dots and single hair FU was documented. No trichoscopic changes were detected in group B.

CONCLUSIONS: Topical finasteride is as safe and effective as topical minoxidil in FPHL. Both treatments showed greater effectiveness clinically and trichoscopically than topical spironolactone. The use of topical finasteride may be another solution for the treatment of FPHL in minoxidil non-responders or in the presence of intolerable side effects.

PMID:40117614 | DOI:10.5826/dpc.1501a4698

Dermatol Pract Concept. 2025 Jan 30;15(1). doi: 10.5826/dpc.1501a4511.

ABSTRACT

INTRODUCTION: Psoriasis is an inflammatory skin disease characterized by erythematous, scaly, pruritic plaques on the extensor areas of the extremities. It is one of the most common dermatological diseases in the geriatric population.

OBJECTIVE: The aim of this investigation was to evaluate the demographic data, clinical characteristics, and treatment responses of the geriatric population (≥65 years) with psoriasis at our hospital.

METHODS: In this study, we examined 160 geriatric patients diagnosed with psoriasis. We evaluated patients in two groups: early onset (EaO) (<60 years) and elderly onset (EO) (≥60 years).

RESULTS: In our study, 53.8% of the patients were male, the average age was 68.7 years, and 65% of the patients were considered EaO. Knee and elbow lesions were detected more frequently at the beginning and during the disease in the EaO group; 44.4% of patients had nail psoriasis, while 20.6% had psoriatic arthritis. Nail involvement (P = 0.17) and the presence of psoriatic arthritis (P = 0.035) were more common in the EaO group. Erythrodermic psoriasis was more common in the EaO group, but it was not statistically significant (P = 0.097). It was observed that the disease course of psoriasis was slower in the EaO group compared to the EO group (P = 0.001). Systemic treatment was predominantly initiated as the first treatment agent in the EO group (P = 0.006). Patients in the EaO group received more cyclosporine treatment than the others (P = 0.004).

CONCLUSIONS: The geriatric population is associated with multiple comorbidities and polypharmacy, highlighting the importance of evaluating patients’ medications and comorbidities when selecting a treatment agent for psoriasis.

PMID:40117612 | DOI:10.5826/dpc.1501a4511

Dermatol Pract Concept. 2025 Jan 30;15(1). doi: 10.5826/dpc.1501a4805.

ABSTRACT

INTRODUCTION: Psoriasis is a chronic immune-mediated skin condition. One of the intriguing challenges in studying psoriasis has been identification of correlations between this disease and gender and body weight.

OBJECTIVES: A multicenter retrospective study was conducted among patients with moderate-to-severe psoriasis who attended the outpatient clinics of 6 University Hospitals in Italy. The effects of apremilast on weight and body mass index (BMI) according to gender after 24 weeks and 48 weeks of therapy were considered.

METHODS: We enrolled retrospectively 120 adult patients with moderate-to-severe psoriasis who underwent apremilast treatment for at least 24 weeks. Baseline characteristics, including age, gender, psoriasis area severity index (PASI), comorbidities, smoking and alcohol habits, relevant medical history and previous psoriasis systemic and biologic treatments were recorded. Weight and BMI were evaluated at baseline (T0) and at 24 (w24) and 48 weeks (w48). A descriptive statistical analysis has been performed.

RESULTS: The analysis showed a significant reduction in body weight in females at w24 and w48 (P < 0.001), with a mean difference of -2.6 kg at w24 and of -5.7 kg at w48. We observed a reduction of weight of 3.6% at w24, and 7.9% at w48. Similar assessments were also observed for BMI, which was reduced in women by 3.6% at w24 and 8% at w48. In men, no changes in weight and BMI were observed at w24 and/or w48.

CONCLUSIONS: Understanding the interplay between psoriasis, gender, and body weight is essential for effective disease management and improving patient outcomes.

PMID:40117605 | DOI:10.5826/dpc.1501a4805

Dermatol Pract Concept. 2025 Jan 30;15(1). doi: 10.5826/dpc.1501a4237.

ABSTRACT

INTRODUCTION: An emerging hypothesis suggests a potential link between enhanced intestinal permeability and the advancement of chronic spontaneous urticaria (CSU).

OBJECTIVE: This study aimed to investigate the role of intestinal permeability in the etiopathogenesis of CSU by measuring serum zonulin levels, a marker of intestinal permeability, in both CSU patients and control subjects. Additionally, the study sought to explore the correlation between the severity of the illness and zonulin levels.

METHODS: The study involved 61 patients with CSU and 59 healthy control individuals. For the CSU patients, comprehensive data were collected encompassing various aspects: age at onset of the condition, duration of the most recent attack, presence of any comorbid conditions, dosage of antihistamines being used, and urticaria activity score as well as detailed personal and family medical histories. Additionally, demographic information for these patients was also meticulously documented.

RESULT: The study revealed a statistically significant difference in zonulin levels between the CSU patient group and the control group, with a p-value of 0.000, indicating a highly significant disparity. Furthermore, among the CSU patients, those who presented with angioedema exhibited considerably higher zonulin levels compared to those without angioedema. This variation in zonulin levels based on the presence of angioedema was also statistically significant, with a p-value of 0.023.

CONCLUSION: The observed results suggest that increased intestinal permeability, as indicated by elevated zonulin levels, may play a crucial role in the pathophysiology of both CSU and angioedema. This association highlights the potential significance of intestinal permeability in the development and manifestation of these conditions.

PMID:40117602 | DOI:10.5826/dpc.1501a4237

J Med Internet Res. 2025 Mar 21;27:e67967. doi: 10.2196/67967.

