What are the highest yielding search strategy terms for systematic reviews in atopic dermatitis? A systematic review.

The impact of search strategies on systematic reviews (SR) of atopic dermatitis (AD) is unknown. The purpose of this review was to evaluate search strategies used in SR of AD and their impact on the frequency of manuscripts identified. MEDLINE and EMBASE were searched for SR related to AD. Simulations were performed by running combinations of search terms in MEDLINE and EMBASE. Overall, 250 SR met inclusion criteria, of which 225 specified search strategies. SR using 5-6 terms (20.0% to 12.1%) or ≥ 7 (40.0% to 18.8%) terms decreased, whereas SR using 3-4 terms numerically increased (18.8% to 30.2%) and 1-2 terms remained similar (37.5% to 38.9%) from 1999-2009 to 2015-2019. The most commonly searched terms were "atopic dermatitis" (n = 166), followed by "eczema" (n = 156), "dermatitis atopic'" (n = 81), "atopic eczema" (n = 74), "neurodermatitis" (n = 59), "Besniers prurigo" (n = 29), "infantile eczema" (n = 27), and "childhood eczema" (n = 19). Simulations revealed that "eczema" and "atopic dermatitis" yielded the most hits. The number of search terms that maximized hits in MEDLINE and EMBASE was 5 and 4, respectively. Search strategies for AD were heterogeneous, with high proportions of search strategies providing few search hits. Future studies should use standardized and optimized search terms.

Screening and Intervention for Skin Cancer in the Galapagos.

OBJECTIVE: This study aimed to assess the general dermatological needs and correlation of tentative skin cancer screening diagnoses with histopathological confirmation in the highly sun-exposed locals of the Galapagos Islands. METHODS: An institutional review board-approved prospective study was performed at Blanca's House, a nonprofit surgical volunteer organization, free clinics in the Galapagos. After consent, a 40-item modified SPOTme-inspired questionnaire was completed. Partial or total body skin examinations were conducted by board-certified dermatologists. Board-certified plastic and general surgeons performed excisional biopsies on suspicious lesions. Individuals younger than 18 years, and non-Spanish or non-English speakers were excluded. RESULTS: A total of 273 patients were included in the study, of which 202 reported skin concerns. Benign nevi (n = 76), seborrheic keratosis (n = 42), melasma (n = 19), actinic keratosis (n = 16), acne (n = 15), eczema (n = 13), fungal infections (n = 12), seborrheic dermatitis (n = 5), and psoriasis (n = 5) were most commonly identified.Twelve patients (4.4%) had presumptive skin cancer after screening. Six of 8 biopsies confirmed cancer (group 1), 2 declined a biopsy and 2 were unresectable. Seven basal cell carcinomas and one squamous cell carcinoma were excised with clear margins. A right lower eyelid melanoma was diagnosed and subsequently treated in the United States where invasive melanoma with a Breslow thickness of 0.3 mm was found.Compared with the noncancer group (group 2: n = 265), group 1 had significantly higher likelihood of reporting having seen a dermatologist (P = 0.02), taking any medications (P = 0.0001), having blonde or red hair (P = 0.01), having blue or green eyes (P < 0.0001), and having used indoor tanning equipment (P < 0.0001). Group 1 was also more likely to report 4 or more blistering sunburns (P = 0.08), which approached significance. When evaluated by a dermatologist, group 1 was significantly more likely to be classified as "high risk" for developing cancerous lesions (P < 0.0001) compared with group 2. CONCLUSIONS: Skin concerns in the Galapagos included benign and malignant conditions. There is a need for dermatological care in this medically underserved population. This modified SPOTme-inspired skin cancer questionnaire, confirmed by histology, is a useful tool in identifying high-risk patients and detecting skin cancer in international communities that would have otherwise experienced delays in diagnosis or treatment.

Role of neuroimmune circuits and pruritus in psoriasis.

Psoriasis is a chronic inflammatory skin disease presenting with an array of clinical phenotypes, often associated with pruritus. Environmental and psychological stressors can exacerbate psoriasis symptoms and provoke flares. Recent studies suggest a dysfunctional hypothalamic-pituitary-adrenal (HPA) axis in some patients with psoriasis that can result in immune dysregulation. The immune system, in turn, can communicate with the nervous system to induce, maintain or aggravate psoriasis. In the skin, peripheral sensory as well as autonomic nerves control release of inflammatory mediators from dendritic cells, mast cells, T cells or keratinocytes, thereby modulating inflammatory responses and, in case of sensory nerves, pruritus. In response to the environment or stress, cytokines, chemokines, proteases, and neuropeptides fluctuate in psoriasis and influence immune responses as well as nerve activity. Furthermore, immune cells communicate with sensory nerves which control release of cytokines, such as IL-23, that are ultimately involved in psoriasis pathogenesis. Nerves also communicate with keratinocytes to induce epidermal proliferation. Notably, in contrast to recent years the debilitating problem of pruritus in psoriasis has been increasingly appreciated. Thus, investigating neuroimmune communication in psoriasis will not only expand our knowledge about the impact of sensory nerves in inflammation and pruritus and give new insights into the impact of environmental factors activating neuroimmune circuits or of stress in psoriasis, but may also lead to novel therapies. This review summarizes the relevant literature on the role of neuroimmune circuits, stress and how the central HPA axis and its peripheral equivalent in the skin, impact psoriasis.