Including the latest on acne, atopic dermatitis, COVID-19, cutaneous oncology, drugs and devices, hair and nails, infectious disease, and more.
GENERAL DERMATOLOGY
A cohort (N=53) of patients with BRACHIORADIAL PRURITUS were treated with medical therapy and/or computed tomography–guided C-spine transforaminal epidural corticosteroid injections. A mean daily dose of gabapentin greater than 1500mg was more often successful than a lower dose. Transforaminal corticosteroid injections were even more effective at reducing itching (based on numerical rating scores) than medical therapy. The key was identifying cervical spine abnormalities and performing injections in those levels affected (most commonly C5-6).
TO READ MORE: Gutierrez RA, et al. Evaluation of Gabapentin and Transforaminal Corticosteroid Injections for Brachioradial Pruritus [published online ahead of print, 2022 Jul 13]. JAMA Dermatol. 2022;e222376. doi:10.1001/jamadermatol.2022.2376.
A single-center, retrospective chart review of 288 patients with PRURIGO NODULARIS (PN) revealed that women were more frequently affected than men and also were more frequently diagnosed with a mental health comorbidity. Forty-four percent overall of PN has one or more psychiatric comorbidity. Mood and anxiety disorders were most common in this cohort.
TO READ MORE: Han J, Palomino A, et al. Psychiatric Comorbidity in Prurigo Nodularis and the Impact of Socioeconomic Status. J Clin Aesthet Dermatol. 2022;15(6):53-58.
Modernizing Medicine performed a nationally representative survey of 2,000 individuals. Interesting findings included: 74% consider online reviews when choosing a new doctor; 61% consider the ability to make online appointments an important factor for continuing a medical relationship; and 42% left a medical office at least once due to excessive wait time!
TO READ MORE: ModMed. 2022 PATIENT EXPERIENCE Report. https://www.modmed.com/
PEDIATRIC DERMATOLOGY
A small (N=15) retrospective study demonstrated that treatment with a 308-nm laser for PEDIATRIC VITILIGO induced repigmentation in 86.7% of facial lesions, 80% of body lesions and 61.7% of extremity lesions. Three years later, facial repigmentation was retained in 80% of facial lesions, but only in 40% of the body and 20% of the extremity lesions. Patients with more than five lesions and those with rapidly worsening disease fared the worst overall.
TO READ MORE: Sethi S, et al. Short and Long-Term Outcomes of 308-nm Laser for Pediatric Vitiligo. J Drugs Dermatol. 2022;21(7):773-775. doi:10.36849/JDD.6895.
PSORIASIS
In a head-to-head comparison (N=50 in each group), SUBCUTANEOUS METHOTREXATE outperformed oral methotrexate for the treatment of severe plaque psoriasis. More patients treated subcutaneously achieved Psoriasis Area Severity Index 90 (PASI90) and in a shorter time than those treated orally. Safety measures were comparable.
TO READ MORE: Dogra S, et al. Comparison of overall efficacy and safety of oral versus subcutaneous methotrexate in severe psoriasis. Dermatol Ther. 2022;35(8):e15656. doi:10.1111/dth.15656.
A retrospective global literature review was conducted utilizing 19 studies composed of 172 patients. It appears that COMBINING APREMILAST WITH VARIOUS BIOLOGIC AGENTS is safe for psoriasis management. Combination therapy may also increase efficacy, although currently available data is insufficient to draw that conclusion definitively.
TO READ MORE: Gyldenløve M, et al. Combination Therapy with Apremilast and Biologics for Psoriasis: A Systematic Review [published online ahead of print, 2022 Jun 23]. Am J Clin Dermatol. 2022;10.1007/s40257-022-00703-1. doi:10.1007/s40257-022-00703-1.
A network meta-analysis including eight randomized clinical trials (3,612 patients) showed that all JANUS KINASE (JAK) INHIBITORS studied demonstrated superior PASI75 and Physician’s Global Assessment (PGA) response compared to placebo at both 8 and 12 weeks. Tofacitinib 15mg and 10mg twice daily were the most efficacious, followed by the selective TYK2 drug, deucravacitinib 12mg daily.
TO READ MORE: Zhang L, et al. The efficacy and safety of tofacitinib, peficitinib, solcitinib, baricitinib, abrocitinib and deucravacitinib in plaque psoriasis – A network meta-analysis [published online ahead of print, 2022 May 24]. J Eur Acad Dermatol Venereol. 2022;10.1111/jdv.18263. doi:10.1111/jdv.18263.
