This month's news from across the specialty
What's hot
January 1, 2021
In this monthly column, members of the DermWorld Editorial Advisory Workgroup identify exciting news from across the specialty.
Cutaneous Lyme disease, erythema chronicum migrans, is a clinical diagnosis. Serologic testing may be unreliable as both false positive and false negative results have been reported. Some cases may not be straightforward, prompting the dermatologist to perform a punch biopsy. Characteristic findings of erythema chronicum migrans on histopathology include a superficial and deep infiltrate of lymphocytes and plasma cells. These findings are not pathognomonic, and result in a differential diagnosis proposed by the dermatopathologist.
In a recent study on Lyme disease histopathology, interface dermatitis was found in many of these patients (Am J Dermatopathol. 2020; 42: 745-750). The authors studied skin biopsies from 14 cases of unequivocal or highly suspicious cases of Lyme disease. Focal interface changes were seen in 86% (12 of 14 cases). The dermal infiltrate contained eosinophils (50%) and plasma cells (71%). This new information about the histopathology of erythema chronicum migrans can be beneficial both to dermatologists and dermatopathologists in making the diagnosis.
Refocusing on rosacea
Learn about the new classification system for rosacea.
The SCORTEN score is a predictor of mortality for Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) patients. Databases were searched for studies on the use of SCORTEN (J Eur Acad Dermatol Venereol. 2020. June 17. doi: 10.1111/jdv.16685). Meta-analyses were performed on patients with SJS/TEN who received supportive care alone or supportive care combined with systemic steroids, cyclosporine, etanercept, IVIg, or systemic steroids plus IVIg. Of 3,893 studies, 52 studies involving 2,466 patients with SJS/TEN were selected. Data from 38 of these studies (1,827 patients) were pooled and the meta-analyses revealed:
0.13 (95% CI, -0.15,0.40) for supportive care alone
-0.13 (95% CI, -0.42,0.16) for systemic steroids
-0.88 (95% CI, -1.47,-0.29) for cyclosporine
-0.95 (95% CI, -1.82,-0.07) for etanercept
-0.39 (95% CI, -0.87,0.09) for IVIg
-0.56 (95% CI, -0.94,-0.19) for systemic steroid plus IVIg
The meta-regression analysis showed that only two treatment options, 1. cyclosporine, and 2. the combination of systemic steroids plus IVIg (but not either systemic steroids or IVIg alone) were associated with a lower death rate than that predicted by SCORTEN. The authors state that even though these two treatment options show a better performance, there is not enough evidence to recommend their use in every patient.
Is rosacea linked to cardiometabolic disease? A recent systematic review and meta-analysis published in JAAD (2020 Nov; 83(5): 1331-40) found that rosacea is correlated with dyslipidemia and hypertension, but not with ischemic heart disease, stroke, or diabetes. Specifically, patients with rosacea were found to have a higher prevalence of higher total cholesterol and low-density lipoprotein (LDL), higher triglycerides, higher systolic and diastolic blood pressure, and higher fasting glucose. Rosacea was not associated with ischemic heart disease, stroke, frank diabetes, or high-density lipoprotein (HDL). This serves as an important reminder for dermatologists to refer at-risk patients to their primary care physicians for appropriate screening and monitoring.
No longer on display
Read more about the resurgence of syphilis.
In ordinary times, a marked decline in sexually transmitted diseases (STDs) would be cause for celebration.
Not during the COVID-19 pandemic, however.
Cases of chlamydia, gonorrhea, and syphilis had been expected to hit record levels in 2020, but the opposite has happened. According to the New York Times, chlamydia cases in April 2020 were down by about half compared with April 2019, and gonorrhea and syphilis cases by about a third.
Experts say those diseases are still out there; they’re just not being diagnosed and treated. The pandemic has caused some STD clinics to close; has led some people to avoid seeking health care because of concerns of catching the virus; and has drained testing supplies — especially those important for diagnosis of chlamydia and gonorrhea — from clinics and laboratories. That last factor led the CDC to issue guidelines on rationing STD tests (PDF download) in September 2020 to ensure availability of testing of those most at risk.
The upshot is that there could be even more STDs, including HIV, during the COVID-19 pandemic than were projected pre-pandemic.
Public health officials clearly have work to do. Dermatologists likely will too.
With fewer STD clinics open, people with mucocutaneous symptoms of STDs might instead see dermatologists, who also might lack testing supplies in their offices and in laboratories to which they refer patients. Ultimately, if the concerns about an increasing reservoir of undiagnosed STDs prove accurate, dermatologists along with other clinicians might see more STDs, including HIV.
Vigilance, not celebration, is in order.
