BACKGROUND AND OBJECTIVES:Achieving sustained drug adherence in psoriasis remains challenging despite effective therapies. This exploratory study aims to investigate the care situation and factors associated with drug adherence in patients with moderate-to-severe psoriasis vulgaris (PsO). PATIENTS AND METHODS:A single-center study was conducted at the University Medical Center Regensburg, Germany, comprising a retrospective analysis of 312 patient records of individuals treated between 01/2023 and 06/2023 and a prospective questionnaire-based cross-sectional survey of 62 patients treated between 10/2023 and 03/2024. Sociodemographic, clinical, and treatment-related variables and quality of life (QoL) were analyzed descriptively and explored using inferential statistics. RESULTS:Most patients resided outside the urban care center (82.1% retrospective, 81.0% prospective). Approximately three quarters were adherent (75.0% and 72.4%, respectively). Non-adherence was associated with occupational status, medication class, adverse events, and nicotine use. Patient-reported reasons included administrative barriers (43.8%), financial burden, and adverse events (18.8% each). Non-adherent patients tended to report higher disease burden and lower QoL. CONCLUSIONS:Drug adherence in moderate-to-severe PsO is associated with socioeconomic and therapy-related factors. Targeted patient-centered strategies may help improve long-term adherence, particularly in vulnerable patient groups, optimize overall outcomes, and reduce financial burden on the healthcare system.
BACKGROUND AND OBJECTIVES:Cemiplimab was the first systemic therapy approved for advanced cutaneous squamous cell carcinoma (cSCC). PATIENTS AND METHODS:We report findings from the Italian early access program cohort, comprising 134 patients treated with cemiplimab, with emphasis on late-onset toxicities and long-term clinical outcomes. Late toxicities were defined as treatment-related adverse events (TRAEs) occurring ≥ 6 months after therapy initiation. Objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS) were evaluated. RESULTS:Median PFS was 9 months. 58 (43.3%) patients experienced progression while 76 (56.7%) maintained a response. Median OS was 21 months (range 0-32), and 67 (50%) patients died. The ORR and DCR were 58.9% and 72.4%, respectively. CR increased from 15% (20 patients) in September 2020 to 19.4% (26 patients) in early 2022. 15 (11.2%) patients had at least one TRAE and 2 of them stopped cemiplimab. Median time to TRAE onset was 12 months (range 6-23); all events resolved after therapy discontinuation, and none of the AEs became chronic. CONCLUSIONS:With a longer follow-up than that reported in registrational studies and real-world reports, the clinical activity of cemiplimab was confirmed, with a limited incidence of late toxicities. However, some TRAEs may emerge after prolonged treatment.
BACKGROUND AND OBJECTIVES:Dermatofibrosarcoma protuberans (DFSP) is a rare sarcoma with a low metastatic rate; however, the prognosis worsens once distant metastasis occurs. We aimed to identify clinicopathological risk factors and molecular features associated with distant metastasis. PATIENTS AND METHODS:Fourteen metastatic DFSP cases and 29 matched non-metastatic controls were analyzed for clinicopathological parameters, surgical margins, immunohistochemistry, and COL1A1-PDGFB fusion. Univariate and multivariate conditional logistic regression analyses were performed. RESULTS:Among the 14 patients with metastasis, 78.6 % experienced multiple recurrences. Fibrosarcomatous transformation (FS-DFSP) was predominant in both primary (10/14) and metastatic (13/14) lesions. All patients showed a COL1A1-PDGFB fusion, and lung metastases were identified in 100 % of the patients. The metastatic group exhibited more frequent local recurrences, a higher proportion of FS-DFSP, a higher Ki-67 index, and a higher mitotic count than the control group (all p < 0.01). Local recurrence occurring ≥ 2 times was identified as an independent risk factor for metastasis (OR = 21.49, p = 0.03). In addition, FS-DFSP showed a strong trend toward an association with metastasis (OR = 6.21, p = 0.06). Response to imatinib was heterogeneous. CONCLUSIONS:Multiple local recurrences and fibrosarcomatous transformation appear to be key drivers of distant metastasis in DFSP. The COL1A1-PDGFB fusion gene remains a stable diagnostic marker, even in cases with loss of CD34 expression. The lung is the predominant site of distant metastasis. Imatinib demonstrates limited efficacy, highlighting the need for close surveillance of high-risk patients.
