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Vitamin D plays a role in inflammatory skin disease, but the exact mechanisms and the clinical significance remain unclear. According to the free hormone hypothesis, it is the free concentration of 25-hydroxy vitamin D (25(OH)D) that is biologically active. Vitamin D-binding protein (DBP) acts as the major transporter of vitamin D in the circulation, and DBP concentration defines the free 25(OH)D levels. DBP levels are elevated in various inflammatory conditions, including psoriasis. Narrowband-ultraviolet B (NB-UVB) is the most widely used phototherapy and is an established first-line treatment for psoriasis and atopic dermatitis (AD), often used before proceeding to systemic treatment. The aim of this study was to investigate the influence of NB-UVB phototherapy on DBP and high-sensitivity C-reactive protein (hsCRP) levels, as markers of systemic inflammation, in inflammatory skin disease. Thirty adults (psoriasis (n = 20) and AD (n = 10)) were treated with NB-UVB. Serum DBP, hsCRP, total and free 25(OH)D, and 1,25-dihydroxy vitamin D (1,25(OH)2D) were measured before and after NB-UVB. Disease severity was assessed with Psoriasis Area and Severity Index (PASI), SCORing Atopic Dermatitis (SCORAD), and Visual Analogue Scale (VAS). DBP decreased in psoriasis patients and varied with no clear trend in AD patients. HsCRP decreased in both groups, but this did not reach statistical significance. PASI, SCORAD, and VAS improved, and vitamin D levels increased after NB-UVB. Sub-analysis indicated a better response to NB-UVB for patients with vitamin D deficiency and insufficiency compared to vitamin D-sufficient patients. The decrease in DBP after NB-UVB in psoriasis patients suggests a potential systemic anti-inflammatory effect of phototherapy. Measurement of vitamin D levels may potentially serve as a tool to identify patients who would derive the greatest benefit from NB-UVB phototherapy. [ABSTRACT FROM AUTHOR]

The role of vitamin D in atopic dermatitis (AD) is controversial. Conflicting data could be due to the use of inadequate markers for assessing vitamin D status. So far, directly measured free 25(OH)D concentrations have not been reported in AD patients. Ten adults with AD were treated with narrow band ultraviolet light B (NB-UVB) for 10–12 weeks. SCORing atopic dermatitis (SCORAD) and the visual analogue scale (VAS) were used to assess disease severity before and after NB-UVB therapy. Total and free 25(OH)D and 1,25(OH)2D serum levels were analyzed before and after treatment. Free 25(OH)D concentrations were measured with a two-step immunosorbent assay (ELISA). The majority of patients had sufficient levels of 25(OH)D before treatment (mean 76.4 nmol/L). Mean free 25(OH)D was 11.9 pmol/L and mean 1,25(OH)2D was 108.9 pmol/L. Median SCORAD decreased from 37.1 to 19.8 and VAS improved significantly after phototherapy. Total and free 25(OH)D increased in all subjects. No correlations between disease severity and vitamin D levels were found. There was no correlation between total and free 25(OH)D levels. Larger studies are needed to test the applicability of the free hormone hypothesis in AD pathogenesis. [ABSTRACT FROM AUTHOR]

Background/purpose: Organ transplant recipients (OTRs) are at high risk of developing skin cancer and are therefore advised to protect their skin against ultraviolet radiation from the sun. Specialized OTR clinics with dermatological follow‐up may improve sun habits among OTRs. In this study, we compared self‐reported sun exposure and sun protection behaviour between OTRs and non‐transplant patients (non‐TPs) and between OTRs with and without special dermatological follow‐up. Methods: Patients from Sahlgrenska University Hospital, Gothenburg, Sweden, completed a sun exposure questionnaire. Between 2011 and 2015, 282 OTRs transplanted in the period 1976‐2014 and 414 non‐TPs were recruited among dermatological outpatients. Participants were stratified into five groups by their status as OTRs or non‐TPs and by attendance to dermatological follow‐up. Results: More non‐TPs than OTRs reported one or more sunburns in the past year, 46% vs. 20%, P <.0001). More OTRs with than OTRs without dermatological follow‐up reported frequent use of sunscreens (63% vs 44%, P =.006). More OTRs with follow‐up used one or more sun protection measure such as covering clothes, than other OTRs (54% vs 34%, P =.016). Conclusion: In this study, OTRs reported less sun exposure than non‐TPs. Specialized dermatological follow‐up seems to improve sun protection behaviour among OTRs. We suggest that specialized OTR clinics should be more broadly implemented. [ABSTRACT FROM AUTHOR]

