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BACKGROUND: Infantile hemangiomas (IHs) of the anogenital region remain poorly characterized. OBJECTIVE: To examine the distribution, ulceration rate, and associated congenital anomalies of anogenital IHs. METHODS: Retrospective study at 8 tertiary referral centers. RESULTS: A total of 435 infants with an IH of the anogenital region were enrolled (of which, 319 [73%] were girls). Congenital anomalies were present in 6.4% (n = 28) of infants with an anogenital IH. Segmental or partial segmental anogenital IHs ulcerated in 72% (n = 99 of 138) of infants, whereas 45% (n = 133 of 297) of focal anogenital IHs experienced ulceration (P < .001). In a multivariable logistic regression analysis, segmental or partial segmental morphology (adjusted odds ratio [aOR], 2.70; 95% CI, 1.60-4.64), mixed type (aOR, 3.44; 95% CI, 2.01-6.07), and perianal (aOR, 3.01; 95% CI, 1.53-6.12) and buttocks location (aOR, 2.08; 95% CI, 1.17-3.76) had increased odds of ulceration. Segmental or partial segmental IHs of the genitalia were confined to distinct anatomic territories and were predominantly distributed unilaterally, with a linear demarcation at the perineal raphe. LIMITATIONS: Possible selection bias, given recruitment at tertiary referral centers. CONCLUSION: This study improves our understanding of high-risk features of anogenital IHs and demonstrates that genital segmental or partial segmental IHs develop within distinct anatomic territories.
RESUMEN
Early intervention in cicatricial alopecias is critical to prevent permanent damage to the hair follicles. Previous literature, however, has suggested that individuals who are black are less likely to visit dermatologists than individuals who are white.1.
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Alopecia/tratamiento farmacológico , Dermatología , Disparidades en Atención de Salud , Aceptación de la Atención de Salud , Adulto , Alopecia/etnología , Alopecia/patología , Población Negra , Cicatriz/patología , District of Columbia , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND: Management of inpatient skin disease represents a unique subspecialty within dermatology. OBJECTIVE: To assess the national burden of inpatient dermatology in adults. METHODS: Using the 2014 National Inpatient Sample, we performed a retrospective cohort study of adults hospitalized for dermatologic conditions. RESULTS: In 2014, there were 644,320 weighted hospitalizations principally for skin disease in adults, which cost the health care system $5.04 billion. Overall, skin disease was diagnosed in 1 in 8 hospitalized adults. Dermatologic hospitalizations were associated with a lack of medical insurance (odds ratio [OR], 2.27; 95% confidence interval [CI], 2.20-2.34), residence in a low-income community (OR, 1.10; 95% CI, 1.07-1.13), and small (OR, 1.27; 95% CI, 1.23-1.32) or rural hospitals (OR, 1.38; 95% CI, 1.32-1.44). Racial minorities were less likely to be hospitalized for skin disease than were whites (for blacks: OR, 0.77; 95% CI, 0.75-0.79; for Hispanics: OR, 0.85; 95% CI, 0.83-0.8; for Asians: OR, 0.59; 95% CI, 0.55-0.64). Only 0.47% of patients admitted for skin disease experienced in-hospital mortality; however, mortality rates were high in hospitalizations for cutaneous lymphomas (9.19%) and malignant melanoma (6.54%). LIMITATIONS: We could not assess the impact of inpatient dermatology consultations on hospitalization outcomes. CONCLUSIONS: Skin disease is highly prevalent among hospitalized patients.
