Summary
The recent hidradenitis suppurativa (HS) Cochrane review identified outcome measure heterogeneity as an important issue to address when designing future HS trials. Our objective was to follow ...the Harmonising Outcome Measures for Eczema (HOME) roadmap, by performing a systematic review of HS outcome measure instruments to inform the development of an HS core outcome set. We performed a systematic review to identify validation evidence for outcome measure instruments used in HS randomized controlled trials (RCTs), and assessed the methodological quality of all HS outcome measure validity studies using the COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The 12 RCTs included in the Cochrane review utilized 30 outcome measure instruments, including 16 physician‐reported instruments, 11 patient‐reported instruments and three composite measures containing elements of both. Twenty‐seven (90%) of the instruments lacked any validation data. Two further instruments have been developed and partially validated. Of the seven studies meeting our inclusion criteria, six were of ‘fair’ or ‘poor’ methodological quality, in part because most of the studies were not primarily designed for instrument validation. The HiSCR instrument is supported by good‐quality validation data, but there are gaps, including assessment of internal consistency, inter‐rater reliability and minimal clinically important difference, and convergent validity fell below the acceptable range for some comparisons. Multiple, usually unvalidated, outcome measure instruments have been used in HS RCTs. Where validation evidence is available there are issues of low methodological quality or incomplete validity assessment and so, currently, no instruments can be fully recommended.
What's already known about this topic?
The recent hidradenitis suppurativa (HS) Cochrane review identified heterogeneity of outcome measure instruments as an important obstacle in the design of future HS trials.
The Harmonising Outcome Measures for Eczema (HOME) initiative provides a roadmap for developing a core outcomes set in HS.
What does this study add?
Twenty‐seven of the 30 outcome measure instruments used in HS randomized controlled trials are not supported by any formal validation data.
Where available, validation evidence is generally of relatively low methodological quality, or remains incomplete, and so no instruments can be fully recommended currently.
Linked Comment: van der Zee et al. Br J Dermatol 2016; 175:242.
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The pathogenesis of dermatomyositis Thompson, C.; Piguet, V.; Choy, E.
British journal of dermatology (1951),
December 2018, 2018-12-00, 20181201, Volume:
179, Issue:
6
Journal Article
Peer reviewed
Summary
This review looks at the many different factors thought to play a role in idiopathic inflammatory myopathies (IIM), concentrating mainly on the dermatomyositis (DM) subtype. Subject areas ...addressed include looking at the different clinical features of IIM, paying particular attention to the skin manifestations. There is a discussion around investigations needed with their perceived value, followed by a description of the immunohistochemical findings of DM. This review goes on to address other attributing factors such as genetic associations with the different subtypes of IIM, and environmental factors including infections, ultraviolet radiation and vitamin D deficiency and drugs. Finally, the potential immunopathogenesis of DM is summarized, looking at T cells, B cells, autoantibodies, dendritic cells, cytokines and nonimmune‐mediated endoplasmic reticulum stress.
What's already known about this topic?
Dermatomyositis is a heterogeneous and multifactorial disease.
Individuals present with a spectrum of signs and symptoms but there are standard baseline investigations.
There are a range of factors thought to play a role in the pathogenesis including genetic, environmental, immune and nonimmune‐mediated responses.
What does this study add?
This review adds a concise but full summary of the clinical features and key investigations required when presented with a patient with dermatomyositis.
It goes on to explore the main potential contributing factors.
Linked Editorial: Piguet and Choy. Br J Dermatol 2018; 179:1233–1234.
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Onychomycosis: a review Gupta, A.K.; Stec, N.; Summerbell, R.C. ...
