IMPORTANCE: The identification and validation of biomarkers in hidradenitis suppurativa (HS) has potential to improve the understanding and management of this chronic, burdensome disease. OBJECTIVE: ...To systematically identify all known HS biomarkers, categorize them by biomarker type, and critically evaluate their validity according to established criteria. EVIDENCE REVIEW: Eligibility criteria for this review (PROSPERO Registration 230830) included randomized clinical trials, uncontrolled clinical trials, cohort studies, case-control studies, and other observational studies with no restrictions of patient age, sex, race or ethnicity, or language of publication up until December 31, 2020. All articles were categorized into biomarker type, defined using the US Food and Drug Administration Biomarkers, Endpoints, and other Tools (BEST) glossary. Assessment of each identified biomarker was undertaken in line with the US Food and Drug Administration and European Medicines Agency guidelines for the validation of proposed biomarkers. Assessment of the strength of overall data regarding individual biomarkers was undertaken using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. FINDINGS: A total of 3953 nonduplicate articles were screened, of which 1429 articles were retrieved based on the include/exclusion criteria applied. After full-text screen and data extraction, 106 articles were included in this review. The evidence of strength of 6 categories of biomarkers (susceptibility/risk, diagnostic, monitoring, predictive, prognostic, and pharmacodynamic/response biomarkers) was assessed using GRADE criteria. A total of 48 biomarkers were identified with a minimum GRADE rating of moderate. Only 1 diagnostic (serum IL-2R), 1 monitoring (dermal Doppler vascularity), and 2 predictive biomarkers (epithelialized tunnels and positive family history of HS) achieved a GRADE rating of high. None of the identified biomarkers had sufficient clinical validity to be recommended for routine use in the clinical setting. CONCLUSIONS AND RELEVANCE: Major barriers to the identification, validation, and introduction of routine biomarkers in the management of HS include lack of independent biomarker validation studies (especially assumption-free “omics”-based techniques); insufficient assessment of collinearity between identified or proposed biomarkers; and a lack of routine integration of biomarkers into the structure of clinical trials. International consensus among researchers, clinicians, and pharmaceutical stakeholders is required to standardize goals and methods and encourage biomarker integration into future HS clinical trials. This systematic review presents a number of priorities for near-term future research to overcome such barriers and limitations of biomarkers in HS.
Abstract
Background
Teledermatology has provided new avenues through which dermatologists can provide healthcare. Teledermatology was introduced to the Emergency Department (ED) to enable immediate ...dermatological consult. We aimed to assess the impact of teledermatology on the management of dermatological conditions by emergency medicine physicians and subsequent health resource utilization.
Methods
We conducted a retrospective review of teledermatology referrals from the ED of our tertiary hospital in Singapore from June 2015 to December 2019. The dermatological conditions, the triaging and treatment recommendations were analyzed. Follow-up plans were recorded.
Results
Between June 2015 and December 2019, 147 patients were referred from the ED via teledermatology; 11 (7.5%) were admitted, and 136 (92.5%) were recommended to be discharged with a dermatological diagnosis and management plan. If required, a follow-up appointment in the dermatology specialist clinic was arranged. Of the 136 patients who were discharged, 129 (94.9%) patients were provided with outpatient appointment in the dermatology clinic, out of which 110 patients returned for follow-up. 90 (81.8%) patients retained the initial teledermatology diagnoses and 20 (18.2%) patients had their teledermatology diagnoses revised after in-person review.
Conclusions
Teledermatology allows for more efficient triaging of patients with dermatological conditions. Reliability between teledermatology and clinic-based examination is good. Patients may be managed mainly in the outpatient setting with appropriate specialty-directed treatment, return advice, and appropriately-triaged follow-up outpatient appointment.
The COVID-19 pandemic has accelerated the use of pediatric teledermatology, with centers showing increased uptake of teledermatology. Pediatric patients possess unique characteristics that pose ...different challenges with teledermatology compared to adults, in turn affecting the feasibility and uptake of pediatric teledermatology in the community.
This narrative review summarizes the evolution of pediatric teledermatology from pre-COVID-19 pandemic times to the post-COVID-19 period.