Editor’s note: Oral tofacitinib is not approved for plaque psoriasis in the United States.
A retrospective analysis based on insurance claims data showed that, among systemic-naïve psoriasis patients, those treated with APREMILAST had a 14.4% biologic drug initiation rate compared to a 28.6% biologic drug initiation rate for those treated with methotrexate. Although the study had several limitations, the results suggest better symptom control and clinical outcome with apremilast compared to methotrexate.
TO READ MORE: Kaplan D, et al. Biologic initiation rates in systemic-naive psoriasis patients after first-line apremilast versus methotrexate use. J Comp Eff Res. 2022;11(8):575-582. doi:10.2217/cer-2021-0311.
A retrospective analysis based on insurance claims data (IBM MarketSCan Commercial Database) between 2005 and 2018, inclusive, revealed that the COST PER CLAIM FOR MOST BIOLOGIC DRUGS increased considerably in excess of medical inflation alone. The cost for adalimumab during the time period studied, for example, rose 224%, which was just over twice the rate of medical inflation. Only the cost of secukinumab declined.
TO READ MORE: Patel D, et al. A retrospective claims analysis confirms the cost of most biologic agents for psoriasis is increasing more rapidly than medical inflation [published online ahead of print, 2022 Jun 23]. J Am Acad Dermatol. 2022;S0190-9622(22)02212-5. doi:10.1016/j.jaad.2022.06.1164.
ATOPIC DERMATITIS
Investigators performed a post hoc analysis of three randomized clinical trials of UPADACITINIB in patients with moderate to severe atopic dermatitis. Overall, acne occurred in 9.8% of those randomly assigned to 15mg upadacitinib daily, in 15.2% of those randomly assigned to 30mg upadacitinib and in only 2.2% of placebo recipients. Acne was first reported about 40 days after drug initiation. Acne was more common in women, in non-White patients and in younger individuals. In nearly all patients, acne was mild to moderate in severity and either resolved spontaneously or responded to conventional topical therapy.
TO READ MORE: Mendes-Bastos P, et al. Characterization of acne associated with upadacitinib treatment in patients with moderate-to-severe atopic dermatitis: A post hoc integrated analysis of 3 phase 3 randomized, double-blind, placebo-controlled trials [published online ahead of print, 2022 Jun 15]. J Am Acad Dermatol. 2022;S0190-9622(22)00996-3. doi:10.1016/j.jaad.2022.06.012.
ACNE
A literature review found that ORAL VITAMIN A (daily doses ranging from 36,000 IU to 500,000 IU; most frequently used dose 100,000 IU) could achieve efficacy, relapse rate and safety comparable to isotretinoin. However, due to teratogenicity, potential toxicity and long half-life, administration by a medical provider is advisable.
TO READ MORE: Cook M, et al. Oral Vitamin A for Acne Management: A Possible Substitute for Isotretinoin. J Drugs Dermatol. 2022;21(6):683-686. doi:10.36849/JDD.6781.
Analysis of pivotal study data showed that TAZAROTENE 0.045% LOTION reduced both inflammatory and non-inflammatory lesions well in “transition” age group (18-24) and adult age group (>25). The topical was well tolerated in this older study subset.
TO READ MORE: Stein Gold L, et al. Tazarotene 0.045% Lotion for Females With Acne: Analysis of Two Adult Age Groups. J Drugs Dermatol. 2022;21(6):587-595. doi:10.36849/JDD.6876.
An anonymous online survey posted on a dermatology group on social media garnered 510 board-certified respondents from across the United States. The survey results suggested a widespread desire for a SIMPLER RISK MANAGEMENT PROGRAM than iPLEDGE, and further indicated that the burden of the current program is a deterrent to isotretinoin prescribing.
TO READ MORE: Lee G, et al. Administrative Burden of iPLEDGE Deters Isotretinoin Prescriptions: Results From a Survey of Dermatologists. Cutis. 2022;110(1):44-47. doi:10.12788/cutis.0558.
In about 85% of severe acne patients treated with INTENSE PULSED LIGHT (IPL), there is significant improvement in disease affecting the back and chest. The study included 50 patients (mean age 23.8), and two-thirds of participants had failed conventional interventions (even isotretinoin). Four IPL treatment sessions were delivered, each occurring after a two-week interval. Erythema and a burning sensation may accompany treatment but resolve within four days post-therapy.
