Tag: nevin manimala

Hepatology. 2025 Mar 21. doi: 10.1097/HEP.0000000000001312. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: This large-scale, population-based cohort study examined the associations between metabolic syndrome and cholangiocarcinoma risk, including its intra- and extra-hepatic forms.

APPROACH AND RESULTS: A total of 4,932,211 adults aged ≥40 years participated in a government-initiated health checkup program (2012-2017), which collected lifestyle data, anthropometric measurements, and biochemical tests. Follow-up continued until 2021, with data linkage to National Cancer and Death Registries to ascertain the occurrence of cholangiocarcinoma and obtain vital status information. Fine and Gray models accounted for competing risks. During 35,879,371 person-years of follow-up, 6,117 cholangiocarcinoma cases were identified, with an incidence rate of 17.05 (95% CI: 15.90-18.20) per 100,000 person-years. Individuals with metabolic syndrome had significantly higher incidences of both intra- and extra-hepatic cholangiocarcinoma (p<0.0001). The multivariate-adjusted hazard ratio (HR) for cholangiocarcinoma among those with metabolic syndrome was 1.20 (1.14-1.27). Stratification analyses by age, sex, liver enzyme levels, and comorbidities consistently demonstrated an increased cholangiocarcinoma risk among individuals with metabolic syndrome. A dose-response relationship was observed, with a higher number of metabolic components correlating with an elevated cholangiocarcinoma risk, even after accounting for all-cause mortality as a competing risk. The adjusted subdistribution HRs ranged from 1.16 (95% CI: 1.02-1.32) for individuals with one metabolic component to 1.67 (95% CI: 1.45-1.94) for those with five (p for trend <0.0001).

CONCLUSIONS: The positive association between metabolic syndrome and cholangiocarcinoma risk suggests that managing metabolic risk factors might reduce the occurrence of both intra- and extra-hepatic cholangiocarcinoma.

PMID:40117647 | DOI:10.1097/HEP.0000000000001312

Dermatol Pract Concept. 2025 Jan 30;15(1). doi: 10.5826/dpc.1404a4566.

ABSTRACT

INTRODUCTION: Hidradenitis suppurativa is a disease with a decisive burden on sufferers, both physical and psychological. It was expected that the more intense the severity of symptoms the patients experienced, the greater the correlation with the psychosomatic manifestations would be.

OBJECTIVES: The present study aimed to explore the correlation between hidradenitis suppurativa and the psychosomatic burden, the personality, and the demographic characteristics of the participants.

METHODS: The participants were 90 outpatients of the hospital, aged 18 to 65, who had been diagnosed with hidradenitis and were sufficiently proficient in Greek. The psychometric instruments administered were the Symptom Checklist-90 (SCL90), the Beck Depression Inventory (BDI), the Eysenck Personality Questionnaire (EPQ), the short-form McGill Pain Questionnaire (SF-MPQ), the Hurley and refined Hurley classifications, the International Hidradenitis Suppurativa Severity Scoring System (IHS4), and a short demographic questionnaire. All statistical analyses were performed using the SPSS-28 statistical package.

RESULTS: According to statistical analyses, there was no statistically significant relationship between disease severity, psychosomatic burden, and personality. However, there were statistically significant associations with demographic factors, such as being female or not being in a relationship, the patient’s body mass index, the locus of the skin lesion, a history of hospitalization, comorbidities, psychiatric history, and pain with psychopathological manifestations and personality.

CONCLUSIONS: It is important that further research be conducted that will include more mental disorders besides anxiety and depression while at the same time excluding confounding factors for safer interpretation of the results.

PMID:40117646 | DOI:10.5826/dpc.1404a4566

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