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Dermatología/economía , Costos de Hospital , Hospitalización/economía , Enfermedades de la Piel/economía , Enfermedades de la Piel/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Mortalidad Hospitalaria/tendencias , Hospitalización/estadística & datos numéricos , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Factores Sexuales , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/terapia , Estados Unidos , Adulto JovenRESUMEN
BACKGROUND: Hospital readmissions represent a potential target for reducing unnecessary health care expenditures; however, readmissions following dermatology hospitalizations remain poorly characterized. OBJECTIVE: To assess the frequency and demographics of readmissions for skin disease. METHODS: We performed a retrospective cohort study of dermatology hospitalizations by using the 2014 Nationwide Readmissions Database. RESULTS: Readmissions following dermatologic hospitalizations cost the American health care system $1.05 billion in 2014. The 30-day rate of all-cause readmission following the 647,251 weighted index admissions for skin disease was 12.63%. Readmission was most common following hospitalizations for cutaneous lymphomas (39.63%), connective tissue disorders (26.28%), and cutaneous congenital abnormalities (23.86%). Predictors of readmission included public insurance with Medicaid (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.53-1.70) or Medicare (OR, 1.55; 95% CI, 1.48-1.62), residence in a low-income community (OR, 1.14; 95% CI, 1.09-1.20), an increased number of chronic conditions (OR, 4.46; 95% CI, 4.15-4.79), and a large hospital (OR, 1.10; 95% CI, 1.05-1.16). Urban (OR, 0.90; 95% CI, 0.87-0.94) and rural (OR, 0.78; 95% CI, 0.73-0.82) nonteaching hospitals were protective against readmissions from skin disease. LIMITATIONS: We were unable to assess the impact of inpatient dermatology consultations on hospital readmission rates. CONCLUSIONS: There are significant health care and demographic disparities in readmissions for skin disease.
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Gastos en Salud , Hospitalización/estadística & datos numéricos , Readmisión del Paciente/economía , Enfermedades de la Piel/economía , Enfermedades de la Piel/terapia , Adulto , Anciano , Estudios de Cohortes , Costo de Enfermedad , Bases de Datos Factuales , Femenino , Humanos , Masculino , Medicaid/economía , Medicare/economía , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Estudios Retrospectivos , Medición de Riesgo , Enfermedades de la Piel/diagnóstico , Estados UnidosRESUMEN
BACKGROUND/OBJECTIVES: It is known that inpatient care accounts for a significant portion of health care expenditures, but the national burden of inpatient pediatric dermatology is poorly characterized. We sought to assess risk factors, conditions, and financial costs associated with pediatric hospitalizations for skin disease. METHODS: We performed a cross-sectional study of pediatric dermatology hospitalizations using the 2012 Kids' Inpatient Database, which samples 80% of non-birth-related pediatric admissions from 44 states to generate national estimates. The demographic characteristics of children admitted for dermatologic and nondermatologic conditions were compared, and the financial costs of these admissions were analyzed. RESULTS: In 2012, there were 74 229 (95% confidence interval (CI) = 68 620-79 978) pediatric dermatology hospitalizations, accounting for 4.2% of all pediatric admissions and $379.8 million (95% CI = $341.3-418.4 million) in health care costs. Bacterial infections (n = 59 115, 95% CI = 54 669-63 561), viral diseases (n = 3812, 95% CI = 3457-4167), and noncancerous skin growths (n = 2931, 95% CI = 2318-3545) were the most common conditions requiring hospitalization. The highest mean cost per hospitalization was for admissions for cutaneous lymphomas ($58 294, 95% CI = $31 694-84 893), congenital skin abnormalities ($24 186, 95% CI = $16 645-31 728), and ulcers ($17 064, 95% CI = $14 683-19 446). Pediatric dermatology hospitalizations were most strongly associated with living in a low-income community (odds ratio (OR) = 1.22, 95% CI = 1.16-1.29) and the South (OR = 1.32, 95% CI = 1.19-1.46) and being uninsured (OR = 1.35, 95% CI = 1.26-1.45) or having Medicaid insurance (OR = 1.17, 95% CI = 1.13-1.22). CONCLUSION: Skin disease is a common cause of hospitalizations in children, and there are disparities in these admissions that could reflect inadequate access to outpatient pediatric dermatologists.