Journal of the European Academy of Dermatology and Venereology,
September 2020, 2020-Sep, 2020-09-00, Volume:
34, Issue:
9
Journal Article
Peer reviewed
Onychomycosis is a fungal infection of the nail, causing discoloration and thickening of the affected nail plate, and is the most common nail infection worldwide. Onychomycosis was initially thought ...to be predominantly caused by dermatophytes; however, new research has revealed that mixed infections and those caused by non‐dermatophyte moulds (NDMs) are more prevalent than previously thought, especially in warmer climates. Microscopy and fungal culture are the gold standard techniques for onychomycosis diagnosis, but high false‐negative rates have pushed for more accurate methods, such as histology and PCR. As NDMs are skin and laboratory contaminants, their presence as an infectious agent requires multiple confirmations and repeated sampling. There are several treatment options available, including oral antifungals, topicals and devices. Oral antifungals have higher cure rates and shorter treatment periods than topical treatments, but have adverse side effects such as hepatotoxicity and drug interactions. Terbinafine, itraconazole and fluconazole are most commonly used, with new oral antifungals such as fosravuconazole being evaluated. Topical treatments, such as efinaconazole, tavaborole, ciclopirox and amorolfine have less serious side effects, but also have generally lower cure rates and much longer treatment regimens. New topical formulations are being investigated as faster‐acting alternatives to the currently available topical treatments. Devices such as lasers have shown promise in improving the cosmetic appearance of the nail, but due to a high variation of study methods and definitions of cure, their effectiveness for onychomycosis has yet to be sufficiently proven. Recurrence rates for onychomycosis are high; once infected, patients should seek medical treatment as soon as possible and sanitize their shoes and socks. Prophylactic application of topicals and avoiding walking barefoot in public places may help prevent recurrence.
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Androgenetic alopecia, or male/female pattern baldness, is the most common type of progressive hair loss disorder. The aim of this study was to review recent advances in non‐surgical treatments for ...androgenetic alopecia and identify the most effective treatments. A network meta‐analysis (NMA) was conducted of the available literature of the six most common non‐surgical treatment options for treating androgenetic alopecia in both men and women; dutasteride 0.5 mg, finasteride 1 mg, low‐level laser therapy (LLLT), minoxidil 2%, minoxidil 5% and platelet‐rich plasma (PRP). Seventy‐eight studies met the inclusion criteria, and 22 studies had the data necessary for a network meta‐analysis. Relative effects show LLLT as the superior treatment. Relative effects show PRP, finasteride 1 mg (male), finasteride 1 mg (female), minoxidil 5%, minoxidil 2% and dutasteride (male) are approximately equivalent in mean change hair count following treatment. Minoxidil 5% and minoxidil 2% reported the most drug‐related adverse events (n = 45 and n = 23, respectively). The quality of evidence of minoxidil 2% vs. minoxidil 5% was high; minoxidil 5% vs. placebo was moderate; dutasteride (male) vs. placebo, finasteride (female) vs. placebo, minoxidil 2% vs. placebo and minoxidil 5% vs. LLLT was low; and finasteride (male) vs. placebo, LLLT vs. sham, PRP vs. placebo and finasteride vs. minoxidil 2% was very low. Results of this NMA indicate the emergence of novel, non‐hormonal therapies as effective treatments for hair loss; however, the quality of evidence is generally low. High‐quality randomized controlled trials and head‐to‐head trials are required to support these findings and aid in the development of more standardized protocols, particularly for PRP. Regardless, this analysis may aid physicians in clinical decision‐making and highlight the variety of non‐surgical hair restoration options for patients.
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Summary
Background
Epidemiology data regarding hidradenitis suppurativa (HS) are conflicting and prevalence estimates vary 80‐fold, from 0·05% in a population‐based study to 4%.
Objectives
To assess ...the hypothesis that previous population‐based studies underestimated true HS prevalence by missing undiagnosed cases.
Methods
We performed a population‐based observational and case–control study using the U.K. Clinical Practice Research Datalink (CPRD) linked to hospital episode statistics data. Physician‐diagnosed cases in the CPRD were identified from specific Read codes. Algorithms identified unrecognized ‘proxy’ cases, with at least five Read code records for boils in flexural skin sites. Validation of proxy cases was undertaken with general practitioner (GP) questionnaires to confirm criteria‐diagnosed cases. A case–control study assessed disease associations.
