Journal Digest: August 21

JEADV Clinical Practice: Differences in Frequency of Vulvar Dermatoses According to Ethnicity: A Study of a Cohort of Patients in a Large Diverse UK Teaching Hospital

A study conducted at the National Health Service Hospital Trust in East London analyzed the prevalence of vulvar dermatoses among ethnically diverse patients. Data from 246 patients attending vulvar clinics in 2022-2023 revealed significant variations in diagnosis by ethnicity. Although lichen sclerosus was the most common diagnosis among White patients, lichen simplex predominated in Asian and Black patients, with Asian patients showing a 20.2 times higher likelihood of receiving a diagnosis compared with White patients. According to Patel et al, the findings suggest that differences among ethnicities may be linked to genetic predisposition, cultural practices, and health-seeking behaviors. The study authors noted that frequent genital washing, as recommended in Islamic teachings, may exacerbate lichen simplex. Patel et al concluded by emphasizing the need for further research to understand the complex factors influencing vulvar dermatoses in different ethnic groups, with an aim to optimize patient management across diverse populations.¹

Dermatologic Surgery: Conversion of a Validated Melanoma Risk Stratification Tool Into a Tablet-Based Patient Questionnaire for Targeted Melanoma Screening in Primary Care Settings: A Pilot Study

Gupta et al’s pilot study explored the adaptation of the Mackie melanoma risk stratification tool into a tablet-based, self-administered patient questionnaire for use in primary care settings. The goal was to identify high-risk individuals for targeted melanoma screening. The questionnaire was implemented across 2 academic centers between 2019 and 2021, and the study included 7893 respondents. The results showed that 26% of respondents were classified as high-risk, with a number needed to screen (NNS) of 64 to detect one melanoma in this group, a significant improvement compared to general population screenings according to Gupta et al. The study authors concluded that the self-administered tool effectively identifies high-risk individuals, potentially improving early detection while minimizing unnecessary screenings. However, further research is needed to enhance its sensitivity and specificity, particularly in diverse patient populations.²

Indian Journal of Dermatology: Hereditary Sensory and Autonomic Neuropathy—Report of Two Cases in Siblings and Review of Literature

Gowda et al’s report describes 2 siblings, a 12-year-old boy and a 16-year-old girl, diagnosed with Hereditary Sensory and Autonomic Neuropathy (HSAN), a rare condition that affects peripheral sensory and autonomic neurons. Both siblings showed significant distal sensory loss, including resorption of toes, lichenified ulcers, and callosities. Sensory and motor function examinations found diminished reflexes, and nerve conduction studies confirmed symmetrical sensory axonal polyneuropathy. The absence of autonomic symptoms and normal nerve thickness were also recorded. According to the authors, the diagnosis of HSAN was made based on clinical presentation and family history, with no genetic analysis performed due to financial constraints. Gowda et al emphasized that their report highlights the challenges in classifying HSAN due to overlapping symptoms among subtypes.³

Journal of Cutaneous Pathology: Granulomatous Secondary Syphilis: When to Maintain a High Index of Suspicion?

Di Prete et al’s study highlighted the challenge of identifying secondary syphilis when granulomatous inflammation is present. The case involved a 48-year-old woman with a diffuse rash misdiagnosed initially as cutaneous lymphoma. Histopathological examination revealed granulomatous inflammation, but immunohistochemistry for Treponema pallidum was negative. Despite this, Di Prete et al performed serological testing, which was initially negative due to the "prozone phenomenon." Later real-time polymerase chain reaction testing and repeated serology confirmed the diagnosis of syphilis. The patient responded well to treatment with diaminocillin. According to the study authors, the patient case shows the importance of considering syphilis in granulomatous inflammation cases, even when serological and immunohistochemical tests are negative.⁴

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References

1. Patel M, Simpson J, Stuart B, Thamban S, Ekeowa-Anderson A. Differences in frequency of vulvar dermatoses according to ethnicity: a study of a cohort of patients in a large diverse UK teaching hospital. JEADV Clin Pract. Published online August 18, 2024. https://doi.org/10.1002/jvc2.529
2. Gupta N, Kim DP, Conomikes A, et al. Conversion of a validated melanoma risk stratification tool into a tablet-based patient questionnaire for targeted melanoma screening in primary care settings: a pilot study. Dermatol Surg. 2024;50(7):611-615. doi:10.1097/DSS.0000000000004186
3. Gowda SK, Garg S, Behera B, Priyadharsan B, Thakur V. Hereditary sensory and autonomic neuropathy—report of two cases in siblings and review of literature. Indian J Dermatol. 202469(4):p366. doi:10.4103/ijd.ijd_1179_23
4. Di Prete M, Latini A, Lora V, Pimpinelli F, Cota C. Granulomatous secondary syphilis: When to maintain a high index of suspicion?. J Cutan Pathol. Published online August 14, 2024. doi:10.1111/cup.1470