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Costo de Enfermedad , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/economía , Pacientes Internos/estadística & datos numéricos , Enfermedades de la Piel/economía , Adolescente , Niño , Preescolar , Estudios Transversales , Bases de Datos Factuales , Dermatología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Enfermedades de la Piel/mortalidad , Estados UnidosRESUMEN
INTRODUCTION: One of the most serious known adverse effects of feminizing cross-sex hormone therapy (CSHT) is venous thromboembolism (VTE); however, no study has assessed the incidence of VTE from the hormone therapies used in the United States because previous publications on this topic have originated in Europe. CSHT in the United States typically includes estradiol with the antiandrogen spironolactone, whereas in Europe estradiol is prescribed with the progestin cyproterone acetate. AIM: To estimate the incidence of VTE from the standard feminizing CSHTs used in the United States. METHODS: A retrospective chart review of transgender women who had been prescribed oral estradiol at a District of Columbia community health center was performed. MAIN OUTCOME MEASURE: The primary outcomes of interest were deep vein thrombosis or pulmonary emboli. RESULTS: From January 1, 2008 through March 31, 2016, 676 transgender women received oral estradiol-based CSHT for a total of 1,286 years of hormone treatment and a mean of 1.9 years of CSHT per patient. Only one individual, or 0.15% of the population, sustained a VTE, for an incidence of 7.8 events per 10,000 person-years. CONCLUSION: There was a low incidence of VTE in this population of transgender women receiving oral estradiol.
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Estradiol/efectos adversos , Estrógenos/efectos adversos , Transexualidad/complicaciones , Trombosis de la Vena/inducido químicamente , Administración Oral , Adulto , Antagonistas de Andrógenos/administración & dosificación , Acetato de Ciproterona/efectos adversos , District of Columbia/epidemiología , Estradiol/administración & dosificación , Estrógenos/administración & dosificación , Europa (Continente) , Femenino , Identidad de Género , Hormonas Esteroides Gonadales/administración & dosificación , Hormonas Esteroides Gonadales/efectos adversos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Antagonistas de Receptores de Mineralocorticoides/administración & dosificación , Antagonistas de Receptores de Mineralocorticoides/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Espironolactona/administración & dosificación , Espironolactona/efectos adversos , Personas Transgénero/psicología , Transexualidad/epidemiología , Transexualidad/psicología , Trombosis de la Vena/epidemiologíaRESUMEN
Human cytomegalovirus (HCMV) contributes its own set of microRNAs (miRNAs) during lytic infection of cells, likely fine-tuning conditions important for viral replication. To enhance our understanding of this component of the HCMV-host transcriptome, we have conducted deep-sequencing analysis of small RNAs (smRNA-seq) from infected human fibroblast cells. We found that HCMV-encoded miRNAs accumulate to â¼20% of the total smRNA population at late stages of infection, and our analysis led to improvements in viral miRNA annotations and identification of two novel HCMV miRNAs, miR-US22 and miR-US33as. Both of these miRNAs were capable of functionally repressing synthetic targets in transient transfection experiments. Additionally, through cross-linking and immunoprecipitation (CLIP) of Argonaute (Ago)-bound RNAs from infected cells, followed by high-throughput sequencing, we have obtained direct evidence for incorporation of all HCMV miRNAs into the endogenous host silencing machinery. Surprisingly, three HCMV miRNA precursors exhibited differential incorporation of their mature miRNA arms between Ago2 and Ago1 complexes. Host miRNA abundances were also affected by HCMV infection, with significant upregulation observed for an miRNA cluster containing miR-96, miR-182, and miR-183. In addition to miRNAs, we also identified novel forms of virus-derived smRNAs, revealing greater complexity within the smRNA population during HCMV infection.