Methotrexate treatment has been linked with an increased risk of melanoma. However, a possible dose-response relationship with respect to methotrexate exposure and melanoma has not been addressed. The aim of the present study was to investigate whether higher accumulated doses of methotrexate correlate with an increased risk of melanoma, which would further support a possible association. A nationwide retrospective cohort study was conducted. All Swedish patients over 18 years of age who were dispensed methotrexate in the period 2005 to 2014 were registered (n = 101,966) and matched to the cancer registry. A Cox proportional hazards model, testing risk of melanoma vs. total accumulated methotrexate dose, controlled for sex, age group, and time from first to last dispensed prescription of methotrexate, yielded no significant risk dependence on dose, and a hazard ratio of 1.02 (95% CI 0.97-1.08). Overall, no conclusive dose-response relationship was observed between methotrexate exposure and risk of melanoma. [ABSTRACT FROM AUTHOR]

The article discusses the Methotrexate which is a folic acid inhibitor that has been used to treat psoriasis since the 1970s and is highly effective treatment with few side-effects. It states that ultraviolet treatment and measurement in randomized controlled trials are being used in treating the disease.

Phototherapy is an effective and widely used treatment for generalised plaque psoriasis. Despite the mutagenic effects of UVB this type of therapy is still assumed to be a safe treatment option. We have performed a cross sectional study to assess the risk of skin cancer in the cohort of psoriasis patients treated with UVB. A total of 162 white patients (116 men and 46 women, mean ± standard deviation age 56.0 ± 13.5 years) were included in the study. All patients have previously been treated with UVB at least 100 times in the last 5 years. Eight patients (4.9%, 0.95 CI: 2.2–9.5%) out of the 162 included in the study had histopathologically verified skin cancer. We found that the risk of skin cancer in psoriasis patients treated with UVB correlated with the number of treatments (controlling for age) but not with the type of UVB lamp. However, the overall risk of malignancy in the UVB-treated patients was not greater than in the general population. [ABSTRACT FROM AUTHOR]

