Rosacea: Current state of epidemiology Tan, Jerry, MD; Berg, Mats, MD
Journal of the American Academy of Dermatology,
12/2013, Letnik:
69, Številka:
6
Journal Article
Recenzirano
Case definitions are critical in epidemiologic research. However, modern disease indicators must now consider complex data from gene-based research along with traditional clinical parameters. Rosacea ...is a skin disorder with multiple signs and symptoms. In individuals, these features may be multiple or one may predominate. While studies on the epidemiology of rosacea have previously been sparse, there has been a recent increase in research activity. A broader body of epidemiological information that includes a greater variety of countries beyond Northern Europe and general population-based demographics is needed. As there are operational issues in current case definitions of rosacea subtypes—rationalization and standardization—universal consistent applications in future research is also imperative. Further improvement in disease definition combining new research information along with clinical pragmatism should increase the accuracy of rosacea case ascertainment and facilitate further epidemiological research.
Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older.
The objective of this study was to provide evidence-based recommendations for the management of acne.
A ...work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations.
This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements.
Analysis is based on the best available evidence at the time of the systematic review.
These guidelines provide evidence-based recommendations for the management of acne vulgaris.
A needs assessment for patients with hidradenitis suppurativa (HS) will support advancements in multidisciplinary care, treatment, research, advocacy, and philanthropy.
To evaluate unmet needs from ...the perspective of HS patients.
Prospective multinational survey of patients between October 2017 and July 2018.
Before receiving a formal HS diagnosis, 63.7% (n = 827) of patients visited a physician ≥5 times. Mean delay in diagnosis was 10.2 ± 8.9 years. Patients experienced flare daily, weekly, or monthly in 23.0%, 29.8%, and 31.1%, respectively. Most (61.4% n = 798) rated recent HS-related pain as moderate or higher, and 4.5% described recent pain to be the worst possible. Access to dermatology was rated as difficult by 37.0% (n = 481). Patients reported visiting the emergency department and hospital ≥5 times for symptoms in 18.3% and 12.5%, respectively. An extreme impact on life was reported by 43.3% (n = 563), and 14.5% were disabled due to disease. Patients reported a high frequency of comorbidities, most commonly mood disorders. Patients were dissatisfied with medical or procedural treatments in 45.9% and 34.6%, respectively.
Data were self-reported. Patients with more severe disease may have been selected.
HS patients have identified several critical unmet needs that will require stakeholder collaboration to meaningfully address.
Background
The authors report results from the thyroid carcinoma cohort of the multicohort phase 2 KEYNOTE‐158 study (NCT02628067), which evaluated pembrolizumab monotherapy in patients with ...previously treated cancers.
Methods
Eligible patients had histologically and/or cytologically confirmed papillary or follicular thyroid carcinoma, failure of or intolerance to prior therapy, and measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. Patients received pembrolizumab (200 mg) every 3 weeks for up to 35 cycles. The primary end point was objective response rate (ORR) per RECIST v1.1 by independent central review.
Results
A total of 103 patients were enrolled and received pembrolizumab. Median duration from first dose to data cutoff (October 5, 2020) was 49.4 (range, 43.9–54.9) months. ORR was 6.8% (95% confidence interval CI, 2.8%–13.5%), and median duration of response was 18.4 (range, 4.2‒47.2+) months. ORR was 8.7% (95% CI, 2.4%‒20.8%) among patients with programmed cell death ligand 1 (PD‐L1) combined positive score (CPS) ≥1 (n = 46) and 5.7% (95% CI, 1.2%‒15.7%) among patients with PD‐L1 CPS <1 (n = 53). Median overall survival and progression‐free survival were 34.5 (95% CI, 21.2 to not reached) and 4.2 (95% CI, 3.9‒6.2) months, respectively. Treatment‐related adverse events occurred in 69.9% of patients (grade 3‒5, 14.6%).
Conclusions
Pembrolizumab demonstrated manageable toxicity and durable antitumor activity in a small subset of patients with advanced thyroid cancer. These results provide evidence of modest antitumor activity in this setting regardless of tumor PD‐L1 expression. Future studies evaluating immune checkpoint inhibitors in patients with differentiated thyroid cancer should focus on biomarker‐driven patient selection or combination of immune checkpoint inhibitors with other agents, in order to achieve higher response rates than observed in this study.
Among 103 patients with previously treated papillary or follicular thyroid cancer who received pembrolizumab monotherapy, seven patients (6.8%) had an objective response. Responses occurred regardless of tumor programmed cell death ligand 1 status and were durable.
Background Olumacostat glasaretil (OG) inhibits acetyl-coenzyme A carboxylase, the enzyme responsible for the first, rate-limiting step in de novo fatty acid synthesis. OG inhibited in vitro human ...sebocyte lipid production and reduced in vivo sebaceous gland size in hamster ears. Objectives Safety and efficacy of OG 7.5% gel were evaluated in patients with moderate to severe facial acne vulgaris. Methods Patients were randomized (1:1) to twice-daily application of OG or vehicle for 12 weeks. Efficacy was measured through changes in lesion counts and improvement in acne severity scores. Results A total of 108 patients received OG (n = 53) or vehicle (n = 55); these groups had mean baseline counts of 29.7 and 28.6 inflammatory and 40.9 and 38.8 noninflammatory lesions, respectively. At week 12, OG treatment showed greater reductions from baseline in inflammatory lesions (−63.9% vs −45.9%; P = .0006) and noninflammatory lesions (−48.1% vs −28.8%; P = .0025), and more patients with greater than or equal to 2-grade improvement in investigator global assessment score (24.5% vs 7.3%; P = .0070) than vehicle. Application-site adverse events (typically mild or moderate intensity) were more common with OG. Limitations Larger trials are needed to optimize OG dosing and confirm the current results. Conclusion OG was well tolerated and showed evidence of efficacy, suggesting further development is warranted.
Background Acne research is hindered by the absence of a universal, consistently applied standard for severity grading. Acne experts recently identified 4 essential clinical components and 2 features ...for an ideal acne global grading scale (AGGS). Objective This study evaluated current AGGSs against consensus criteria previously identified as necessary. Methods AGGSs were identified by systematic literature search and then evaluated independently by 4 raters against criteria (components and subcomponents; features and subfeatures) identified as essential. Results Eighteen AGGSs fulfilled selection criteria. Three scored 1 full SD above the mean for categorical scores. We also identified highest-ranked AGGSs for subcategory scores. Limitations Only English-language scales were selected. Efficiency and acceptance were not evaluable. Conclusion Although no singular scale fulfilled all essential criteria, this study did identify highly ranked AGGSs. Incorporation and rationalization of their components and features should facilitate development of an ideal standard.
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