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Infecciones por Citomegalovirus/genética , Infecciones por Citomegalovirus/virología , Citomegalovirus/genética , Perfilación de la Expresión Génica , MicroARNs/genética , ARN Viral/genética , Secuencia de Bases , Línea Celular , Citomegalovirus/metabolismo , Infecciones por Citomegalovirus/metabolismo , Interacciones Huésped-Patógeno , Humanos , MicroARNs/metabolismo , Datos de Secuencia Molecular , ARN Viral/metabolismo , Análisis de Secuencia de ARNAsunto(s)
Síndrome Estafilocócico de la Piel Escaldada/epidemiología , Adolescente , Adulto , Negro o Afroamericano/estadística & datos numéricos , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios Transversales , Femenino , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Síndrome Estafilocócico de la Piel Escaldada/etnología , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricos , Adulto JovenRESUMEN
INTRODUCTION: Alopecia areata is a heterogenous, immune-mediated hair loss disorder that can affect any hair-bearing site on the body. Despite being one of the most prevalent autoimmune skin diseases, treatments have historically been limited to off-label medications that have demonstrated limited efficacy, especially in more severe forms of disease. Thus, there has long been an unmet need for rigorously studied therapeutics in alopecia areata. AREAS COVERED: Janus kinase inhibitors have proven to be an effective class of drugs for treating several inflammatory disorders. One such drug, baricitinib, has recently demonstrated significant hair regrowth in phase 2 and 3 alopecia areata trials. It has since become the first systemic therapy approved for treating severe alopecia areata. This review examines the role of Janus kinase pathways in alopecia areata's pathogenesis and the safety and efficacy of baricitinib for treating severe alopecia areata. EXPERT OPINION: The approval of baricitinib for treating severe alopecia areata marks a major milestone in the disease's history. While baricitinib has proven to be efficacious for this indication and has demonstrated an overall good safety profile, patients' individual risk factors for serious adverse events should be assessed during shared decision-making with patients before initiating treatment.
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Alopecia Areata , Humanos , Alopecia Areata/tratamiento farmacológico , Alopecia Areata/patología , Sulfonamidas/uso terapéutico , Pirazoles/uso terapéuticoRESUMEN
Importance: In the US, incidence of and mortality due to anal carcinoma are rising faster than for most other cancers. Identifying populations who have a higher risk of developing anal cancers is critical to target preventive interventions. Objective: To assess the risk of developing anal carcinoma in adults living with HIV who have a history of anogenital warts. Design, Setting, and Participants: This longitudinal cohort study included adults living with HIV from 14 clinics in Washington, DC, and at least 18 months of follow-up. Data were collected from January 1, 2011, to March 31, 2017, and analyzed from June 1, 2019, to October 31, 2020. Exposures: Development of warts in the anal or genital region identified by diagnosis codes. Main Outcomes and Measures: Individuals with anal carcinoma were identified by diagnosis codes or anal biopsy results. Results: A total of 6515 participants were enrolled (4720 male [72.4%] at birth; mean [SD] age, 49.9 [12.7] years), and 383 (5.9%) developed anogenital warts during the study period. Patients who were diagnosed with anogenital warts were more likely to subsequently develop anal carcinoma (17 of 383 [4.4%]) compared with participants without a history of anogenital warts (17 of 6132 [0.3%]) (P < .001). After adjusting for covariates, the odds of developing anal carcinoma were 12.79 (95% CI, 6.19-26.45; P < .001) times higher in individuals with a history of anogenital warts compared with individuals without a history of anogenital warts. Conclusions and Relevance: These findings suggest that adults living with HIV who have a history of anogenital warts have a substantially increased risk of developing anal carcinoma. Clinicians should counsel individuals living with HIV who have anogenital warts on this risk.
