COVID19
Ted Rosen, MD, FAAD, Editor-in-Chief
Using readily available May, 2021, CDC data, it was found that only 1.1% of all U.S. hospitalizations due to COVID-19 were in fully vaccinated individuals and that only 0.8% of all deaths were those who were fully vaccinated. To read more: Johnson CK, Stobbe M. Nearly all COVID deaths in the U.S. are now among unvaccinated. Associated Press analytic report. June 29, 2021. Available at: https://apnews.com/article/coronavirus-pandemic-health-941fcf43d9731c76c16e7354f5d5e187
Recent reports suggest that myocarditis (less often pericarditis) may follow mRNA-based COVID-19 vaccination. Chest pain 3-5 days after the receipt of vaccination, typically the second injection, is characteristic. Adolescents and young adults have most often been affected. Data from Israel suggests a rough incidence of 24 per million vaccination recipients. All patients have recovered thus far, and this side effect is considered uncommon enough to be an acceptable risk. To read more: Shay DK, et al. Myocarditis occurring after immunization with mRNA-Based COVID-19 vaccines. JAMA Cardiol. June 29, 2021. doi:10.1001/jamacardio.2021.2821.
A double-blind, randomized placebo-controlled trial did not support the efficacy of oral ivermectin (300ug/kg/d for 5 days) for mild COVID-19 infection. To read more: López-Medina E, et al. Effect of ivermectin on time to resolution of symptoms among adults with mild COVID-19: a randomized clinical trial. JAMA Dermatol. 2021;325(14):1426-1435.
“Americans who have been fully vaccinated do not need a booster shot at this time. FDA, CDC, and NIH are engaged in a science-based, rigorous process to consider whether or when a booster might be necessary. This process takes into account laboratory data, clinical trial data, and cohort data – which can include data from specific pharmaceutical companies, but does not rely on those data exclusively.” Joint CDC and FDA statement on vaccine boosters, July 8, 2021 (Editor’s Note: We will see if this opinion changes in the next few months.)
Pediatric Dermatology
A retrospective study from the Children’s Hospital of Los Angeles demonstrated that a skin biopsy was a crucial component of the care for hospitalized, immunocompromised children who acutely develop erythematous papules or nodules. Biopsy results altered management in over half the cases. Infection was identified in 43% of cases, fungal etiology being most common. To read more: Kamath S, et al. Diagnostic yield of skin biopsies of cutaneous red nodules in hospitalized immunocompromised children: a retrospective review from a single institution. J Am Acad Dermatol. 2021;84(5)1489-1491.
Midface toddler excoriation syndrome is a recently described entity linked to PRDM12 gene mutation. This syndrome is clinically characterized by infantile onset of excoriations and sequelae of long-term scratching, present over midface, with a predilection for the nasal bridge. Mutations in PRDM12 gene cause hereditary sensory and autonomic neuropathy. To read more: Kumar P, Das A. Midface toddler excoriation syndrome. Indian J Dermatol Venereol Leprol. 2021;87:528-9.
Infectious Diseases
Nonendemic dermatological infectious diseases are primarily encountered among immigrants, but about 10% of these are seen in returning U.S. travelers. Hansen’s disease is the most frequent such disease in immigrants, followed by filariasis and mycetoma. By contrast, cutaneous leishmaniasis is the most common among U.S. travelers. To read more: Thomas C, Nambudiri VE. Delayed diagnosis of nonendemic dermatologic diseases: a retrospective review. J Am Acad Dermatol. 2021;84(5):1451-1453. (Editor’s Note: In my experience, cutaneous larva migrans is the most common souvenir from travelers, especially those coming from the Caribbean.)
The FDA recently approved single 2.0g oral dose of secnidazole (Solosec®) for the treatment of trichomoniasis. The cure rate was 92% in the pivotal trial, and equal or greater to that in women with concurrent bacterial vaginosis or concomitant HIV infection. The drug is supplied in a single-use packet of granules intended to be sprinkled on applesauce, yogurt, or pudding. To read more: Muzny CA, et al. Efficacy and safety of single oral dosing of secnidazole for trichomoniasis in women: results of a phase 3, randomized, double-blind, placebo-controlled, delayed-treatment study. Clin Infect Dis. March 26, 2021. doi: 10.1093/cid/ciab242.