BACKGROUND AND OBJECTIVES:Given the increasing incidence of cutaneous neoplasms, the nationwide skin cancer screening program was implemented in Germany in 2008. However, there are few studies evaluating its effectiveness. The aim of this analysis was to assess factors influencing participation and outcomes of skin cancer screening within the cohort of the Gutenberg Health Study (GHS). PATIENTS AND METHODS:The GHS is a retrospective cohort study conducted at the University Medical Center Mainz since 2007. Initially, 15,010 participants aged 35-74 years were recruited, with later inclusion of younger and older individuals. Data were collected through interviews on skin cancer screening participation and linked to participant-specific information such as cancer history and occupational background. RESULTS:In the GHS cohort, the participation rate in skin cancer screening was 62.1% (3,383 out of 5,452). Occupational UV exposure was associated with lower screening participation, whereas a history of cancer correlated with higher participation. Dermatologists were the preferred screening providers and demonstrated higher malignancy detection rates compared to general practitioners (36.7% compared to 20%). CONCLUSIONS:The participation rate in skin cancer screening within the GHS cohort was substantially higher than national averages. Nevertheless, risk-prone populations with outdoor occupations are currently not adequately reached by the screening program. Improved education and targeted interventions for high-risk groups are needed.
BACKGROUND:Dermoscopy enhances melanoma detection, but small-diameter melanomas (SDMs) remain diagnostically challenging. Convolutional neural networks (CNNs) may detect subtle patterns beyond human perception. This study evaluates how lesion diameter influences the diagnostic accuracy of dermatologists, with and without CNN support. PATIENTS AND METHODS:This multicenter cross-sectional study included 150 histopathologically verified lesions: 110 small lesions (70 SDM, 40 nevi) and 40 large-diameter melanomas (LDM > 5 mm). Dermatologists evaluated lesions at level: (I) dermoscopy, close-up image, and clinical metadata; (II) plus CNN predictions. Primary outcomes were sensitivity, specificity, and ROC-AUC. RESULTS:The CNN achieved a sensitivity of 62.7% (53.4%-71.2%), specificity of 80.0% (65.2%-89.5%), and ROC-AUC of 0.800 (0.723-0.876). Dermatologists performed higher at 71.8% (62.8%-79.4%), 82.5% (68.1%-91.3%), and 0.853 (0.794-0.912), improving slightly with CNN support to 72.7% (63.7%-80.2%), 85.0% (70.9%-92.9%), and 0.860 (0.796-0.923) (all p > 0.180). Subgroup analyses showed lower CNN performance in SDM, with sensitivity 48.6% (37.3%-60.1%) and ROC-AUC 0.740 (0.644-0.836), compared with LDM at 87.2% (73.3%-94.4%) and 0.904 (0.836-0.973). Dermatologists also reached their highest ROC-AUC in the LDM subgroup (0.925 [0.858-0.991]). Overall, CNN support led to slight, non-significant improvements, most notably in SDM (all p > 0.720). CONCLUSIONS:Lesion size strongly influences melanoma diagnosis. CNN support offers modest, non-significant gains, with highest accuracy achieved by experts using AI assistance.