Results
On 30 June 2013, 23 353 physician‐diagnosed HS cases were documented in 4 364 308 research‐standard records. In total, 68 890 proxy cases were identified, reduced to 10 146 criteria‐diagnosed cases after validation, extrapolated from 107 completed questionnaires (61% return rate). Overall point prevalence was 0·77% 95% confidence interval (CI) 0·76–0·78%. An additional 18 417 cases had a history of one to four flexural skin boils. In physician‐diagnosed cases, odds ratios (ORs) for current smoker and obesity (body mass index > 30 kg m‐2) were 3·61 (95% CI 3·44–3·79) and 3·29 (95% CI 3·14–3·45). HS was associated with type 2 diabetes, Crohn disease, hyperlipidaemia, acne and depression, and not associated with ulcerative colitis or polycystic ovary syndrome.
Conclusions
Contrary to results of previous population‐based studies, HS is relatively common, with a U.K. prevalence of 0·77%, one‐third being unrecognized, criteria‐diagnosed cases using the most stringent disease definition. If individuals with probable cases are included, HS prevalence rises to 1·19%.
What's already known about this topic?
Previous population‐based studies suggest that the prevalence of hidradenitis suppurativa (HS) may be as low as 0·05% but existing studies have not quantified undiagnosed cases.
What does this study add?
Analysis of 4·3 million research‐standard records in the U.K. Clinical Practice Research Datalink demonstrates a HS prevalence of 0·77% using the most stringent disease definition 95% confidence interval (CI) 0·76–0·78%, one‐third being undiagnosed cases, rising to 1·19% (95% CI 1·18–1·20%) if probable cases are included.
Linked Comment: Sbidian. Br J Dermatol 2018; 178:831–832.
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Summary
Clinically amyopathic dermatomyositis (CADM) affects a subset of 5–20% of patients with dermatomyositis and is defined as the presence of cutaneous features of dermatomyositis without ...clinical muscle weakness for ≥ 6 months. There is no consensus on first‐line treatment for CADM and whether treatment should differ from treatment of classic dermatomyositis with muscle weakness. We carried out a systematic review of published literature about treatment of adult patients with CADM, via the Embase, Medline, CINAHL and ClinicalTrials.gov databases on 17 February 2015. The aim was to establish which treatments have been used for adult‐onset CADM and what evidence is available regarding the efficacy of these treatments including topical treatments, dapsone, antimalarials, intravenous immunoglobulin (IVIG), nonsteroidal oral immunosuppressants and biological therapies. Eighteen cases series and 42 case reports were found. These provided data on 153 adult patients who met the inclusion criteria. No randomized controlled trials or robust observational studies were found. The majority of patients (60%) had tried more than one treatment due to side‐effects or lack of efficacy. Antimalarial agents were the most commonly used treatment type. In the majority of patients (55%), antimalarial treatments were discontinued due to lack of improvement or inability to wean concomitant steroids. IVIG was the treatment that led to improvement or remission in the greatest proportion of patients. Further robust, high‐quality studies are needed to assess treatment efficacy in CADM without bias.
What's already known about this topic?
Clinically amyopathic dermatomyositis (CADM) is defined as the presence of cutaneous signs of dermatomyositis with no clinical evidence of muscle weakness for ≥ 6 months.
CADM affects 5–20% of patients with dermatomyositis and has a significant impact on quality of life.
There is no current consensus on the treatment of CADM and no previous systematic reviews have assessed this.
What does this study add?
This systematic review has established that there are no randomized controlled trials or robust observational studies for treatment of CADM.
From the compilation of case series and reports, hydroxychloroquine is the most commonly prescribed treatment for CADM.
A proportion of patients have treatment‐resistant disease.
In comparison with other treatments, intravenous immunoglobulin led to improvement or remission in the highest proportion of patients included in our review.
Linked Editorial: Piguet and Choy. Br J Dermatol 2018; 179:1233–1234.
Plain language summary available online
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