Rheumatologic Diseases
In a Phase III placebo-controlled international trial involving 95 dermatomyositis patients, IVIg was found to be superior in terms of objective improvement measurements for both skin and muscle signs and symptoms. The dosage utilized was 2 g/kg of IVIg (Octagam 10%) or placebo administered every 4 weeks. To read more: Aggarwal R, et al. OP0008 A randomized, double-blind, placebo-controlled phase III trial of IVIG 10% in patients with dermatomyositis. The PRODERM study: results on efficacy and safety. Ann Rheum Dis. 2021. doi: 10.1136/annrheumdis-2021-eular.1389.
Psoriasis
Once weekly azathioprine pulse (300mg) can be effective for psoriasis. However, in this double-blind, randomized comparison done in India, weekly methotrexate (15mg) proved superior after 5 months of therapy. To read more: Verma KK, et al. Azathioprine weekly pulse versus methotrexate for the treatment of chronic plaque psoriasis: a randomized controlled trial. Indian J Dermatol Venereol Leprol. 2021;87:509-14.
Psoriasis affects approximately 3% of the adult population in the U.S., according to a recent population-based cross-sectional study. Psoriasis prevalence was similar between women and men, with 3.2% (95% CI, 2.6%-3.8%) in women and 2.8% (95% CI, 2.4%-3.3%) in men. To read more: Armstrong AW, et al. Psoriasis prevalence in adults in the United States. JAMA Dermatol. 2021 Jun 30. doi: 10.1001/jamadermatol.2021.2007.
Atopic Dermatitis
A double-blind, vehicle-controlled, single-center randomized clinical trial of 11 adult patients with moderate to severe atopic dermatitis showed that topically reapplied autologous coagulase-negative staphylococci (concentration of 107 colony-forming units/g) lead to improvement in eczema area and severity index (EASI) score. This suggests that bacteriotherapy may be beneficial for atopic dermatitis. To read more: Nakatsuji T, et al. Use of autologous bacteriotherapy to treat staphylococcus aureus in patients with atopic dermatitis: a randomized double-blind clinical trial. JAMA Dermatol. 2021; June 16. doi:10.1001/jamadermatol.2021.131. (Editor’s Note: Larger scale and longer duration studies are needed to confirm this intriguing result.)
Contact Dermatitis
At least among Chinese individuals, positive patch tests are more common in winter and among women compared to men, and increase with age. To read more: Li B, et al. Analysis of factors influencing patch test reactions: results from a large-scale population-based study in Chinese. J Cosmet Dermatol. 2021. July 9. doi: 10.1111/jocd.14338.
Hair and Nails
A systematic review and meta-analysis of 41 studies, including nearly 8000 patients, with androgenetic alopecia found an association with decreased health-related quality of life. Surprisingly, however, patterned hair loss was not associated with symptoms of depression. To read more: Huang C, et al. Health-related quality of life, depression, and self-esteem in patients with androgenetic alopecia: a systematic review and meta-analysis. JAMA Dermatol. 2021; July 7. doi:10.1001/jamadermatol.2021.2196.
Hidradenitis Suppurativa
A retrospective study done at the University of Pittsburgh demonstrated that 25 of 76 patients treated with a weekly dose of adalimumab discontinued therapy due to lack of effect or adverse events. Of those who continued therapy, the concomitant presence of inflammatory bowel disease was a factor predicting long-term usage. Conversely, scalp and face involvement predicted the likelihood of drug discontinuation. To read more: Khosravi H, et al. Real-world experience of adalimumab in the treatment of hidradenitis suppurativa. J Am Acad Dermatol. 2021;84(5):1406-1409.