ABSTRACT

BACKGROUND: Clinical reasoning (CR) is an essential skill; yet, physicians often receive limited feedback. Artificial intelligence holds promise to fill this gap.

OBJECTIVE: We report the development of named entity recognition (NER), logic-based and large language model (LLM)-based assessments of CR documentation in the electronic health record across 2 institutions (New York University Grossman School of Medicine [NYU] and University of Cincinnati College of Medicine [UC]).

METHODS: The note corpus consisted of internal medicine resident admission notes (retrospective set: July 2020-December 2021, n=700 NYU and 450 UC notes and prospective validation set: July 2023-December 2023, n=155 NYU and 92 UC notes). Clinicians rated CR documentation quality in each note using a previously validated tool (Revised-IDEA), on 3-point scales across 2 domains: differential diagnosis (D0, D1, and D2) and explanation of reasoning, (EA0, EA1, and EA2). At NYU, the retrospective set was annotated for NER for 5 entities (diagnosis, diagnostic category, prioritization of diagnosis language, data, and linkage terms). Models were developed using different artificial intelligence approaches, including NER, logic-based model: a large word vector model (scispaCy en_core_sci_lg) with model weights adjusted with backpropagation from annotations, developed at NYU with external validation at UC, NYUTron LLM: an NYU internal 110 million parameter LLM pretrained on 7.25 million clinical notes, only validated at NYU, and GatorTron LLM: an open source 345 million parameter LLM pretrained on 82 billion words of clinical text, fined tuned on NYU retrospective sets, then externally validated and further fine-tuned at UC. Model performance was assessed in the prospective sets with F₁-scores for the NER, logic-based model and area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC) for the LLMs.

RESULTS: At NYU, the NYUTron LLM performed best: the D0 and D2 models had AUROC/AUPRC 0.87/0.79 and 0.89/0.86, respectively. The D1, EA0, and EA1 models had insufficient performance for implementation (AUROC range 0.57-0.80, AUPRC range 0.33-0.63). For the D1 classification, the approach pivoted to a stepwise approach taking advantage of the more performant D0 and D2 models. For the EA model, the approach pivoted to a binary EA2 model (ie, EA2 vs not EA2) with excellent performance, AUROC/AUPRC 0.85/ 0.80. At UC, the NER, D-logic-based model was the best performing D model (F₁-scores 0.80, 0.74, and 0.80 for D0, D1, D2, respectively. The GatorTron LLM performed best for EA2 scores AUROC/AUPRC 0.75/ 0.69.

CONCLUSIONS: This is the first multi-institutional study to apply LLMs for assessing CR documentation in the electronic health record. Such tools can enhance feedback on CR. Lessons learned by implementing these models at distinct institutions support the generalizability of this approach.

PMID:40117575 | DOI:10.2196/67967

J Med Internet Res. 2025 Mar 21;27:e60148. doi: 10.2196/60148.

ABSTRACT

BACKGROUND: Despite the rapid growth of research in artificial intelligence/machine learning (AI/ML), little is known about how often study results are disclosed years after study completion.

OBJECTIVE: We aimed to estimate the proportion of AI/ML research that reported results through ClinicalTrials.gov or peer-reviewed publications indexed in PubMed or Scopus.

METHODS: Using data from the Clinical Trials Transformation Initiative Aggregate Analysis of ClinicalTrials.gov, we identified studies initiated and completed between January 2010 and December 2023 that contained AI/ML-specific terms in the official title, brief summary, interventions, conditions, detailed descriptions, primary outcomes, or keywords. For 842 completed studies, we searched PubMed and Scopus for publications containing study identifiers and AI/ML-specific terms in relevant fields, such as the title, abstract, and keywords. We calculated disclosure rates within 3 years of study completion and median times to disclosure-from the “primary completion date” to the “results first posted date” on ClinicalTrials.gov or the earliest date of journal publication.

RESULTS: Of 842 completed studies (n=357 interventional; n=485 observational), 5.5% (46/842) disclosed results on ClinicalTrials.gov, 13.9% (117/842) in journal publications, and 17.7% (149/842) through either route within 3 years of completion. Higher disclosure rates were observed for trials: 10.4% (37/357) on ClinicalTrials.gov, 19.3% (69/357) in journal publications, and 26.1% (93/357) through either route. Randomized controlled trials had even higher disclosure rates: 11.3% (23/203) on ClinicalTrials.gov, 24.6% (50/203) in journal publications, and 32% (65/203) through either route. Nevertheless, most study findings (82.3%; 693/842) remained undisclosed 3 years after study completion. Trials using randomization (vs nonrandomized) or masking (vs open label) had higher disclosure rates and shorter times to disclosure. Most trials (85%; 305/357) had sample sizes of ≤1000, yet larger trials (n>1000) had higher publication rates (30.8%; 16/52) than smaller trials (n≤1000) (17.4%; 53/305). Hospitals (12.4%; 42/340), academia (15.1%; 39/259), and industry (13.7%; 20/146) published the most. High-income countries accounted for 82.4% (89/108) of all published studies. Of studies with disclosed results, the median times to report through ClinicalTrials.gov and in journal publications were 505 days (IQR 399-676) and 407 days (IQR 257-674), respectively. Open-label trials were common (60%; 214/357). Single-center designs were prevalent in both trials (83.3%; 290/348) and observational studies (82.3%; 377/458).

CONCLUSIONS: For over 80% of AI/ML studies completed during 2010-2023, study findings remained undisclosed even 3 years after study completion, raising questions about the representativeness of publicly available evidence. While methodological rigor was generally associated with higher publication rates, the predominance of single-center designs and high-income countries may limit the generalizability of the results currently accessible.

PMID:40117574 | DOI:10.2196/60148