BACKGROUND AND OBJECTIVES:Some atopic dermatitis (AD) treatments have been linked to an increased risk of herpes zoster (HZ). Limited evidence suggests an independent association between atopic dermatitis and herpes zoster. The study aimed to investigate the association between atopic dermatitis and herpes zoster in the UK and to explore the role of treatments in this relationship. PATIENTS AND METHODS:We conducted a matched cohort study using routinely collected primary care data from the UK Clinical Practice Research Datalink (CPRD) Aurum database (1997-2023) and applied Cox regression models. Age, behavioral factors, several comorbid diseases and different treatment exposures were included as covariates. RESULTS:Individuals with atopic dermatitis had an adjusted hazard ratio of 1.28 (95% CI: 1.27-1.29) for HZ. Adjustments for different definitions of oral corticosteroid exposure as well as other traditional immunosuppressants led to minimal reductions in the association. The risk of herpes zoster increased with AD severity (aHR for mild AD: 1.22 [95% CI: 1.20-1.23]; aHR for moderate AD: 1.28 [95% CI: 1.27-1.30]; aHR for severe AD: 2.33 [95% CI: 2.22-2.45]). CONCLUSIONS:The risk of HZ is increased in individuals with atopic dermatitis, independent of comorbidities and the use of oral corticosteroids or immunosuppressants. This elevated baseline risk is particularly relevant because herpes zoster is also a known adverse effect of newer therapies such as Janus kinase (JAK) inhibitors. These findings may inform vaccination guidelines.
Digital pathology has become an increasingly established component of routine diagnostic practice in recent years. Whole-slide imaging enables the complete digitization of histological slides and allows for primary diagnosis using digital images. This development offers new opportunities for diagnostics, consultations, archiving, education, and quality assurance. In dermatology and dermatopathology, digital pathology is particularly relevant for the evaluation of inflammatory skin diseases, melanocytic lesions, epithelial skin tumors, and immunohistochemical analyses. This article provides an overview of the technical principles of digital pathology, describes workflow integration and implementation in clinical routine, and outlines requirements for quality assurance and validation. Key applications in dermatology as well as advantages and limitations of digital diagnosis are discussed. A dedicated section addresses the role of artificial intelligence as an assistive tool in dermatopathological diagnostics. The aim of this CME article is to provide dermatologists and pathologists with a comprehensive basis for evaluating and applying digital pathology systems in clinical practice and to place current developments into a realistic clinical context.
Zusammenfassung Die digitale Pathologie hat sich in den vergangenen Jahren zu einem etablierten Bestandteil der diagnostischen Routine entwickelt. Durch Whole‐Slide‐Imaging können histologische Präparate vollständig digitalisiert und am Bildschirm befundet werden. Dies eröffnet neue Möglichkeiten für Diagnostik, Konsile, Archivierung, Lehre und Qualitätssicherung. Insbesondere in der Dermatologie und Dermatopathologie bietet die digitale Pathologie Vorteile bei der Beurteilung entzündlicher Dermatosen, melanozytärer Läsionen und epithelialer Hauttumoren sowie bei immunhistochemischen Zusatzuntersuchungen. Dieser Artikel gibt einen Überblick über die technischen Grundlagen digitaler Pathologiesysteme, beschreibt Arbeitsabläufe und Implementierung im klinischen Alltag und stellt Anforderungen an Qualitätssicherung und Validierung dar. Darüber hinaus werden zentrale Einsatzgebiete in der Dermatologie sowie Vorteile und Limitationen der digitalen Befundung diskutiert. Ein eigenständiger Schwerpunkt liegt auf der Rolle künstlicher Intelligenz als unterstützendes Werkzeug in der dermatopathologischen Diagnostik. Ziel des Artikels ist es, Dermatologen und Pathologen eine fundierte Grundlage für die sachgerechte Bewertung und den klinischen Einsatz digitaler Pathologie zu vermitteln und aktuelle Entwicklungen realistisch einzuordnen.