Primary cutaneous B-cell lymphomas (PCBCLs) are a group of commonly indolent diseases that comprises primary cutaneous follicle center lymphoma (PCFCL), primary cutaneous marginal zone lymphoma (PCMZL) and primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL, LT). PCBCLs affect mainly adults but also children. Treatment is watchful waiting, excision, radiotherapy, rituximab, and systemic chemotherapy in case of extracutaneous spread disease. The disease is rare and there is a huge need of studies on clinical features and treatment outcomes. The aim of the study was to present demographics, clinical features and treatment outcomes of patients with PCBCLs in West Sweden. This is a descriptive, register-based, single center retrospective study of patients diagnosed with PCBCLs at Department of Dermatology and Venerology at Sahlgrenska University Hospital between 2002-2021. Data regarding demographics, clinical characteristics, pathological- and medical examination findings, comorbidities, staging according to TNM-system and treatment response were collected from patients' medical records and the hospital-based skin lymphoma register. Nine patients with PCBCLs were identified and included in the study. Mean age at diagnosis was 53.8±14.5 years for patients with PCFCL (n=5) and 49.2±28.1 for PCMZL (n=4), respectively. Skin presentations of PCFCL were in form of papules, plaques and tumors (40%) preferably distributed on the head (60%) and trunk (40%). Papules (75%) on upper extremity (50%) were the most common manifestation in PCMZL. In most cases the histopathological diagnosis was set after the first pathological anatomical diagnosis but for PCFCL it required two or three biopsies before the diagnosis was confirmed. Monoclonality was identified in 20–25% in PCFCL and PCMZL. Lactate dehydrogenase was increased at any time in PCFCL 40% and PCMZL 25%. All the patients with PCFCL were tested for borreliosis and all were negative. One of two PCMZL patients was tested positive for borreliosis. Enlarged lymph node was found in 20% of the patients with PCFCL, all had done a CT. Radiotherapy, excision, topical/intralesional corticosteroids, chemotherapy and rituximab were used to treat PCBCLs. PCMZL had complete remission when treated with chemotherapy, radiotherapy and with excision. The treatments were commonly used as monotherapy or in a combination over time. The study population had a wide range of different comorbidities including cardiovascular diseases, hypothyroidism, rheumatic arthritis and dermatological diseases including malignant melanoma, basal cell carcinoma and herpes zoster. This study contributes to increased knowledge on demographics, clinical features, diagnostics, and treatment response of PCBCLs. The results of the study can be used in future research and adds some new knowledge about these unusual diseases in clinical practice. [ABSTRACT FROM AUTHOR]

Mycosis fungoides (MF) and Sézary syndrome (SS) are forms of primary cutaneous T-cell lymphomas. The clinical aspects and symptoms vary greatly depending on the stage of disease. These are rare diseases which remain incurable, but there is a wide variety of treatment options. Few studies have been performed on this topic in Sweden and there is an emerging need for descriptive studies and research in this field. The aim of this study is to describe and analyze diagnostic criteria for patients with MF/SS and to describe treatment modalities and evaluate treatment response of this patient-group. This is a descriptive retrospective study based on the data collected in the Primary Cutaneous Lymphoma quality register at the department of Dermatology and Venerology at Sahlgrenska University Hospital between 1997-2021. Eighty-two patients, median age 55.9 years (range 8.6–91.7) at diagnosis, with MF (n=70) or SS (n=12) were included. Male to female ratio was 1.7:1. From the onset of skin symptoms until initial diagnosis took on average 2.7 years (median, range 0.1–42.4 years). The subtypes of MF were folliculotropic (n=9), syringotropic (n=4), hypopigmented (n=1) and hyperpigmented (n=1). The majority of the patients (n=63) were diagnosed at early-stage disease (IA-IIA) while 18 patients were diagnosed with advanced stage disease (IIB–IVB). Overall disease progression was seen in 10% (n=8) of the patients. Eight (10%) patients were deceased out of which three (3.8%) deaths were associated with MF/ SS related causes. The most common co-morbidities in our study population were overweight 31%, hypertension (29%), obesity (18%), hyperlipidaemia (16%), diabetes mellitus (15%), and dermatitis (11%). The most common malignancies were basal cell carcinoma (16%), haematological malignancies (7%), malignant melanoma (6%) and prostate cancer (6%). Topical corticosteroids (96.3%), UVB (57.3%) and PUVA (47.6%) were common choices of treatment in all patients, along with acitretin in those with advanced stage disease. No significant difference in overall response was detected between patients with early-stage disease and advanced stage disease for any treatment. This study contributes to knowledge on epidemiological and clinical features in addition to diagnostic findings in patients with MF and SS diagnosed and/or followed up for a long period of time in Western Sweden. We observed increased risk of cardiovascular disease and higher risk of developing other malignancies. This study suggests that treatment for these patients have been adequately adjusted for stage and highlights the importance of topical corticosteroids as an integrated part of the treatment. UVB and PUVA are beneficial treatments for patients with early-stage disease, but could also be valuable for patients with advanced disease along with acitretin. Hopefully this study will inspire to and be integrated in future research ahead. [ABSTRACT FROM AUTHOR]