Cutaneous Oncology, Surgery and Lasers
Small (about 1cm in diameter) post-Mohs surgery defects on the dorsal hand healed with equal rapidity and equivalent cosmetic outcome whether undergoing primary closure, purse-string closure or healing by secondary intent. To read more: Miedema J, et al. Wound healing on the dorsal hands: an intrapatient comparison of primary closure, purse-string closure and secondary intention. Cutis. 2021;107:318-319.
The two-year relative survival for advanced-stage melanoma cases diagnosed during 2001-2009 was stable, but it increased 3.1% per year for those diagnosed during 2009-2014. Also, the two-year relative survival slightly increased for early- and intermediate-stage melanoma cases diagnosed during 2001-2014. To read more: Islami F, et al. Annual report to the nation on the status of cancer, part 1: national cancer statistics. JNCI: Journal of the National Cancer Institute. 2021. July 8. doi.org/10.1093/jnci/djab131.
A whole-population, case-control study using the Icelandic Cancer Registry and Icelandic Prescription Medicine Register identified 6,880 patients diagnosed with first-time basal cell carcinoma. The risk of first BCC decreased significantly among those who were being treated with metformin (mostly for Type 2 diabetes). However, this study had many limitations, including a lack of data on comorbidities, photodynamic therapy use, frequency of tanning bed use, overall lifetime UV exposure, smoking status, socioeconomic status, or potential confounding medication use. To read more: Adalsteinsson JA, et al. J Am Acad Dermatol. 2021;85(1):56-61.
Drugs and Devices
A certain degree of inflammation is not only expected but also desirable when utilizing imiquimod therapy for both benign and malignant indications. However, a case report reminds us that when clinical features of this inflammation suggest it, we should consider secondary impetigo as a potential adverse event associated with imiquimod use. To read more: Heng LW, Chandran NS. Impetigo as an adverse effect of 5% imiquimod treatment for viral warts. Int J Dermatol. 2021;60:907-0908.
General Dermatology
A rare ulcerating variant of carpal tunnel syndrome is reported. All patients experienced paresthesia, and all developed crusted erosions of the distal, palmar aspect of the second and third digits. Electromyography demonstrated sensory and motor nerve conduction loss in the distribution of the median nerve. Both surgical therapy and conservative management (bracing) led to a resolution in some cases. To read more: Gomes TF, et al. Clinical characteristics of ulcerating carpal tunnel syndrome among older adults in Portugal. JAMA Dermatol. 2021;157(6): 731-733.
Pyoderma gangrenosum may be differentiated from skin and skin structure infection by using objective criteria. Neutrophilic infiltrate at the ulcer edge plus any 4 minor criteria (infection exclusion, pathergy, IBD or inflammatory arthritis, ulceration of papule/pustule, undermined and tender border, involvement of anterior lower leg, typical cribriform scarring, and response to immunosuppressive therapy) generally establish the diagnosis. To read more: Haque EK, et al. How to save a limb: identification of pyoderma gangrenosum. Cutis. 2021;107:328-331.
A cohort of 114 adult French patients whose severe facial seborrhea cleared following desonide cream treatment was randomized to either tacrolimus 0.1% ointment or ciclopiroxolamine 1% cream twice weekly for maintenance. Those who received tacrolimus had a lower rate of relapse and a longer disease-free remission. To read more: Joly P, et al. Tacrolimus 0.1% versus ciclopiroxolamine 1% for maintenance therapy in patients with severe facial seborrheic dermatitis: a multicenter, double-blind, randomized controlled study. J Am Acad Dermatol. 2021;84(5):1278-1284.
Acne
A retrospective review of 403 young adult women with acne treated with spironolactone at a single academic center is presented. The most common dose was 100mg/day. Only 23% discontinued therapy due to adverse events. Therapy was continued for well over a year, on average; the most common reason for discontinuation was acne clearance. To read more: Garg V, et al. Long-term use of spironolactone for acne in women: a case series of 403 patients. J Am Acad Dermatol. 2021;84:1348-1355.