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Enfermedades del Ano/complicaciones , Neoplasias del Ano/epidemiología , Condiloma Acuminado/complicaciones , Infecciones por VIH/complicaciones , Adolescente , Adulto , Anciano , Enfermedades del Ano/diagnóstico , Enfermedades del Ano/virología , Neoplasias del Ano/etiología , Estudios de Cohortes , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/virología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
The etiology of vulvar lichen sclerosus (LS) remains unclear; however, alterations in cutaneous and gut microbiota may be contributing to the pathogenesis of this inflammatory condition. To explore this hypothesis, we conducted a pilot case-control study, obtaining dermal swab and stool samples from prepubertal girls with vulvar LS (n = 5), girls with nonspecific vulvovaginitis (n = 5), and healthy controls (n = 3). Samples (n = 56) were subjected to total DNA extractions. Resulting DNA was purified, subjected to PCR (targeting the V3V4 region of the 16S rRNA gene), sequenced, and analyzed using QIIME, MetagenomeSeq, and DESeq2 software packages. Our findings showed that there were significant differences in the cutaneous and gut microbiotas of girls with LS compared to controls. On the skin, girls with LS had a statistically significantly higher relative abundance of Porphyromonas spp., Parvimonas spp., Peptoniphilus spp., Prevotella spp., Dialister spp., and Peptostreptococcus spp., but a lower relative abundance of Cornyebacterium compared to the control group. In the gut samples, girls with LS had a significantly higher relative abundance of Dialister spp., Clostridiales spp., Paraprevotella spp., Escherichia coli, Bifidobacterium adolescentis, and Akkermansia muciniphila, and a lower relative abundance of Roseburia faecis and Ruminococcus bromii compared to controls. These results suggest a potential association between cutaneous and gut dysbiosis and pediatric vulvar LS. Future studies involving larger samples sizes are warranted to further evaluate this association.
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Microbioma Gastrointestinal , Liquen Escleroso y Atrófico/microbiología , Menarquia/fisiología , Piel/microbiología , Biodiversidad , Estudios de Casos y Controles , Niño , Femenino , Humanos , Filogenia , Proyectos PilotoRESUMEN
Importance: Hidradenitis suppurativa (HS) in pediatric patients has been understudied. Increased awareness and recognition of HS prevalence in children demand efforts to better understand this condition. Objective: To describe the demographics, clinical features, treatment, associated comorbidities, and outcomes in a large cohort of pediatric patients with HS. Design, Setting, and Participants: International, multicenter, retrospective medical record review of pediatric patients (aged 1-18 years) with a clinical diagnosis of HS carried out in 10 dermatology clinics across the US, Canada, Israel, Australia, and Italy from January 1996 to January 2017. Main Outcomes and Measures: Patient demographics, clinical features, severity, associated comorbidities, and treatments in pediatric patients with HS. Results: This cross-sectional study included 481 patients diagnosed with HS. Overall, 386 (80%) were girls. The mean (SD) age of disease onset was 12.5 (2.9) years, and the mean (SD) age at diagnosis was 14.4 (3.5) years. Family history of HS was present in 111 of 271 (41%) patients. First signs/symptoms reported at disease onset were cyst/abscess in 229 of 481 (48%), pain/tenderness in 118 of 481 (25%), and papules/pustules in 117 of 481 (24%). At initial dermatologic assessment, 233 of 481 (48%) patients already had evidence of skin scarring. Disease severity (Hurley staging) was documented in 288 of 481 (60%) patients (47% stage 1, 45% stage 2 and 8% stage 3). Comorbid conditions were reported in 406 of 481 (85%) patients, the most common being obesity (263/406 [65%]) and acne vulgaris (118/406 [29%]). Complications occurred in 378 of 481 (79%) patients, the most common of which were scars or contractures (301/378 [80%]). Conclusions and Relevance: The findings of this study indicate that there is a gap in recognizing and diagnosing pediatric HS. Pediatric patients with HS are likely to present with other comorbidities. Prospective observational and interventional studies are needed to better understand clinical course and optimal treatments for pediatric HS.
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Hidradenitis Supurativa/diagnóstico , Hidradenitis Supurativa/epidemiología , Adolescente , Edad de Inicio , Australia , Canadá , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Israel , Italia , Masculino , Prevalencia , Estudios Retrospectivos , Estados UnidosRESUMEN
This case report describes an uncircumcised male individual with tender perimeatal erythema and ulceration extending to the right glans.