Development and Validation of Diagnostic Criteria for Elderly Atopic Dermatitis

Objective:Elderly atopic dermatitis(AD)is a newly identified subtype of AD.Whether specific diagnostic criteria are needed for elderly AD has been debated.This study aimed to propose diagnostic criteria for elderly AD and evaluate the sensitivity.Methods:A hospital-based study was conducted.We screened the clinical features of 1,312 patients with AD of different ages in 1 cohort and proposed a set of diagnostic criteria for elderly AD.The criteria were then validated in another cohort of 223 patients clinically diagnosed with elderly AD by dermatologists specialized in AD to examine the diagnostic sensitivity compared with other criteria by chi-square test.Results:Based on the patients’clinical features,a set of diagnostic criteria for elderly AD were proposed.The new diagnostic criteria showed significantly higher sensitivity than the classical diagnostic criteria(P<0.001),especially for mild and moderate AD(P<0.001).Of all 223 patients with elderly AD,93.3%fulfilled our criteria,while only 43.5%,65.5%,and 52.0%fulfilled the Hanifin and Rajka criteria,the Japanese Dermatology Academy criteria,and the United Kingdom Working Party criteria,respectively.Conclusion:The newly proposed criteria for elderly AD yielded high diagnostic sensitivity,particularly for mild and moderate AD.

Prevalence of psoriatic arthritis in Chinese population with psoriasis:A multicenter study conducted by experienced rheumatologists

Background:Reports on the prevalence of psoriatic arthritis(PsA)among Chinese patients with psoriasis are very limited.This study,conducted by rheumatologists,estimated the prevalence of PsA in a large number of Chinese patients with psoriasis.Methods:Consecutive patients with a confirmed diagnosis of psoriasis attending nine dermatology clinics in five hospitals were recruited.All psoriasis patients were asked to complete a questionnaire comprising 16 questions to identify possible cases of PsA.All patients with one or more positive answers to the questionnaire were evaluated by two experienced rheumatologists.Results:A total of 2434 psoriasis patients,including 1561 males and 873 females,were enrolled.Both the questionnaire and rheumatologists’examinations were completed in the dermatology clinics.The results identified 252 patients with PsA,comprising 168 males and 84 females.The overall prevalence of PsA among psoriasis patients was 10.4%(95%confidence interval[95%CI],9.1%-11.7%).By sex,the prevalence was 10.8%(95%CI,9.2%-12.5%)for males and 9.6%(95%CI,7.7%-11.9%)for females and there was no significant sex difference in the prevalence of PsA(P=0.38).Of the 252 PsA patients,125(49.6%,95%CI,41.3%-59.1%)were newly diagnosed by rheumatologists.Consequently,the prevalence of undiagnosed PsA among psoriasis patients was 5.2%(95%CI,4.4%-6.2%).Conclusion:The prevalence of PsA in the Chinese population with psoriasis is about 10.4%,which is almost double that of previous reports in the Chinese population,but lower than that in Caucasians.

Cutibacterium acnes in Atopic Dermatitis:Roles and Potential Therapeutic Applications

Atopic dermatitis(AD)is a chronic relapsing inflammatory skin disease.The main initiating mechanisms of AD are disruptions in the skin microbiota,dysfunction of the skin barrier,and predominantly elevated type 2 immune responses.Cutibacterium acnes(C.acnes)is a commensal bacterium that is ubiquitous and predominant in healthy skin and shows intraspecific subtype diversity.The abundance of C.acnes is closely related to the sebum secreted by sebaceous glands.C.acnes has long been considered a proinflammatory skin bacterium that drives the development of acne vulgaris.Growing evidence indicates that C.acnes promotes skin microbiota homeostasis and skin barrier maintenance;however,the potential role of C.acnes in AD remains largely unexamined.This review provides the latest information on the distribution of C.acnes and its phylotypes in healthy skin and AD as well as an overview of the possible role of C.acnes in the pathophysiological pathways underlying AD.Additionally,the review focuses on new evidence regarding the protective functions of C.acnes and its metabolites in AD and discusses the potential for therapeutic applications.

Cohort study of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis in China:evaluation of risk models and new predictor of pulmonary consolidation on computed tomography

Stevens-Johnson syndrome(SJS)and toxic epidermal necrolysis(TEN)are rare but severe diseases.This study aimed to validate the predictive ability of risk models in patients with SJS/TEN and propose possible refinement in China.Patients in the Department of Dermatology of Huashan Hospital from January 2008 to January 2019 were included.Results showed that the severity-of-illness score for TEN(SCORTEN)had a good discrimination(area under the receiver operating characteristic curve(AUC),0.78),and it was superior to auxiliary score(AS)and ABCD-10,which indicates age,bicarbonate level,cancer,dialysis,and 10%involved body surface area(AUC,0.69 and 0.68,respectively).The calibration of SCORTEN(Hosmer-Lemeshow goodness-of-fit test,P=0.69)was also better than that of AS(P=0.25)and ABCD-10(P=0.55).SCORTEN and ABCD-10 were similar(Brier score(BS),0.04 and 0.04)in terms of accuracy of predictions.In addition,the imaging appearance of pulmonary consolidation on computed tomography was associated with high mortality.Refined models were formed using the variables and this imaging appearance.The refined AS and ABCD-10 models were similar in discrimination compared with the original SCORTEN(0.74 vs.0.78,P=0.23;0.74 vs.0.78,P=0.30,respectively).Therefore,SCORTEN showed good discrimination performance,calibration,and accuracy,and refined AS or ABCD-10 model may be an option when SCORTEN variables are not available.