Zusammenfassung Das hereditäre Angioödem ( Hereditary angioedema , HAE), eine seltene und belastende Erkrankung, die durch rezidivierende und spontane Gewebeschwellungsattacken gekennzeichnet ist, weist einen hohen ungedeckten therapeutischen Bedarf auf, da Patienten unter aktuellen prophylaktischen Behandlungen eine unzureichende Krankheitskontrolle erfahren. Das Ziel der HAE‐Behandlung gemäß den Leitlinien ist das Erreichen einer vollständigen Krankheitskontrolle und die Normalisierung des Lebens der Patienten. Faktor XII (FXII), der Hauptinitiator des Kontaktsystems, reguliert letztlich das Kallikrein‐Kinin‐System. Der aktivierte Faktor XII (FXIIa) wandelt Plasma‐Präkallikrein in Plasma‐Kallikrein um, welches das hochmolekulare Kininogen spaltet, um das vasoaktive Peptid Bradykinin zu erzeugen. In der Pathophysiologie des HAE führt eine Dysregulation des Kallikrein‐Kinin‐Systems zu einer übermäßigen Bradykininproduktion. Der monoklonale Anti‐FXIIa‐Antikörper Garadacimab ist zur Langzeitprophylaxe von HAE‐Attacken zugelassen. In der zulassungsrelevanten Phase‐III‐Studie (VANGUARD) und den laufenden offenen Phase‐III‐Erweiterungsstudien zeigte Garadacimab bei subkutaner Verabreichung (Aufdosierung mit 2 × 200 mg, gefolgt von 200 mg einmal monatlich) eine dauerhafte Wirksamkeit mit frühem Schutzbeginn und ein günstiges Langzeit‐Sicherheitsprofil. Basierend auf diesen und früheren klinischen Daten hat Garadacimab das Potenzial, Patienten den leitliniengemäßen Zielen der Krankheitskontrolle und Normalisierung des Lebens näherzubringen. Hier geben wir einen Überblick über die Ergebnisse des klinischen Entwicklungsprogramms von Garadacimab.
Zusammenfassung Hintergrund und Zielsetzung Menschen mit Hauterkrankungen werden in der Gesundheitsversorgung und Körperpflege häufig stigmatisiert, was ihre Lebensqualität erheblich beeinträchtigt. Diese randomisierte kontrollierte Parallelgruppenstudie evaluierte ein Präsenzseminar, das darauf abzielte, diese Stigmatisierung unter Fachkräften des Gesundheits‐ und Körperpflegebereichs (FGKP) zu verringern. Patienten und Methodik Kosmetikerinnen, Friseure, Pflegekräfte und Physiotherapeutinnen wurden randomisiert einer Interventionsgruppe (IG; n = 64) oder einer Kontrollgruppe (KG; n = 65) zugeordnet. Die IG nahm an einem Seminar teil, das Selbstreflexionsübungen, Aufklärung und eine Begegnung mit einem Patienten umfasste; die KG erhielt ein Seminar zum Thema „Gesundheit am Arbeitsplatz”. Zustimmung zu negativen Stereotypen, krankheitsbezogene Fehlannahmen, Wunsch nach sozialer Distanz und Verhaltensabsichten wurden zu Beginn (t0), nach der Intervention (t1) und nach 3 Monaten (t2) bewertet. Ergebnisse Die Interventionsgruppe zeigte im Laufe der Zeit eine signifikante Verringerung der krankheitsbezogenen Fehlannahmen (p < 0,001; η p 2 = 0,12) und Zustimmung zu Stereotypen (p = 0,002; η p 2 = 0,12). In beiden Gruppen nahm der Wunsch nach sozialer Distanz nach dem Seminar ab, erreichte bei der Nachuntersuchung jedoch wieder den Ausgangswert. Schlussfolgerungen Das Seminar hat die stigmatisierenden Überzeugungen und Einstellungen von FGKP in Bezug auf Hauterkrankungen verbessert. Seine Integration in Berufsbildungslehrpläne oder die Durchführung in Workshops, um das Wissen über Hauterkrankungen zu erweitern und Vorurteile in verschiedenen Berufsgruppen abzubauen, ist vielversprechend.