TO READ MORE: Piccolo D, et al. Effective Intense Pulsed Light Protocol in the Treatment of Moderate to Severe Acne Vulgaris of the Chest and Back. J Clin Aesthet Dermatol. 2022;15(3):22-25.
ROSACEA
Low ADHERENCE (<80%) to topical therapy for rosacea is common, but worse amongst those with mild compared to severe disease. This was a small (N=30) prospective, single-center study.
TO READ MORE: Perche PO, et al. Greater rosacea severity correlates with greater adherence and improvement in a clinical study [published online ahead of print, 2022 Apr 28]. J Am Acad Dermatol. 2022;S0190-9622(22)00703-4. doi:10.1016/j.jaad.2022.04.037.
INFECTIOUS DISEASES
The CDC’s Advisory Committee on Immunization Practices (ACIP) recommends the newer, non-replicating ORTHOPOXVIRUS VACCINE (JYNNEOS) in lieu of the older, replicating smallpox vaccine. This vaccine should be given to laboratory researchers, emergency room personnel, and first responders who might be exposed to monkeypox during this current surge in cases. Wherever enough vaccine is available, it is also suitable for those who have had direct contact with verified monkeypox cases or those deemed “at high risk” for acquiring this infection.
TO READ MORE: Kuehn BM. Newer Poxvirus Vaccine Is Recommended. JAMA. 2022;328(2):123. doi:10.1001/jama.2022.11221.
Two companion papers detailed that the current MONKEYPOX epidemic largely began during travel activities (like Gay Pride Maspalomas 2022, Canary Islands). Most recent cases, primarily affecting self-identified men who have sex with men, are locally acquired via close personal contact (sexual activity).
TO READ MORE: Martinez JI, et al. Monkeypox outbreak predominantly affecting men who have sex with men, Madrid, Spain, 26 April to 16 June 2022. Euro Surveill. 2022;27(27):2200471. doi:10.2807/1560-7917.ES.2022.27.27.2200471 and Selb R, et al. A shift from travel-associated cases to autochthonous transmission with Berlin as epicentre of the monkeypox outbreak in Germany, May to June 2022. Euro Surveill. 2022;27(27):2200499. doi:10.2807/1560-7917.ES.2022.27.27.2200499.
A case of ITRACONAZOLE-REFRACTORY CUTANEOUS SPOROTRICHOSIS was effectively treated by physical means. Thermotherapy (40-450C, three times a day, for 20 minutes,) was not successful. Cryosurgery was then administered monthly (two 15-30 second applications at each session). The residual affected tissue was then subject to curettage and electrodesiccation. The electrosurgical wound healed by secondary intention in less than 2 months.
TO READ MORE: Silva RDC, et al. Refractory sporotrichosis lesion: An effective and pioneering approach in a patient living with human immunodeficiency virus/acquired immunodeficiency syndrome. JAAD Case Rep. 2022;26:32-34. Published 2022 Jun 22. doi:10.1016/j.jdcr.2022.05.040.
BioFire Global Fever Panel is the first 1-hour sample-to-result whole blood test with high degree of positive and negative predictive values for select, common fever-causing organisms. It is based on nucleic acid amplification technology and should be available soon.
TO READ MORE: Manabe VC, et al. Clinical evaluation of the BioFire Global Fever Panel for the identification of malaria, leptospirosis, chikungunya and dengue from whole blood. A prospective, multicenter, cross-sectional diagnostic accuracy study. Lancet Infect Dis. 2022;June 15. doi:10.1016/S1473-3099(22)00290-0.
In a news release, the CDC disclosed that the deadly bacteria, Burkholderia pseudomallei, has been isolated from soil and water samples collected in the United States (coastal Mississippi). This bacterium, which causes MELIOIDOSIS, is typically linked to Southeast Asia, Africa, and Australia, and especially Malaysia, Singapore, Thailand, and Northern Australia. One of the complications of this rare disease is formation of skin abscesses, which eventuate into ulcers (13-24%).