A search of MEDLINE, PubMed, and Embase was performed for original articles written in English and published from December 1, 2019, to April 1, 2022.
A total of 22 publications were included.
Teledermatology will continue to play an increasing role in the management of skin diseases. A mindset shift in the types of conditions deemed suitable for pediatric teledermatology is needed.
Dear Editor, Systemic glucocorticoids remain a cornerstone of therapy in immunobullous diseases. Yet little is known about glucocorticoid induced osteoporosis (GIOP) in patients with immunobullous ...diseases. We performed a retrospective review of medical records at an immunodermatology clinic in a Singaporean tertiary centre. Inclusion criteria consisted of patients with a newly diagnosed immunobullous condition between January 2011 and October 2017, who were on long-term (>= 3 months) systemic glucocorticoids at a minimum daily dose of prednisolone 15mg. ...
ObjectiveTo explore the phenomenon of topical corticosteroid (TCS) phobia and comprehensively understand the factors driving TCS concerns, in particular pertaining to steroid addiction and ...withdrawal.DesignProspective qualitative study using 1:1 in-depth semistructured interviews and analysed using grounded theory.ParticipantsPatients with a prior experience of TCS use for a dermatological condition recruited from a tertiary academic dermatology clinic, or through word of mouth and online social media platforms.Results26 participants encompassing those with positive, neutral and negative opinions towards TCS were interviewed. 13 reported having topical steroid addiction or withdrawal. The drivers of TCS concerns could be categorised into seven themes: attitudes towards TCS (comprising beliefs and knowledge about TCS), availability of alternatives, treatment inconvenience, personality, patient’s ongoing evaluation of clinical response to TCS, doctor–patient relationship and healthcare-seeking behaviour. Of mention, patients placed high value and trust on their own experiences with TCS, such as their perceived experienced side effects. The doctor who failed to acknowledge the patient’s opinions and instead emphasised the safety of TCS was often viewed as dismissive, resulting in a deteriorating patient–doctor relationship.ConclusionProvision of knowledge and education is important but may be ineffective if the basis for TCS concern regarding safety is reasonable, or when the patient has a firmly established belief supporting his/her concern. In such instances, failure to acknowledge and respect the patient’s decision to avoid TCS could worsen the doctor–patient relationship.
Besides the reasons shared by patients for declining proposed teleconsults, additional contextual factors may be involved. ...the inclusion of teledermatology during peacetime provides an additional ...service option that increases patient satisfaction especially if it is seamless, secure, and easy to use 5. Funkhouser CH, Funkhouser ME, Wolverton JE, Maurer T. Teledermatology consults in a county hospital setting: retrospective analysis. JMIR Dermatol 2021 Sep 8;4(2):e30530 Funkhouser CH, Funkhouser ME, Wolverton JE, Maurer T. Teledermatology consults in a county hospital setting: retrospective analysis.
Skin toxicities are the most prevalent immune‐related adverse events of immune checkpoint inhibitors (ICIs), but psoriasis is uncommon. To date, there are no treatment guidelines for this unique ...patient cohort. We describe a case of ICI‐mediated psoriasis and its treatment using a tumour necrosis factor‐α blocker. A 61‐year‐old Chinese female with stage IV intrahepatic cholangiocarcinoma experienced significant worsening of her chronic plaque psoriasis and nail psoriasis 1 week after her second cycle of pembrolizumab. The patient developed extensive thin scaly psoriatic papules and plaques (psoriasis area and severity index (PASI) 9.1, body surface area (BSA) 40%) involving her abdomen, back, arms and legs. Two months before the start of pembrolizumab, she had psoriatic plaques (PASI 0.9, BSA 5%) treated only with topical 0.1% betamethasone valerate cream, urea 10% cream and coal tar 25% shampoo. We initiated adalimumab given the extent of BSA involvement and severity of the flare of chronic plaque psoriasis. Two months later, her psoriasis improved (PASI 9, BSA 19%) and pembrolizumab was continued. Eight months after the initiation of adalimumab, her chronic plaque psoriasis remained stable and her cholangiocarcinoma remained in remission. We hope to share our experience of using biologics to attain prompt control of ICI‐mediated psoriasis.