TO READ MORE: CDC. “Bacteria that causes rare disease, melioidosis, discovered in US environmental samples.” (press release) July 27, 2022. Bacteria that Causes Rare Disease Melioidosis Discovered in U.S. Environmental Samples | CDC Online Newsroom | CDC
A randomized open-label study enrolled 500 individuals from HIV or Sexual Health clinics is San Francisco and Seattle. Subjects were randomly assigned (2:1 ratio) to receive a single 200 mg dose of doxycycline within 72 hours of condomless sexual intercourse or no intervention whatsoever. Among the 327 participants who were taking PREEXPOSURE PROPHYLAXIS (PrEP), only 11% of those given doxycycline developed a bacterial sexually transmitted disease compared to 32% in the control (no intervention) arm. Among the remaining HIV positive participants (N=174), new bacterial sexually transmitted infections developed in only 12% of the doxycycline arm, compared to 30.5% in the no intervention arm. This is the second study to show that among those at high risk, rapid post-condomless sex ingestion of a single 200 mg dose of doxycycline significantly reduces their likelihood of developing an STD.
SOURCE: Luetkemeyer A. Doxycycline post-exposure prophylaxis for STI prevention among MSM and transgender women on HIV PrEP or living with HIV: high efficacy to reduce incident STI’s in a randomized trial. Abstract 13231. International AIDS Conference. July 27-Aug 2, 2022. Montreal, Canada.
HAIR AND NAILS
The results of a 6-month, randomized, double-blind, placebo-controlled study followed by another 6 months of an open-label extension showed improvements in various parameters in women demonstrating hair loss. Increased hair growth, improved quality of hair, and decreased hair shedding accompanied administration of a NUTRACEUTICAL, Nutrafol Women’s Balance.
TO READ MORE: Ablon G, et al. A Long-Term Study of the Safety and Efficacy of a Nutraceutical Supplement for Promoting Hair Growth in Perimenopausal, Menopausal, and Postmenopausal Women. J Drugs Dermatol. 2022;21(7):783. doi:10.36849/JDD.776.
Editor’s note: This product is commercially available.
This multi-center study evaluated the utility of dermoscopy in the diagnosis of SUBUNGUAL GLOMUS tumors. In general, there were no major findings elicited on dermoscopy that could not also be seen during a careful clinical examination. However, bluish spots, longitudinal erythronychia, and onycholysis could be found in more cases when dermoscopy was added to the clinical exam.
TO READ MORE: Göktay F, et al. The role of dermoscopy in the diagnosis of subungual glomus tumors. Int J Dermatol. 2022;61(7):826-832. doi:10.1111/ijd.16042.
CUTANEOUS ONCOLOGY, SURGERY AND LASERS
Five-hundred-eighty-one high-risk primary cutaneous squamous cell carcinomas were identified in 527 patients from two university-affiliated, private practice Mohs micrographic surgery referral centers. In this patient cohort treated with MOHS SURGERY, lower rates of local recurrence, nodal metastasis, and disease-specific death were determined when compared to historical reference controls. Mohs surgery confers an advantage over wide local excision in high-risk cutaneous squamous cell carcinoma.
TO READ MORE: Soleymani T, et al. Clinical outcomes of high-risk cutaneous squamous cell carcinomas treated with Mohs micrographic surgery alone: an analysis of local recurrence, regional nodal metastases, progression-free survival, and disease-specific death [published online ahead of print, 2022 Jun 24]. J Am Acad Dermatol. 2022;S0190-9622(22)02217-4. doi:10.1016/j.jaad.2022.06.1169.
A representative database (National Ambulatory Medical Care Survey) was used to assess when patients
were told to return for evaluation following either cryosurgery or topical 5-FU treatment for ACTINIC KERATOSIS. Many patients were told to return in two months, which might be too soon due to the presence of residual treatment-related inflammation. Surprisingly, a quarter of patients who received either intervention were not given any specific guidance on when to return.
TO READ MORE: Singh R, et al. Infrequent Follow-Up for Actinic Keratosis Treatment: A National Ambulatory Medical Care Survey. J Clin Aesthet Dermatol. 2022;15(6):65-67.
Based upon Vancouver Scar Scale ratings 6 months post-operatively, this single-center American retrospective review (N=66) concluded that cosmetic outcome was superior following local skin flap repair compared to full-thickness skin graft for BASAL CELL CARCINOMAS of the distal third of the nose.
TO READ MORE: Fronek LF, et al. Surgical Outcomes Following Mohs Micrographic Surgery for Basal Cell Carcinoma on the Distal Third of the Nose. J Clin Aesthet Dermatol. 2022;15(6):32-36.
DRUGS AND DEVICES
A retrospective study of adverse ocular events associated with HYDROCORTISONE use was performed using the FDA Adverse Event Reporting System (FAERS) database. When compared to the incidence of both cataracts and glaucoma in the general population, the incidence of these disorders is much lower among those treated with hydrocortisone for dermatologic disease (less than 0.5% for both). It appears that for most patients, hydrocortisone use—even in the periocular region—is safe.
TO READ MORE: Wang Y, et al. Retrospective analysis of ocular adverse events with topical hydrocortisone when used for dermatologic indications. Dermatol Ther. 2022;35(1):e15178. doi:10.1111/dth.15178.
A retrospective study of adverse events associated with MYCOPHENOLATE MOFETIL (MMF) AND METHOTREXATE (MTX) use was performed using the FDA Adverse Event Reporting System (FAERS) database. Gastrointestinal discomfort, nausea, and diarrhea have been the common adverse events associated with MMF, although leukopenia, pancytopenia, and abnormal liver function studies have been reported in 4-6%. Gastrointestinal complaints are also the most common adverse events seen in conjunction with MTX treatment. Abnormal liver functions have been reported in about 5% of MTX recipients, and myelosuppression in 2-10%.
TO READ MORE: Wang Y. Retrospective analysis of adverse events with mycophenolate mofetil and methotrexate when used for dermatologic indications. Int J Dermatol. 2022;61(7):e275-e276. doi:10.1111/ijd.15767.
RHEUMATOLOGIC DISEASES
Adults with autoimmune diseases do not risk a flare of those disorders following receipt of the recombinant HERPES ZOSTER VACCINE (Shingrix).
TO READ MORE: Leung J, et al. Recombinant Zoster Vaccine Uptake and Risk of Flares Among Older Adults with Immune-Mediated Inflammatory Diseases in the United States [published online ahead of print, 2022 Jun 6]. Arthritis Rheumatol. 2022;10.1002/art.42261. doi:10.1002/art.42261.
Pregnancy in those with SYSTEMIC SCLERODERMA carries a higher risk (61%) of first term miscarriage, preeclampsia, small-for-gestational weight, and preterm delivery compared to pregnancy in healthy matched controls (10%) or patients with systemic lupus erythematosus (37.5%).
TO READ MORE: Barilaro G, et al. Systemic sclerosis and pregnancy outcomes: a retrospective study from a single center. Arthritis Res Ther. 2022;24(1):91. Published 2022 Apr 27. doi:10.1186/s13075-022-02783-0.
COVID19
The COVID-19 pandemic led to increasing numbers and rates of FUNGAL INFECTIONS and related deaths during 2020 and 2021. Candida and Aspergillus species were the most commonly responsible pathogens. Superficial skin lesions, with eschar formation, may be the first obvious indication of potentially fatal fungal infection complicating COVID-19.
TO READ MORE: Gold JAW, et al. Increased deaths from fungal infections during the COVID-19 pandemic-National Vital Statistics System, United States, January 2020-December 2021 [published online ahead of print, 2022 Jun 19]. Clin Infect Dis. 2022;ciac489. doi:10.1093/cid/ciac489.
ALOPECIA AREATA may follow administration of mRNA COVID-19 vaccines. The disease tends to be acute in onset and widespread in distribution. Vaccine-related alopecia areata tends to respond well to typical treatment maneuvers.
TO READ MORE: May Lee M, et al. Alopecia areata following COVID-19 vaccination: vaccine-induced autoimmunity? Int J Dermatol. 2022;61(5):634-635. doi:10.1111/ijd.16113and Baffa ME, et al. Marie Antoinette syndrome following COVID-19 vaccination. Int J Dermatol. 2022;61(7):903-904. doi:10.1111/ijd.16262.
Due to the COVID-19 pandemic, there was an increase in hospital usage and ANTIBIOTIC ADMINISTRATION during hospitalization. Unfortunately, this led to a significant increase in the prevalence of antimicrobial resistant bacteria. For example, during the first two years of the COVID-19 pandemic: carbapenem-resistant Acinetobacter infections increased by 78%, multidrug-resistant Pseudomonas aeruginosa infections increased 32%, and MRSA infections rose 13%.
TO READ MORE: Centers for Disease Control and Prevention; National Center for Emerging and Zoonotic Infectious Diseases; Division of Healthcare Quality Promotion. “COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022.” June 14, 2022. https://stacks.cdc.gov/view/cdc/117915
